466 



SCIENCE. 



[Vol. XIII. No. 332 



If, then, tuberculosis is not inherited, the question of prevention 

 resolves itself principally into the avoidance of tubercular meat and 

 milk and the destruction of the discharges, especially the sputum of 

 tubercular individuals. As to the first means of communication, 

 those measures of prevention alone answer the requirements which 

 embrace the governmental inspection of'dairy cows and of animals 

 slaughtered for food, and the rigid exclusion and destruction of all 

 those found to be tubercular. 



For the removal of the second means of communication, i.e., the 

 sputum of tubercular individuals, the problem is simple when the 

 patients are confined to their rooms or houses. Then, wooden or 

 pasteboard cups, with covers, should always be at hand for the re- 

 ception of the sputum. These cups are supported in simple racks, 

 and at least once daily, or more frequently if necessary, should be 

 removed from the racks and thrown with their contents into the 

 fire. A cheap and efficient cup answering this purpose is now on 

 the market, and is supplied by the druggists. 



The disposition of the expectoration of persons who are not con- 

 fined to their rooms or homes is a far more difficult problem. The 

 expectoration certainly should not be discharged on the street, and 

 the only practicable means for its collection seems to be in handker- 

 chiefs, which, when soiled, should at the earliest possible moment 

 be soaked in a solution of five percent carbolic acid, and then boiled 

 and washed. Handkerchiefs thus soiled are exceedingly danger- 

 ous factors in distributing tubercle bacilli ; for, when the sputum 

 becomes dry, it is easily separated in flakes from the cloth, and 

 then soon becomes pulverized and suspended as dust. 



It becomes evident from what has been said that the means 

 which will most certainly prevent the spread of this disease from 

 one individual to another are those of scrupulous cleanliness re- 

 garding the sputum. These means lie largely within the power of 

 the affected individual. It is furthermore to be remembered that 

 consumption is not always, as was formerly supposed, a fatal dis- 

 ease, but that it is in very many cases a distinctly curable affection. 



An individual who is well on the road to recovery may, if he does 

 not with the greatest care destroy his sputum, diriiinish greatly his 

 chances of recovery by self-inoculation. 



While the greatest danger of the spread of this disease from the 

 sick to the well is in private houses and in hospitals, yet, if this 

 danger is thoroughly appreciated, it is, for the most part, quite 

 under control through the immediate destruction of the sputum 

 and the enforcement of habits of cleanliness. But in places of 

 public assembly, such as churches and theatres, particularly the 

 latter, conditions are different, and the safety would seem to de- 

 pend largely upon a dilution and partial removal of the floating and 

 possibly dangerous dust by means of adequate ventilation. 



Rooms in private houses and hospital wards that are occupied by 

 phthisical patients should from tim.e to time be thoroughly cleaned 

 and disinfected, and this should always be done after they are 

 vacated before they are again occupied by other individuals. 

 Steamship companies should be obliged to furnish separate apart- 

 ments for consumptive persons, so that no person in the exigencies 

 of travel need be forced to share his room with one who might be 

 a source of active danger to him. 



Drs. Ptudden, Biggs, and Lcomis desire especially to emphasize 

 the following facts : (i) that tuberculosis is a distinctly preventable 

 disease ; (2) that it is not directly inherited ; and (3) that it is ac- 

 quired by the direct transmission of the tubercle bacilli from the 

 sick to the healthy, usually by means of the dried and pulverized 

 sputum floating as dust in the air. 



The measures, then, which are suggested for the prevention of 

 the spread of tuberculosis are (i) the security of the public against 

 tubercular meat and milk, attained by a system of rigid official in- 

 spection of cattle ; (2) the dissemination among the people of the 

 knowledge that every tubercular person may be a source of actual- 

 danger to his associates if the discharges from the lungs are not 

 immediately destroyed or rendered harmless; and (3) the careful 

 disinfection of rooms and hospital wards that are occupied or have 

 been occupied by phthisical patients. 



The annual meeting of the American Climatological Society 

 will be held in Boston, June 24 and 25; Dr. V. L. Bowditch of 

 Boston, president. 



