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 SUPPLEMENTAL REPORT 
 
 ON 
 
 STATE MEDICINE, HYGIENE, ETC. 
 
 Read before the Medical Society of the State of California, at* it* 
 Annual Meeting, held in San Francisco, in April, 1892, 
 
 BY 
 
 M. M. CHIPMAN, M, D. 
 
 MEMBER OF THE 
 
 San Francisco County Medical Society, 
 
 Medical Society of the State of California 
 
 American Medical Association, 
 
 AUTHOR OF 
 
 REPORTS ON MINING DEBRIS DEPOSITS, FOREST PRESERVATION AND 
 TIMBER CULTIVATION, PUBLIC HYGIENE AND STATE MEDICINE, MICRO- 
 ORGANISMS AND THEIR RELATION TO HUMAN AND ANIMAL LIFE* 
 AND OTHER REPORTS AND PAPERS, WRITTEN AND RENDERED 
 AS A MEMBER OF OR AS CHAIRMAN OF DIFFERENT COM- 
 MITTEES, AT THE SEVERAL INSTANCES, OF THE STATE 
 MEDICAL SOCIETY, AND RE-PRINTED FROM ITS 
 VOLUMES OF TRANSACTIONS. 
 
 jifooilfik^ 
 
 llillijl 
 
 iqOt 
 X 'V X \ 
 
 W. A. Woodward & Co , Printers, 12 Sutter street, San Francisco 
 
SUPPLEMENTAL REPORT 
 
 ON 
 
 STATE MEDICINE, HYGIENE, ETC. 
 
 By M. M. CHIPMAN, M. D., San Jose. 
 
 Mr. President and Members of the State Medical Society: 
 
 Of the numerous species of microbes which infest the animal 
 life and the bodies and habitations of men, but do not attack 
 the living tissues of the body, the works on bacteriology give 
 no definite description of their manner of subsistence; but as 
 some of the experimenters have found that many species feed 
 on combinations of carbon, it is evident that the carbon which 
 issues with the expired breath and from the external sweat pores, 
 furnishes, largely, the pabulum; and the hair, wool and feathers 
 of animals and of birds and the clothing of the human being 
 furnish the shelter and warmth required for their development 
 and multiplication; and in human habitations the artificial heat, 
 required during the cooler season, provides supplemental means 
 of comfort and perpetuation to these external parasites. The 
 animal life is, more or less, tolerant of the non-malignant 
 microbes. Their relations to the human being might be com- 
 pared to that of weeds to the trees of an orchard; the cleaner 
 the ground is kept of the weeds, the better the trees thrive and 
 the more abundant and better the quality of the fruit, and the 
 less the liability to disease ; but if the ground be made perfectly 
 free of weeds it yet always contains the seed which will send 
 forth another crop; and so with the animal and especially with 
 more susceptible man, however clean, however free from exter- 
 nal parasites he may make himself, there is always enough of 
 germ life remaining in his clothing, on the furniture, the walls 
 and ceilings of the house and in the atmosphere, within and 
 without, to repopulate his person and his dwelling within a few 
 hours; and thus it is that we are obliged to continuously fight 
 these dependents lest the creatures which feed upon the excre- 
 mentitious substances of the food, which has already served as 
 our nutriment, and impose themselves upon our persons, against 
 our wishes, shall become over-dominant. It is not alone in the 
 active life of these minute organisms that they annoy us, but 
 
 / 
 j 
 
2 Supplemental Report on State Medicine, Hygiene, Etc. 
 
 also by their remains after death; their life period being brief 
 and at the close of which, the lifeless bodies are left on the ani- 
 mal or person whom they inhabited; and he who too long neglects 
 bathing will thus become encrusted over to the diminishment of 
 the perspiratory function. 
 
 As ordinary methods of ventilation leave places in the rooms 
 of dwelling houses which the fresh air does not reach, I would 
 suggest that, in the construction of houses, all the apartments 
 should be provided with ventilating spaces, both at the top and 
 bottom of the rooms, with swinging or sliding doors, something 
 after the manner of the ventilation of passenger cars, and these 
 little doors should be opened for awhile every day, preferably, 
 whilst cool, in the morning; and thus, with the sweeping of the 
 floor and the dusting of the furniture, the fresh outside air 
 would sweep the air of the room as well, and the invisible pop- 
 ulation of the apartment would be reduced to a minimum; and 
 with so light a seeding the repopulation would not become dense 
 again during the succeeding twenty-four hours. 
 
 Heavy woolen carpets are a complete refuge for microbes 
 and their use should be discontinued, especially during the 
 warmer months; and to compensate for the wool carpets, cloth 
 or felt slippers might be worn in the rooms if required. 
 
