genial. So that the unqualified adherence to an aeriform propagation leads to the sanitary inspection of a flower pot on the bed room window sill, and lays the charge of malaria-madness on the profession. These obscure cases, however, become susceptible of explanation without a recourse to infinitesimals in etiology, if we allow the possible introduction of the poison by water carriage.

Colin failed to find that marsh and other stagnant waters produced intermittents, and regards himself as having failed to find that they produced malarial disease, but these obscure cases are never intermittents; they are irregular fevers of a remittent or continued type and adynamic character. The natives of malarious countries hold very generally that there is danger in drinking the surface waters. Sir Joseph Fayrer, in his Croonian lecture (British Med. Jour., April 1, 1882,) says: "The natives of India attach little importance to atmospheric states, but believe that the water of pools, tanks, or even of streams flowing through certain jungles or marshy places is charged with the fever poison." The villagers of the malarious plains of the Crimea informed Dr. Parkes that those who drank marsh water had fever at all times, while those who drank pure water got ague only during the late summer and autumn months. Malarial fevers have been recorded as occurring in ships at sea on account of exhalations from organic matters in the hold or bilge; but in M. Boudin's celebrated case, exhalation must undoubtedly be excluded. The transport Argo sailed from Bone for France with one hundred and twenty soldiers, and of these thirteen died on the short voyage, and ninety-eight were landed at Marseilles suffering from pernicious malarial fevers, which yielded as if by enchantment to quinine. Four casks for the soldiers' supply had been filled with marsh water at Bone. The crew of the vessel were unaffected; they had a different water supply. Other transports sailed at the same time, but none of them suffered from fever; the Argo was the only vessel which stored the marsh water. M. Colin disposes of this case by declaring that he does not believe it; that M. Boudin must have made a mistake; that the cases must have been typhous or dysenteric, because he himself never met with any experience of this nature. This case is unique in the history of malaria. Its testimony is guarded at every point; exhalation from the soil is precluded; exhalation from organic matter in the ship is precluded; exposure to miasma before embarkation is precluded; and M. Boudin, who treated the cases in the hospital at Marseilles, testifies most definitely to their malarial character. Instances where the conditions are so perfectly arranged to test a theory or determine a cause, are rare in the history of medicine. That there should be in malarial literature a scarcity of cases in which suspicion has attached to the water-supply is not surprising, when we consider that malarious waters, if such exist, must usually be found in malarious districts, where the propagation of the disease can plausibly be ascribed in all cases to aeriform transmission,-anomalous cases being anomalous only so far as we are unable to distinguish the causative conditions, which nevertheless are assumed to exist because the disease occurred. At the same time the attention of the profession has not been directed to the possibility of water-infection. On the contrary, some writers have scouted the idea of propagation by this means. In an old medical journal (Transylvania, 1828,) to which I had occasion to refer recently, John Esten

Cooke says that: "Bad drinking water has also been considered by some as the cause of these (malarial)epidemics. A single consideration will show the incorrectness of this opinion. Epidemics occur in hot weather particularly, and therefore nothing present throughout the year can be the cause of the disease." The water-supply is here assumed to be always the same; but an unprejudiced critic even then might have disproved the assumption by the experience of the senses.

Certain waters containing organic matter, those especially which are spoken of by medical writers as "bad waters," are well known to produce diarrhoeas, but that this is the only evil effect resulting from organic impurity in water is now recognized to be erroneous. The specific poisons of typhoid fever and cholera have been traced to the water-supply in many instances; but to do this in the case of malaria is difficult for the reason already given. Yet while the published cases of suspected malaria are few, there is an unwritten record in medicine which is not lost, though unpublished, but has its influence on progress. I allude to the experience, not of the few who have time to express themselves in the journals, but to the many who have not. This unwritten record is disposed to acknowledge the existence of malarious waters. Among the physicians of our malarious sections will be found many whose experience inclines them to this view, although no special instances are brought forward to which exception may not be taken on account of the difficulty of excluding the possibility of ærial transmission. Occasionally in reports and papers a similar belief is acknowledged; thus, in the article malaria in Connecticut, in the report of the State Board of Health for 1881, Dr. Swift, of Colchester, suggests that shallow wells, affording only surface water, are, among other things, a prolific source of typho-malarial fever.

