was preceded by an epidemic swarming of rats, and he showed from many illustrations that the first persons attacked with plague lived in those quarters where grain was stored up and who were actually employed in granaries and storehouses, as along the quays; and he further illustrated how, through rats in the holds of ships, the disease was carried from port to port. It was pointed out further that the contagion from person to person in hospitals was wholly exceptional, and many physicians in plague hospitals refused to admit the contagiousness of plague.

Dr. Bryce quoted from the marvellous series of reports by Dr. John Simon, the greatest of all sanitarians, who said, in 1874, in the prevention of disease we must "remove the cause of uncleanliness," that was, "remove filth." This eminent sanitarian then illustrated the varieties and degrees of filth as (a) putrescent refuse matter, solid and fluid, causing effluvia and pollution by soil soakage; (b) overcrowding, thus polluting the two sources of public health, air and water. Dr. Bryce concluded by saying (1) thus we might, as regards typhoid fever, arrange works for disposal of the garbage and sewage of houses, towns, camps, so as to make local accumulations of organic vegetable and animal pollution impossible, in which the typhoid germs might grow, and from which they might be carried to food and drink. (2) By drainage soil pollution by either vegetable or organic matters would be prevented, so that mosquitoes could not breed in the vicinity of habitations and so be in a position to become disseminators of the malarial parasite; and if they were present, houses should be protected against them, especially at night. (3) Houses should be so constructed as to render them not very accessible to rats, and such a condition of cleanliness of rooms, clothing, and persons should be maintained in these that infected matter would not be present, or, if it was introduced, there would not be flies to carry it. (4) As regards ships, the very means which were now in practical operation at well-equipped quarantine stations would amply serve to destroy rats, i. e., sulphur and formol. (5) Passengers should be detained longer than is necessary for the disinfection of a ship and the elapse of the period of incubation of five days for plague, to which, in the presence of actual infection, might be added a protective inoculation.

Dr. FRANK W. WRIGHT, health officer of New Haven, Conn., read a paper on "Prevention of Contagious Diseases." To prevent the spread of contagious diseases, two objects must be ac

complished: First, the destruction by disinfection of the poison given out from the sick person, and, second, the prevention of any poison that had escaped disinfection, from coming in contact with susceptible persons-isolation. Certain diseases might be limited by rendering persons immune to inoculation, as in smallpox or diphtheria, it being now practicably impossible for the former of these diseases to obtain a firm foothold in any well-vaccinated community. A good hospital for the accommodation of persons affected with contagious diseases should be maintained in every State. The writer found a short time ago, by inquiry, that of sixty-two principal cities in the United States and Canada, less than one-quarter were provided with decent hospitals for contagious diseases, some not even having a place for the care of smallpox patients. He believed many lives were sacrificed by contagious diseases annually that could be saved if all persons would conscientiously give attention to details and lend support both morally and financially.

Dr. J. E. MONJARAS, of San Luis Potosi, Mexico, dwelt upon transmissible diseases in that city, and made some general remarks on their etiology and prevention.

In the discussion, Dr. CHARLES A. LINDSLEY, secretary of the State Board of Health of Connecticut, made the point that the work of enforcing health laws was much facilitated by placing the authority for prosecution directly in the hands of an attorney, rather than leaving it with a doctor, who knew nothing about law. He had found that this plan added much to the effectiveness of work in his State. Reports of infectious and contagious diseases had much improved there of late both in accuracy and promptitude.

Dr. CHARLES V. CHAPIN, of Providence, R. I., made an argument for thorough teaching of modern scientific hygiene in universities and medical schools.

Dr. WYATT JOHNSTON, of Montreal, said that the great trouble was that the time at the disposal of the professors in the schools was so limited as to prevent the introduction of adequate courses. He suggested that diploma courses in hygiene in the universities should be introduced, and advised the appointment of a committee to further his proposition.

Dr. CHARLES O. PROBST, of Columbus, Ohio, related his experience along this line at the University of Ohio, where an attempt. was made to hold a hygienic course, but which was defeated by

the entire lack of interest upon the part of the class from which the students would be drawn.

Dr. BENJAMIN LEE, of Philadelphia, advocated the more general teaching of hygiene in colleges and universities.

School Inspection in Boston.

Dr. SAMUEL H. DURGIN, health officer, spoke on the system of school inspection in Boston. The schools were visited daily by physicians who examined any suspicious cases. These physicians were also charged with the duty of seeing that all cases of infectious diseases were properly isolated.

Dr. JOHN N. HURTY, Secretary of State Board of Health of Indiana, said that the jealousy of business men was an important factor in enforcing health laws, and he gave an account of a recent epidemic of smallpox in Valparaiso, Ind., which was reported as chicken-pox by the physicians in that city, supposedly because merchants said it would hurt business. The foolishness of such a course was pointed out. The Indiana State Board of Health purposed to require a certain standard of knowledge in its health offi

cers.

