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 RA436 M33 The recent advances 
 
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The Recent Advances of Sanitary Science. 
 
 THE RELATION OF MICRO-ORGANISMS TO DISEASE. 
 
 ANNUAL ADDRESS 
 
 DELIVERED BEFORE THE 
 
 among 0|| g$i mmnt 
 
 AT NEW YORK, 
 
 OCTOBER lOth, 1883, 
 
 HENRY O. MARCY, A.M., M.D., 
 
 President of the Academy. 
 
 Member of the British Medical Association; Corresponding Member of the Medico- 
 
 Chirurgical Society of Bologna, Italy ; Member of the American Medical 
 
 Association; Member of the Massachusetts Medical Society; 
 
 Fellow of the Boston Gynaecological Society, etc. 
 
 PHILADELPHIA 
 
 1883. 
 
: 
 
THE RECENT ADVANCES OF SANITARY SCIENCE. 
 
 THE RELATIONS OF MICRO-ORGANISMS TO DISEASE. 
 
 The unexpected honor which one year ago your kind suffrages 
 conferred upon me in electing me to preside over your councils, I 
 hold to be equally shared by a thoughtful discharge of the duties of 
 the office. The profession at large may be congratulated that the 
 American Academy of Medicine owes its origin and existence to a 
 wide-spread spontaneity of feeling that the times were ripe for and 
 demanded some organized effort to aid as a controlling power in 
 elevating the standard of medicine in our country. How well thus 
 far we have succeeded must be left, not to our own prejudiced views, 
 but rather to the unsparing criticisms of all interested in a higher 
 medical education. Since, by our position, we have invited it, let 
 it arouse each one of us to yet better endeavors in the discharge of our 
 self-imposed task. He who studies the history of medicine in a 
 broad philosophic spirit will learn much of both interest and profit. 
 Viewed from this standpoint, its evolution in the present generation 
 in common with its sister sciences, marks an era in civilization. 
 Differences of opinion, even on the fundamental factors of our 
 polity, have and very likely will continue to exist. Other things 
 being equal, the better trained and armed soldiery win and hold 
 the field. Whatsoever the diversity of gifts, the profession should 
 be actuated by one spirit. Under its guidance, moved by a generous 
 rivalry, the divine decree of the golden rule should be its only code. 
 In the clear light of science rationalistic medicine can have no 
 rivals, and the isms and pathies, which smack of ignorance and 
 superstition, will cease to exist. New fields of investigation, yet more 
 attractive, because nearer to the great source of truth, will open, 
 and there will arise a more noble emulation for the still greater 
 advancement of a united and harmonious profession. 
 
 A few weeks since, as I stood on the rock-bound coast of the Bay 
 of Fundy, and beheld its insurging tides, rising more than half a 
 hundred feet, converting empty gorges into deep rivers, and wide- 
 spreading meadows into broad bays, I read in this mighty unseen 
 
 3 
 
4 
 
 force the symbol of the progress of our age. The quiet waters of the 
 harbor of Louisburg, whose blue expanse covers the w 7 recks of the 
 French and the English armadas of a past century, at whose stormy 
 burial sank the hopes of nations who would fain have founded in a 
 new world empires based upon the aggrandizing ambitions of kings 
 and clergy, gave no hint, save in the mournful desolation of its 
 shores, of a fatal policy which so long dominated the ages of the 
 past. In the busy subdivided occupation of happy peoples, each 
 individual addingtothe common store of good, national interests inter- 
 woven in one grand commonalty by the iron bands of commerce, we 
 mark the monuments of our age, in the elevating of the masses to a 
 higher plane of intellectual and moral development than the world 
 has ever seen. 
 
 In the proud contemplation of such progress, the thought arises, 
 have the science and art of medicine grown in ratio with the general 
 development of the age ? To discuss a question of such magnitude 
 in the short hour at my disposal would provoke a smile. And yet, 
 stimulated by the belief that, although proud of present progress, w T e 
 are on the eve of far greater discoveries and clearer knowledge, we 
 would counsel and urge upon the Academy the greatest devotion and 
 most enthusiastic zeal in elevating the standard of medical education. 
 
 The late lamented Dr. Edward H. Clarke, of Boston, whose 
 memory is enshrined in the loving remembrance of many classes of 
 pupils, divided the teachings upon materia medica into a course 
 for two years, one devoted entirely to the circumfusa of the patient, 
 and one to the medicines which might be administered. In a some- 
 what similar spirit I would divide the duties of our profession, and 
 would place first the prevention rather than the cure of disease. 
 
 Sanitation can hardly be called a science. Many of its most 
 important factors are, at the best, but imperfectly understood. The 
 sanitary laws instituted by Moses are based upon principles which 
 cannot be under-estimated or ignored, and the Egyptians for centu- 
 ries previous had understood some sanitary questions and their 
 solution better than ourselves. The traveler to-day may see in the 
 elegant courts of the old Pompeian houses the marble basins, with 
 their leaden pipes and stop-cocks still seemingly ready to turn the 
 treasured waters of the distant mountain into their old, time- 
 accustomed channels, alike to bath and fountain, and go again sing- 
 ing in joyous cadence, ministering to need and pleasure as they 
 found their way through the once busy city to the bay below. Our 
 
modern system of water carriage to remove sewage is but the 
 adaptation of means to ends well recognized by the ancients, and 
 it would to-day be difficult to find a better specimen of sewer or 
 masonry than the Cloaca Maxima of old Rome. 
 
 That age of Grecian prosperity and extraordinary intellectual 
 activity, which gave to the world Pericles, Sophocles, Aristophanes, 
 Pindar, Plato, Xenophon and Socrates, also furnished Hippocrates, 
 the father of medicine. He it was who formulated the fundamental 
 principles of sanitary science, " Pure air, pure water, and a pure soil." 
 The little island of Cos was his home, and here was located one of the 
 most celebrated temples of the Asclepiadse, or priest physicians of 
 the Greeks. If Hippocrates, living upon this pearl of the JEgean 
 archipelago, whose leafy groves were musical in the evenly- 
 tempered, balmy breezes which ever played in health-giving zephyrs, 
 whose gentle rills were fed from springs gushing forth the distilled 
 dews of heaven, whose verdant slopes, basking in the clear, warm 
 suulight, were kissed by the deep blue waves of the Mediterranean, 
 the very place of ideal purity and loveliness, recognized the 
 importance of such maxims, what should be their value to the 
 multitudes crowded, at the behest of commerce, in localities selected 
 without thought of sanitary surroundings ? 
 