 There is nothing of greater use or utility, in proportion to the 
 trouble and expense involved, than the sterilization of water by 
 boiling, both in medical and surgical practice; and for drinking, 
 when necessary. As to the time required to sterilize :— in ordi- 
 nary drinking water the microbic life will become nearly extinct 
 against it has been brought to the point of ebullition, but it is 
 safer to continue the boiling for two or three minutes, if to be 
 used immediately; but if to be kept for a day or more, it 
 should be boiled for twice that length of time: and if heavily 
 charged with microbic life, especially if the presence of malig- 
 nant bacteria is suspected, the boiling should be still prolonged 
 to perhaps ten minutes. Boiled water becomes reinfected if 
 exposed to the air on cooling very rapidly. Tyndall, in his 
 experiments, found that his infusions, on removal from the heat- 
 ing flame, became reinfected within the space of two minutes, if 
 exposed; and water, if not to be used immediately, should either 
 be boiled in a water bath, in closed vessels, or stoppered before 
 ebullition ceases, and the stoppers not removed until thej mo- 
 ment of using. 
 
Supplemental Report on State Medicine, Hygiene, Etc. 3 
 
 Pasteur states that it requires a temperature of, at least, 110 
 degrees Centigrade, equal to 230 Fahrenheit, to effectively steril- 
 ize milk; but Pasteur intended the milk to be so completely- 
 sterilized that it could be kept in air-tight vessels for an indefin- 
 ite period without developing organic life . Two vessels or bot- 
 tles, containing milk of equal freshness, might be kept exposed 
 to the same degree of heat for the same length of time and the 
 milk in one of the bottles might be so thoroughly sterilized that 
 it would keep indefinitely, whilst in the other organic life might 
 develop in the course of a week or more; the difference in the 
 conduct of the two samples, arising from the circumstance, that 
 the milk of the infected sample had been exposed to the intro- 
 duction, before the heating, either of niore persistent species 
 than the other, or that it had received germs which had been 
 more thoroughly dessicated, and, therefore, required a longer 
 exposure to heat, in order to destroy them. I have no doubt 
 that much benefit has been derived from the ordinary scalding 
 of milk, as it is termed, as the greater part of germ life will be 
 destroyed by the exposure to two hundred and twelve degrees 
 Fahrenheit; and by long enough subjection, at the boiling point 
 of water, milk will become thoroughly sterilized; and as it is 
 liable to be injured, in quality, by exposure to too great heat, 
 the water-bath is a safeguard, in that respect; but I would 
 recommend that the water, in which the bottles are immersed, 
 should be kept in ebullition for at least ten minutes, in case the 
 milk is for immediate use, and for a longer time, if to be kept 
 for a day or two. Some of the dairies of all cities, should pro- 
 vide themselves with apparatus for sterilizing milk by heat, to 
 deliver in bottles, or closed vessels, to such customers as would 
 prefer it in that form, which would be a great convenience and 
 beneficial to many families, and could be made remunerative to 
 those engaged in the business. 
 
 The external micro-organisms, those which do not directly 
 attack the human organism, cause us a great deal of trouble, 
 and oblige us to exercise constant care and watchfulness; yet 
 with such care and vigilance, we are able to hold our own 
 against them; but the more malignant species, those which have 
 the capacity to attack the living tissues, are our dread; and 
 they, together with those which colonize in the partially digested 
 contents of the alimentary canal, cause us alarm whenever their 
 presence becomes known; and against these we are obliged to 
 
