July 3, 1914] 



SCIENCE 



not reached the greater number a hundred 

 years later. Creighton says: 



It ■would be within the mark to say that less 

 than one tenth of the population was urban in any 

 distinctive sense of the term. After London, Nor- 

 wick, York and Lincoln, there were probably no 

 towns with five thousand inhabitants. 



Indeed, urban life, as we now know it, 

 was quite impossible in this age of pesti- 

 lence and would soon become so again were 

 the functions of preventive medicine 

 relaxed. 



■Most of the great epidemics of the middle 

 ages were designated as pestilentia or 

 magna mortalitas. In the most deadly 

 visitations the bubonic plague is so accu- 

 rately described that there can be no doubt 

 about its identity, but it must not be sup- 

 posed that the people enjoyed any high 

 degree of health even in those periods when 

 this contagion languished on account of 

 exhaustion of susceptible victims. Ergot- 

 ism, under the name of Saint Anthony's 

 fire, was endemic in France and adjacent 

 territories; Normandy was filled with 

 lepers, but Christ's poor were not confined 

 to that country. England was regarded 

 as the special home of hunger, but abun- 

 dance was a stranger to the masses in every 

 land. The mysterious sweating sickness, 

 apparently brought to England with Henry 

 Tudor in 1485, developed in five distinct epi- 

 demics which were characterized by the fact 

 that the mortality was greater among the 

 rich than among the poor. Typhus, known as 

 morbus pauperum, prevailed largely in the 

 jails, on ships and among the squalid in- 

 habitants of the cities. Even the discovery 

 of America carried to Europe the scourge 

 of syphilis, which was spread over Italy by 

 the soldiers of Charles VIII., and within 

 a few years reached the most distant parts 

 of Europe. Smallpox appeared in Eng- 

 land in the sixteenth century, having jour- 

 neyed, according to the most reliable au- 



thority, all the way from the Orient. That 

 tuberculosis, diphtheria, dysentery and 

 other diseases, still with us, prevailed dur- 

 ing the middle ages is shown by the records, 

 but they were overshadowed by the higher 

 mortality of those mentioned above. Im- 

 proved agriculture has extinguished the 

 fire of St. Anthony, except in the most 

 benighted provinces of Russia. The great 

 fire in London in 1666 destroyed the in- 

 fected rats and relieved England of the 

 bubonic plague, which had been endemic 

 in that country since 1349. Something 

 more than one hundred years later the dis- 

 covery of Jenner robbed smallpox of its 

 horrors, wherever vaccination is properly 

 enforced. The investigations of Howard 

 improved the sanitation of jails and work- 

 houses, and did much to eradicate typhus. 

 The claim has been advanced that the 

 infectious diseases have benefited the race 

 by the destruction of the unfit. This idea 

 I have combated most vigorously since our 

 study of typhoid fever in the army in 1898. 

 My coUeag-ues and I found that out of 9,481 

 soldiers who had previously been on the 

 sick report and could not be regarded as 

 possessing standard health, 648, or 6.8 per 

 cent., contracted typhoid fever; whereas, 

 out of 46,384 men who had no preceding 

 illness, 7,197, or 15.3 per cent., developed 

 typhoid fever. More than 90 per cent, of 

 the men who developed typhoid had no 

 preceding intestinal disorder. Under ordi- 

 nary conditions the strong, busy man, espe- 

 cially the one whose activities demand wide 

 excursions from his home, is more likely to 

 become infected than the one whose sphere 

 of action is more limited on account of in- 

 firmity. The reason for this is too obvious 

 to need statement, and it follows that more 

 men than women and more adults than 

 children have typhoid fever. Moreover, 

 the case mortality is greater among the 

 strong, because death in the infectious dis- 