 The discussion of the problems of life, and the important factorage 
 of ills thereto belonging, by the wise and thoughtful of the ages long 
 ago, is not alone instructive, but has a fascination of its own. 
 Whatever else may be said of Mohammedism as a code of morals 
 and virtue, its cardinal principles of cleanliness and careful living 
 deserve special recognition at the hands of science. The great 
 plagues of the Middle Ages and the desolations following the Crusades 
 which swept over Europe, were filth diseases of a preventable char- 
 acter. Although spurred into recognition by the bitter experiences 
 of the passing generations, sanitary science is yet under only partial 
 recognition of the laws, and a popular interest is scarcely aroused, 
 even among our more intelligent classes of citizens. 
 
 The vital processes, in their sway over matter, hold the balancing 
 between waste and repair. This hypothetical equilibrium is perhaps 
 the best definition of health, and the safe removal of the waste, worn-out 
 material, is one of the chief factors of sanitary science. This, to the 
 individual as ordinarily situated, might seem a question for easy 
 solution. In the wide stretches of country surroundings, although 
 there are many exceptions, this is generally true, but in the crowded 
 
6 
 
 conditions of city life there is no problem more pressing or complex. 
 The law of decomposition is vital rather than chemical, and in the 
 changes which ensue there are reproduced, in the most marvelous 
 abundance, lower forms of microscopic vegetable life, which in their 
 death-dealing danger are far more potent than the evolution of 
 noxious gases. The relation between the house we occupy, its loca- 
 tion and surroundings, its water supply and the best means of 
 removal of waste, are as yet but imperfectly understood. The local 
 causes in the production of disease are occupying in a greater degree 
 at present than ever before the best scientists of the medical profession. 
 Although many vital points are yet undetermined, great progress 
 has been and .is being made. It is sufficiently established that the 
 water drank which is contaminated with the specific infection of 
 cholera, typhoid fever, and other diarrhceal diseases, will, at least in 
 certain conditions of the system, reproduce these diseases, and if these 
 conditions are wide-spread an epidemic will ensue. A similar law 
 holds good in reference to malarial or intermittent fever, although 
 it is very probable the sources of contamination are not confined to 
 the water supply alone. Heat, moisture, and the resulting decom- 
 position are the seeming gross factors, but it is quite certain that 
 minute living organisms introduced into the system are the potent 
 factors in the production of these diseases. 
 
 The condition which this age of steam brings, with its modern 
 miracle of civilization, massing the population in great centres, 
 gives new sanitary problems of a very difficult and complex char- 
 acter. 
 
 Surrounded by a media from which there is even momentarily no 
 escape, and which we must ever breathe, atmospheric impurities 
 must be considered as of the highest importance. The air has no 
 absolutely fixed normal composition ; however, its two essential 
 elements, oxygen and nitrogen, under ordinary circumstances, are so 
 nearly invariable they may be regarded as stable factors. Although, 
 in a simple mechanical mixture, the air is very rarely free from 
 carbonic acid and water, yet carbonic acid, so far as known, is a 
 harmless, but superfluous agent to the animal economy, while, on the 
 contrary, to the vegetable world it is food of the most important 
 character. Some plants go through their entire period of evolution 
 dependent only upon this element and water. 
 
 The mechanical admixture of water in the form of vapor is a 
 constantly varying factor, dependent upon location, climate, temper- 
 
ature, etc., and, although rarely entirely absent, is of itself an 
 element comparatively unimportant, but, combined with other 
 factors, it makes possible the development of lower forms of the 
 vegetable organisms, to which we are now warranted in ascribing 
 some of the most dangerous and wide-spread diseases of the entire 
 animal kingdom. In its indirect bearings upon climatology, 
 influence upon heat, etc., atmospheric moisture is of the first 
 importance. 
 
 In the analysis of air, ozone, from its admitted powers, especially 
 in its bearing upon climate and health, should be carefully consid- 
 ered. It is an allotropic form of oxygen which has attained new 
 properties, of an intensely active character, supposed to have been 
 chiefly produced by the action of electricity. Its molecular weight 
 is 48, oxygen 32, and its density is about one and one-half times 
 greater than oxygen. According to Houzeau, the maximum 
 quantity of ozone in the air never exceeds yooWo P ar ^ °f ^s bulk, 
 and it is often entirely wanting. More ozone is found during the 
 night than the day ; in winter than in summer ; upon high rather 
 than low lands ; in country than in town ; and most of all, after a 
 severe thunderstorm. 
 
 Ozone owes its great value as a disinfecting agent to its exceed- 
 ingly powerful oxidizing qualities. The compounds of ammonia, 
 phosphorus and sulphur are acted upon with great rapidity, and 
 the odors resulting from animal decomposition are removed instantly. 
 It is probably destructive to all the minute vegetable organisms 
 when in active development, but its effect in destroying the vitality 
 of the spores of plants has not yet been determined. 
 
 From the exceedingly active properties of ozone in destroying the 
 low forms of vegetable organisms, and consequent prevention of 
 putrefaction, as well as the induction of catarrhal affections, when 
 experimented with artificially, the important query of its value as 
 a factor of atmospheric composition, and its relationship, if any, to 
 epidemic diseases, has arisen. A committee of the American 
 Medical Association, under the efficient leadership of Dr. N. S. 
 Davis, of Chicago, during the last three years has been doing a 
 considerable amount of work in the solution of this important, but 
 complex problem. Under their direction, careful tests to determine 
 the amount of ozone in the atmosphere are daily made in a number 
 of our large cities, in which localities, clinical records are taken by 
 a number of independent observers, to ascertain the initial date of 
 
8 
 
 acute diseases. Reports of progress have been made, but sufficient 
 data have not been secured to warrant any general conclusions. 
 The committee desire a wider interest and assistance in the further 
 accomplishment of a work which promises to be of great value. 
 
