THE RÖNTGEN RAY IN TUBERCULOSIS

In discusssing the use of the Röntgen ray in the diagnosis of pulmonary tuberculosis, Dr. Walsham said that in normal lungs they were quite transparent from apex to base, with the exception of a few ill-defined, shadowy lines to the right of the heart. The movement of the diaphragm like a piston up and down was ordinarily equal on the two sides of the chest, but in disease was much less on the affected side, even when the disease was limited to one apex. In well-developed cases of tuberculosis the diseased areas showed as flocculent shadows punctate in parts. He would say that the rays could not decide the earliest stage of tuberculosis in the lungs, but they would definitely show tuberculosis, and that at a very early stage,

THE TUBERCLE BACILLUS

Dr. Alfred Moeller, of Belzig, in opening the discussion of the morphological and physiological variations of the bacillus of tuberculosis and its relation to other bacteria resistant to acids and to the streptothrices, said that he had shown that bacteria which were acid fast were not necessarily tubercle bacilli, as, for instance, the smegma bacillus and the bacillus of avian tuberculosis. A series of bacilli resembling the tubercle bacillus had recently been found, including the butter bacillus and the Timothy bacillus. The tubercle bacilli, like all the acid fast bacilli, seemed to belong to the streptothriciæ.

RESOLUTIONS ADOPTED BY THE CONGRESS

The last general meeting was held on the afternoon of July 26 and the following resolutions were adopted:

1. That tuberculous sputum is the main agent for the conveyance of the virus of tuberculosis from man to man. Indiscriminate spitting should, therefore, be suppressed.

2. That it is the opinion of this congress that all public hospitals and dispensaries should present every out-patient suffering from phthisis with a leaflet containing instructions with regard to the prevention of consumption, and should supply and insist on the proper use of a pocket spittoon.

3. That the voluntary notification of cases of phthisis attended with tuberculous expectoration and the increased preventive action which it has rendered practicable has been attended by a promising measure of success, and that the extension of notification should be encouraged in all districts in which efficient sanitary administration renders it possible to adopt the consequential measures.

4. That the provision of sanitoria is an indispensable part of the means necessary for the diminution of consumption.

5. In the opinion of this congress, in the light of the work that has been presented at its sittings, medical officers of health should continue to use all the powers at their disposal and relax no efforts to prevent the spread of tuberculosis by milk and meat.

6. That in view of the doubts thrown on the identity of human and bovine tuberculosis, it is expedient that the government be approached and requested to institute an immediate inquiry into this question which is of vital importance to the public health and of great consequence to the agricultural industry.

7. That the educational work of the great national societies for the prevention of tuberculosis, is deserving of every encouragement and support; it is through their agency that a rational public opinion may be formed, the duties of public health officers made easier to perform, and such local and state legislation as may be required called into existence.

8. That this congress is of the opinion that a permanent international committee should be appointed to collect evidence and report on the measures that have been adopted for the prevention of tuberculosis in different countries, to publish a popular statement of these measures, to keep and publish periodically a record of scientific research in relation to tuberculosis, and to consider and recommend measures of prevention. This congress is further of opinion that such a committee should consist of representatives to be elected by the great national societies formed for the suppression of tuberculosis and also representatives nominated by various governments. It is further of the opinion that all international committees and great national societies whose object is the prevention of tuberculosis should be invited to cooperate.

9. In the opinion of this congress, overcrowding, defective ventilation, damp general unsanitary condition in the houses of the working classes, diminish the chance of curing consumption and aid in pre-disposing and spreading the disease.

10. That while recognizing the great importance of sanatoria in combating with tuberculosis in countries, the attention of governments should be directed towards informing charitable and philanthropic individuals and societies of the necessity for anti-tuberculous dispensaries as the best means of checking tuberculous disease among the industrial and indigent classes. A. R. THOMAS,

Respectfully,

The SURGEON-GENERAL,

Passed Assistant Surgeon, U. S. M. H. S.

U. S. Marine-Hospital Service.

XV

THE BUBONIC PLAGUE

There is no disease of modern times so fatal as the plague, and none so persistent in its occupancy when it once gets a good foothold.

It has been approaching the west from India and China so menacingly, and appearing at so many unexpected points, that the people, especially the health authorities, should be thoroughly informed in regard to it, in order, if possible, that an outbreak may be averted; or if occurring, should be stamped out as promptly as possible. To that end we present herewith a valuable contribution to the literature of this disease by DR. WALTER WYMAN, Surgeon-General Marine Hospital service, which we are kindly permitted to reprint:

LETTER OF TRANSMITTAL

TREASURY Department

OFFICE OF THE SUPERVISING SURGEON-GENERAL
MARINE-HOSPITAL SERVICE

The Secretary of the Treasury;

WASHINGTON, D. C., Jan. 6, 1900.

SIR: I have the honor to submit herewith an article on the bubonic plague, being a revision of the article prepared by myself and published in the annual report for 1897.

Within the past two years many facts of importance have become known with regard to this insidious epidemic disease, and it is the object of this revision to embody in available form the latest information which may be of practical value to quarantine officers, health officers and others.

In this undertaking I have had the assistance of Passed Assistant-Surgeon H. D. Geddings, who was the technical delegate from the United States to the International Plague Conference in Venice in 1897, and subsequently was ordered to the Pasteur Institute in Paris, to familiarize himself with the latest scientific advances in the bacteriology of this disease. Valuable information also has recently been forwarded by Surgeon Eugene Wasdin, now engaged in like manner in the Pasteur Institute.

care

From the facts set forth in the article it is obvious that the greatest must be exercised in the inspection at quarantine of vessels, even thou g

they hail from non-infected ports, for they may carry passengers, crew, stowaways or merchandise from plague-infected districts.

