ably adulterate milk to any extent or in any way before sending it to the city.

DR. E. T. EASTMAN stated that housekeepers often accuse the milkman unjustly. In a case known to him the servant was in the habit of taking off a portion from the top of the can, and supplying the deficiency with water, and the housekeeper complained that the milkman was delivering adulterated milk. This source of deterioration in the milk supplied to families is often forgotten, and the milkman is charged with adulteration. In reply to the question how the supply of cream is obtained which is sold for table use at an advanced price, it was stated that the surplus of each day's milk was passed through a machine called the "separator," which removes the cream and leaves a pure skimmed milk which is sold to bakers, to families for domestic use, and for feeding to pigs. Another method of obtaining cream is also regularly followed. Each day cans of milk fresh from the dairy are poured into large receivers which are surrounded with ice, and are left undisturbed for twenty-two hours. At the end of this time it is skimmed with a conical skimmer, and about ten per cent. of cream obtained, which is the average amount of good milk.

DR. EDES asked how the milkmen are sure of the quality of milk which they supply to their customers. The reply was made that the quality of the milk is examined each day, and sometimes a favorite dairy will be found unfit for use, and will be rejected, and a supply from some other source obtained in its place. Suspicion was recently aroused in respect to a dairy, and on "setting" the milk it was found to yield only six per cent. of cream. The milk from a neighboring dairy was also "set," and yielded fifteen per cent. of cream. Consumers would hardly have been satisfied if this milk had been delivered to them in glass jars sealed in the country, though they could not then accuse the milkman of tampering with it. Often the milk from a reliable dairy will be found sour, and, of course, must be rejected, and used for butter. The quality of the milk also depends on the food of the cow. Brewers' grains are not considered an unhealthy nutriment for cows, but the milk is thin and white.

In reply to a question by Dr. White as to how many cows are represented in one can of milk, it was stated that rarely would one can contain the milk of more than two cows. The farmer milks the cows in succession, and as soon as each cow is milked the milk is strained into the cans, which are successively filled and at once placed in water to cool. After arriving in the city the milk is mixed, and is then drawn into the service cans for distribution.

The statement has been made that the cream sold by milkmen was obtained from creameries, as it was impossible to obtain good cream from the tops of their cans. Mr. Abbott stated that in his earlier experirience as a milkman he found no difficulty in getting a large share of the cream, the motion of the cars was so slight and the sudden cooling with ice caused the cream to rise so that most of the, cans have a heavy cream on them when reaching the city. Those that did not could be iced and kept over, as nearly every milkman carries a surplus.

Dr. Barnes stated that the Milk Inspector, in speaking of the arduous duties of his office, said that if the city would furnish him with a team, he could accomplish much more. Mr. Abbott produced the Milk Inspector's report for the year ending March 21, 1883, showing that the number of visits made and samples inspected was 1153, or, allowing three hundred working days, would be less than four per day, which Mr. Abbott thought, with our system of horse cars and good sidewalks, would not be a very laborious work for an able-bodied man. Our Milk Inspector receives $1800 per year, and has a clerk at $500, making $2300; divide this by 1153 and it will be seen that it costs the city of Boston nearly two dollars apiece for every sample of milk inspected. To this must be added $140 for analysis in fourteen cases, as a result of which thirteen persons were prosecuted and twelve convicted. In looking further we find that at that date eight hundred and sixty storekeepers or retail dealers have been licensed; is it possible that only that number of storekeepers in Boston have heard that there is a milk law! Such being the case, it is not to be wondered that the milk dealers speak with contempt of the Milk Inspector and his office.

DR. MARCY remarked that we should not forget that in the plan for furnishing milk as described and practiced by Dr. Morris all chances of contamination of the milk from dirty vessels, all manipulation by middlemen, and all abstraction by servants after the milk has been delivered, is prevented. The most of the objections urged against milk as now supplied would at once be removed. There seems to be no good reason why a plan which can be carried on in Philadelphia to the satisfaction of the consumer and at a fair profit to the projector might not work equally well in Boston.