 1 " There is much evidence in favor of adopting the analysis for 
 oxygen, instead of that of carbonic acid, as a test of atmospheric 
 purity ; the test would be an absolute one, if we could be sure of 
 the uniformity of the proportion of oxygen in pure air. Taking 
 this, as we probably may, for granted, we can say that the carbonic 
 acid, in most cases, increases directly at the expense of the oxygen 
 of the air, and therefore a diminution of oxygen points logically to 
 an increase of carbonic acid. There is this disadvantage in taking 
 the oxygen test, it removes from view the accidental impurities, such 
 as the discharges from chimneys, w T hich are certainly important." 
 
 Carbonic acid is a product of combustion, and in its formation 
 represents in nearly fixed ratio the destruction of oxygen. The 
 entire animal kingdom is constantly consuming oxygen and emitting 
 carbonic acid, and atmospheric conditions dangerous to life would 
 ensue, were it not for the equilibrium maintained by the consump- 
 tion of carbonic acid and generation of oxygen by vegetable growth. 
 Owing to the remarkable diffusion of gases, the wind currents, etc., 
 the immense amount of carbonic acid poured out into the air as the 
 product of combustion never produces atmospheric changes in any 
 marked degree. It is estimated by Smith that in Manchester, from 
 this source alone, over fifteen tons of carbonic acid are produced 
 daily, and yet, when this is added to the product of respiration and 
 animal waste, he found the entire quantity was not sufficient to 
 raise the average percentage above four parts in ten thousand, 
 which is within the so-called normal limits of a number of investi- 
 gators. The decided increase of carbonic acid in cities is due 
 mainly to the confinement of air in courts and alleys, and the 
 sanitary lesson should be, the construction of wide streets, with open 
 courts or squares. 
 
 Too much importance has been placed upon carbonic acid as a 
 deleterious constituent of the atmosphere. Very little, if any, 
 annoyance is felt from the accidental escape of pure carbonic acid 
 in the charging of soda fountains, although the air may contain two 
 per cent, of the gas. Forster states that he had no difficulty in 
 
 1 "The Atmosphere.'' By D. F. Lincoln, m. d., Ziemssen*s Cyclopaedia, 
 Vol. xviii, page 6Uo. 
 
9 
 
 remaining ten minutes in a cellar containing fermenting wine, 
 although the carbonic acid gas amounted to forty parts per thousand. 
 
 There is a vast difference when the oxygen is lessened in propor- 
 tion as the carbonic acid is increased, as, for example, the entering 
 of a chamber where candles are burnt until extinguished for want 
 of oxygen ; or again, where the carbonic acid is produced by respi- 
 ration. The presence of this gas in living-rooms in any appreciable 
 quantity is of first importance, not so much as a deleterious chemical 
 agent, as because of the bad company in which it is found, and the 
 presence of which it indicates. One serious objection to the 
 numerous gas-jets of the brilliantly lighted salon and audience 
 room is found in the fact that the ordinary burner consumes as 
 much oxygen as four persons. From a sanitary standpoint, lighting 
 our homes by electricity will be a great gain, and this evil obviated. 
 One large room in a Lowell mill, lighted by four hundred gas 
 burners, had been ever a source of complaint in its defective venti- 
 lation and great heat. Lighted by electricity, the change was 
 surprising, while the difference in temperature was over twenty 
 degrees. 
 
 Products of decomposition from cess-pools, the organic exhala- 
 tions from respiration, the lessening of oxygen from the combustion 
 which is going on in the brilliantly lighted rooms, all these are 
 dangerously infective and devitalizing elements which demand a 
 system of ventilation usually ignored in modern house-construction. 
 
 From the address upon State Medicine before the American 
 Medical Association at St. Paul, 1882, by Dr. Gihon, Medical 
 Director, U. S. K"., I quote, all too briefly, " So long, however, as 
 society, in its highest development of rank and culture, ignorantly 
 jostles and wedges itself in contracted parlors and drawing-rooms, 
 already defiled by blazing gas-jets and defective furnaces, where 
 hundreds of lavishly dressed human machines befoul the air and 
 poison one another with the noxious gases and their own effete 
 animal products in deadlier quantity than the ragged rabble which 
 herd in the open street, and call this pleasure ; so long as godly 
 people drowse and yawn in badly ventilated churches, surcharging 
 their brains and impairing their minds with blood not half aerated, 
 and ungodly ones exhaust their whole reserve force to resist the 
 insanitary influence of the no less badly ventilated theatre and 
 exhibition hall, and call the one pious worship and the other 
 rational amusement: so lona: as men toil to amass riches and then 
 
10 
 
 build residences palatial, or sham palatial, and in the name of 
 luxury and sestheticism flood them with artificial light and heat to 
 consume the oxygen which prince and beggar must breathe, and 
 admit the invisible filth by the sumptuously decorated closet and 
 bathroom by which they think to exclude the vile necessities of 
 humanity which prince and beggar alike cannot escape, and call 
 this comfort and refinement ; so long as our children are sent to 
 overcrowded and unwholesome schools, where their eyes are bleared, 
 their hearing dulled, their plastic bodies distorted and their brains 
 fuddled, and call this education ; so long as men and women violate 
 daily in themselves and in their children the simplest precepts of 
 hygiene, parents countenancing half-dressed daughters wearing out 
 their strength in unwholesome ball-rooms, seeking their slumber that 
 cannot refresh only when dawn appears ; sons launched upon the 
 world to encounter physical wreck in a thousand channels where no 
 beacon warns of danger; old men, senators, judges, divines, per- 
 chance learned doctors, uncomplainingly breathing the foul air of 
 public conveyances and apartments in which every door and window 
 have been carefully closed and ventilator carelessly ignored ; streets 
 reeking with filth which decrepid laborers play the farce of sweeping 
 in broad daylight ; what can State Medicine hope to accomplish in 
 legislative chambers and halls of Congress which are themselves 
 even evidences of sanitary ignorance, sanitary neglect and sanitary 
 indifference ? " 
 
 The foreign ingredients of the atmosphere are very various ; as 
 dust they are carried great distances by the wind and deposited 
 often hundreds of miles from their source. African organisms have 
 been found in the air of Berlin. It is often difficult to obtain air 
 free from the pulverulent debris of vegetation, and both vegetable 
 and animal organisms abound. From the vegetable kingdom come 
 pollen, vegetable hairs, fibres, scales, cells, seed capsules, etc., also 
 spores of fungi and various forms of bacterial growths in marvelous 
 abundance. In the air of living-rooms we may find portions of 
 food, animal and vegetable fibres, pus globules, fatty crystals, scaly 
 epithelium, and a number of the micro-organisms. 
 