Attention is called to the ambulant, or walking form of the disease, which might readily escape detection by ordinary inspection, but becomes as active an agent in dissemination as the more violent form.

With great care in inspection and enforcement of other regulations at domestic ports, supplemented by the information conveyed by medical officers of the service in foreign ports and their surveillance over vessels, it is hoped that no case of plague will be admitted. But should this misfortune occur, the observations detailed in the article show that energetic sanitary measures may be made to avail, while we have in the curative serum and the Haffkine prophylactic additional and effective weapons in preventing the spread of the disease. While these facts are encouraging in character, it should not be forgotten that the epidemic is surely, though slowly, extending, and that for the first time in history it has invaded the Western Hemisphere.

The necessity, therefore, of especial vigilance has been, and is still being, impressed upon quarantine officers by the Bureau; and of equal importance is the provision which should be made by municipalities, especially those on the seaboard, to correct immediately unsanitary conditions which are now so well known to favor the propagation of infectious disease. New facts as they develop and new measures which may become necessary will be duly promulgated in the Public Health Reports issued weekly by the Bureau.

As this brochure is intended to be one of practical utility, I have to recommend that authority be granted for its publication.

The plague, known also as the bubonic plague, Pestis bubonica, Levantine, Oriental, and black plague, and black death, is a disease which has ravaged from time to time the several countries of Africa, Asia and Europe almost from time immemorial. The literature on the subject is appalling in extent, a mere enumeration of titles with authors covering forty pages, royal quarto size, of the Index Catalogue of the Library of the SurgeonGeneral's Office, United States Army, and a score or more of the columns of the Index Medicus, published since the issue of the Index Catalogue in 1889.

Manetho, an Egyptian historian, who lived at the beginning of the third century B. C., described pestilences, supposed to have been the plague, as having occurred in the reign of the most ancient Egyptian kings. It prevailed in Athens 432-429 B. C., and reappeared in eighteen months after the last-named date. Thucydides has described it, and had the disease, and Hippocrates noted it. It is said that Athens lost more than one-third of its population by the epidemic.

According to Rufus of Ephesus, plague prevailed in Lybia in the third century B. C., and its home was considered to be in northern Africa.

The

great plague reported by Livy, who died 221 B. C., is said to have destroyed a million of persons in Africa, but it is not mentioned that it passed into Europe. Plague is also alluded to in the Bible, Zachariah xiv, 18, as peculiarly Egyptian, of which country this disease has been a great scourge. In the Christian era it is not until the sixth century that we find bubonic plague in Europe. In 542 it spread over Egypt; and passed to Constantinople, where it carried off 10,000 persons in one day, and in the same century appeared in Italy, and extended also along the northern coast of Africa. It prevailed in England in the seventh century.

In the fourteenth century it was introduced from the East and prevailed throughout Armenia, Asia Minor, Egypt, northern Africa, and nearly the whole of Europe. Hecker calculates that one-fourth the population of Europe, or 25,000,000 persons, died in all of the epidemics in the fourteenth century. It was in this century that the first measures were taken to check the spread of the plague, Venice appointing in 1348 three guardians of the public health for this purpose.

In the fifteenth century it recurred frequently in nearly all parts of Europe, in one year, 1466, the mortality reaching 40,000. The first quarantine establishment was founded in this century. namely, at Venice, in 1403, on a small island adjoining the city.

The sixteenth century was not more free from plague than the fifteenth. In 1572 50,000 died at Lyons. In 1576 Venice lost 70,000.

In the seventeenth century it still prevailed in Europe, though less widely than in the middle ages. In 1656 one of the most destructive of all recorded epidemics raged in Naples. It is said to have carried off 300,000 in a period of five months. The great plague of London was in 1664 and 1665. The total number of deaths in 1665, according to the bills of mortality, was 68,596 in an estimated population of 460,000, out of whom two-thirds are supposed to have fled to escape contagion.

In the eighteenth century it prevailed extensively in Europe, the most notable epidemics being in Marseilles (1720), when from 40,000 to 60,000 persons were carried off. In 1721 it appeared in Toulon and spread over Provence, and out of a population of 250,000 persons 87,659 are said to have died. Sicily was visited in 1743, namely, at Messina, where the mortality was between 40,000 and 50,000. In 1771 it broke out in Moscow, and more than 50,000 persons, nearly one-quarter of the population, were carried off.

The nineteenth century has been marked by a recession of the plague toward the East, although in 1815 it appeared on the eastern coast of Italy, confined to a small district-its last appearance in that country. An isoloted epidemic appeared in Greece in 1828. It appeared in Egypt between 1833 and 1845, the last year witnessing the last plague epidemic observed in that country and marking its great eastward recession.

There was an epidemic of extreme severity in Cairo, 1835, during which there died a number of the inhabitants equal to the whole adult male population.

In 1840, Dalmatia; in 1841, Constantinople, and in 1813 and 1844, the eastern part of Egypt, were its western boundaries.

THE PLAGUE IN THE LATTER PART OF THE NINETEENTH CENTURY-THE "PLAGUE BELT"

Since 1850 the western limit of the plague is the Canary Islands, 1852,