4 Supplemental Report on State Medicine, Hygiene, Etc. 
 
 wage a war of extermination; but, fortunately, the very condi- 
 tions of their subsistence render them unable to extensively 
 pervade the air, water and soil, as do the comparatively harm- 
 less microbes, and this limitation enables us, with the knowl- 
 edge acquired by the study of their habits, to prosecute the war 
 with some degree of success. As to the manner of the introduc- 
 tion of pathogenic microbes into the human system, that is a 
 question which has not yet been definitely settled, in all 
 respects. In every act of respiration, it might naturally be 
 supposed, that we are liable to infection, provided germs of a 
 malignant species are present; but nature has provided protec- 
 tion against such constant exposure, in the complicated struct- 
 ure of the lungs, by wtiich the air is filtered of its germs as it 
 is inhaled. Professor Lister first pointed out, that air, which 
 has passed through the lungs, has lost its power of producing 
 putrefaction; and Tyndall, by a series of experiments, ascer- 
 tained that, in the act of expiration, the last of the air expired 
 had been purified of its germs. But whilst I do not consider 
 that such experiments have been carried to the extent to justify 
 the statement, as an ascertained fact, that living germs never 
 enter the body through the lungs, yet there is evidence enough 
 to confirm the position, that such entrance is rare, if it ever 
 occurs; whilst on the other hand, there is no obstacle to en- 
 trance by the mouth and alimentary canal, with the food and 
 beverages; and, therefore, except such infection as may be 
 introduced by the means of external wounds, punctures or 
 abrasions and the specially exposed mucous surfaces, the hurtful 
 micro-organisms, if not exclusively, must principally obtain 
 entrance by the way of the oral cavity. And having gained 
 admission, the obscure, pernicious visitant is carried forward, 
 with the food and fluids, which minister to the animal life, into 
 the alimentary canal, and perhaps on through other conduits, 
 until a location is reached, wherein abound the special resour- 
 ces adapted to its nutrition and development, and there pro- 
 ceeds to appropriate, to colonize and multiply. The micrococ- 
 cus of diphtheria travels but a short distance, locating on the 
 tonsils and in the throat, where it initiates its poisonous pro- 
 cesses; the newly discovered bacillus of influenza first puts its 
 grip on the throat and bronchial passages; the comma bacillus 
 glides smoothly along with the ingested food, until having 
 passed below where the greater part of the digestive solvents 
 
Supplemental Report on State Medicine, Hygiene, Etc, 5 
 
 have been poured in upon it, and the process of digestion has 
 become pretty well advanced, when the microbe finds that the 
 changes wrought in its vehicle of entrance has converted the 
 semi-fluid mass into a culture medium, just suited to its use; the 
 bacillus of typhoid fever finds its special nutriment in the glands 
 of the small intestine; the pneumococcus and the bacillus of 
 tubercle are developed most readily in the aerobic conditions 
 and tissues of the lungs; whilst the germs which originate 
 small-pox and other papular and eruptive diseases are evidently 
 absorbed from the canal, and thence carried through the circu- 
 lation to near the surface, before they find the conditions of 
 shelter from the greater blood currents and the character of 
 tissues adapted to their colonization. But not all microbes are 
 so limited, as to choice of location, but are ready to commence 
 work with the first opportunity of entrance to the body; as ty- 
 pical of those with less fastidiousness of conditions, I will men- 
 tion the micrococcus of erysipelas and the microbe of syphilis, 
 both of which usually obtain entrance through the external 
 surfaces, although unlike otherwise in their habits and processes 
 of working. 
 
 In a recent edition of a standard work on syphilis, an old, 
 but now manifest, error is perpetuated in the statement, in 
 regard to the incubation, that, " after the poison of syphilis has 
 been absorbed, it ferments, as it were, in the blood, until it is 
 ready to give itself local expression." To see the incorrectness 
 of this statement, we have only to consider certain anatomical 
 and physiological facts and the evidences in regard to it. The 
 arteries, capillaries and veins form one continuous system, 
 through which the blood is impelled by the heart's action, 
 favored by the elastic structure of the blood vessels, at a rate, as 
 found by the experiments of Vierordt, by which some part of 
 it makes the circuit of the body, during each period of twenty- 
 seven pulse beats, in the average person equal to thirty-two and 
 two-tenths seconds of time, and although such portion of the 
 blood as performs the greater circuit of the extremities, and that 
 which is sent off to perform its functions in the liver, kidneys 
 and other glandular organs, is somewhat delayed in the return, 
 yet it all obeys the progressive impulse and keeps moving on. 
 Now, as the virus of syphilis, as we have every reason to be- 
 lieve, consists of microbes or microbic germs, and as all organic 
 fermentations are the results of the working in, the changes in 
 
6 Supplemental Report on State Medicine, Hygiene, Etc. 
 
 the substance, wrought by the microbes, and as micro-organisms 
 require conditions of rest, in order to develop and multiply, the 
 continual motion of the blood, subject to a considerable degree 
 of pressure in the heart and the arteries, with the aeration it is 
 subject to in the lungs, and the straining process, as it were, in 
 the capillaries and in the glands, where the globules pass only 
 in small companies, or in single file, must all be unfavorable to, 
 and protective as against, the process of fermentation. Then 
 again, it has been ascertained by direct experiments, that the 
 composition of the living blood is highly antiseptic. 
 
