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isolation is not everything. Even in relation to these diseases, the milk supply is vital.

In Amesbury, Mass., in December, 1904, forty-three cases of scarlet fever broke out. An investigation showed that the patients used milk furnished by a single farmer, and that the milk was handled and delivered by his son, who was just acquiring a mild form of the disease himself. This milk supply was cut off for a time, all the utensils were then sterilized, and no one who came in contact with a scarlet fever patient was allowed to handle them. The epidemic at once fell off and shortly disappeared. Uncounted epidemics have had a similar source. The milk supply of every community should be considered a possible menace, to be watched with unfailing vigilance. Better knowledge regarding the food of children, then, better scrutiny of the milk supply, the sterilizing of milk, and quarantining have accounted in large measure for the saving of children. Tenement-house laws to prevent filth and overcrowding, tenement-house inspection to see that the laws are enforced, street cleaning, and the enforcement of board of health rules have all played their part in the great human task. Medical inspection of children in the public schools, compulsory vaccination (and re-vaccination whenever smallpox breaks out in a neighborhood), parks, and piers, and floating hospitals-these have done their share, more particularly in protecting the children of the less well-to-do. It is almost needless to point out that the work has not gone half far enough, that the greater proportion of the children who die every year in appalling numbers-one-fifth of all who are born in the larger cities before they have lived a year-die needlessly because some well-known precaution has been criminally neglected by some one through carelessness, ignorance, or greed.

THE CONQUEST OF DIPHTHERIA

The most remarkable advance, however, that has been made in bringing down the death rate of children has been due to none of these things, but to a revolutionary medical discovery. Diphtheria and membranous croup, within the memory of all of us dreaded as among the deadliest of diseases, are robbed of their terrors. The process of finding the diphtheria anti-toxin gives the hope of a specific cure for many another dread disease.

The conquest of diphtheria was accomplished when Klebs and Loeffler first discovered the

specific germ of diphtheria and when Bering, in Germany, and Roux, in France, produced the anti-toxin for it by inoculating horses with diphtheria and drawing off and straining the serum of the blood. This is injected into a child suffering with diphtheria or membranous croup. If given early enough, it is an almost certain cure.

It was first used extensively in 1895. The death rate from diphtheria and membranous croup dropped off at once, and it has been going down steadily ever since. The accompanying diagram from a recent report of the Chicago board of health tells the story at a glance, though the actual figures are a trifle too low to strike the average for the country. The diagram has the merit, however, of showing how the use of a specific remedy modifies the seasonal fluctuations of the diseases.

A bacteriological examination will show at once whether a child has diphtheria or membranous croup. If pure anti-toxin is used in the early stages of the disease, there is very little danger, but experience shows that with each day's delay in its administration, the death rate goes up. The remedy is not only effective with the suffering child; its use with those who run any danger of contracting the disease renders them immune for a time. In some

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districts physicians have been slow about using it. Their neglect should be regarded as criminal malpractice.

CONTROLLING FEVERS

Simultaneously with the saving of children brought about by the discovery of the diphtheria anti-toxin and the enforcement of sanitary measures, has come a remarkable advance in the control of certain infective diseases that attack people of all ages.

Two of the greatest medical advances in prevention that have been made in the last few years have been the investigations that have proved how typhoid fever and how malaria and yellow fever are caused. The methods adopted for controlling these diseases have been put into the hands of individuals and boards of health-and they have been practiced with increasing thoroughness. Not only children have been saved, but adults too, for typhoid makes most of its ravages on people from twenty to thirty years old, and malaria and yellow fever make no distinction of ages.

The typhoid germ was discovered in 1884a bacillus that attacks the intestines, causing ulcerations which often, in fatal cases, perforate the bowels. It has been pointedly said: "You can eat typhoid and you can drink typhoid, but you cannot catch typhoid." Yet every case of typhoid comes from another case. The virulent germs are cast off in all the patient's emanations, and are disseminated through the use of water from wells or ponds into which filth seeps or from rivers that take the drainage from one town and furnish a germladen water-supply to the town below. The disease is sent abroad also through vegetables fertilized with materials containing germs, through oysters and clams from waters into which drainage empties, and through milk watered with germ-bearing water or kept in cans washed with such water. Flies will carry the germs. The refuse from a single case will start an epidemic that will sweep a whole city.

