the reports of cases increased gradually, the public did not become thoroughly alarmed until March 13th, the day 107 cases were reported. A leading daily journal of that date voiced the public sentiment in a double-leaded editorial, as follows:

"At the time when the health physician has warned the people that every glassful of that water is full of typhoid germs; at a time when he declares that the city is now threatened with a typhoid epidemic caused by the water from that cursed Bird Island Pier, the engineer deliberately proposes to fill up the reservoir with the poisoned water, and drive it through the mains for the people to drink!

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Now, it is high time that the people of this city were told the truth. What is the reason that, with the best water supply that could be procured anywhere right at the feet of the city, what is the reason that after all the expenditures that have been freely paid by the taxpayers, there should be this condition of things-at one time danger of a water famine, and, to avert that, the use of water that is impregnated with filth?"

The Board of Aldermen immediately voted unlimited power to the health physician, who at once ordered that "Bird Island" Inlet should not again be opened, that the reservoir be sealed so that no water could flow back into the water-pipes, closed all the faucets in the public schools, ordered a general disinfection, and issued a circular advising every householder to filter and boil all water for potable purposes. The community was then thoroughly awakened to a realization of the dangers of the situation, and regarded the instructions pretty generally.

By reference to the report above given, it will be seen that about the 18th of March, or within twenty-five days after the last polluted water from "Bird Island" pier had been consumed, the number of daily cases dropped off, not to increase again. But what we cannot readily account for is that after the 26th of March, and up to May 1st, the average daily cases were 2 to 3. It will be remembered that the daily supply of water is taken not from a reservoir of standing water, but from the water-main, so that the supply consisted of water freshly pumped every day; that none was taken from "Bird Island" pier after February 26th, and that we have undoubted evidence, in the repeated trials of Dr. Vandenberg, that all water taken at any time from the outer pier is of the highest standard of

purity. Moreover, in all these years since only water from the outer pier has been used, the annual death-rate from typhoid fever has been about 1 in 3000, while for this short period it was about 1 in 350 of population. Again, the bulk of the cases observed the usual time of incubation of the disease-not more than twenty-four days from the time the last poison was taken-but the report shows also an exception to this incubation period; for there were 2 to 3 a day all through April, or 50 to 60 days after supposed infection. It is possible that sufficient poison for infusion might remain adherent to the water-pipes during all these fifty days; but if so, why should not a greater number have been affected?

The clinching argument for the position that the epidemic was caused by infection from the polluted water lies in the fact that no cases were reported from families using only the Jubilee Spring water. Taking, then, all the facts in consideration, the unavoidable verdict must be: "Died from drinking 'Bird Island' pier water."

TO WHAT EXTENT DO PHYSICIANS CONVEY

INFECTION?

BY F. H. ORME, M.D., ATLANTA, GA.

WITH all the advancement in knowledge in general, and especially in medical knowledge, in recent times, there is still much that is unknown and mysterious concerning diseases, particularly infectious diseases; and where there is lack of knowledge in matters of this kind, superstition rules and increases the fears that are natural to the situation.

While it is well understood by enlightened people that the dissemination of disease, like all things else in the universe, is governed by law; the laws governing the spread of infectious diseases have so far, to a large extent, eluded discovery, and the obscurity still attaching to the nature and cause of spread of pestilences is the source of an incalculable amount of dread and misery, for unseen and undiscoverable foes affright us more than do real dangers. Shadows produce paralyzing terror, while substantial enemies excite courage and arouse to resistance.

Is it not possible, by a systematic study of the subject, with a determination to eliminate all possible sources of error, to separate the real from the imaginary dangers? Surely the subject is worthy of an effort, and might well engage the attention of the Sanitary Bureau and the sanitary experts of this Institute.

The question at the head of this paper of necessity opens up a wide field of research, involving the whole question of infection and disinfection, directly or collaterally. What is the infective principle? Under what condition does it live and by what is it destroyed? How is it conveyed, and how can its conveyance be prevented?

