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EPIDEMIC DISEASES, SANITARY CONTROL OF. 



punctually as had been enjoined, so that, on 

 one occasion at least, the cows were seen in 

 the midst of them, and licking up the flock of 

 the bed which lay on the grass. These cows 

 were in perfect health when first put out to 

 grass in this meadow ; but in twelve or four- 

 teen days, five out of the eight milch-cows 

 showed symptoms of sickness, and the whole 

 of the cows were certainly affected within 

 three days of each other," with the general 

 symptoms of small-pox. 



Immersion in water seems to have but little 

 effect in destroying the germs of yellow fever 

 and small-pox, for it has been noticed that an 

 infected mattress thrown into the Mississippi 

 River from a steamboat, and afterward recov- 

 ered by persons living on the shore, communi- 

 cated the contagion. The air is also infected by 

 the presence of bodies dead of specific diseases. 

 To such an extent is this the case that in many 

 cities public funerals of persons who have 

 died of certain specific diseases are forbidden. 

 The so-called " sewer-gas " is simply air pol- 

 luted by the various organic matters contained 

 in the sewers ; and, as the diseases have their 

 specific seed or germ, it follows that they can 

 not be spontaneously generated from a gase- 

 ous poison. Sewer-air, however, may be a car- 

 rier of infection when the seed is sown, and it 

 is certain that sewage itself, and the crypto- 

 gamic growths on the sides of sewers and 

 house-drains, afford a favorable field for the 

 propagation and development of fever-germs, 

 especially typhoid fever, scarlet fever, and 

 diphtheria ; and, when the excreted matters 

 from a typhoid-fever patient are conveyed into 

 the sewer, they may then affect the air pass- 

 ing through it, gain entrance into the house, 

 and in this manner spread the infection. If it 

 were possible to prevent the discharges from 

 typhoid-fever patients, and expectorated matter 

 from patients suffering with diphtheria, from 

 gaining entrance to the sewers, it is doubtful, 

 in view of existing theories, if sewer-air could 

 ever be a means of propagating these infections. 



WATER AS A CARRIER OF INFECTION. The 

 most frequent means of propagation of typhoid 

 fever as well as cholera is by water-carriage of 

 the germ. The several outbreaks of typhoid 

 that have occurred in England and this coun- 

 try have been traced, without much possibility 

 of error in the conclusion, to water used for 

 drinking purposes having become infected with 

 the excreta from typhoid-fever patients. In a 

 recent epidemic in England it is believed that 

 it was due to the washing of milk-pans with 

 polluted water! 



Dr. MacNamara states: "The eighth char- 

 acteristic of cholera is that the more explicit 

 the examination the clearer the fact appears 

 that the disease in the majority of cases spreads 

 from one human being to another by means 

 of the cholera fomes finding its way into drink- 

 ing-water, and thus into the intestines of other 

 people." Of the truth of this proposition 

 there is abundant evidence. 



FILTH AND SEWAGE. In consonance with 

 the views expressed as to the specific origin of 

 the infection named, it follows that no amount 

 of filth, no amount of ordinary sewage, can pro- 

 duce epidemic disease of its own accord, un- 

 less the seed be previously sown. It is certain, 

 however, that fever-germs are best propagated 

 and attain their greatest malignity where filth 

 is found in the greatest abundance. That it will 

 not produce it is proved. An example illustrat- 

 ing this fact was recently given by Minister John 

 M. Langston in regard to the sanitary condition 

 of Port-au-Prince, Hayti (" Bulletins of Public 

 Health," Marine Hospital Service, 1881, page 

 114) : u The streets (of Port-au-Prince) are ex- 

 ceedingly foul, and police regulations of no 

 sort are enforced. There is no regulation to 

 oblige even the filthiest person to remove de- 

 posits from the streets, or from the gutters and 

 sidewalks ; and the harbor is also full of foul 

 matter of every sort." Now, although this 

 filthy condition had then existed for several 

 years, in one of the hottest of climates, the filth 

 itself saturated with moisture, and necessarily 

 raised to the elevated temperature tending to 

 develop the latent germs of yellow fever, if 

 any were present, the city was free from it for 

 a period of fifteen years up to 1879, although 

 it raged in the adjacent islands. It is known 

 that heat and moisture favor the development 

 and propagation of specific fever-germs when 

 once sown, with the exception of the small- 

 pox virus, which attains its greatest malignity 

 at a low temperature. 



SANITARY CONTROL. From what has been 

 said as to the general nature of infection and 

 the means for its propagation, the measures to 

 be adopted for the sanitary control of epidemic 

 diseases are almost self-apparent. They are 

 such, in the first place, as will destroy the 

 germs ; and, in the second place, to enforce 

 perfect cleanliness, so that the germs, although 

 gaining entrance to the proper spot, shall not 

 find a harboring-place for their propagation. 

 One of the first things that should interest a 

 municipal health officer is the sanitary history 

 of his town or city. He should ascertain with 

 especial care the periods at which epidemics 

 of any kind have appeared in the city or vil- 

 lage under his charge. Wherever possible he 

 should ascertain by investigation the spot where 

 the first case made its appearance, and, if pos- 

 sible, trace the source of infection. Then the 

 directions in which it spread from the initial 

 cases should be noted. Other things being 

 equal, the average meteorological conditions 

 of the locality being practically unchanged 

 from year to year; the introduction of the 

 infection in a particular manner will usually 

 lead to the same result in any given year, as in 

 the past, favored on the one hand by increased 

 population and diminished on the other by its 

 decrease. Having mastered the details as to 

 the past history, he should next ascertain the 

 present sanitary condition of the locality by 

 the inspection of the place, and an examina- 



