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sick, some for the insane, and all for humanity, and each of these is doing its full share towards making Baltimore a healthy city. In addition to these we have sanitariums and homes for sick children, free excursions for the poor, asylums, etc., which I might describe and praise if time permitted, but if prevention is better than cure, then these all unite to do a power of good.

Among other medical features, we have six regular medical colleges that send forth a total of about 500 graduates yearly.

We have lovely suburbs, which teem with the summer homes of our wealthy citizens, and the cottages of our middle classes; and our woods and parks, river and bay swarm with excursionists and picnickers during warm weather. Druid Hill Park is one of the most beautiful to be found anywhere, and is a constant source of health to our people.

We have a well organized and highly efficient Health Department. A brief synopsis will show the important duties and responsibilites devolved on these, our custodians of public health, in 1894. It has a permanent corps of 22 vaccine physicians, whose number is increased when emergency requires. During 1894 they made 48,475 calls, and vaccinated. 42,042 persons. Vaccination is compulsory, and no unvaccinated child is allowed to attend the public schools of Baltimore. This is another of our sources of health.

Our food inspectors inspect all food. products, condemning any and all that is unfit for use. During 1894 they condemned 67,322 pounds of various kinds of meat and 1449 pounds of poultry, thus sparing our olfactories and guarding our health. Our milk inspectors examine milk, and spill into the streets all that shows by the lactometer a less specific gravity than 129 at 60° or is proven by microscopical examination to be dirty; and for these causes during the year 1894, 6679 gallons were condemned and spilled. Our milk supply for the year consisted of about 8,000,000 gallons of milk and cream, brought to us by twelve railroads and seventy country wagons, added to that gotten from the 1126 cows kept in the city.

We have an inspector of plumbing and drain work, whose duties and importance to the public health are obvious to all medical men. 3595 inspections were made during the year.

We also have an inspector of buildings, whose duties require him to see that all new buildings are erected with regard to safety to life and limb, and every dwelling house erected is compelled by law to contain a bath-tubanother decided source of health.

There are two inspectors of covered gutters and sewer inlets, who make daily visits of inspection, cleaning and disin fecting wherever and whenever necessary. Thirty-six tons of carbolate of lime were used by the Health Department in 1894. Their value to the public health makes it money well spent. Our coroners, five in number, are all physicians, and in addition we have two postmortem medical examiners, who made 73 post-mortem examinations for the authorities during the year. We also have a public morgue, to which 163 bodies. were sent, 127 white and 36 colored : 140 of these were males and 23 were females. 81 of these were subsequently claimed and buried by their friends. Baltimore has now a new and efficient quarantine hospital, with a disinfecting plant, equal if not superior to any in the country. country. This hospital is on the river, a few miles below the city, and is in charge of a quarantine physician and his assistants. 503 vessels were boarded and inspected during the year 1894, and twenty-four patients with infectious diseases were treated in the hospital. ing the year 7692 unsanitary mattresses from emigrant steamships were destroyed in this port. Baltimore is the only American port in which they are destroyed.

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The city has twelve sanitary inspectors, who examined and abated 20,582 nuisances during the year, and had 286 vacant lots drained and filled. It is also their duty to examine into all cases of contagious disease; diphtheria, scarlet fever, croup, measles, smallpox, etc., and to disinfect the premises after recovery. In 1894, 1977 cases were reported by the attending physicians, who are com

pelled by the laws to report every case. The importance of these rules in maintaining the public health could scarcely be overestimated. There were issued by the Health Department during 1894, 59,923 notices and orders to place premises in more sanitary condition, and 74,874 permits to clean privies were given; and every year on the approach of warm weather all persons are compelled to place premises and privies in a sanitary condition.

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In regard to night-soil, 90,721 airtight cartloads, equal to 18,144,200 gallons of liquid material, and 268,466 loads of garbage and ashes, were moved from the city in 1894, all by daylight, the former by what is known as the odorless system, to the two dumps, and carried thence down the river in scows, and disposed of to agriculturists. There were also removed 169,915 loads of street dirt and sand. In some portions of the city the streets are cleaned by sweeping-machines, but the dirt is taken from the majority of streets, lanes and alleys by laborers, scraping and sweeping. The daily average number of loads of street dirt removed was 600; and besides this, during the year, 9987 cartloads of refuse and filth were removed from the various sewers, sewer inlets, and covered gutters and 1105 cartloads of vegetable and other offal were taken from the various city docks, all with a view to maintain the public health.