It would seem that these questions ought to be readily settled by a resort to the experience of the hundreds of thousands of physicians who have made observations; but alas! when we apply to this source for information we find wide differences of views, and are

led to ask, why is this so? Certainly it is not that the laws in the cases are variable, but that cases are modified by interfering influences, and that physicians reason differently from the same appearance of facts. All theories at least appear to be overthrown by particular cases, while these, more carefully observed and analyzed, would sometimes be found to be confirmatory-exceptions proving the rule. A renewed attempt should be made to gather the results of experience and to read aright, in the light of increased knowledge, their import.

The writer has for some time past taken considerable pains in this direction, and by direct personal application, and by correspondence, has obtained the observations and opinions of a large number of physicians of extended experience--the whole embracing in the aggregate many hundreds of years of practice--and the almost uniform testimony has been that they have never known of their conveying any of the infectious diseases from infected patients or houses to other houses. A few questionable exceptions have been given; but the consensus of opinion (corresponding with that of the writer) seems to be that diseases are not conveyed by physicians or visitors to such patients, as is generally supposed--certainly not to the extent that is generally apprehended.

If the infection of the most common of the infectious diseases, such as small-pox, scarlet fever, diphtheria, measles, chicken-pox, etc., were conveyed as is generally thought, physicians in active practice could often be tracked through the cities by the houses infected by them; and the children of these physicians would show a much larger proportion of cases of these diseases than is found in the families of others-which is not, so far as can be learned, the These two considerations seem to have much significance, and much force as argument against the popular opinions.

case.

One physician of eminence, whose practice, large in extent, has included forty-eight years, recently assured the writer that in an attendance upon about one hundred cases of small-pox, while also engaged in general practice, he never took any precautions whatever, but sat upon the beds of the patients and handled them without reserve, and yet he never knew a case in which he was responsible for the spread of the disease. Much similar testimony concerning this and other diseases, has been gathered, which corresponds, in a general way, with that of the writer.

Further, it has always been the practice of the writer, as of many others, to direct that after a case of scarlet fever or other infectious disease, when the period of danger of infection from the person is considered passed, the bedding and other articles about the rooms of the patients should be exposed freely to the sun and air, generally on the lots on which the houses stood, while a case of infection from this practice has not been heard of, nor can any be recalled. Now if the diseases in question were disseminated as is generally supposed, why should not whole communities be infected from such practice?

It is somewhat the custom with some physicians to have bedding, clothing, carpets and other articles in the room of infected patients burnt or fumigated or "disinfected," as it is considered, without knowing, to be sure, whether these proceedings, excepting the burning, really disinfect or not. To be truly consistent on this line the houses should be burnt down.

An interesting incidental question here arises: To what extent. do "disinfectants" disinfect? During the yellow fever epidemic in New Orleans in 1878, that distinguished sanitarian, Dr. White, conceived the idea that he could demonstrate the disinfecting quality of carbolic acid and check the spread of the epidemic, and had the privilege of and facilities for disinfecting a selected district of the city. The whole air of this district was made redolent--offensively so was really saturated with the disagreeable so-called disinfectant. But behold! the pestilence marched right on, without any regard to this obnoxious "protection." Might not a scientific test prove the inefficacy of many other supposed disinfectants? Our germicides appear to be only effective against discovered germs, while the still mysterious causes of disease defy this power.

Manifestly there are erroneous views held by at least some of the profession and the people, and it is obviously desirable that something more positive should be known about the conditions under which the germs of different diseases live and are propogated, and under which they die or have their development retarded.

All diseases are not subject to the same laws of propagation or conveyance; but there are some rules that appear to be pretty general. It may be safely stated, for example, that Nature's disinfectants, fresh air, sunlight and hot water, are the chief safeguards against infection, and are of more worth than all of the chemical