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(Cable dispatches from New Zealand of Dec. 16 reported that Mr. Stevenson had died in Samoa of apoplexy on Dec. 3.)

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A New Medical

THE PROGRESS OF THE WORLD.

If reports from Paris and Berlin may be trusted, a cure has been found for diphDiscovery. theria; and nothing else in the world's recent progress of which these pages could make note has an equal degree of interest or importance. Just four years ago, public health officers, hospital authorities and private medical practitioners were vieing with each other in their haste to reach Berlin and to obtain a modicum of Dr. Koch's precious lymph for the cure of consumption by inoculation. The whole world was thrilled with excitement over the great discovery. Unfortunately the hopes then aroused have not been realized. The nature of pulmonary disease is better understood than ever before, and undoubtedly its ravages have been somewhat diminished by wise methods of prevention, by constitutional treatment in the early stages, and by timely resort to those climates which are natural sanitariums. But the specific annihilation of the tuberculosis germ through Dr. Koch's remedy would seem thus far to have proved a failure. Some two years ago, after one season of cholera epidemic in Russia and various parts of Europe, and in anticipation of another and more trying season, it was announced that Dr. Pasteur in his Paris laboratory had perfected a cure for cholera. His method also was that of the introduction into the human system, by hypodermic injection, of a substance which was to give the person thus inoculated a sure immunity from the dreaded Asiatic scourge. Happily, stalwart measures of quarantine, isolation, water-supply purification, and the like, have driven the cholera back to oriental confines where such administrative precautions are non-existent. But whether or not the Pasteur cholera cure has actual merit, the world at large has not accepted it; and no great community, so far as we can learn, has yet pretended to rely upon it. In the United States, Great Britain, France, and Germany, the cholera is a disease whose actual ravages and possible dangers dwindle into insignificance in comparison with so ever-present and frightful a scourge as diphtheria. This dreaded malady is no respecter of social classes. It invades the palace of the millionaire in almost as high a percentage of cases as the hovel or the crowded tenement house. It defies the best medical skill, so that the grim records show that

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theria mortality from more than fifty per cent. to about ten. If the Koch consumption cure and the Pasteur cholera cure have as yet come short of the immediate practical results that were anticipated for them, it does not follow by any means that these distinguished bacteriologists were not upon the right track, nor is there on that account any greater reason for skepticism about the diphtheria cure. The New York Board of Health, which commands scientific talent of a high order, has undertaken the experiment of preparing the anti-toxine serum at much expense and with great care. The health authorities of Boston have taken similar action. We have good reason therefore to believe that official tests in these two great American cities will within a few months give us a conclusive demonstration of the question

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whether or not the much-discussed new diphtheria cure is a practical and effective remedy.

The Decline of Certain Old-fashioned Maladies.

While small-pox has never been suppressed beyond the possibility of its re-appearance with occasional threats of epidemic virulence, there is to-day very little fear of it in highly civilized countries. Compulsory vaccination is in many lands one of the most firmly established features of health administration. Aged men and women remember well how fearful and how imminent a scourge the small-pox was in their youth. Nowadays, in the homes of well-to-do people, small-pox is regarded as practically an extinct malady; yet few indeed are the families whose records of two or three generations ago do not contain instances of death by small-pox. There is an anti-vaccination movement in England, with international affiliations, whose adherents maintain with some ingenuity and with intense conviction that the disappearance of small-pox has been retarded rather than assisted by vaccination, and that the decline of what a few decades ago was the commonest and most fatal of infectious diseases has been due simply to general sanitary progress. They attribute the change to our improved arrangements for isolation and disinfection, and to what may be termed the general triumph of private and public cleanliness. It is possible that they are right, although the great consensus of scientific authority is on the side of vaccination;