 1 Dr. Sternberg, in his Report to the Xational Board of Health, 
 says: "The fact, observed by myself, that during the summer 
 months the mud in the gutters of New Orleans possesses an extra- 
 ordinary degree of virulence, shows that pathogenic varieties of 
 
 1 Special Report to Xational Board of Health. April 30, 1881. 
 
11 
 
 bacteria are not alone bred in the bodies of living animals. The 
 more I study this subject the more probable it seems to me that in 
 this direction lies the explanation of many problems which have 
 puzzled epidemiologists, and that the sanitarians are right in fighting 
 against filth as a prime factor in the production of epidemics ; a 
 factor of which the role is easily understood, if this view is correct. 
 The presence of septic organisms, possessing different degrees of 
 virulence, depending upon the abundance and kind of pabulum 
 furnished them, and upon meteorological conditions more or less 
 favorable, produces, in my opinion, the epidemic constitution of the 
 atmosphere, which wise men were wont to speak of a few years ago 
 as a cloak for ignorance. It must be remembered that the gutter 
 mud of to-day, with its deadly septic organisms, is the dust of 
 to-morrow, which, in respiration, is deposited upon the mucous 
 membrane of the respiratory passages of those who breathe the air 
 loaded with it." 
 
 The spores of certain forms of these lower orders of vegetation 
 have a remarkable vitality. They are of extreme minuteness, often 
 less than a two hundred thousandth of an inch in diameter and 
 have resisted a dry heat quite above boiling water. Tyndall was 
 the first to make popular the test of a beam of light through the 
 air as one of the best to show the presence of minute particles. 
 Indeed, it is only owing to these particles that the beam of light is 
 revealed, for in purified air it ceases to be visible, and air thus 
 purified no longer possesses the power of exciting putrefaction in 
 albuminous fluids previously sterilized. From the almost universal 
 pi'esence of these minute forms of micro-organisms and their diffi- 
 culty of exclusion arose the belief in spontaneous generation. Owing 
 to a better knowledge of these organic constituents ever present in 
 confined spaces and the dangers therefrom to wounds, has arisen 
 the revolution in surgery during the last decade. 
 
 By a slower process, because beset with far greater complications 
 and difficulties, there is being surely evolved the so-called germ 
 theory of disease which, although not dependent upon the atmos- 
 phere alone for the spread of contagion, is the more usual medium 
 for the dissemination of infection. The organic matter exhaled 
 from the lungs is molecular and is disseminated by atmospheric 
 currents. The odor from the decomposition of these organic 
 elements is generally perceptible when the carbonic acid reaches 
 seven parts in ten thousand, and is strong when it amounts to ten 
 
12 
 
 parts. The microscopic examination of these exhalations into the 
 air of crowded rooms, when condensed with the vapors upon the 
 cold glass of the window, often shows them to be undergoing decom- 
 position, in the process of which are developed confervoid growths 
 intermingled with myriads of bacteria and micrococci. One danger 
 from tuberculous patients may be found in the careless disposition 
 of the sputum. This not seldom falls to the ground, is pulverized 
 and distributed as dust. In respiration of the atmosphere thus 
 infected, the bacilli are lodged upon the mucous membrane of the 
 lungs. In the laborious researches recently published of M. Vignal, 
 of Paris, upon the bacillus of tubercle, he dried in a flat receptacle 
 some sputum containing bacilli ; this he afterwards pulverized, then 
 moistened and subsequently dried. The specimen was in this way 
 moistened and dried eight times, and the bacilli were as abundant 
 as in the fresh sputum. 
 
 Owing to the multiplicity of agents and causes rendering air 
 impure, its analysis has, as a rule, been very uncertain and unsatis- 
 factory. The term albuminoid ammonia, much used in the analysis 
 of air as well as of water, has usuallv represented a whole series of 
 unknown factors. Like amaurosis of the eye by the older writers, 
 it gave a learned phraseology to ignorance and disfigured science, 
 much in keeping with the making of the geographical map of our 
 boyhood, where the vast unexplored region of the territories this 
 side of the Rocky Mountains was called the Great American Desert. 
 
 It was first noticed by Gay Lussac that all the nitrogen of 
 organic matter, when heated with caustic hydrates, appeared as 
 ammonia. Albuminoid compounds, when disorganized by the 
 growth of the lower forms of organisms, set free ammonia, and the 
 quantity of the free ammonia may, in a general way, serve as a 
 standard to indicate the amount of decomposition which has taken 
 place. 
 
 The term albuminoid ammonia, on the contrary, stands for the 
 quantity of nitrogenous material in air or water which may 
 serve as food for the growth of these infinitesimal organisms. This 
 as yet undecomposed oi'ganic matter is not by any means in itself 
 necessarily hurtful, although always objectionable. Combined with 
 moisture at ordinary temperatures, it furnishes the condition for 
 bacterial growth and may prove sufficient for the development and 
 spread of an epidemic of some one of the class of contagious diseases. 
 AVe can have no chemical test for discriminating- between hurtful 
 
13 
 
 and harmless organic matter, since the poisonous infection is vital, 
 and where found must ever be looked upon with suspicion. 
 
 I take great pleasure in referring to the microscopic investigations 
 of atmospheric impurities by Surgeon J. H. Kidder, U. S. N., Wash- 
 ington, published in the Report of the Surgeon General, U. S. N., 
 1880, and continued in report for 1881, by Passed Assistant Surgeon 
 T. H. Streets. 
 