 Dr. Sternberg states that, " If we add a quantity of a cult- 
 ure fluid containing the bacteria of putrefaction to the blood 
 of an animal, withdrawn from circulation into a proper recep- 
 tacle, and maintained in a culture oven at blood heat, we 
 will find that the bacteria multiply abundantly, and evidence 
 of putrefactive decomposition will soon be perceived. But 
 if we inject a like quantity of the culture fluid with its con- 
 taining bacteria into the circulation of a living animal, not 
 only does no increase and putrefactive change occur, but the 
 bacteria, introduced, quickly disappear, and at the end of an 
 hour or two the most careful microscopical observation will not 
 reveal the presence of a single bacterium. This difference we 
 ascribe to the vital properties of the fluid, as contained in the 
 vessels of the living aminal." Lewis and Cunningham, in 
 experiments upon quite a number of animals, found that bacte- 
 ria which were injected into the circulation, had disappeared 
 from the blood of nearly one-half of the animals at the end of 
 twenty-four hours; and of thirty animals treated, bacteria were 
 found in only two, when the examinations were made within 
 seven days after the injection. The results of the different and 
 varied experiments of Traube and Gscheidlen, Fodor and Wyso- 
 kowicz, Schmidt and Grohman, Nutall, Nissen, Buchner, Hali- 
 burton, Hankin, Stern and others, bear evidence to the anti- 
 septic 'and germicidal properties of the blood, and even that 
 blood after being drawn, still retains those properties, for a 
 limited time Stern found that the blood taken from different 
 men, or from the same man, at different times, varies, mark- 
 edly! in its germicidal properties. But, not only has it been 
 found that bacteria, when injected into the blood, rapidly dis- 
 appear from the circulation, by numerous experiments upon 
 animals, but also in the case of diseases induced by microbes, 
 
Supplemental Report on State Medicine, Hygiene, Etc. 7 
 
 that during the period at which the disease is at its height, the 
 special microbe of the disease becomes numerous in the blood 
 of the patient and then disappears as the disease abates. 
 
 Dr. Canon, of the Moabit Hospital, found in his investiga- 
 tions of the recently discovered bacillus of influenza, that those 
 special bacilli were abundant in the blood during the fever of 
 influenza, but that they disappeared with the disappearance of 
 the fever. And the same thing has been noted, repeatedly, of 
 splenic fever and of other bacterial fevers. 
 
 Wysokowicz accounted for the disappearance of the bacteria 
 from the circulation, not by the supposition that they were 
 destroyed by the blood, but that they found lodgment in the 
 capillaries. But such supposition, I think not reasonable, as an 
 accumulation of bacteria in the capillaries would be obstruct- 
 ive of the circulation and likely to produce mischievous results 
 otherwise. It has been found by numerous observers that 
 micro organisms of different species and in varying proportions 
 in different subjects, are present in the faeces, and I think the 
 following to be a reasonable account of the manner of their dis- 
 appearance from the blood, whether introduced by artificial 
 injections or absorbed into the blood from the developments of 
 bacteria in other tissues of the body. 
 
 One of the functions of the blood is to carry all effete, useless 
 or hurtful matters to the glands which co-operate in the elimina- 
 tion, and the intruding organisms are thus consigned to the 
 lymphatics, which terminate in the lower bowels, with the excre- 
 tive products of the metabolic processes within the tissues, and 
 in that manner become a part of the faeces. 
 
 The supposition that the bacterial diseases were caused by 
 fermentation of the blood, prevailed during the period immedi- 
 ately following the first discovery in bacteriology, viz: that fer- 
 mentation is the result of the working of microbes in the sub- 
 stance undergoing the process, and when little else was known 
 concerning micro-organisms; but as further discoveries were made 
 that supposition was discarded, and by all who have kept them- 
 selves acquainted with the progress of this modern science has 
 now, for several years, been relegated among the errors of the 
 past. In fact, it is apparent that were there any species of 
 microbes possessed of the power to effect the molecular changes 
 in the blood involved in the process of fermentation their intro- 
 duction into the circulation would speedily end in the death of 
 the subject in all cases. 
 