Dr. BlodgetT remarked that a part of the responsibility for adulterated milk undoubtedly rests upon the people consuming it. Very few people in the city know how pure milk looks, and expect a rich yellow milk at all times of the year and under all circumstances. Cows' milk is not all yellow, nor is it always yellow. The farmers endeavor to secure cows which will yield large amounts of milk, but the color is often very pale. The farmer gets three and a quarter cents a quart for milk, and he tries to get the largest possible amount from the cows. A farmer cannot furnish Jersey milk for three and a quarter cents per quart. If people demand a quality in milk which does not belong to it there are no doubt many milkmen who are willing to furnish it of any desired color; and thus the consumer unconsciously encourages adulteration.

OFFICIAL LIST OF CHANGES OF STATIONS AND DUTIES OF MEDICAL OFFICERS OF THE U. S, MARINE HOSPITAL SERVICE, JANUARY 1, 1884. TO MARCH 31, 1884.

FESSENDEN, C. S. D., surgeon. To proceed to Cairo, Hlinois, and Memphis, Tennessee, as inspector. March 5, 1884. PURVIANCE, GEORGE, surgeon. Granted leave of absence for thirty days. February 16, 1884.

SMITH, HENRY, surgeon. To rejoin his station at Norfolk, Virginia. March 7, 1884.

IRWIN, FAIRFAX, passed assistant surgeon. Relieved from duty at Norfolk, Virginia; to assume charge of Cape Charles Quarantine Station. March 7, 1884.

CARMICHAEL, D. A., assistant surgeon. To report to Surgeon Purviance for examination for promotion. March 5,

1884.

To report to Surgeon March 5, 1884. Leave of absence ex

ARMSTRONG, S. T., assistant surgeon. Fessenden for examination for promotion. BENNETT, P. H., assistant surgeon. tended ten days. January 18, 1884. AMES, R. P. M., assistant surgeon. Detailed for temporary duty on relief boat, Ohio River flood sufferers. February 16 and March 1, 1884.

DEVAN, S. C., assistant surgeon. Upon expiration of leave of absence to proceed to St. Louis, Missouri, for temporary duty. February 6, 1884.

KALLOCH, P. C., assistant surgeon. To proceed to Charleston, South Carolina, for temporary duty. February 1, 1884. BEVAN, A. D., assistant surgeon. Granted leave of absence for seven days. March 13, 1884.

WASDIN, EUGENE, assistant surgeon. Granted leave of absence for fifteen days. March 4, 1884.

follows: Number of operations, twenty-one; number of recov eries, ten. Very truly yours, GEO. W. GAY, M. D. BOSTON, April 5, 1884.

- The

THE ASSOCIATION OF AMERICAN MEDICAL EDITORS. ANNUAL MEETING, WASHINGTON, D. C., MAY 5, 1884. annual meeting of the Association of American Medical Editors will be held in Washington, May 5th, at eight P. M., in Medical Hall, southeast corner of Sixth and F Streets. The Annual Address will be delivered by President Leartus Connor, M. D., on The American Medical Journal of the Future, as indicated by the History of American Medical Journals in the Past. Dr. N. S. Davis will open the discussion on How far can Legislation Aid in Elevating the Standard of Medical Education in this Country? in which Dr. A. B. Palmer, Dr. H. O. Marcy, Dr. L. S. McMurtry, Dr. C. H. Hughes, Dr. Frank Woodbury, Dr. William Brodie, Dr. A. N. Bell, Dr. William B. Atkinson, Dr. W. C. Wile, Dr. W. R. D. Blackwood, Dr. Henry Leffmann, and Dr. Deering J. Roberts will take part. All members of the profession, especially journalists and authors, are invited to be present and take part in the meeting. JOHN V. SHOEMAKER, M. D., Secretary. PHILADELPHIA, 1031 Walnut Street.