 The material for examination was collected by the use of a funnel- 
 shaped instrument connected to a winged vane, causing the opening 
 to face the air current, which is made to impinge upon a slide placed 
 horizontally, a portion of which has been moistened in glycerine. 
 In out-of-doors air thus collected and examined, he enumerates the 
 following substances as the most important : — 
 "1. Epithelium from the skin and mucous membranes. 
 
 2. Vegetable epithelium and unrecognized debris. 
 
 3. Hairs and threads of various fabrics. 
 
 4. Particles of sand, glass, metals, soot and starch. 
 
 5. Parts of the chitinous shells of small insects. 
 
 6. Bits of feathers and the pappous bristles of composite plants. 
 
 7. Minute, highly refracting dots, simulating micrococcus. 
 
 8. Crystals of various forms and sizes. 
 
 9. Pollen spores of many different kinds. 
 
 10. Leaf hairs. 
 
 11. Mycelium and spores of fungi. 
 
 12. Nucleated cells resembling leucocytes. 
 
 13. Bacteria, as bacterium, vibrio, bacillus and micrococcus, and 
 under the forms of aggregation known as zooglcea, "swarms," lepto- 
 ihrix and torulaP 
 
 Dust collected dry, by simple exposure of slips and disks to the 
 air, contained sand, soot, etc., and numerous crystals, mostly rods 
 and radiating needles. And, finally, the disks and tubes containing 
 collections made in hospital wards abounded in epithelium, starch, 
 cells resembling leucocytes, and threads and hairs. Epithelium, 
 as appears from the foregoing summary, is always and everywhere 
 present in the air. Considering the probability of the communica- 
 tion of contagious exanthemata by this mode, the constant presence 
 of epithelium in the air becomes a fact of considerable hygienic 
 importance. Minute, highly-refracting dots, very numerous in 
 winter dust, are likely to be mistaken for micrococcus, especially 
 when mounted in fluid and agitated by the Brownian movement. 
 
14 
 
 " They are usually the most minute parts of coal ashes, and may 
 be distinguished from organic forms by the fact that they are not 
 affected by strong sulphuric acid. * * * After a long 
 
 series of observations I am, however, constrained to believe that 
 there is no absolute reliance to be placed upon identity or similarity 
 of form in the recognition of crystals occurring in dilute solutions." 
 •Jn the sanitary investigations of Dr. Streets, the cultivation of 
 the organisms of atmospheric dust gave most interesting results. 
 The rare form of bacillus ruber accidentally appeared in some of the 
 culture tests and was made the subject of a number of laboratory 
 studies, and from their cultivation the air of the laboratory became 
 so completely infected with them that unless extraordinary care 
 was exercised they appeared as a pervading element in all cultures. 
 From my own laboratory studies I have been made aware of the 
 great difficulty in excluding germs during the manipulation of 
 sterilized nutrient fluids. To the special student, Dr. Street's 
 observations are of great interest. I cannot forbear quoting con- 
 cerning his growing the bacillus ruber upon rice under a bell jar in a 
 darkened room. " Whenever the bell glass was removed the nostrils 
 were greeted by an agreeable odor of apples ; several persons 
 noticed it. * The bacillus (Beck's Ko. 10 immer- 
 
 sion) was shown to be in single rods or two joined together, rarely 
 four or more united. Each rod enclosed two brightly refracting 
 granules usually one at either end. The movement of the rods was 
 active and perpendicular to the stratum of liquid in which they 
 swam ; moving points only were seen coming apparently in contact 
 with the thin glass cover; as their motion became less active the 
 rods floated horizontally in the liquid." 
 
 A proper discussion of the impurities in water would far exceed 
 the limits of this entire paper. Chemically pure drinking water is 
 neither necessary nor wholesome. Soaking into the earth, certain 
 mineral constituents must be present in varying quantity. These 
 have long been recognized and may be easily determined. In all 
 natural waters there is more or less organic matter in solution. 
 This is reduced to the minimum in the supply from springs and 
 deep wells properly protected. Organic material may not be 
 injurious, dependent upon its character; dissolved vegetable material 
 may deeply color the water, or the low form of algse give it a very 
 disagreeable taste without being especially harmful ; on the con- 
 trary clear, sparkling, tasteless water may contain impurities in the 
 
15 
 
 highest degree dangerous. Water containing albuminoids in solu- 
 tion, if allowed to become standing, is sure to undergo deleterious 
 changes, from its infection by the ever present atmospheric germs 
 which utilize these products as food and reproduce in numbers 
 utterly beyond conception. It is owing to such infection that the 
 water drainage from swamps and marshes, especially in hot climates, 
 has ever been a prolific source of intestinal disease. 
 
 As in the discussion of atmospheric impurities, we found the 
 ever-present moisture an important factor, so in the treating of the 
 water supply, soil pollution must be necessarily therewith taken 
 into consideration. In this relation no question is more important 
 than the power of the soil to purify water by filtration and the 
 retention therein of injurious products. The albuminoid compounds 
 may here be utilized as food for the higher order of plants, and 
 thus be extracted from the aqueous solution. Under the influence 
 of sunlight oxidation destroys many of the lower growths, and air 
 and water both thus become purified. It has long been recognized 
 that certain soils in time lose their ability to filter out the impuri- 
 ties from polluted waters. Many cases of disease and even epi- 
 demics have been traced directly to the use of water containing 
 sewage that had passed a greater or less distance through the soil. 
 It is apparent that this danger has been greatly underestimated by 
 all classes. The specific contamination of the ground water and 
 thereby of the supply for household use, is the more common and 
 wide-spread source of certain of our most dangerous diseases, the 
 example of which best known is typhoid fever. It is also an estab- 
 lished fact that the air which everywhere permeates all soils to the 
 ground water, moves in consonance with every barometric change of 
 the outer atmosphere ; these air currents, also modified by heat, are of 
 importance from a sanitary standpoint. Every vault, every cess- 
 pool, is a source of pollution, and these subsoil air currents are 
 drawn into our cellars from all directions when they are used as is 
 the custom of most of our northern cities, as the source from which 
 the heat in winter is distributed through the house. 
 