8 Supplemental Report on State Medicine, Hygiene, Etc. 
 
 But no such organism has, as yet, developed; on the contrary, 
 even those microbes which attack the living tissues, and which, 
 as might be supposed, have been found to possess a greater 
 degree of tolerance of the sanguineous conditions than other 
 species have been proved by observations to, in a measure, lose 
 their activity and virulence by being subjected to experiments 
 by which they were exposed to the germicidal properties of the 
 blood. Grohmann and Schmidt found that anthrax bacilli, 
 after being kept in coagulating blood plasma, were less virulent, 
 as shown by their effects upon rabbits. Fodor made a series of 
 experiments with blood taken from the heart, which showed its 
 marked germicidal properties on anthrax bacilli and much other 
 experimentation with this, one of the most virulent species of 
 parasites, exhibits like evidence with the preceding. It is true 
 that several experimenters have succeeded in producing syphilis 
 by inoculating with the blood of a subject of syphilis; and it is 
 probable that other bacterial diseases can be reproduced, or 
 marked effects caused, by inoculating with the blood of the 
 subject during the maximum period of the disease; but that the 
 microbes remain dormant whilst in the blood and are unable to 
 develop until they have been conveyed to conditions of shelter 
 from the circulation, is sustained by all observations .and evi- 
 dence bearing upon the subject; whilst the view of the fermen- 
 tability of the living blood could be sustained only by the 
 reversal of the established principles of physiology and in con- 
 tradiction to the pathological observations in this connection. 
 But the condition of dormancy of these organisms and retention 
 of vitality, is the means by which certain of the species are dis- 
 tributed, by the circulation, to their respective locations of 
 development; which in the case of syphilis, however, is without 
 much choice as to tissues and not, necessarily, but little shelter 
 from the blood current, as is evidenced in the advanced stage by 
 its general prevalence in the system and, in some cases, by its 
 ravages in the tissues of the heart and lungs and even in the 
 walls of the blood vessels. 
 
 The real manner of the incubation of syphilis may be illus- 
 trated by the more observed process in vaccination, to which it 
 is similar. In vaccinating, experience has shown that in intro- 
 ducing the virus the chances of success are best by removing 
 only the cuticle without drawing blood; and in the usual infec- 
 tion of syphilis it is evident that the infection takes place 
 
Supplemental Report on State Medicine, Hygiene, Etc. 9 
 
 without the extrusion of blood; neither is the virus absorbed 
 into the blood vessels but it is merely withdrawn from the im- 
 mediate surface by the limited inter-cellular circulation of the 
 tissue juices, the co-operative accompaniment of the nutritive 
 changes within the tissues, and the subsequent chancrous devel- 
 opment is the result of the multiplication of the microbes in the 
 adjacent tissues; being the counterpart of the process which, in 
 vaccination, forms the vesicle. In those cases of syphilis, in 
 which cauterization or excision failed to reach the seat of infec- 
 tion, or in which no chancre appeared, the germs have been 
 withdrawn by the intercellular circulation beyond the reach of 
 ordinary cauterization or a shallow excision, and the primary 
 colony was developed so far within the tissues as to escape 
 observation. 
 
 It has become established by numerous experiments, that 
 those microbes which affect the animal tissues, but which, like 
 the true scavenger birds, wait until life has become extinct be- 
 fore entering upon their work, are comparatively innocuous; 
 but there are several species which delight in conditions of im- 
 paired vitality, hovering between life and death, as it were, 
 which infest localities where pathological conditions are present, 
 waiting for opportunity to gain entrance to the body of some 
 subject, through an abrasion, puncture or excised surface, and 
 then succeed in the outcome of their work, very much in pro- 
 portion to the unsoundness of the parts entered upon, or the 
 general loss of vitality of the subject attacked; the representa- 
 tive species of which are pyaemia, septicaemia, gangrene and 
 erysipelas. But these show by their works their inability to 
 contest the germicidal properties of sound blood, in the full 
 strength of its normal constituents and circulation. The 
 bacillus of tubercle, as is well-known, progresses in its des- 
 truction of tissue, in proportion to the impairment of the diges- 
 tion, the assimilative process, or the lack of proper nourishment, 
 and is held in abeyance by improved conditions in these respects. 
 
 The slow working but persistent bacillus lepra first becomes 
 established in its subject, through conditions of squalor and 
 lack of suitable nutriment. Scurvy is developed by lack of a 
 certain class of food, which is necessary to keep the blood in its 
 normal proportions; and the principal curative treatment con- 
 sists in supplying the required diet, to restore the sanguineous 
 fluid to the condition which nature prescribed. But enough of 
 