Pittsburg and Allegheny, Pa., continue to drink Monongahela River water and continue to have a high typhoid death rate. Epidemics break out from time to time in cities all over the country. The disease will frequently break out in one city which uses a river water supply, and in about the time required for the drainage to run down the river, break out suddenly in another city below. Scrupulous attention to

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water supply and scrupulous care that the emanations of a patient are made aseptic and disposed of so that there is no possibility of germs reaching another human body would practically wipe out the disease. This is so certain that it has been said with some point that for every case of typhoid some one should be hanged-doctor, nurse, or watcher, of some typhoid patient. Even before the cause of the disease was thoroughly known, its fatality fell off nearly 70 per cent. after sewerage and house drainage were generally instituted.

In places where the utmost care is taken, typhoid has been brought more and more under control. In Massachusetts, for example, it has declined since the Civil War as shown in the above table.

Since the cause of the disease and the preventive measures have been known, the state has examined suspected water supplies and warned local health boards of dangers. It has investigated typhoid epidemics, and traced them back to their source. In one case the epidemic was traced to a man who boarded two employees of a milk contractor. The germs had been carried from this man into the milk which these men delivered. In most cases of late, an infected milk supply spread the disease, though the earlier decline in the death rate was

due as much to infected water-supplies. The death rate from typhoid came down about 25 per cent. in the registration area of the country from 1890 to 1900, but it has fluctuated since 1900 at a level nearly twice as high as that of Massachusetts, because elsewhere precautions are not so well enforced. Here is another reason why the milk supply should be watchedand the water supply with equal vigilance.

Malaria, it has been conclusively proved in the last few years, can be transmitted in but one way-by mosquitos. The same fact was proved of yellow fever. All the superstitions about the evil effects of night air, bad air, marshy miasmas, and sewer gas went straightway into the scrap-heap that science is making of medical delusions. When the investigators, by successive steps of exclusion, had narrowed down to the mosquito as the bearer of the vegetable-like micro-organism that causes malaria, two English physicians went to the Italian Campagna-dreaded since the early days of Rome as a pestilential spot, the night air of which was considered deadly. They slept in the marshes from June to September, 1900, unharmed. Then one of the doctors allowed himself to be bitten by mosquitos, and at once developed malaria. Mosquitos were brought from Italy and allowed to bite a perfectly well man. Malaria seized him at once, and an examination showed the characteristic organisms in his blood. Enough experiments like this were made to settle conclusively that malaria is given to a human being only through the bite of an Anopheles mosquito that has previously bitten some individual already infected.

Similar experiments, in one of which Major Walter Reed, of the United States Army, sacrificed his life, proved just as conclusively that yellow fever is transmitted by another mosquito (Stegomyia fasciata). The army surgeons carried on this work most heroically. When they found that a man who slept in the nightclothes and in the unchanged bed of a patient who had died of the dreaded "Yellow Jack" was immune if screened from mosquitos, and that one who slept in clean, antiseptic surroundings took the disease if exposed to the bite of an infected mosquito, their case was proved. So, by screening well people from Anopheles and Stegomyia-which fly only by night-by screening sick people so that the mosquitos cannot gather their burden of deadliness, and by destroying the mosquito larvæ,

both "Yellow Jack" and "Creeping Johnny" have been robbed of half their terrors. Quarantine, too, has worked wonders. When, through defective quarantining, yellow fever got into New Orleans a year ago, a rigid quarantine, maintained by Doctor Tabor, the state health officer, kept it out of Texas. But the people of Texas slept under mosquito bars, just the

same.

Yet, of all the medical achievements, this one of placing the guilt for causing malaria on the Anopheles mosquito is the least wellknown. Yellow fever was practically wiped out of Havana, and malaria is being kept in hand by Colonel Gorgas in the Canal Zone, because the people in those places have been taught or compelled to observe precautions. But throughout our Northern states, malaria is still prevalent and still deadly. Some progress has been made in eliminating mosquitos by draining the places where the young develop in stagnant water, and by using oil on pools. But not enough. When the virulence of the Anopheles is better known to the public at large, people will cease to regard mosquitobites on their babies with equanimity. The death rate from malaria has gone down in some places, but not in others. It should be lower in all.

