SOME PROBLEMS IX SANITARY SCIENCE. 115 



number of years and they have been productive of more or less good, 

 depending upon the effectiveness and thoroughness with which they were 

 carried out. In 1894, diphtheria antitoxin was introduced as a pre- 

 ventive and curative agent in cases of diphtheria. The public and even 

 a large percentage of the medical profession rebelled against this inno- 

 vation. It was necessary to establish i^ublic opinion in favor of the 

 use of antitoxin. Judging by the mortality statistics quoted above, this 

 education has been slow. For at least three years the teachings of 

 scientists and sanitarians had little effect and the death-dealing diph- 

 theria held its place in the list of dangerous communicable diseases. 

 During the next three years, however, this new method has become more 

 popular and the effect is apparent. In Detroit during the past three 

 3'ears we have made every effort to convert peo})le to the use of antitoxin. 

 Whenever a person has been exposed to diphtheria he can be protected 

 against this disease by a dose of antitoxin as surely as a person who 

 has been exposed to smallpox can be protected by vaccination. Vaccin- 

 ation has stamped out smallpox, antitoxin can and will do the same with 

 diphtheria. The board of health offers diphtheria antitoxin free to all 

 persons for the purpose of immunization and therefore no one need 

 hesitate to use it on account of its cost. Antitoxin is harmless and 

 should be used in all cases of exposure. "The number of cases in Detroit 

 has been greatly reduced by a free use of this remedy as a preventive 

 and the mortality has consequently been reduced, inasmuch as a certain 

 percentage of the cases thus prevented would have been fatal had they 

 been allowed to develop. The use of antitoxin is still in its infancy, 

 public opinion in favor of its use is not yet strongly established. The 

 public must demand its use and just in proportion as they do, will the 

 cases of diphtheria and the deaths from this disease be reduced. It is 

 the privilege and perhaps the duty of the intelligent members of a com- 

 munity to help mold this public opinion. I submit this question to you 

 as a second problem in sanitary science vv'orthy of your attention. 



Referring again to the State Board of Health mortality statistics, we 

 find typhoid fever fourth on this list in the first table and fifth in the 

 second. Typhoid fever is, then, a disease of considerable importance in 

 this State as a cause of death. In Detroit this disease caused sixty 

 deaths during the year ending June 30, 1003. It is a well known fact, 

 and one that is universally accepted, that typhoid may be and is, in a 

 large percentage of cases, spread by the drinking water. The specific 

 germ of this disease is found in the discharge of the patient and may be 

 readily transmitted to the water supply and in this manner many epi- 

 demics have been caused. In a comparatively recent number of the 

 ''Municipal Journal and Engineer," Mr. George W. Fuller has published 

 a table giving the typhoid fever death rates for 189S. 18!)9, 1900 and 1901 

 and the average for these four years of all cities in the United States 

 having over 30,000 population. There are 132 cities in the table, and 

 there are but eight with a lower typhoid fever death rate than Detroit, 

 which for the four years has an average death rate from this disease of 

 eighteen per 100.000 inhabitants. Mr. Fuller, in a very instructive arti- 

 cle accompanying the table referred to, says concerning the interpreta- 

 tion of typhoid fever death rates as applied to public water supplies : 

 "Just where a line should be drawn separating a pure water supply from 

 a suspicious one. according to typhoid fever death rate. is. of course, 