10 Supplemental Report on State Medicine, Hygiene, Etc. 
 
 these matters has been stated to illustrate the principle. Water 
 which has become separated from the ocean, deprived of its 
 antiseptic protection and stands in swamps and pools, may be- 
 come corrupted and fill the air with malarious emanations; but 
 the great body of salt water remains self protected against the 
 attack of the all pervading micro-organic life, and diffuses its 
 corrective principles into the atmosphere, as far as its influence 
 reaches; and somewhat in comparison are the relations of the 
 volume of the blood within the body. When by reason of 
 occlusion or destruction of the vessels, other tissues are deprived 
 of their normal blood supply, or the blood itself is lacking in 
 its normal protective constituents, the pathogenic specie s may 
 attack the parts left defenseless, or the devitalized system, with 
 success; but in the vital fluid itself, whilst the life remains, the 
 most malignant species are unable to effect the molecular 
 changes, which would cause its disintegration; and whilst the 
 blood continues in its integrity, with its full power of protective 
 constituents and with free circulation, the tissues are fully pro- 
 tected against all but a few of the more virulent of the species, 
 and those are obliged to do their work under conditions of 
 shelter from the currents of the circulation. The blood diseases, 
 as so long popularly called, are not blood diseases, in the cor- 
 rect meaning of the term, but are diseased conditions of other 
 tissues; the devitalization and other morbid manifestations 
 being due to the absorption, into the blood, of the results of 
 the molecular changes wrought by malignant micro-organisms, 
 in the affected tissues. Formerly the products of the pro- 
 cesses of these organisms were all included under the name 
 of ptomaines; but as investigation has advanced, these pro- 
 ducts have been found to possess different characteristics, and 
 hence other names have been applied to designate the different 
 products. The latest work on bacterial poisons, is entitled, 
 "Ptomaines, Leucomaines and Bacterial Proteids," recently 
 published by Lea Brothers & Co. ; the work of Victor C. Vaughn, 
 Ph. D., M. D., and Frederick G. Novy, Sc. D., M. D., both of 
 the faculty of the University of Michigan. This late work 
 states that, ' ' a number of bacterial poisons have been obtained 
 from the bodies of men and the lower animals;" and that, " we 
 now expect to find each specific micro-organism producing its 
 characteristic poison or poisons." Of the non-malignant species, 
 those used for effecting chemical changes, interesting discov- 
 
Supplemental Report on State Medicine, Hygiene, Etc. 11 
 
 eries have also been made, in regard to their products varying, 
 according to the medium or substances which they are furnished 
 to work in. 
 
 The processes and results of the pathogenic bacteria, in the 
 tissues, very well explain the causes of the extraordinary waste 
 and devitalization in the, properly so called, wasting diseases; 
 and the pathology, in connection, and physiology, show the 
 reasons why the blood is, necessarily, the principal medium by 
 which remedies are applied, in such diseases; and why stim- 
 ulants, tonics, sedatives, nutrients and anti-sepsis are required, 
 according to the special conditions of each case. And in some 
 chronic conditions, the permanent entrenchment of certain non- 
 tissue working species, within the digestive organs, waiting to 
 enter into the ingested food, after each meal, and which by their 
 appropriation, undergoes changes, detrimental to the assimila- 
 tion of the subject; and the poisonous products of the pathogenic 
 species in their destructive work in the tissues, with the great 
 variety of their chemical characteristics, and of which more or 
 less must be absorbed into the bloo d of the subject, thereby, 
 as we may suppose, affecting to a greater or less extent, the 
 chemical constituents of the secreted food solvents, exhibit to 
 us, why the therapeutics of nutrition are often more intricate, 
 in chronic conditions, than the medical therapy, and will con- 
 tinue to be so, until investigation and observations have re- 
 vealed much that is now hidden. 
 
 There have been some curious results attained by acting upon 
 suggestions, furnished by the success of vaccination. In the 
 first instance, by Pasteur in his treatment of rabies, which has 
 been, to an extent, a success. In the second instance the at- 
 tempts to stay the ravages of anthrax , by inoculation with its 
 attenuated virus, which has never gone into general practice. 
 The third, the attempt to stay the progress of yellow fever, by 
 a similar process; and the latest, the numerous experiments 
 with the Koch lymph, the failure of which to meet the public 
 expectations, was all the more notable, from the former suc- 
 cesses and the reputation of its originator. 
 
 Were cow pox a modified form of small pox, as has been 
 claimed by some writers, there might be more warrant, in the 
 example of vaccination for the process of inoculation, with at- 
 tenuated virus, in other diseases; but the history of one hun- 
 dred years practice of vaccination, exhibits no tendency of 
 
