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Seymour Haden has called attention to the supposed advantages of perishable coffins, so that the putrefactive changes may be carried out as quickly as possible. And certainly, if burying is to continue, it seems reasonable that no undue obstacle should be placed in the way of changes which are sooner or later inevitable.

When, in the course of years, it becomes imperative to reconsider this question, and land burial will have to be modified, some arguments may present themselves to maritime nations in favor of burying in the sea rather than of burning. In the burial at sea, some of the body at least would go at once to support other forms of life, more rapidly than in the case of land burial, and without the danger of evolution of hurtful products.

Burning, or cremation, has attracted much attention of late years. In this country the subject has been discussed by Sir Henry Thompson and Mr. Eassie, and abroad much has been written, especially in Germany and Italy, in both which countries the method has been practically tried. It would certainly appear that the body can be disposed of in a very short time and in an inoffensive manner, while the expense would unquestionably be much reduced if the practice became general. One hour appears sufficient to reduce a body to ashes, and it has been successfully tried in this country.

The only really valid argument against cremation is the possible concealment of crime, such as poisoning. This, however, might be guarded against by suitable precautions.

In time of war, and especially in the case of beleaguered fortresses, the disposal of the dead becomes often a matter of difficulty. In that case burning may have to be resorted to. If the bodies are buried, they should always be at as great a distance as possible, and as deep as they can be. If procurable, charcoal should be thrown over them; if it cannot be obtained, sawdust and sulphate of zinc, or carbolic acid may be employed. Quicklime is also commonly employed, but it is less useful.

At Metz, in 1870, the following plan was adopted :-A pit of about 17 feet in depth was filled with dead, disposed of as follows:-A row of bodies was laid side by side; above this a second row was placed, with the heads laid against the feet of the first row; the third row were placed across, and the fourth row in the same way, but with the heads to the feet of the former; the fifth row were placed as No. 1, and so on. Between each layer of bodies about an inch of lime, in powder, was placed. From 90 to 100 bodies were thus arranged on a length of 6 feet, and reached to about 6 feet from the surface; the pit was then filled up with earth, and though 8,400 bodies were put in that pit, there were no perceptible emanations at any time.

Around Metz the graves of men and horses and cattle were disinfected with lime, charcoal, and sulphate of iron. Immense exertions were made to clean and disinfect the camps and battle-fields, and in the month of May, 1871, from 1,200 to 1,600 laborers were employed by the Germans. Wherever practicable, the ground was sown with oats or barley or grass. The hillocks formed by the graves were planted with trees.

In many cases, at Metz, bodies were dug up by the Germans when there was any fear of watercourses being contaminated, or if houses were near. On account of the danger to the workmen, graves containing more than six bodies were left untouched, and the work was always done under the immediate superintendence of a physician. The earth was removed carefully, but not far enough to uncover the corpse; then one end of the corpse was uncovered, and as soon as uniform or parts of the body were

seen, chloride of lime and sawdust, or charcoal and carbolic acid, put in; the whole earth round the body was thus treated, and the body at length laid bare, lifted and carried away. The second body was then treated in the same way.

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Near Sedan, where there were many bodies very superficially buried, burning was had recourse to. Straw mixed with pitch was put into the graves, and was lighted; 1 ton of pitch sufficed for from 15 to 20 bodies. Opinions as to this practice were divided, and it is not certain how many graves were thus dealt with. It seems probable that only the surface of the body was burnt, and when many bodies were together in one grave some were not touched at all. On the whole, the experiment appears to have been unsuccessful.

The Belgian experience at Sedan was in favor of employing chloride of lime, nitric acid, sulphate of iron, and chlorine gas. Carbolic acid did not answer so well. The sulphate of zinc and charcoal, which Barker found so useful, was not tried.

Mr. Eassie has lately called attention to the desirability of an ambulatory cremation furnace for the disposal of bodies in war. If such an arrangement proved practicable, it would unquestionably be of immense advantage from a hygienic point of view.

CHAPTER XVIII.

ON THE PREVENTION OF SOME IMPORTANT AND

COMMON DISEASES.

THERE are two modes by which we may attempt to prevent the occurrence of disease.

1. By conforming with the general rules of hygiene, by which the body and mind are brought into a state of more vigorous health.

2. By investigating and removing the causes of the diseases which we find actually in operation. This part of the inquiry is in fact a necessary supplement to the other, though in proportion to the observance of the general rules of hygiene, the causes of disease will gradually be removed. At present, however, we have to deal with the facts before us,-viz., that there are a great number of diseases actually existent which must form the subject of investigation. We proceed in this case from the particular to the general, whereas, in the first mode, we deduce general rules which have to be applied to individual instances.

Hygiene is in this direction an application of etiology, and etiology is the philosophy of medicine; while in its turn the very foundation and basis of etiology is an accurate diagnosis of disease. Unless diseases are completely identified, all inquiry into causes is hopeless. Let us remember, for example, what utter confusion prevailed in our opinions as to causes and preventive measures at the time when typhus and typhoid fevers were considered identical, or when paroxysmal fever and the true yellow fever or vomito were thought to own a common cause. Any useful rules of prevention were simply impossible—as impossible as at present in many of the diseases of nutrition, which, in the proper sense of the word, are yet undiagnosed.

The advance of diagnosis has of late years been owing not merely to improved methods of observation, but to the more complete recognition of the great principle of the invariableness of causation. The sequence of phenomena in the diseased body proceeds with the same regularity and constancy as in astronomy or chemistry. Like causes always produce like effects. To suppose that from the same cause should proceed a sequence of phenomena so utterly distinct as those of typhus and typhoid fever, now seems incredible; yet with a full, or at any rate a sufficient knowledge of the phenomena, it was at one time almost universally believed that these two perfectly distinct diseases owned a common origin. At the present moment, the superficial resemblance between gout and rheumatism causes them to be put together in almost all systems of nosology, although, with the exception of the joints being affected, the diseases have almost nothing in common.