In addition to garbage and dirt carts, we have covered wagons for the removal of dead animals, fowls, tainted meat, etc. During 1894, 45,211 of the former, and 2713 pounds of the latter and more than 112,000 fish, crabs and eggs were removed, and all done so quietly that probably many of our people do not even know of the existence of such wagons.

Our police force ably assists the health authorities in carrying out all laws relating to the public health. It consists of 808 officers and men, maintained in 1894 at a cost of $825,000. To say that we have a model police organization, with a most excellent detective service, would certainly be no exagger

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ation. We have 7 police stations and to each is attached one of the vaccine physicians, and a patrol wagon. This wagon not only carries. arrested persons from the signal-box nearest the point of arrest, but it is also utilized for the humanitarian duty of carrying sick and wounded persons to their homes or to the hospitals. There are 2 abattoirs, and quite a number of slaughter-houses, all under private management. This is one of our chief unsanitary features.

Baltimore is lighted by 1039 electric lights, costing 35 cents each per night; besides there are 5932 gas lamps, and also 1036 gasoline-lamps, in small streets and alleys where there are no gas mains. These all conduce to safety of life and limb to pedestrians, and secure our persons and property against evil-doers.

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Among other things we must estab lish and maintain perfect supervision over our water supply, and protect it against any and every possible source of pollution. We must adopt a more rational and scientific method of disposing of our garbage, fecal matter and other offal, either by desiccation or cremation. We must abolish our abominable privy vault system and adopt dry earth closets, or some other still better method. must legislate the 97 cow-stables, with their 1126 cows, and all other nuisances, out of the city, and keep them out. We must abolish, together with all other pathological industries, every private slaughter-house, and place all abattoirs under such rules as insure full protection to the public health. We must devise some method of securing perfectly accurate statistics of births. Free public baths on an ample scale, centrally or conveniently located for the masses, should be established. The dangers of every unsanitary lane and alley in Baltimore should be removed by making it smooth with asphalt. We, also, badly need a public disinfecting plant for the city, and a city hospital for the care and treatment of the milder contagious diseases, i. e., scarlet fever, diphtheria, measles, etc., while smallpox, yellow fever, cholera, etc., should continue to be treated at the Quarantine Hospital.

I shall mention one more blessing we possess, and I am done, that is, that in addition to all else Baltimore is a lucky city, for in addition to having hosts of worthy men and noble women, she escapes many of the sorrows that fall to some other communities, for she is neither subject to earthquakes nor volcanoes, tornadoes, cyclones nor blizzards, and neither war nor pestilence has ever laid its hand heavily upon her. Besides, she has suffered no great fires, no sweeping floods, no withering droughts, no ghastly famines, or other dire calamities. And thankfully appreciating these facts, we, her citizens, "with malice towards none, but with charity for all," are determined, under God, to exert all the powers of our hands, and of our heads, and to our hearts, to make fair Baltimore in the future, as she is today, one of the healthiest and happiest cities in the world.

SOCIETY REPORTS.

AMERICAN MEDICAL

ASSOCIATION.

FORTY-SIXTH ANNUAL MEETING, HELD IN BALTIMORE, MAY 7-10, 1895.

SECTION ON DISEASES OF CHILDREN.

FIRST DAY, TUESDAY, MAY 7. Dr. John E. Woodbridge of Youngstown, O., then read a paper entitled Typhoid Fever in Children, in which he said typhoid fever runs the same course and is governed by the same laws, at any age, and the course of the disease is only modified by the different condition of the organs and the quantity of the poison ingested, in different subjects. In any case of typhoid fever

the treatment should be directed towards the counteraction of the specific poison. At a sufficiently early stage, every case of typhoid fever can be aborted, and death avoided. The treatment is mild and simple, does an incalculable amount of good and most important of all, can do no harm; yet treated symptomatically it becomes one of the most dangerous diseases both of childhood and adult life. In many cases the child goes through an attack