12 Supplemental Report on State Medicine, Hygiene, Etc. 
 
 vaccina to verge into variola; but on the contrary, the protec- 
 tive disease has remained constant to its original charcteristics, 
 in the mildness of its course, and in its own peculiar manifesta- 
 tion; and the history of the experiments of inoculation, in other 
 diseases, adds to the evidence, that there has been no instance, 
 as yet, developed of a parallel of the relations of any other 
 diseases to each other, as that which exists between vaccina and 
 variola; for even the limited success of Pasteur, in the treatment 
 of rabies, has only been achieved throughfa complicated, tedi- 
 ous process, evolved by along series of experimentation, under 
 Pasteur's own patient and skillful manipulation; and having 
 formed a system which yielded results to justify the application 
 in practice, has been carried out only in institutes, specially 
 established, with extensive adjuncts and appliances, and in the 
 charge of men, specially trained for the work. Had as simple 
 a system been adopted for rabies, as that of vaccination against 
 small pox, the inaugurator of the practice would have been re- 
 warded with imprisonment, instead of French francs and popu- 
 lar reputation. The fact is, that no real similarity has ever been 
 proven to exist between small pox and cow pox, except in that 
 they are both self limiting and one attack, usually, gives immu 
 nity against future attack; the circumstance that vaccination is 
 protective against variola, being attributed to the coincidence, 
 that the microbes of the two diseases both require the same 
 peculiar principle of pabulum, in order to develop; the self li- 
 mitation being dependent upon the exhaustion, in the subject, 
 of that certain principle; and as vaccina exhausts the said prin- 
 ciple, without causing dangerous sickness, it is much the safer 
 disease to have and, therefore, a beneficent protection, as 
 against the other. 
 In my report to this society for 1885, I mentioned the Chinese 
 / method of disposing of the detritus of their cities, as related by 
 f Dr. Williams, in his work entitled " The Middle Kingdom." 
 Those people cannot be considered as advanced in their sanitary 
 arrangements, in most respects, but in this particular, their 
 simple management, in my opinion, is very much superior to 
 the complicated and expensive systems, in use by the cities of 
 Europe and America. Desiring to obtain more detailed infor- 
 mation in regard to this matter, I interviewed an intelligent 
 Cantonese, by the name of De Wing, at present interpreter for 
 the law courts, at San Jose, and, from him, obtained the follow- 
 
Supplemental Report on State Medicine, Hygiene, Etc. 13 
 
 ing. The city of Canton, containing a million and a half of in- 
 habitants, has no sewerage, the offal and faecal accumulations 
 being carried off, from day to day, by a force of from five to six 
 hundred men. Quite early in the morning, these men go to the 
 houses of the citizens, each with two large wooden buckets, 
 which are filled with the accumulations of the previous twenty- 
 four hours. The contents of each pair of buckets weigh about 
 one hundred and twenty pounds, and this load each man car- 
 ries to the river landing, and thence conveys, with a small boat, 
 to the farming lands of the neighborhood ; where it is applied to 
 fertilize the soil, in the cultivation of rice, Irish potatoes, sweet 
 potatoes, cucumbers, garlics, melons and other products for the 
 city markets. The farmers make contracts, in advance, with the 
 collectors and carriers for the fertilizer, for a certain length of 
 time, and pay them for the delivery, a stipulated price. This is 
 a wise and beneficent arrangement for the parties immediately 
 concerned and for the entire population; as by it, the people of 
 the city are rid of their detritus, without any expense to them- 
 selves, and so promptly, that there is no time for putrefaction to 
 set in or disease germs to develop; in corroboration of which 
 Dr. Williams states that typhus, typhoid, scarlet fever and 
 diphtheria are not included in the list of the prevalent diseases 
 of China. And the farmers are compensated for their disburse- 
 ments, in the increased product of their lands, the laborers ob- 
 tain their living by the employment, and the city and surround- 
 ing country are able to sustain their population, by this means; 
 whereas, were these, so called, waste products destroyed, as is 
 now done in a great part of the world, starvation and, more or 
 less, depopulation would, necessarily, come to pass. In the 
 populous province of Canton, corresponding to one of our 
 states, there are seventy-two cities, including Canton, and no 
 sewerage in any of them, the detritus of the other cities being 
 disposed of in a similar manner, as at Canton, except that at 
 the inland towns, the containing buckets are carried by the la- 
 borers on foot, the entire distance, to the suburban farms and 
 gardens. As to whether the cities of China, other than those 
 of the province of Canton, have sewerage or not, De Wing could 
 not positively state, but his impression was that there is no 
 sewerage in the Chinese Empire, and as the work of Dr. Williams 
 referred to the Chinese method, of disposing of the detritus, in 
 a manner to indicate that it is the general practice, it is likely 
 