SIXTH ANNUAL REPORT. OF THE SUPERINTENDENT 

 OF HEALTH OF PROVIDENCE. 



In this report. Dr. Charles V. Chapin, the superintendent of 

 health, records many important facts and observations. The num- 

 ber of deaths reported was 2,608. The population of the city be- 

 ing 121,500, this gives a death-rate of 21.48 per thousand. From 

 consumption there were 359 deaths, an increase of 46 over 1887 : 

 10.39 ps"" cent of all deaths were from diarrhoeal diseases. Mala- 

 rial fever first appeared in Providence in 1880, when one death was 

 reported from that cause. Since that time 92 deaths have occurred 

 from that cause: 9 in 18S5, 11 in 1886, 28 in 18S7, and 19 in r888. 

 The disease is confined almost entirely to certain well-defined dis- 

 tricts of the city, which are particularly exposed to those influences 

 which have been conclusively shown to be the chief causes of the 

 production of the malarial poison. But 2 deaths occurred from 

 measles, while there were 28 from whooping-cough. There were 

 no deaths from small-pox : indeed, there has been but one death 

 from that disease in Providence since 1875. 



Dr. Chapin, in this report, deals specially with two forms of con- 

 tagious disease, — scarlet-fever and typhoid-fever, — and it is to- 

 these two subjects that we shall mainly devote our attention. In 

 writing of scarlet-fever, he says, " Scarlet-fever is one of those 

 contagious diseases which tend to recur in epidemics at more or 

 less regular intervals. Since 1S40 there have been ten epidemic 

 periods, separated by intervals of about five years. As is usual 

 with the disease in this part of the world, these epidemics generally 

 have begun in the autumn, and increased in severity until late in 

 the winter or spring. One of these epidemics, though not a severe 

 one either as regards the number of cases or the mortality, began 

 in August, 1884, attained its maximum in November, and was 

 pretty well over by early spring. In 1887 another epidemic oc- 

 curred, beginning in August. 



" During the epidemic of 1884, some efforts were made by this 

 department, chiefly by regulating school-attendance, to check its 

 spread, but apparently without any very great influence. The 

 rapid onset of the disease in the autumn of 1887 so attracted the 

 attention of the public, that it was deemed feasible to adopt more 

 stringent measures. While it cannot be definitely proved that the 

 marked falling-off in the cases and deaths from this disease which 

 immediately followed the adoption of more stringent measures was 

 due to this, yet it is rendered highly probable from the fact that 

 such a decrease in scarlet- fever at that time of the year is markedly 

 at variance with the usual course of the disease in Providence, and 

 indeed in all cities in this climate. Though there is no theoretical 

 reason why scarlet-fever, being a purely parasitic disease, should 

 not be entirely stamped out, yet we can never hope to accomplish 

 this, so long as the public, and physicians also, are as careless 

 about it as they are at the present day. While in the majority of 

 cases, except among the very poor pretty fair isolation is main- 

 tained at first, it is not kept up long enough, and children are often 

 allowed to ride in the horse-cars, go to Sunday-school, or visit a 

 clothing store and try on half a dozen different coats, by the end of 

 the third week, and before they have ceased to peel ; and the most 

 discouraging thing about it is, that it is often done with the consent 

 of the attending physician. It must, I am afraid, be the duty of 

 the health department to insist upon the contagious nature of this 

 disease for many years to come, and, while striving not to render 

 its rules inoperative by reason of their being too far in advance of 

 public sentiment, strive, whenever opportunity offers, to make them 

 more and more stringent. 



" It is popularly believed that nearly every person will have 

 scarlet-fever sooner or later ; and I very frequently see persons 

 who say they had rather let their children catch scarlet-fever while 

 they are young, as it would go so much harder with them when 

 they grow up. But such a belief is totally without foundation. 

 During the past five years there were reported about 2,300 cases of 

 scarlet- fever. If we assume that this rate has been continuous for 

 the last fifteen years, then there have been only a little over 7,000 

 cases of scarlet-fever during that time. If w"e approach the prob- 

 lem in another way, and take the deaths during the last fifteen 

 years, and assume the mortality to have been ten per cent, which is 

 certainly low, the number of cases during this time is 13,970, or, in 