either to recovery or death without a correct diagnosis being made. Typhoid fever probably occurs in children oftener than is commonly suspected and I have often seen it mistaken for cholera infantum, indigestion, meningitis, or even intestinal worms. If a child presents the slightest symptoms of typhoid, treatment should be applied at once, on account of the great advantage derived from early treatment and because it is curative and absolutely harmless. Dr. Woodbridge then cited several cases of his own in which through "criminal stupidity" no diagnosis was made and death resulted. His present treatment would have saved them. He also cited cases showing how correct diagnosis might be hindered by the prominence of the complicating cerebral symptoms. In conclusion, Dr. Woodbridge said his treatment was simple and effective and there is no excuse for a patient dying of typhoid fever. Since he has adopted it he has never lost a case. It consists in administration of podophyllin, calomel, guaiacol, menthol and eucalyptol every

four hours.

Dr. W. S. Thayer of Baltimore read a paper on the Diagnosis of Malaria in Children, with Demonstration of the Plasmodia. Malaria is caused by a parasite which in some way gains access to the system and attacks the red blood cells; the cells die, the spores of the parasite find lodgment in other cells, develop, kill those and thus go through this cycle. The parasites are the cause of the regular forms, the quotidian, tertian and quartan and also of the irregular forms often called typho-malarial fevers. In the regular forms the parasites are present in the blood in groups, all of which groups are in the same stage of development, and consequently the segmentation of all the groups occurs at the same time. The segmentation of these groups is always followed by a paroxysm. If a large number of groups sporulate there is a violent paroxysm; if a small number a slight paroxysm. These paroxysms are caused by some toxic substance liberated by the parasites at the time of sporulation. The tertian variety re

quires 48 hours to pass through its cycle and hence a paroxysm occurs every other day. In the quartan form 72 hours is required to complete its cycle. The tertian form is by far the most common in this country. In the double tertian form, there are two groups of parasites, which sporulate on alternate days. The double quartan form is very rare in this climate. The irregular forms are due to groups sporulating at irregular intervals which overlap each other and hence cause irregular paroxysms. In the spring and early summer we find the tertian and quartan forms, later the double tertian and in autumn the irregular forms begin to appear. The proofs of the causation of malaria by the parasite are undoubted and the best method of diagnosis, which is a positive one, is by the microscope.

In the irregular autumnal forms, it is often difficult at first to distinguish the parasites, for they are small and non-pigmented, but later they are more easily demonstrable. In examining the blood for the plasmodia, one must first be familiar with the appearances of normal blood. It is best to examine a fresh specimen. Thoroughly cleanse your slides with ether or alcohol and drop on it a drop of blood. In adults take the blood from the finger but in children who become frightened, from the lobe of the ear. The specimen is then hardened, stained with methylene blue. Counter-staining may be done with eosin. The specimen is best examined. with an oil immersion lens.

Dr. Adolph Koenig of Pittsburg then read a paper on Guaiacol in the Treatment of Typhoid Fever in Children. He believed it to be caused entirely by water infection and that the liability to it increased as the chlld got older and took more solid and liquid food. That the system of treatment resolved itself chiefly at first into one of hygiene and diet, however, later in the disease, medication would often become necessary. The first thing to be done is to clean out the intestinal tract and then to render it thoroughly aseptic and thus prevent all fermentative processes. If symptoms point towards typhoid fever, first

thoroughly cleanse the intestinal tract with calomel- of a grain, every two or three hours, restrain all solid food and give plenty of pure water and milk, either pure or diluted with barley water. Guaiacol should be given as an intestinal antiseptic and also applied externally to reduce the temperature. When this treatment is carried out the disease runs a milder course and tympanites is often absent. He does not claim specific properties for guaiacol, but uses it merely as an antiseptic.