MIDDLESEX SOUTH DISTRICT MEDICAL SOCIETY. annual meeting will be held at Porter's Hotel, North Cambridge, on Wednesday, April 16, 1884, at twelve o'clock. The Annual Address will be delivered at one o'clock P. M. by Dr. H. M. Field, of Newton. A special dinner will be served at two o'clock P. M. The Censors of the Society will meet at the same place, at 11.30 A. M. of the same day, to consider applications for admission to the Massachusetts Medical Society. The annual as

the meeting of the State Society. Members may order telephone messages to be sent to No. 7081, and they will be delivered at the Hotel. WALTER ELA, Secretary. CAMBRIDGE, April 9, 1884.

ILLINOIS STATE BOARD OF HEALTH.-The regular quarterly meeting of the Illinois State Board of Health will be held at the Grand Pacific Hotel, in Chicago, beginning Thursday, April 17th. At this session candidates for certificates will be examined, both non-graduates, who must undergo an examination upon their preliminary education, as well as in the usual branches of medical study, and also graduates of colleges which have not fully complied with the schedule of minimum requirements adopted by the Board in 1880, and in force from and after the session of 1882-83.

BOOKS AND PAMPHLETS RECEIVED. Fourteenth Annual Report of the Massachusetts Homœopathic Hospital and of the Ladies' Aid Association for the Year ending December 31, 1883. Boston. 1884.

more, Md. 1884.

ENTERIC FEVER IN NEW HAVEN.1

EXFORY

BY GUSTAVUS ELIOT, A. M., M. D.,
Attending Physician to the New Haven Dispensary.

I HAVE chosen to use the name enteric fever to designate the disease commonly known as typhoid fever, in preference to the latter term, for the following reasons: First, the adjective typhoid has been used to such an extent, in connection with various diseases accompanied by serious symptoms, that its use at the present time is frequently misleading both to the public and to the profession. Second, the name enteric fever is used instead of typhoid fever in the Provisional Nomenclature of the Royal College of Physicians, London, which was adopted in 1873 by the United States Marine Hospital Bureau as the nosological system to be observed by medical officers of the service in their reports and communications. Third, the same name is now frequently employed by medical authors and teachers.

2

Few diseases which prevail in this vicinity are more terrible than the one under consideration. Selecting as its victims those in the full vigor of early adult life, insidious in its onset, increasing daily in severity, protracted in its course, steadily destructive to the most vital tissues and organs of the body, attended by a liability to the most serious complications, it frequently proves fatal, and even when life is spared it is too often followed by disagreeable sequelæ and protracted convalescence. And yet all this is avoidable if we may believe a recent writer on this subject, who tells us that "enteric fever destroys more lives that could be saved than any other acute disease." If there is any ground for such an assertion, the conditions which govern the occurrence of the disease are of incalculable practical importance. I have therefore ventured to introduce the subject at this time with the hope that the members of the Society may from their personal experience contribute some facts toward the solution of the obscure problem, what is the origin of the cases of enteric fever which occur in this city?

bles:

I. NUMBER OF DEATHS FROM "TYPHOID FEVER" FOR EACH MONTH SINCE

1874

1875

JULY, 1874.

8

1

8

8

2

8

6

32

221

223

A

1

6

6

1

2

1

4

1

4

8

September..

October.....
November...

December...

Total.......

29

were an unusual number of deaths from this disease.

