296 



SCIENCE. 



[Vol. X. No. 254 



affections, and capable of propagation by inoculation. Whooping- 

 cough may be an exception so far as eruptions and glandular affec- 

 tions are concerned. 



2. I have not the least doubt of the communicability of scarlet- 

 fever. I know that it can be propagated by fomztes. Diseases that 

 can be communicated and transmitted hy fomzfcs are absolutely 

 contagious : this is self-evident, and cannot be disputed with any 

 show of reason. 



3. I know a remarkable instance of the communicability of 

 scarlet-fever by things. It occurred in my own family, living more 

 than two thousand yards from any infected place. The subjects of 

 it got the disease from the clothes of a person who had visited a 

 house in which there were two or more cases. 



4. I have no information touching bovine virus. 



5. I have known children who had had scarlet-fever, a week after 

 the process of desquamation had been completed, and after anti- 

 septic baths, and their clothes and house environments had been 

 subjected to a disinfecting process, to return to school, and mingle 

 freely with other pupils without communicating the disease to any 

 one. Some writers in the medical journals express the opinion 

 that from four to six weeks should be allowed to elapse before 

 those who have recently had scarlet-fever be permitted to have free 

 intercourse. 



6. This question is answered in Paragraphs i and 3. 



7. I have no experience with regard to the length of time the in- 

 fection of scarlet-fever may be retained in any articles, but authors 

 will be referred to wlien Question 14 is under consideration. 



8. Boards of health should be empowered by legislative enact- 

 ments in every State to enforce physicians, and the laity also, — 

 every citizen who may know of a case, or even a ' suspicious case,' 

 anywhere in his vicinity, or indeed in any place from which the dis- 

 ease might be introduced, — to report without delay to the proper 

 authorities. 



9. The duty of boards of health and others in authority is to act 

 promptly on receipt of the report of the tirst case of scarlet-fever, 

 and enforce isolation and disinfection rigorously ; and it should be 

 made incumbent on the attending physician to change his clothes, 

 and bathe, etc., before visiting other houses not infected. I have 

 known the morbific principle, both of small-pox and yellow-fever, to 

 be carried in men's beards, and communicated to their wives and 

 children. Indeed, the materies morbi, or germs of all contagious 

 diseases, can be transmitted from place to place by any thing 

 capable of absorbing, or holding adherent to it, any substance, 

 dead or living, whether in a solid, fluid, or gaseous form. 



10. Besides what I have already indicated in answer to Question 

 9, I know of no other plan of preventing the spread of scarlet-fever 

 except inoculation and the administration of small doses of bella- 

 donna, which should be considered as only a small part of the plan 

 already indicated. 



12. As just stated in answer to Question 9, I should state that I 

 gave belladonna to three children for whooping-cough, living in the 

 same house, situated in the very heart of a district infected with 

 scarlet-fever, which was epidemic, and whose parents communi- 

 cated freely with persons who had the disease, and every one of 

 them escaped. 



13. Touching the questions stated in your circular, I can give no 

 further evidence of importance as the result of my own personal 

 observations, but refer to the following authorities, which I have 

 selected from many others in my library : viz., Watson's ' Practice 

 of Medicine ' (American edition, edited by Dr. Francis Condie), 

 p. II 80 ; Ziemssen's ' Cyclopaedia of the Practice of Medicine,' vol. 

 ii. pp. iis\ et seq.; Aitken's ' Science and Practice of Medicine,' 6th 

 edition, vol. i. p. 480. 