Dr. Samuel S. Adams of Washington, D. C., then read a paper on the Brandt method in children. He had tried one method after another and gradually discarded them one by one until in 1893 he first tried the Brandt method. He then exhibited some charts made in 1892-93, before the adoption of the Brandt method, and compared them with charts made in 1893-94, after its use. The charts speak for themselves, the later ones being shorter, with more satisfactory terminations, a lower per cent. of mortality and without a drop of medicine. He was not prepared to claim this as the only method of treatment, that the disease was shortened very little by it, but that when it is used the patients are more comfortable and the delirium greatly diminished. The only test of this treatment is to apply it as its author suggested. Do not entrust the case while in the bath to nurses, but have it done under the supervision of an assistant. Do not take the child to the water, but bring the water to the child at the bedside. Since 1893, he had not given a dose of medicine in typhoid fever, except one hypodermic injection of ergotin in a case of intestinal hemorrhage. The temperature of the first bath should be 72°-73° when the child is put in; this should be then reduced to 70°. If the first bath is well borne the next time he may be put directly into water at 70°. Keep in five to fifteen minutes, depending on the temperature, pulse, color, etc. The patient should be put into the bath when the temperature reaches 103.5°F. taken in the rectum. After the bath the patient should be given a drachm of whiskey and

put into a warm bed. He then usually falls asleep and wakes in an improved mental condition, and when the delirium returns it is of a milder form. From the time in which the bath is used the daily range of temperature diminishes. The only death from typhoid which he had since last August was a case in which, owing to the cerebral symptoms, the diagnosis of typhoid fever was not made until just before death. Dr. Adams then exhibited a number of charts showing his results with the Brandt method. One case being remarkable in having an intestinal hemorrhage every fourteen days, on account of which the baths were suspended after seventy-one had been given. The icecap was then applied and kept on for a week. This case lasted from September 4, until November 27; though the patient was greatly emaciated, he finally recovered. In conclusion, Dr. Adams said he believes he can get just as good results from the Brandt method as any other and without giving medicines.

Dr. Wm. Osler of Baltimore said we must agree that young children are not so susceptible to typhoid fever as adults and that in any lengthy series of cases it pursues a milder course than in adults. He also made a brief allusion to the cerebral symptoms often obscuring the diagnosis on account of the headache, retraction of the head, strabismus, muscular twitchings, etc., closely simulating meningitis. In regard to intestinal antisepsis, Dr. Osler said; No doubt the bacilli were more common in the mesenteric glands than in Peyer's glands, where they are often absent. And besides typhoid, septicemia is not always due to a streptococcus infection, but often to an infection by the bacillus typhosus. He doubted if it was well to make such an emphatic statement as that made by Dr. Woodbridge that "no case of typhoid fever need die." Such a statement might be reasonable in a daily paper, but it is not justifiable. coming from a physician. The bacilli live not on the surface of the intestine, but in the tissues, and what good can antiseptics given by the mouth do in this condition? He was a warm advo

vate of the Brandt method as outlined by Dr. Adams, with the exception that he preferred to have it given by nurses, as residents have not the requisite amount of patience.

Dr. Wm. Pepper of Philadelphia said: The last word concerning the diagnosis of typhoid fever in children has not yet been said. We need more refined methods of diagnosis before we can make it early enough to abort the disease in many cases. He thoroughly agreed with Dr. Adams in his remarks concerning the Brandt system of treatment and believed that any physician who did not give his patients the benefit of it was derelict; and also that the man who applied it routinely, without noting the requirements for medication, is not up in the resources of his profession, for it is decidedly not incompatible with other methods of treatment. Typhoid fever is not simply a local lesion, but a penetrating infection and upon the diet largely depends the degree to which the intestinal lesions may extend. As soon as the suspicion arises that there is a systemic infection, some drug may be given to act as a simple antiseptic and astringent, but be careful you do no harm. He believed that before the time for the use of the Brandt method arrived there is a use for local treatment by diet and agents which act as tonics and generally assist digestion. To say the treatment for typhoid fever is the antiseptic method is wrong and to say it is the Brandt method is also wrong. Rather say it is the treatment which fully appreciates all the necessities of the case, that in short is, avoid dogmatism.

Dr. J. A. Work of Elkhart, Ind., said he was not prepared to treat any case of typhoid fever, either altogether with or without medicines. He believed early and effective elimination to be the key to the treatment.

Dr. George N. Acker of Washington, D. C., said he believed the diagnosis of typhoid fever was often made after the disease is over. He believed more in medicinal treatment than Dr. Adams did. He favored giving salol, sulphuric acid, etc., rather than the Brandt treatment,

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