WHAT KILLS ADULTS

Now while all these advances have been going on, saving the children, checking the epidemic diseases, and increasing the average length of life, certain non-infective diseases which attack grown-up people have increased in their deadliness. With the spread of knowledge regarding the efficacy of a nourishing diet and open-air life, and sanitary precautions, tuberculosis is coming more and more under control. Its death rate is gradually declining. But its place as the deadliest of all the diseases, in the United States killing more persons annually than any other, has been taken by pneumonia. Heart disease, nephritis and Bright's disease, apoplexy, cancer, cirrhosis of the liver, diabetes, and appendicitis, have all increased. The increase in appendicitis is due partly to the fact that the disease is now recognized, whereas within the lifetime of most of us it was not. The other diseases are peculiarly the ones that affect people in the prime of life. These, with pneumonia and the diarrhoeal diseases, are the causes of the increasing death rate of adults.

They are direct results of city life, of crowding, of hurry, of luxury and physical sloth, of worry, of eating too much and drinking too much, of steam heat, of carelessness, ignorance, and neglect. They are the menaces that lie in wait for all of us. For many years now the physicans have been getting the infective

diseases under control. Meanwhile the organic diseases have increased because they have been in a measure neglected. They are just as preventable in most cases as the infective diseases. It is time that attention should turn toward the means of preventing them in order that adults may be saved, as well as children.

ARE OUR COLLEGES DOING THEIR JOB?

THEIR DEGREE OF EFFICIENCY-THE INFLUENCE OF PROFESSORS

[There are in preparation for THE WORLD'S WORK several articles in which the work of particular colleges and universities will be described and appraised. During the preparation of these, the two articles that follow were sent in by members of the faculties of two of our universities; and they serve as a sort of introductory “confessions," from the inside, of two of the most frequent criticisms made of our academic life.-THE EDITORS.]

I

HAVE crossed the continent twice this summer. First I worked westward, along the lines of conquest, threading in weeks the ways that cost the pioneers generations, coming finally to the Pacific Coast, where frontier and democracy still linger. Now I am working back again, from the hardier, simpler life and virtues to the older, more sophisticated, less alluring East. I like it, like it all-the broad sunny lands out yonder, the cities and snug green farms back here. They are different, the two sections, but the differences seem nothing beside the likenesses. It is all America, and all magnificent-one great nation, tingling with youth, aware that its initial task of clearing the continent is over, making ready to play, with its power and wealth, a still greater part on a still larger stage; crude but honest manhood, conscious of strength, ashamed of mistakes, determined to do better, determined to do very well.

Here, then, is this youthful strong man, girded to run a race with the nations of the earth. And here am I, returning after these weeks of enlightenment and rest to-what? To teach! teach college classes! How great, how immense an anti-climax! And how shameful And how shameful that it is an anti-climax!

But it is. When I reach my college home I drop out of the current, into a smooth, a sleepy, eddy. Say, rather, that I am tossed by the stream off into a Sargasso Sea, where navigation consists in drifting and in polishing the brasses and teaching the cabin-boy the knots and splices.

Let me cite a concrete case, the case that

first opened my eyes to the deep truth of that which I am here setting forth. It is the case of a man who has been called harsh names by his old acquaintances, and associates, because he believes and says, strongly, that colleges exist for service, and only secondarily for investigation; maintains that their faculties. should be utterly democratic, careers open to talents, all men with an equal chance; and declares that a college should be always abreast— a little ahead, rather-of the nation's best life.

This is the exact truth. The colleges are apart, remote; they are drifting, and pottering. They should be the strong young giant, thinking. They are, in reality, his old nurse in the chimney-corner, thinking. No! his nurse they never were; his maiden aunt rather, sitting prim, with her mitts on, thinking she's thinking.