In proportion as this great principle is still more constantly applied,

and as our means of diagnosis advance, and consequently, causes are more satisfactorily investigated, methods of prevention will become obvious and precise. At present they are very far from being so. In many cases they are founded on very imperfect observation; and very frequently all that can be done is to apply general sanitary rules, without attempting to determine what are the special preventive measures which each disease requires.

It is not necessary, however, that we should wait until the causation of any disease is perfectly understood. We must act, as in so many other affairs, on probability; and endeavor to remove those conditions which, in the present state of our knowledge, seem to be the most likely causes of the disease. It may be that, in some cases, we may be attacking only subsidiary or minor causes, and may overlook others equally, or more important. In some cases, indeed, we may overlook entirely the effective causes, and may be fighting with shadows. Still, even from mistakes, progress often arises -indeed, the difficult path of human knowledge is perhaps always through

error.

The term cause is applied by logicians to any antecedent which has a share in producing a certain sequence; and it is well known that in many diseases two sets of causes are in operation-one external and one internal to the body (exciting and predisposing). The investigation of the internal causes, which in some cases are necessary to the action of the external causes, is equally curious and intricate as that of the external causes, and in some respects it is even more obscure; but measures of prevention must deal with them, as well as with the external causes.

In this chapter we can, of course, only venture to enumerate very briefly, and without discussion, what seem to be the best rules of prevention for the principal diseases of soldiers. To enter on the great subject of the prevention of disease generally, and to discuss all the complicated questions connected with causation, would demand a volume.

SECTION I.

THE SPECIFIC DISEASES.

Paroxysmal Fevers.

External Cause.-This was presumed to be putrescent, or, at any rate, decomposing vegetable matter derived from a moist and putrescent soil, which was carried into the body by the medium of water or of air. But the later views of Klebs and Tommasi-Crudeli attribute it to a low organism of the nature of Bacillus, to which they have given the name Bacillus malaria, propagated in the presence of decaying vegetable matter.

If the ingestion is by water, a fresh source must be obtained. Wellwater is generally safe, but not always. Rain-water may be unsafe, if the tanks are not clean. If a fresh source cannot be obtained, boiling, filtration, and alum appear to be the best preventive measures.

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If the introduction be by air, and if the locality cannot be left, the most approved plan is elevation to at least 500 feet above the source of the poison

For an instance of propagation by so-called rain-water, see cases at Tilbury Fort, Volume I., page 49.

Dr. Blanc and Mr. Prideaux preserved themselves from intermittent fever, in a march in Abyssinia, by always using water in the form of tea or coffee.

VOL. II.-9

in temperate climates; and 1,000 to 1,500 feet in the tropics, or higher still, if possible. If this plan cannot be adopted, two points must be aimed at -viz., to obviate local, and to avoid drifting malaria. Thorough subsoil draining; filling up moist ground when practicable; paving or covering the ground with herbage kept closely cut, are the best plans for the first point. For the second, belts of trees, even walls can be interposed; or houses can be so built as not to present openings toward the side of the malarious currents.

The houses themselves should be raised above the ground on arches ; or, if wooden, on piles. Upper floors only should be occupied. The early morning air, for three hours after sunrise, should be avoided; and next to this, night air.

Internal Causes.-The conformation, or structural condition, which permits the external cause to act, is evidently not equal in different individuals, or in different races; but we are quite ignorant of its nature. It is not removed by attacks of the disease; but, on the contrary, after repeated attacks of ague, a peculiar condition is produced, in which the disease can be brought on by causes, such as cold or dietetic errors, which could never have caused it in the first instance. The internal predisposition is greatly heightened by poor feeding, anæmia, and probably by

scurvy.

To remove the internal causes our only means at present are the administration of antiperiodics, especially quinine; and good and generous living, with iron medicines. The use of flannel next the skin, and of warm clothing generally; warm coffee, and a good meal before the time of exposure to the malaria, and perhaps moderate smoking (?), are the other chief measures. Wine in moderation is part of a generous diet; but spirits are useless, and probably hurtful, unless given considerably diluted.

Yellow Fever.

External Cause.-During the last few years the progress of inquiry has entirely disconnected true yellow fever from malaria, though yellowness of the skin is a symptom of some malarious fevers. Yellow fever is a disease of cities and of parts of cities, being often singularly localized, like cholera. In the West Indies it has repeatedly attacked a barrack (at Bermuda, Trinidad, Barbadoes, Jamaica), while no other place in the whole island was affected. In the same way (at Lisbon, Cadiz, and many other places) it has attacked only one section of a town, and, occasionally, like cholera, only one side of a street. In the West Indies, it has repeatedly commenced in the same part of a barrack. In all these points, and in its frequent occurrence in non-malarious places, in the exemption of highly malarious places, in its want of relation to moisture in the atmosphere, and its as evident connection with putrefying fecal and other animal matters, its cause differs entirely from malaria."

If these points were not sufficient, the fact that the agent or poison which causes yellow fever is portable, can be carried and introduced among

'It must be understood that these heights are assumed to be abore a marsh. They will not secure from malaria from marshes, if situated at that or a much greater height. A marsh at Erzeroum is 6,000 feet above sea-level; one at Puebla, in New Mexico, is 5,000 feet; both cause fevers.

The belief in the malarious origin of yellow fever, so long and tenaciously held by many American physicians, seems to be losing ground. (See paper by Dr. Perry, read before the American Health Association, The Daily Picayune, November 23, 1873.)

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