220 



SCIENCE. 



[N. S. Vol. XVI. No. 397. 



tion. Sanitation alone cannot hope to effect 

 these changes. Diseases which arise from 

 some invasion of the organism may possibly 

 be warded c^. As they virtually proceed from 

 the environment which, in theory at least, is 

 under our control, they may be prevented. 

 With such diseases the sanitary science of to- 

 day is chiefly concerned. 



"Sanitation has stamped out smallpox in 

 many civilized communities. It is seeking 

 to-day with more or less success to do away 

 with typhoid fever. It boldly attacks epidem- 

 ics of diphtheria and scarlet fever and has 

 recently sought to control tuberculosis and 

 malaria. There can be no question that it 

 has already won signal victories, and that its 

 practitioners may reasonably hope for fresh 

 laurels in the near future." 



As a matter of fact the achievements of 

 sanitation have been modestly stated, when 

 we consider that the mortality from typhoid 

 fever, diarrhceal diseases and consumption has 

 been reduced during the fifty years fully one 

 half, and that the reduction in the mortality 

 from croup and diphtheria in the United 

 States during the past ten years alone amounts 

 to over 52 per cent. Indeed when the methods 

 of prevention recommended by sanitarians are 

 generally adopted many of these diseases will 

 be reduced to a minimum and probably eradi- 

 cated in the course of a few years. So, for 

 example, in December, 1900, the propagation 

 of yellow fever by mosquitoes was discovered 

 by Surgeon Walter Reed and his colaborers 

 of the United States Army, and the practical 

 value of this discovery, which in point of im- 

 portance ranks only second with Jenner's dis- 

 covery of vaccination, has been proved by 

 the complete eradication of this scourge from 

 Havana. We learn from Surgeon W. 0. 

 Gorgas, Chief Sanitary Officer of Havana, that 

 in 1900, though the general sanitary condition 

 had immensely improved, yellow fever was 

 still present, amounting to 1,400 cases with 

 300 deaths, and he felt discouraged at the little 

 progress made. After Reed demonstrated that 

 the mosquito can be infected only during the 

 first three days of the disease and that there 

 is a period of from twelve to fifteen days 

 when the bite of the stegomya can convey the 



disease. Dr. Gorgas, in February, 1901, re- 

 organized the sanitary department and turned 

 its attention to the local conditions and their 

 relation to the spread and development of the 

 mosquito. The rain barrels, the family cis- 

 tern, all breeding the stegomya, the Chinese 

 gardens from which came anopheles, were 

 studied and 150 men were put to work to de- 

 stroy the breeding places by drainage and the 

 addition of kerosene oil to the stagnant water, 

 and the mosquitoes themselves were killed by 

 fumigation and pyrethrum powder. In Jan- 

 uary, 1901, the city was free from yellow fever, 

 in July the suburbs received a certain amount 

 of reinfection, but on September 28, 1901, the 

 last case of yellow fever occurred. Since that 

 time the land has been practically free, since 

 Havana has been the center of infection. Dr. 

 Gorgas has shown what organized scientific 

 efforts can accomplish in the eradication of 

 disease germs and their carriers, and it is to 

 be hoped that the present government will 

 maintain the same vigilance and radical pre- 

 cautions. There can be no half-way measures. 

 The sanitary history of Havana is one of the 

 most brilliant chapters in American sanita- 

 tion and augurs well for the twentieth cen- 

 tury. What has the Government done to re- 

 ward the labors of Reed, Carroll, Agramento 

 and Lazear? or for that brave young soldier 

 Kissinger, from Ohio, who, on December 5, 

 1900, was the first to volunteer to be bitten 

 by infected mosquitoes, with the only proviso 

 that he should receive no pecuniary reward, 

 but as he expressed it 'solely in the interest of 

 humanity and the cause of science.' Such ex- 

 hibition of moral courage as well expressed 

 by Doctor Reed has never been surpassed in 

 the annals of the Army of the United States, 

 and, we will add, could never have been in- 

 spired except by a man of Dr. Reed's stamp. 



Part II. of Professor Sedgwick's work deals 

 with infection and contagion, their dissemina- 

 tion and control and fundamental problems 

 of public sanitation, and contains ten chap- 

 ters. His selections on man and other ani- 

 mals and their excreta, as sources and prime 

 movers of infection, on dirt and disease and 

 the philosophy of cleanness are presented in 

 an original and effective manner, as are also 