14 Supplemental Report on State Medicine, Hygiene, Etc. 
 
 that De Wing's impression was correct, and that this same sys- 
 tem of husbanding the resources is carried out throughout the 
 Empire. And it would appear, that the important matter has 
 never assumed the proportions of a complicated problem, in 
 China, which has been puzzling the brains, during the later 
 centuries, of legislators, city rulers and scientific engineers, 
 throughout the more modern civilization, and has been, more or 
 less, a constant burden to the tax payers of all modern muni- 
 cipalities; and yet the best systems, developed by all this brain 
 work, skill and money outlay, result in only an imperfect sani- 
 tation, the retarded contents of water closets, cess pools and 
 sewers, being immense cultures, in which breed the deadly mi- 
 crobes of diphtheria, typhoid fever and other infectious dis- 
 eases. Then, from an economic stand point, the sewerage 
 system is an immense, unnecessary and unjustifiable waste of 
 what was intended should, in a measure, re-place the drain 
 upon the soil by the annual tribute, exacted in the cropping, 
 for the sustenance of the earth's population. Vast regions of 
 Asia, which, in ancient times, sustained the most dense popula- 
 tion, and constituted the most civilized portions of the globe, 
 have been practically destroyed; turned into barren wastes by 
 improvident husbandry; and whilst there is some excuse for the 
 populations which existed in those early times, there is much 
 less excuse for such management at this advanced period. Not 
 alone in Asia, where millions are annually exposed to the lia- 
 bility of starvation, through the improvidence of the past na- 
 tions, the preceding occupants of the lands, is there want and 
 misery from lack of food; but throughout almost all of Europe 
 there is nearly perpetual pinching and hunger, among the 
 poorer classes; and in this year of uncommon scarcity, gaunt 
 famine pervades great districts of an Empire which has, usually, 
 exported large quantities of bread stuffs; and the food supply 
 has become a question of, more or less, uncertainty, in most of 
 the countries of that continent; and especially, in the hitherto 
 favored island, which has, in a measure, dominated the world's 
 commerce and held great international influence, her rulers and 
 legislators now find their most difficult and serious problem, to 
 be, that, of devising the ways to enable her laboring classes to 
 earn the food to appease their stomachs; to obtain in a moder- 
 ate measure, the comforts of life and to produce the wherewith, 
 which will be accepted in compensation for the vast quantities 
 
Supplemental Report on State Medicine, Hygiene, Etc. 15 
 
 of the cereals, animal and other foods, which she is annually 
 obliged to import, as contributory to the subsistence of her 
 population. If the wise statesmen of this modern nation would 
 take a lesson from the management of the economic ancient 
 nation of the Orient, in this regard, they would be able, in part, 
 at least, to solve their food problem; and that in a happy and 
 beneficent manner for her agricultural husbandry, the welfare 
 of her working people, and the sanitary betterment of the condi- 
 tion of her cities; and particularly, in the relief for the suburban 
 river districts of the metropolis, now subject to nuisance from 
 the discharge of the sewage of the great city, into the tide-waters 
 of her harbor. 
 
 The Chinese system of immediate collection and transporta- 
 tion to the fields, of city detritus, would be more economical and 
 superior, from a sanitary standpoint, to the system of sewage 
 irrigation, now in use by the cities of Paris, Berlin and many 
 other cities on the continent and in Great Britain; and it is high 
 time that a stop should be put to the waste of this most valuable 
 fertilizer throughout Europe, and the more economic plan 
 adopted. As to America, with its comparatively virgin soil, and 
 less dense population, an excess is raised, as yet, for annual 
 exportation, to supply the deficiencies of other nations ; but 
 unless the inhabitants of the New World will take heed from 
 the lessons of deterioration and impoverishment, brought upon 
 their lands by the carelessness and mismanagement of the older 
 countries, history will surely repeat itself, in that respect, on 
 this continent. 
 
 As to the collecting and transportation, with the appliances 
 which could now be made available, of movable vessels, with 
 impervious lining, two for each water closet, each one to be 
 used alternately, and the one containing the previous day's 
 accumulation, to be placed on retiring, where it would be 
 accessible to the night workmen, outside of the locked apart- 
 ments; with street car tracks of the same gauge as the steam car 
 roads and suitable tanks, to be used on the cars and on trucks, 
 where there were no car tracks; hoisting works for handling the 
 tanks, and the proper arrangements for readily and easily clean- 
 ing the emptied tanks and vessels, as used, the whole collection 
 could be made nightly, during six or seven of the hours of 
 retirement. The cost of the plant would not be more, if as 
 much, as that of . the average sewerage system ; and as to the 
 
16 Supplemental Report on State Medicine, Hygiene, Etc. 
 
 working expenses, they would consist largely of the disburse- 
 ments to the laborers employed. The use, as a fertilizer, would 
 not be limited to the immediate vicinity of the cities, as with 
 railroad facilities, it would bear transportation for considerable 
 distances into the country; and as soon as the farmers had 
 learned its value and become accustomed to its application, the 
 sales of this theretofore accounted waste product, would entirely 
 compensate for all the expenses of collecting and transportation.