In an article in the Am. Jour. Med. Sciences for January, 1878, the connection between the malarial remittents of the Rocky Mountain region and an impure water supply is demonstrated, and the impurity traced, not to swamps, pools, dams, and overflows amid decaying vegetation, as was suspected, but to the rains and snow meltings which periodically flood the rivers. In Buck's Hygiene, vol. 2nd, pp. 132 and 145, this subject is again taken up, and an interesting case quoted from the experience of Dr. John Milhau, who reported in a command of nineteen officers and three hundred and forty-eight men, the occurrence of fever in five officers and one hundred and five men, with cases in addition among the teamsters and herders, of whom no record was kept, and definitely charged the snowwater, pure and clear as it seemed, with the causation of the disease. Rain and snow are impure as they fall from the clouds, and the malaria present in them must come from other and distant localities. Nor is it difficult to allow the possibility of transmission in this way, when we know that the pollen grains of Southern plants have not unfrequently been precipitated as a yellow rain upon our Northern soil.

Since then I have met with several cases where remittent fever has occurred concomitantly with the use of an impure water, and where exposure to malarious exhalations have been more or less excluded. Some of these may be particularized by way of illustration. The raised wooden tanks of New Orleans are, from our point of view, presumably the cause of much of the malarial disease in that city; but the water-supply is seldom questioned,

as the neighboring swamps are conceived to account satisfactorily for all cases. Nevertheless, Dr. Joseph Jones speaks of the well-paved and nonmalarious parts of the city. A sample of cistern water from one of these well-paved and non-malarious sections was sent by the late Dr. C. B. White for examination, as lead contamination was suspected. No lead was present, but the water approximated in character to that of the swamps, and was reported as highly dangerous from malarial possibilities. On the receipt of the report the use of the cistern was interdicted, as adynamic remittent fever was present in the house supplied by it in the person of a woman who had not been away from the vicinity of her home for months. In October, 1879, while examining the water-supply of Jackson, Mississippi, I was taken by Dr. Wirt Johnson to see a case of malarial fever simulating yellow fever, in a negro woman. She had not been away from her home in many months, but the water in her cistern was low and gave results on analysis and under the microscope similar to those derived from swamp-water.

It would seem at first sight scarcely allowable to reason from the cistern water of a negro cabin in Mississippi to the public supply from rivers and lakes of such cities as New York or Boston, and yet the cases are parallel. Rain water from a given water-shed is collected, stored and drawn off for use. The city supply has more or less of spring-water admixture, and becomes purified in its flow over the surface by oxidation and nitrification; but there is ground for believing that this oxidation does not attack the malarial poison. Dead organic matter given up to chemical and other agencies disappears from the water, but the malarial poison is not affected by these agencies, else its diffusion in the air, its fall with the rain and snow, would destroy it, and we should have no records of malarial cases in the Rocky mountains, such as have been given by Dr. Milhau and others.

The reports of the health officers of our cities show that malarial fevers are by no means an infrequent cause of death. From reports rendered to the National Board of Health, it is found that during the year ending December 31, 1881, these fevers caused the death of from four to six persons in every ten thousand of the population of the cities of Louisville, Ky., Wilmington, Del., Paterson, N. J., New Haven, Conn., New York, Yonkers and Brooklyn, N. Y., Holyoke, Mass., and Nashville, Tenn. Evansville, Ind., lost thirteen in ten thousand from these diseases, Memphis, Tenn., fourteen, New Orleans, La., sixteen and Savanah, Ga., seventeen; San Fran.cisco, Cal., lost only four in one hundred thousand. It is singular that so many of these towns should have a death-rate varying only from four to six in ten thousand, and that these should include Holyoke, New Haven and Yonkers, as well as Louisville and Nashville. The three factors, heat, moisture and soil, can scarcely be assumed to account satisfactorily for this singularity in the death-rate; and, if not, has the water-supply a connection therewith, as it undoubtedly has with the malarial fevers of certain parts of our western territories. The influence of local swamps is seen in the larger death-rate affecting some of the other towns mentioned.

It may be suggested that if surface-waters are accountable for the sickness which corresponds to an annual death-rate of four or five per 10,000 in our cities, the profession in Britain, who have gone into sanitary questions with so much zeal and persevering energy, would have detected the con

1

nection.