 The National Board of Health instituted a very elaborate series 
 of investigations in order to determine the extent to which different 
 soils are able to filter the injurious properties out of the air passing 
 through them. The most interesting report upon the relation of 
 soils to health, by Profs. Smyth and Pumpelly can here only be 
 referred to. Their conclusions show the utter worthlessness of sand 
 
16 
 
 as a filter for germinal matter. Our government in no wiser way 
 could aid in the general well being of her citizens than by the 
 continuation of such investigations. 
 
 " The facts here brought out seem to us of importance considered 
 with reference to the sources of supply of our drinking waters ; the 
 relative location of wells, cess-pools, etc., in our towns ; and also 
 w|th reference to the methods of removal of excreta, especially 
 during the prevalence of an infectious disease, the infectious mate- 
 rials of which may be communicated through water. A good bed 
 of sand has commonly been regarded as one of the most efficacious 
 forms of filters, amply protecting our well water against all con- 
 tamination, even though the wells be sunk at no remote distance 
 from sewers, cess-pools, cemeteries, etc. But we see that sand 
 utterly fails to remove germs of putrefaction, such as are normally 
 found in the air and in water, while its power of absorbing dis- 
 solved matter, organic or inorganic, must also be seriously 
 questioned. 1 " 
 
 The subject of germ transmission through the soils demands on 
 the part of sanitarians the most searching investigation, not only on 
 account of the possibility of contamination of our drinking waters, 
 through infiltration of germs, but also because the air, especially in 
 our dwellings, may become infected if the soils in their natural con- 
 dition possess no power of retaining germs or their adult organisms. 
 For whenever in an infected soil the ground water from any cause 
 rises to the surface, germs may be carried with it, and upon drying 
 be taken up by the atmosphere. 
 
 The importance of a supply of pure drinking water cannot be 
 over-estimated, and its pollution is in a very large degree due to 
 germ contamination. This is no exception, even in sparsely settled 
 country districts. In New England, almost entirely exempt from 
 malaria, the danger from specific contamination of the drinking 
 water is shown in the marked increase of typhoid fever. In Massa- 
 chusetts alone there occurred, from 1840 to 1880, 390,000 cases of 
 typhoid fever and 40,000 deaths. 
 
 In the military service, during the late bloody contest between 
 the States, zymotic diseases caused a larger number of deaths than 
 resulted from all the battles of the entire war. We quote from the 
 report of the Surgeon General : " The entire number killed in 
 battle and died as the result of wounds was 93,443 ; died from dis- 
 
 1 Supplement No. 13, National Board of Health Bulletin, p. 18. 
 
17 
 
 ease, 186,216 ; died from zymotic diseases alone, 108,666." If to 
 these hecatombs of victims sacrificed in the vigor of early manhood, 
 Ave add the suffering represented by over 1,700,000 reported cases 
 of diarrhoea and dysentery, and 1,100,000 cases of malarial fever, 
 every village and hamlet of our broad domain still having its 
 representatives of wrecked humanity from these causes, we gain 
 some idea of the dangers resulting from insanitary conditions, 
 although our armies were in service in a mild climate, and the best 
 clothed, fed and housed soldiery the world has ever seen. 
 
 The number of deaths in the United States during 1880 from 
 diphtheria alone, was 38,398, a proportion of 51.33 per 1000. From 
 typhoid fever there occurred 22,905 deaths, a proportion of 31.21 
 per 1000. 
 
 These terrible scourges, like consumption, are the messengers of 
 death which make their daily visitations, and to which people have 
 become so accustomed as to regard their ravages as the inevitable, 
 or, as the clergy have been wont to express it, "the hand of divine 
 Providence laid heavily upon us." The medical profession talk 
 learnedly of the wise means adapted to the cure. Different schools 
 of pharmacists have their vaunted remedies ; but the sad, humiliating 
 lesson of the mortality tables teaches that these invisible monsters 
 are stalking broadcast over the land, seizing prince and beggar 
 alike in their remorseless grasp. 
 
 Since the history of man, the wise of all generations have sought 
 for the cause of disease, yet it would appear that the key to many of 
 these labyrinthian mysteries has been reserved as one of the 
 triumphs of science for the latter part of the nineteenth century. It 
 is now generally conceded that the danger to wounds is a particulate 
 organic infection, which, like the virus of inoculation or vaccine, 
 germinates, and induces systemic poisoning. The whole subject of 
 modern wound treatment is based upon the recognition of this ever 
 threatening danger, and securing the best means of its avoidance. 
 This recent recognition of the dangers from the simplest form of 
 microscopic vegetable growth, has evoked the important question of ' 
 the means best adapted for their destruction. Extremes of heat and 
 cold are by far the most universal, and are the wise measures which 
 nature has adopted as limitations to their development. For a long 
 time carbolic acid has been the surgeon's sine qua non, and the 
 agent most trusted for the disinfection of the sick-room. A long 
 series of careful laboratory investigations conducted under my 
 
18 
 
 supervision have given results not unlike those of Koch and Stern- 
 berg, and place the bichloride of mercury preeminently at the head 
 of the list of germicides. 1 The solution of one part to 2000 is as 
 trustworthy as the 1 to 20 of carbolic acid. Properly marked, to 
 guard against danger, such a solution may be wisely brought into 
 requisition in every household. Under the light of its new values, 
 preparations of mercury in certain diseases are likely to be restored 
 to their old time professional confidences, and teach that the clinical 
 deductions of the fathers were not without foundation in fact. 
 
 The first of the diseases, and the one the clear history of which is 
 perhaps the best known, is anthrax, or malignant pustule. Here 
 the role of specific micro-organisms as cause and effect has been 
 conceded. No more interesting subject could command attention 
 than the analysis in detail of the entire group of zymotic diseases 
 In a purely conservative sense, it is not too much to claim, that it 
 may be shown that each of these affections has its probable origin 
 from, and owes its dissemination to, a contagium vivum of a definite, 
 particulate character. We do not, however, intend by this to 
 convey the meaning that our knowledge, as yet, if ever, will enable 
 us to differentiate each individual factor. In the light of recent 
 astonishing discoveries, no wise man would prognosticate a limit to 
 our future knowledge in this direction. Certainly, the greatest 
 progress in medicine since the days of the fathers is this pertaining 
 to the causes of disease. It is not too much to predicate as possible, 
 or even probable, that the medical art, in the near future, will hold 
 control over the entire class of zymotic diseases as effectually as 
 vaccine has controlled and relegated to an almost hypothetical 
 danger the terrible scourge of smallpox, which ravaged humanity 
 during the many centuries of the historic past. 
 