and the public vaccinator is as well established an official as any other governmental servant. In one respect the friends and the enemies of vaccination occupy common ground. Both parties are solidly committed to the doctrine that the health and wellbeing of the community are enormously dependent upon the effectiveness of public administration. The anti-vaccinationists stand for public sanitary cleansing services of the most perfect description; for prompt and thorough-going detection and isolation by boards of health or municipal authorities of all cases of communicable disease; for all such services as that of disinfection, and for such restrictions and rules in slums and tenement house districts as will diminish the dangers that arise from overcrowding, from domestic uncleanliness, and from insanitary housing conditions. Those who believe in compulsory and official vaccination simply go one long step further in the direction of that public invasion of what was once considered the sacred domain of the individual, which has inevitably marked every advance in modern health services. If the new diphtheria cure. should prove to be as valuable as its advocates are confident that it will, we may expect that its application, particularly in the tenement districts of crowded cities, will fall to the lot of the health authorities. Typhoid fever is one of the great scourges which, almost solely through improved public measures, has been reduced to a position far less important than it once occupied.

Whereas in European cities the batThe New Fight Against tle of the municipal and health auChildren's Diseases. thorities, so far as epidemics were concerned, was until a few years ago waged chiefly against small-pox, typhus, and occasional outbreaks of cholera, it is now considered that the victory has in the main been won against these bolder and grosser enemies of the race, and the conflict has set in against the diseases which are hostile to child life. Scarlet fever and diphtheria are the chief of these children's maladies, with measles as a less dreaded but extremely mischievous third. Thus far the weapons have been mainly those of vigilant, never-ceasing inspection, immediate isolation, disinfection through the aid of highly organized official disinfecting staffs, and in general the sharp blocking up of those avenues through which infection is most likely to be communicated. The difficulty of perfect isolation in tenement houses has led to the great extension of public hospitals for the reception of children ill with diphtheria, scarlet fever and measles. The great objects of the administrators of the public health system are (1) to abolish the plague spots which are the sources of infection, and (2) when infection has appeared to prevent its spread. This of course is the sound policy to be pursued. But, (3) and concurrently, every possible effort is made to save the lives of the poor children actually seized with infectious maladies. If we are rightly informed with regard to the anti-toxine cure for diphtheria, its application is to be beneficial both as a preventive against attack and also, where not previously applied, as a remedy to be administered in the early stages of the disease. Its immediate interest naturally lies in its use as a remedy. A considerable amount of experience, tested in the light of comparative statistics, would be necessary in order to show the preventive value of such treatment, and even then it would be difficult to distribute the honors between a remedial specific of this kind and a generally efficient sanitary administration. As in the case of vaccination, no one could ever tell us conclusively what part the particular treatment has played, and what part improved conditions of public and private cleanliness have had in the gratifying diminution of the malady.

Public

Whatever then should prove to be the merits Health of this alleged cure for diphtheria, there can Services. be no mistake in the policy of public cleanliness and of constantly improved health administra tion. Our American cities come short of their European contemporaries in most points of municipal organization and service. Fortunately, in the matter of public health work we have less to be ashamed of than in almost any other particular. There have been some scandals in the health department of New York City, but there has been very much to commend. All that is needed to bring our American municipal health administration up to a point of scientific and practical efficiency equal to that of the very best managed foreign cities, is a reform of our municipal government in general respects. The

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DR. CYRUS EDSON, OF NEW YORK.

have aroused the slumbering conscience of the wellto-do classes to the fact that the death-rate among families living in one or two rooms of tenement houses is enormously greater than the average death rate for the whole community, and that the housing question is the most serious and vital of all the questions that have to do with the improvement of the industrial, social, and moral condition of city populations. In consequence, a vast amount of attention has been given to various phases of the problem. Stringent regulations have been adopted in most foreign cities to prevent the future construction of badly planned and unhealthy tenements, and houseto-house inspection has been organized to enforce the rules against overcrowding and insanitary conditions. In many instances the public authorities have bought up, condemned and destroyed considerable areas of slum property in order to get rid of narrow and vicious street systems, and to secure complete reconstruction where no mere renovation could avail

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