But the conditions are different with them. We have malarial disease in our cities; we have also vast malarial tracts in the interior of our country, which may poison the air and the rain-clouds which sweep over them. They are notably free from malarial troubles, and their rain-fall is purer than ours-known to be so by analysis—and readily acknowledged to be so when its deriviation by evaporation from the ocean-surface is considered. San Francisco is similarly situated in this respect; for, while exposed to showers which come from the Pacific, it is protected on the east by mountain ranges, which intercept the impure clouds from that direction. Moreover, the English take care of their water-supplies; we do not. Two months ago, while the authorities in London were endeavoring to suppress some work which caused a dust in the vicinity of the filteringbeds of one of the water companies, the City Council of New Orleans was establishing a nuisance-wharf within three blocks of the intake of the city water-supply, and with an in-shore, up-stream current between the two points.

If the surface waters, which constitute the general water-supply of our cities, have at any time a causative connection with the malarial disease which infects them, it is important that we should know it; for were it so, the remedy is in our hands. The well-waters of malarious districts do not convey the specific poison. In those parts of our country where remittents prevailed without any local sources of exhalation, the disease disappeared as settlement was effected, and the pond, tank or running stream which furnished the water-supply of the pioneers became replaced by the purer waters of the wells dug by the permanent settlers.

Sometimes well-water is accused of causing malarial fevers, but there is always a surface inflow in the case. Thus, to take one of the instances collected by Dr. Mallet, in his recent investigation into the methods of water analysis: Dr. C. Drew, of Jacksonville, Florida, submitted the water of a well which supplied a family of twelve persons, five of whom had been attacked with fever like obstinate remittent in some, in others like well marked typhoid-the well received surface water.

While sewage irrigation and farming, as at Croydon, in 1875-6, appear to indicate soil-filtration as efficient in removing the typhoid poison, the Lausen and other epidemics make us hesitate to accept this as a general truth; but no shade of suspicion attaches to percolated waters when malaria is under consideration. Filtration is the remedy, and it is one which is readily applied.

These views are submitted to the Association, not as sustained by the testimony brought forward, but as having so much support from observed facts as to merit consideration, and to call for a close and continued study of the modes of entry of malaria into the sytem, to the end that, if sustained, the remedy, which involves only an outlay of money, may be applied.

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SPECIAL PAPERS.

OUR EYES AND OUR INDUSTRIES.*

BY B. JOY JEFFRIES, M. D., OF BOSTON.

The last report of the Massachusetts State Board of Health contains an interesting and timely paper on the above named subject by Dr. Jeffries, a prominent oculist of Boston, and one of the best authorities, if not the leading one in this country, on Color Blindness. A greater part of the paper is reproduced here.

It has seemed to me, therefore, quite time that the unnecessary causes of impaired vision, as well also as the natural and unavoidable ones which specially affect the mechanic and working classes, should be equally explained and set before those who have it in their power to control them; namely, our educational and school authorities, and those who engage any and all classes of employes in mill or workshop. While the professional or educated man, as he grows up, can, and probably will, look after himself and perhaps also his children in this respect, it is very different with those upon whom our great industries are dependent for their success, and who are the muscle and sinew of our State. These require as good, or better eyesight, by which I mean capacity for continuous labor for many years with the visual organ, as do the educated professional or mercantile class. A bookkeeper who has to write and compute in some large concern six or eight hours a day does not have to tax his eyes more than does the mechanic in certain departments of shoe manufacturing. These are unrealized and unrecognized facts which it has long been my purpose to bring before the community, and which it is the object of this article to point out and draw attention to.

Near-sightedness or myopia has been shown to be on the increase wherever civilization is calling for further education. The warning note of the steady increase of near-sightedness with school and college life, was first publicly given by Dr. Cohn of Breslau. In 1869 I urged that the same investigations should be carried out here. Since Cohn's report, in various places in Europe and finally in several cities in this country, the same sort of investigations have been carried out, and always with similar results, viz., that many children become myopic, and go on becoming still more so with their progressive work in school, college, and university. These facts are now so well known from the many reports, etc., that even the daily press has taken up the subject in notes of warning. In 1869 my suggestions and proposals were not only refused but resisted. The contrast at present is quite striking, when the school committee of a neighboring *Extract from the Fourth Annual Report of the State Board of Health, Lunacy and Charity of Massachusetts, 1883.