 The laborious researches of our distinguished friend, Dr. Henry I. 
 Bowditch, in establishing the relation of soil moisture to consump- 
 tion, builded for himself a monument more grand and enduring 
 than granite or bronze. The ineffable something, the existence of 
 which he was equally sure, remained for younger eyes to discover, 
 and the patient, pains-taking labors of the well trained German 
 student to demonstrate the specific bacillus tuberculosis. 
 
 It is very probable no publication of modern time has awakened 
 so much discussion or caused the undertaking of so great an amount 
 
 1 See American Medical Association Journal, August, 1883 — " Germicides 
 and Their Relative Values." 
 
19 
 
 of study and investigation. Dr. H. C. Ernst, of Boston, read an 
 exhaustive paper, upon this subject, in part a contribution of 
 laboratory work, before the Massachusetts Medical Society in June 
 last. He made a table of references to fifty publications upon this 
 subject, and I am quite sure I have seen nearly one-quarter as 
 many more articles published since this date worthy of reference. 
 Dr. Ernst's conclusions are as follows : — 
 
 " I. A staff-shaped micro-organism exists in all forms of the tuber- 
 culous process, and its presence has been demonstrated in them. 
 
 " II. It is more abundant in the rapid than in the slow form of the 
 process. 
 
 " III. Its specific nature as the cause of tuberculosis is claimed by 
 Koch on the ground of his observation. 
 
 "IV. Its specific character has not been successfully refuted by 
 trustworthy observations. 
 
 " V. Its value as diagnostic evidence of tuberculosis is very great, 
 although its absence cannot be considered as excluding that process." 
 
 The latest novelty in the germ theory of disease is found in the 
 ingenious exposition of the yeast fungus as the cause of diabetes, 
 by Prof. Ekland, of Stockholm. 1 It is offered as theory rather than 
 demonstration, and yet the array of facts brought to support this 
 explanation, if not conclusive, throws at least new light upon this 
 disease, which has ever been considered a dark enigma. 
 
 Dr. Hassall communicated a paper upon the development of 
 Torulse in Urine to the Royal Medical and Chirurgical Society of 
 London, in 1853, in which he arrived at the conclusion that there 
 is a species of fungus which is developed in urine containing even 
 minute traces of sugar, which may be considered characteristic, 
 since it occurs in no other condition of the urine. Dr. Beale"' says : 
 " This is the sugar fungus. But neither the character nor the 
 occurrence of the fungus are sufficiently constant to enable us to 
 accept implicitly Dr. Hassall's conclusions as to its value as a test for 
 the presence of sugar. The sugar fungus which grows in diabetic 
 urine is identical with the yeast plant." From the above it would 
 appear that both Drs. Hassall and Beale believed these organisms 
 developed only after the exposure of the urine to the atmosphere. 
 
 In the archaeological museum in Cambridge may be seen whole 
 series of adult skulls from certain of the prehistoric races of South 
 
 1 N. Y. Medical Journal, July 28, 1882. 
 
 2 " Kidney Diseases and Urinary Deposits." Third edition, 1870, p. 393. 
 
20 
 
 America with perfect teeth. The mouths so well furnished are alas 
 closed to our interrogatories of the why. The last generation of 
 Americans, living upon hot bread and fried meats, might have been 
 described as a teeth-aching race. Oar native genius, rising to the 
 necessity of a, felt want, evolved a new profession, earlier called the 
 Dentist, now the dental and oral surgeon, and the present generation 
 nmy be styled a teeth-preserving and teeth-manufacturing people. 
 An army of seventeen thousand trained specialists are busily engaged, 
 at an estimated annual cost, in the United States alone, of from forty 
 to fifty millions of dollars. In the highest consideration this is 
 a very imperfect compensation for the damage done these compara- 
 tively minor members of the body by the ever-present micro- 
 organisms which riot in this usually filthy cavity. An antiseptically 
 clean mouth and our dentists would become rivals of the historic 
 Micawber, and dyspepsia be placed at the bottom of the lists of 
 diseases. 
 
 A blind man, no matter how well armed and how active, is a 
 dangerous ally ; his blows may fall equally upon friend and foe. 
 How can one who is blind as to causation direct as to the preven- 
 tion of disease ? 
 
 The fundamental basis of all sanitary law, and I may also say of 
 the treatment of disease, lies in the acquisition of such causative 
 knowledge. The application of sanitary law to city life must 
 demand an atmosphere reasonably free from the defilement of 
 organic waste. This necessitates a system of sewerage which shall 
 continue from the house in a steady, unbroken current to its dis- 
 charge at a safe distance from habitation. This current should be 
 of sufficient rapidity to prevent sedimentation, and deliver the house 
 products before time sufficient for putrefaction, even in summer, 
 has elapsed. This can never happen in the systems now in use in 
 those cities situated upon the sea shore, since here the sewers are 
 practically tide-locked a large fraction of the clay, and a cessation of 
 current with sewerage deposit must ensue, while a backward pres- 
 sure is necessarily produced upon the sewer air which, loaded with 
 organic products, must escape into the house through any one of the 
 w T ater traps now in use. 
 
 Sewer-gas poisoning, which means air changed not so much in its 
 chemical constituents as defiled by organic impurities, is thus by no 
 means, in our best constructed houses, a hypothetical danger, here 
 often the greater, for the costly luxuries of water-closets and basins 
 
21 
 
 are each a standing menace, and are to be regarded with suspicion. 
 Boston, which has and yet continues to drain into its Back-Bay and 
 harbor its sewerage, by more than fifty outlets, is upon the eve of 
 inaugurating its new system at an expanse of nearly $5,000,000, by 
 which the sewerage is to be pumped into a storage reservoir situated 
 upon Moon Island and discharged into the out-going tide, and thus 
 protect the harbor from defilement by sewer drainage. 
 