The Cause and Prevention of Infant Mortality.

Dr. ERNEST WENDE, health commissioner of Buffalo, presented a report on the cause and prevention of infant mortality. He paid particular attention to the subject of milk industry, which he said should be under both State and municipal control, operating in harmony under similar principles with the identical object in view, both acting together, forming a system of protection from dairy to consumer. The State should exercise its functions and control until the milk passed within the municipal limits and authority, and the control should include every feature and detail of protective sanitation. These features included briefly: (1) The license system, with fee, periodic systematic inspections with revoking power and penalties for dereliction. (2) The inspection system should include inspection of herds (tuberculin tests), food, animal care. (3) Demand for sanitary environment and buildings, correction of existing evils and examination and approval of plans, pending erection of new ones, which should comply with a standard of sanitary construction with special reference to specific

requirements of the business-viz., separate milking and stabling quarters, proper cubic air space, non-absorbent material. (4) Scrutiny of water supply, standard feeding, health of employees, hygienic care of utensils and cans, cleanliness and protection in milking. (5) Definite rules governing all procedures, particularly as to the cooling process, preparation for market, and in relation to the varying seasons. (6) The differentiation of the various characters of milk by differently colored or shaped cans, which should be properly labeled with date of milking and time of shipment. (7) Prohibition of milk preservatives and coloring agents, or adulteration, and of the marketing of milk from diseased, sick, or parturient cows, or of the use of disinfectants, their necessity implying bad sanitation. (8) The prohibition, particularly, of refuse or swill food upon any dairy premises, of any food considered unhealthful by reason of decomposition or fermentation, and of the association of other domesticated or housing animals with cows. (9) A standard of quality, with periodic testing and analysis. (10) Veterinary inspection with destruction and compensation within the State, and quarantine against the introduction of tuberculous cattle from without. (11) This should be as rigid as against pestilence in man, and it was only by this means that the malady could be circumscribed, and its bearing on human life favorably influenced. (12) With this standard of supervision by the State, the municipality should continue the supervision upon the same lines, which might be outlined as follows: (a) Continuation of the license system with penalties, together with stringent ordinances covering quality, adulteration, sanitary care, and relation to contagious disease contamination; (b) milk should comply with the State standard as determined by lactometer tests, periodically instituted, as ascertained both in milk houses and on wagons; (c) sanitary non-absorbent milk-rooms, of determined size, air space, ventilation, and light; (d) specifically constructed, indirectly plumbed cooling and storage boxes, non-communicating with sleeping-rooms, privies, stables, or other influencing rooms; (e) wagons properly lettered and numbered, with protection from summer heat; (f) stringent prohibition regarding intercourse with houses containing contagious diseases, particularly relating to the exchange of milk bottles and the prohibition of refilling jars en route; (g) the constant surveillance of contagious disease in relation to milk routes by means of the "tell-tale" register; (h) obligatory cleansing of milk utensils by a uniform method, and of

cans before returning to the dairy; (i) special supervision of and discouragement, if not abolishment, of selling in grocery stores, and milk sellers of similar character, where the business was subordinate to other interests, and there was consequent lack of protective facilities; (j) until State and city act in unison in this, where their interests were identical, the adoption of arbitrary interdiction or destruction at the city line of all milk coming from dairies whose conditions, or herds, might have a deleterious influence upon the milk; (k) systematic system of reports, with` mutual warnings and notification of imperilling conditions.

Formaldehyde as a Milk Preservative.

Dr. A. G. YOUNG, secretary of State Board of Health of Maine, contributed a paper on this subject. He said that the results of his examinations of all the available printed and other reports regarding the action of formaldehyde seemed to justify the following conclusions: (1) That used as a preservative, it tended at least to impair the nutritive value of milk. (2) Its tendency was also to interfere with the digestive processes. In either case it was only a question of dosage, and the limit of safety was difficult to determine. (3) That though the inhalation of formaldehyde gas was much less dangerous than the breathing of the other gaseous agents much used as disinfectants, the results of tests upon animals, and of one case of accidental poisoning of a human being, indicated that formaldehyde taken into the digestive system might produce dangerous and even fatal results. (4) It would be unwise and unsafe to encourage or to suffer the use of formaldehyde in the public milk supply, even under any possible restrictive regulations. (5) In every State, as is now the case in many, there should be a law prohibiting with effective penalties the use in milk of any chemical preservative whatsoever.

Typhoid Fever.

At the afternoon session Dr. JOHN L. LEAL, Health Officer of Paterson, N. J., described an epidemic of typhoid fever in that city which was traceable to an infected public water supply.

Dr. H. C. H. HEROLD, of Newark, N. J., spoke of the great decline in the mortality rate of typhoid fever there since the improved water supply of that city was introduced.

Dr. GARDNER T. SWARTS, of Providence, R. I., made a favorable report of a four months' test of a mechanical filter plant at East Providence.