In October the newspapers attempted to excite something of a sensation on account of the cases which had been reported up to that time. The Health Officer was interviewed, and proved by statistics that the disease was not especially prevalent, that, in fact, it was rather less prevalent than usual. An eminent surgeon was reported to have reiterated the views of the Health Officer. Numerous other physicians expressed the opinion that there neither had been nor was then an unusual number of cases of the disease. But in spite of mathematical proofs and favorable prophecies the mortality report for November indicated that there had been nine deaths from "typhoid fever," a larger number than had been reported in any one mouth for

city, the term typho-malarial fever is used by them in a somewhat different sense from that generally understood by the profession. Some apply the name to febrile affections of purely malarial origin which present a certain train of symptoms. Others make use of the term to designate a specific disease distinct from enteric fever on the one hand and from fevers of purely malarial origin on the other. Either of these views is equally untenable when examined by the light of recent literature. The name typho-malarial fever was proposed in the summer of 1862 by Dr. J. J. Woodward, Surgeon United States Army, "to a Board of Medical Officers who were directed to revise the form of sick report in use in the army," to designate the "hybrid forms" of fever "resulting from the combined influence of malarial poisoning and of the causes of typhoid fever" which then prevailed in the Army of the Potomac. In September, 1863, Dr. Woodward, in a circular of the Surgeon-General's office, made a statement of the meaning he designed to attach to the term; and in November of the same year he presented his views upon the subject at some length in the Outlines of the Chief Camp Diseases of the United States Armies." In 1876 he professed to hold "substantially the same views," although at that time he frankly confessed that during his earlier studies he had fallen into "some errors of details (particularly with regard to the pathological

anatomy of the intestines in these forms) which were incorporated in the account presented in the book on Camp Diseases." "During my earlier studies," says Dr. Woodward, "I believed that I had observed certain peculiarities in the character of the ulcers in these cases, by which they might be distinguished from the lesions of simple typhoid. A larger experience, especially the examination of a large number of specimens received by the Medical Section of the Army Medical Museum, has convinced me that this opinion was premature. I renounce it as erroneous. There is really nothing in the lesions of Peyer's glands, in these cases, to distinguish them from ordinary cases of typhoid fever." Such an unequivocal and impartial statement leaves little doubt as to where Dr. Woodward stands on this question. These views he expressed at the International Medical Congress in Philadelphia, 1876. To show that he does not stand alone in adherence to these opinions it is only necessary to quote a resolution adopted by the Section of Medicine of that Congress, as expressing the opinion of the Section, to this effect: "Typho-malarial fever is not a specific or distinct type of disease, but the term may be conveniently applied to the compound forms of fever which result from the combined influence of the causes of the malarious fevers and of typhoid fever." All recent writers are, so far as I know, of the same opin

41882

1883

ion. I need only quote Flint, than whom no author in this country is more extensively read or more implicitly trusted, who says: "Typho-malarial fever is caused by the combined action of malaria and the special cause of typhoid fever." 1

Much of the present confusion in regard to the nomenclature of prevalent febrile affections is due, I believe, to the description of typhoid fever as given by Liebermeister and followed by many later writers. These descriptions led students to expect to find the febrile movement advance with almost mechanical regularity. When in practice they found a disease which manifested all the other symptoms of typhoid fever as they had learned them, but in which the range of temperature did not correspond very closely to what they had learned, they at once set to work to find some cause for what seemed not to belong to the disease. Here, as in numerous other instances, malaria was made the scapegoat, and was forced to bear this along with many other equally undeserved burdens. I do not deny that occasionally the two poisons may exist in the body 1 Flint, Principles and Practice of Medicine, 5th edition, 1881.

together and produce, each its characteristic effects simultaneously. But, on the other hand, I am strongly of the opinion that in the majority of doubtful cases, even where the disease is ushered in by a single or repeated chills and by a rapid rise of temperature, it is more reasonable to believe that the peculiar symtomatology of any particular case is due to a normal though perhaps an unusual manifestation of the typhoid poison than to assume that it is due to the existence within the body of the patient of a poison whose presence it is impossible to prove.

In view of these circumstances, and to more accurately indicate the mortality due to the typhoid poison, I have constructed a third table based upon the total number of deaths from the two diseases for each month of the last six years. (See Table on page 363.)

The same facts so far as they relate to the last four years I have also represented by the graphic method given in the above diagram.

These tables assuming that the causes of death are always correctly reported do not indicate such an unusual prevalence of enteric fever during the past