I do not enjoy saying such things; I didn't enjoy discovering them. I have no prejudice against the colleges; very far from it. I love to teach. I love to study. I remember hiding my Greek grammar under my pillow, to have the fun of studying the verbs before the house was awake. It wasn't a pose, for I never told any one of it till now. It was the way I was drawn-like the drawing of my own children when one of them carries a fairy-book to bed, and the other a cook-book. My father was a scholar; my only desire was to be one. I never really enjoyed life, heart and soul, every waking minute of it, till I got to Leipsic and its lectures. The colleges have given me my (scrimping) livelihood. I've wandered from college life; but only to get homesick and return to it. Ah! that's it. I've wandered; I got

for a time into the world of men. I know what the young giant is doing; for a time I was with him, part and parcel of his activity. That is the reason why now, as I tread the cloisters again, my feeling is of walking among ineffectual ghosts.

Put the whole matter into a nutshell: What is the college's function? What should it, the college, be, primarily the American college? A place of investigation? No man of sense contends for that. Investigation must go on; America must do its share of it; but the colleges as colleges do not exist for that. Their teachers may fittingly engage in investigation in connection with their teaching; some few persons may be maintained for investigation alone, if funds permit. But primarily colleges But primarily colleges exist to teach.

And that means what? That they are here for the purpose of giving the young giant the results, the serviceable, clarified results, of all investigation, all thought. He must play his great part understandingly, without waste. He must have all the insight that the world has accumulated. He must have the power of looking below appearances, looking deep into things; the power, in a word, of thinking.

Who claims that the colleges are now imparting these gifts and powers? Publicly, officially, we claim it; but when the augurs meet in private conclave, and catch squarely one another's eye, they smile.

Of course, it is all very natural. I don't even know that it is anybody's fault. Opportunity never before in the history of the world loomed quite so large as here and now in America, and the keen energetic souls that see and do have most of them been tempted into bigger and better fields than those over which the sound of the college bell floats. The gentler spirits have settled on Faculty Street. And while America has been getting more and more energetic, more and more epical, they have grown steadily more gentle! They haven't made epic; they've read it-read the old epics. They haven't read them for the "go" in them, but microscopically, for the syntax largely, the scanning (which, by the way, they know nothing about), and other oddments. They think they are after the life and stir of it all-and they read three books (or ten) of Homer! It's because they are the gentle spirits. If they had had circulation of the blood, they might have been college teachers and still have felt the stir

all around them and braced the souls of those who came to them, for the encounter.

But those who had the destinies of our colleges in their hands when the decisive moments came were theologians, or kindred dreamers, and did not see their chance-did not see that if America were to be a land of action the men who taught America should have in them a little action too. Then also they were handicapped by the fact that they could not offer the man of bone and sinew a living wage. Parsimony is responsible partly for the situation. Think of asking a man with red blood to work

overwork for $3,000 a year, sometimes for half of it! So, one way and another, the gentle ones were put in charge, and they wandered over to Germany and learned to do (very poorly) the thing that America did not need and would never throw itself into. And there we are! A colleague said to me the other day, "We all are ninth-rate men."

What I have said is true of the humanities, is true of the sciences. Keen-witted, idealistic young America wants the keen, laughing, beauty-loving, inspiring Greek and Latin classics, wants all the fresh, fine books. But it hardly knows that such things exist. It is made to fumble over the letter of them, and hardly ever gets near their hearts. The gentle ones can't see and feel beyond the letter. But how he likes, the lad that we were training, those old throbbing books, full of the very life and problems that he is preparing to face to-day -if he does really get at them! Often he does it in after years, when he has been out in the fight for a time. He discovers them, something guiding him to his own.

"Thunder!" said a man to me not long ago, a man who is playing a considerable part in American affairs to-day, "how did I manage to get through so much Homer, under old 'Histemi Stayso,' and never find at all what it was about? I suppose it was because he badgered me about conditional sentences. I've discovered the Odyssey all over for myself now, and am reading a page or two every night, and it's fine!"

It is just the same with our English classics, just the same with French or German or Italian. We never get at them, they never get at us-unless it's afterward, or by exception.

And then the sciences. What is it precisely that young America wants of them? They, in the hands of their great masters, are making our world over. If there is one thing

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