 The wise political economist and world-renowned historian, Mr. 
 George Bancroft, in discussing the future of civilization, once said 
 to me: "I look upon New York city as the future commercial 
 metropolis of the world, a great centre of ten or fifteen millions of 
 inhabitants." This prophecy of years ago has gone on toward a 
 steady fulfillment, until, like London, she exacts tribute from the 
 entire world. Situated upon a narrow neck of land between a 
 mighty river and a deep bay, it would seem that good soil drainage 
 would be most easily secured ; and yet her sanitary authorities state 
 that the imperfect, incomplete, and broken sewers have caused the 
 soil of whole districts to become so charged with sewage that the 
 saturation point is reached. Nearly four millions of people pour 
 their waste into the river and harbor, as is most convenient, while 
 miles of her shores are fringed with wooden wharves built upon 
 piles, not alone themselves undergoing decay, but a fertile source of 
 detention of putrefying material. The New York physician will 
 tell you that, no matter what disease he has under treatment, the 
 added factor of malaria from such defilement must be taken into 
 consideration. Rich and poor must alike suffer from such danger, 
 and if the prophecy of America's distinguished scholar is to be 
 fulfilled, New York must take her sewage out of the harbor, and 
 rival London and Liverpool with docks of solid granite for the 
 merchandise of the globe. 
 
 The water supply must ever be pure and ample. The extraordi- 
 nary expenditure necessitated by most cities has made water a 
 costly product. Rivers and lakes in sufficient proximity for such 
 use are liable to defilement from suburban towns and manufactories, 
 and only by the greatest vigilance can pollution be prevented. 
 Boston has freely expended her millions upon a water supply con- 
 fessedly inadequate in amount, and of a character which is a con- 
 stantly recurring source of complaint and danger. Much of her 
 water supply is retained in artificial, shallow storage basins, from 
 which the surface soil was never removed, and whose water-shed 
 
22 
 
 comprises a very considerable population ; and Natick, with its 
 
 8000 inhabitants, still drains its waste into Lake Cochituate, the 
 original source selected for the city supply. 
 
 The Board of Health returns for Boston, August, 1883, out of a 
 total of 521, gives from zymotic diseases alone 194 deaths, while 
 135 cases of typhoid fever were reported. 
 
 For September, in a total mortality of 765, there were 253 deaths 
 from zymotic diseases, and 215 cases of typhoid fever were reported. 
 
 "With astonished gaze the traveler views the great arches span- 
 ning and crossing the Campagna, which once bore to old Rome the 
 pure waters of the distant Albian mountains. The last genera- 
 tion of scant population, with singular energy and fore- 
 sight, at the behest of commerce, wedded by a waterway, more 
 than three hundred miles in length, the Great Lakes with the Hud- 
 son river. The twentieth century will exhibit yet greater marvels 
 for the securing of pure water. The project is already under dis- 
 cussion to supply the great Metropolis from no nearer source than 
 Lake George, with the thought of protecting its water-shed fr6m 
 further pollution, and carrying its pure, sparkling water to the 
 thirsty city, at an estimated expense of no less than two hundred 
 millions of dollars. 
 
 The danger from the dead must not be forgotten. As we invite 
 our friends to sympathize in our sorrow, let it not be to their peril. 
 Revive, if need be, the custom of Egyptian preservation, or re- 
 inaugurate the use of the Roman funereal urn, but do not sow the 
 seeds of an epidemic of the ever prevalent contagious diseases by our 
 present display of decomposing remains, adorned as if for a recep- 
 tion. Let the genius of some sanitarian devise a casket at once 
 hermetically sealed, rather than do violence to time honored cus- 
 tom or shock the deepest and most sacred feeling of broken hearts 
 by urging cremation. The public health act of Great Britain 
 makes the holding of a " wake" over the body of ©ne dying from 
 contagious diseases subject to a fine of five pounds. Let American 
 authorities equally protect from similar dangers. 
 
 W 7 e turn reluctantly from the consideration of questions having 
 so great and vital an interest to the medical profession, and of 
 primary importance to the entire animal kingdom. If Rip Van 
 Winkle experiences be granted to us in the twentieth century, with 
 little aid of the prophetic power we may forecast some of the 
 advances then made known to us of our science. In the li^ht of 
 
past history, with its fashions and foibles of the medicamenta, few 
 would presume upon the mission of its pellets and powders. 
 
 Surgery and sanitary scieuce are, however, based upon entirely 
 different factors of our knowledge, and must remain the great corner- 
 stones of a divine art, as wide reaching as humanity. Upon these 
 shall be builded the grand JEsculapian temple of the future, where 
 will be taught a science foreshadowed in the deeds of the great 
 Galilean Master. 
 
 The citizen must not be lost in the physician. A Republican 
 Government demands service of all. As I turned from the motley 
 crowd in Castle Garden I shuddered at the thought that these men 
 were so soon to be my peers in our government ; but the bright- 
 eyed children, hiding in the scanty skirt of the mother, looked 
 hopefully up, as if to say, " Welcome us in our escape from the 
 oppression and over-crowding of the centuries." Then came the 
 vision of our broad domain scattered all over with school houses, 
 academies and colleges. Rosy-hued with health, in youthful vigor, 
 our women in tens of thousands have devoted their best years to 
 the training of the young. Four hundred American colleges and 
 universities with open doors invite to a higher education. Universal 
 knowledge is the Republic's only safety, and further needs have 
 only to be made known to be liberally met by the generosity 
 of the American people. The necessity for research and pure 
 science are recognized as never before, and may the day soon come 
 when our youth will no longer require, for their best development 
 and higher education, European training. 
 
 Be it our bounden duty as physicians to disseminate to the masses 
 proper instruction in the cardinal virtues of right living, and to 
 demand from our government wise sanitary laws, both State and 
 National, in the enforcement of which every house shall be builded 
 and maintained as sanitarily safe as architecturally ; rich and poor 
 alike abundantly supplied with pure air and water, and have their 
 habitation upon an un contaminated soil. 
 
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