Scarlet-fever, in my opinion, is certainly amenable to control by 

 proper sanitary measures under ordinary circumstances ; but if a 

 case occurs in atov/n or city where there exists a certain condition 

 of the atmosphere, or certain meteorological states of the air (of 

 which we know very little, and which has been significantly termed 

 ' epidemic constitution of the air '), spreading diseases will extend 

 per se through it as a medium. Yellow-fever does this, and travels 

 about forty feet a day, and thus, by the concurrent existence of a 

 Hne of personal communication, spreads over a city and its 

 suburbs, and even beyond. Small-pox has been known to spread 



from certain centres (hospitals, for example) for over one thousand 

 yards. It is shown lately (see The America?! Journal of the Medical 

 Sciences for July, 1887, p. 300) by the ' Report of the Local Govern- 

 ment Board of England ' that from small-pox hospitals.the tnaieries 

 morbi of variola will travel per se through the air to the extent of 

 at least half a mile. 



I would refer you to the Medical News, Nov. 26, 1887, p. 627, 

 for a short but excellent paper on the contagion of scarlet-fever. 

 From its tenor the contagious nature of scarlet-fever is admitted, but 

 it is assumed that it is caused by a germ or living organism which 

 has not been shown to exist. I am one of a small minority among 

 the medical profession who cannot accept the germ theory of dis- 

 ease. Germs of microscopical organisms may, nay, no doubt do, 

 carry contagion, but have no etiological relations as to the primary 

 cause, or causa caiisans, of contagious diseases; and I say this irv 

 spite of my familiarity with the literature of the subject, — the latest 

 experiments of Pasteur, Koch-Klein, Edington, Jamieson, Dale, 

 Unger, and others are right now in arm's reach of me, and have 

 been carefully read by me, several for the third time, — I cannot yet 

 accept the germ theory of disease. 



[G. C. Ashman, M.D., Cleveland, O., health-officer.] 



1. I do not. But I think it possible, and even probable, that 

 some of the lower animals have scarlatina, or a disease of which 

 scarlatina in man is a modification. 



2. None whatever. 



3. (a) An instance where clothing worn by children having the 

 disease in January was brought into another family the following 

 April, cases occurring within ten days thereafter ; {b) an instance of 

 school-books used in a family suffering from scarlatina in June, 

 upon being opened and used by other children the following Sep- 

 tember, appeared to cause the disease ; (^r) a large number of in- 

 stances where physicians and others coming in contact with cases 

 have appeared to carry a germ of disease to their own or other 

 families. 



4. None. 



5. I do not know. My observation leads me to the conclusion 

 that the disease is communicable at any stage after fever begins, 

 and at least until desquamation is completed; and this last stage 

 is often very prolonged. 



6. As in No. 3. 



7. Three to four months. 



8. Most certainly. By the physician or other person making 

 diagnosis. For the prevention of extension, thereby saving life and' 

 health. As it is a disease of childhood chiefly, prompt notification 

 of school authorities enables them to exclude infected or infectious 

 children from schools. A placard upon the infected house notifies 

 all who are about to enter of the nature of danger to which they are 

 exposed. It educates the people, and favors isolation. 



9. To notify the public of danger, and to render the infected such 

 assistance as may be necessary ; to have, if possible, a hospital to- 

 which all cases not otherwise isolated should be removed promptly r 

 to give information as to the nature and prevention of the disease. 



10. Yes, prompt and complete isolation of every case. 



11. An instance of a child in a family of four, none of whom had 

 had the disease ; the child affected at once isolated in the same house ; 

 the skin in every part washed twice a day with a solution of mur- 

 curic chloride (i to 1,000), and all secretions and excretions treated 

 by the same solution ; the isolation maintained for nine weeks ; no 

 communication in any way. 



12. Yes, in a measure. I believe there is in every individual a nat- 

 ural resistance to diseases, varying in individuals and the same in- 

 dividual at different times, and in respect to certain diseases. This 

 natural resistance is at its best when all bodily functions are best 

 performed. 



13. Text-books can do it better. 



\_To be continued^ 



BOOK -REVIEWS. 



Higher Grounds. Hints toward settling the Labor Troubles. By 



Augustus Jacobson. Chicago, McClurg & Co. 16°. $1. 



This is a small book, as books go nowadays, for it may easily 



be read through at a sitting. But it demands comment out of 



