tain a variable quantity of ammonia and other nitrogenous or albuminous substances, supposed to be derived from the decomposition of organic matter, and by many suspected to have important etiological relations with such epidemics as cholera, yellow fever, etc. These substances are chemically more or less antagonistic to the active oxidizers represented by hydrogen peroxide and ozone. During the past year, Prof. Remsen, of the Johns Hopkins University, at the solicitation of the National Board of Health, undertook a series of investigations to ascertain the best method of determining the presence and relative quantity of organic constituents in the atmosphere, the results of which were published in the National Board of Health Bulletin for September 11, 1880. From this valuable paper we learn, first, that there is generally an appreciable quantity of such organic products present in the atmosphere; second, that their relative quantity varies much in different times and places; and third, that such apparatus can be devised as will enable the skilful manipulator to determine and record the relative quantity with sufficient accuracy for scientific and sanitary purposes. It is apparent, that if we could add to the ordinary meteorological records now being kept in all parts of our country, a daily record of the relative quantity of both active oxidizers and of organic unoxidized constituents, it would render our knowledge of atmospheric conditions much more complete, and enable us to see with much greater distinctness the actual connection between such conditions and the prevalence of diseases, both endemic and epidemic. To avoid unnecessary expense, the number of localities in which the additional observations are to be made might be limited, and yet so selected as to represent all important geographical divisions of the country, and also include large cities and rural places. For instance, the eastern or Atlantic border of the country could be represented by Boston, Philadelphia, or Baltimore and Charleston; the great interior valley by Chicago, St. Louis, and New Orleans; the Pacific slope by San Francisco; the mountain district by Denver; and the rural sanitary resorts by Aiken, S. C., and Waukesha, Wis. In all, or nearly all of these the usual meteorological records in regard to temperature, moisture, atmospheric currents, barometric pressure, rainfall, clear and cloudy days, etc., are already reliably kept. The expense of furnishing one or more competent persons in such place with the materials for testing and recording the relative proportion of active oxidizing agents in the air each morning and evening would be small. The principal expense would be in furnishing the materials. and apparatus for determining the ammoniacal and albuminoid organic products as recommended by Prof. Remsen, and securing the service of a practical chemist in each place competent to do the work reliably. There would be no difficulty in securing an ample number of active practitioners in each place to keep reliable records of the date of beginning of all acute diseases coming under their observation, and the only expense involved would be for blanks on which to make their returns. If, after due consideration, this Association should deem it wise to spend a part of its time, money, and thought in the work of selecting and, through committees of its own, superintending the execution of important permanent lines of observation, experiment, and records, the analyzed results of which should be presented at each annual meeting for discussion and permanent record in its Transactions, your committee are of the opinion that it would do a hundred fold more for the actual advancement of medical science than it can do either by offering prizes, or by relying upon volunteer papers and the compilations called reports of committees, as has been done in the past. If, in addition to this, each Section of the Association would select, at the annual meeting, a series of questions for discussion at the next annual meeting, such as would be calculated to direct the attention of members, and cause them to note their observations in their many localities during the year, the number, variety, and value of the facts that would be elicited in the discussions of the questions, would be of far greater value than to spend all the time in listening to the titles or abstracts of papers, fourfifths of which are mere compilations on the results of fragmentary and incomplete investigations. Such a change as here proposed would result in greatly reducing the size of our annual volume of Transactions, but its value would be proportionately increased. Aside from all this, however, it must be remembered that there are many problems in medicine, especially in the departments of etiology, sanitation, and therapeutics, that cannot be solved without the co-operation of a considerable number of observers in different localities and through a series of years. On this point Prof. Remsen, at the close of the paper to which we have already referred, well says: "A single individual can do little more than point out the way in which results may be reached, and clear the road for advances. It is only when health departments in a great many places are impressed with the importance of such subtle examinations as those of the air, and provide the means for making them through long periods, that our knowledge will be materially increased on the subject treated in this report. When records, made year after year by competent men using the best methods, are in our possession, then probably conclusions of great importance for sanitary science will be drawn.” What he says here in regard to health departments applies with greater emphasis to this permanently established National Association with its affiliated State and local societies extending into every State and important district within the limits of our country. And what he says in reference to the value of conclusions to sanitary science applies with equal force to the important departments of etiology, prophylaxis, and therapeutics. If it shall be said that there is not enough money in the treasury of this Association to pay for such a continuous series of investigations as recommended in this report, your committee respectfully suggest that the sum in future be increased by lessening the bulk, and consequently the cost, of the publication of the Transactions and papers, by diminishing the amount offered for prizes, and, if need be, by diminishing also the annual honorarium to the Permanent Secretary. We are satisfied, however, that the very important series of investigations contemplated in this report can be successfully inaugurated under the supervision of a judicious committee. without in any degree embarrassing the treasury of the society. As already stated, the materials for the required number of observers to determine the relative proportion of active oxidizing agents in the air would be small. The expense of furnishing circulars and blanks for the records in the same places of the prevalence of disease would be still less. The principal expense and difficulty would be in furnishing the materials and enlisting the services of competent persons to determine the existence and relative quantity of the organic unoxidized ingredients in the air after the manner of Prof. Remsen. But the committee might properly develop this part of the work gradually, by establishing this branch of the work at only one or two of the most feasible stations selected the first year, and extending it to others from year to year, as means and experience should justify. With these views, your Committee would close their report with the following distinct recommendations: 1st. That a committee of five be appointed by the President of this Association, to be called the Standing Committee on Atmospheric Conditions and their Relations to the Prevalence of Disease. 2d. That said Committee be authorized to select such representative plans as will best indicate the atmospheric conditions in the more important climatic and sanitary districts of the United States (the number the first year to be not less than six nor more than twelve), and establish therein the means for continuous observation and record of all appreciable conditions of the atmosphere according to the most approved methods, and of the origin and prevalence of all acute diseases. 3d. That in determining the ozone and other oxidizing elements of the atmosphere, the Committee require the use of the thallium paper as prepared by Schöne, it being less influenced by moisture and other accidental coincident conditions, and sufficiently sensitive for all practical purposes; and for determining the presence and relation generally of ammonia, albuminoid ammonia, and other organic products, they use the pumice stone method recommended by Prof. Ira Remsen, in his recent report to the National Board of Health. 4th. That the Committee require a full and detailed report of the results of the works done at each station to be made semiannually, on the first days of July and January of each year; and the Committee shall carefully analyze these detailed reports. and present a summary or full abstract of the same at each annual meeting of this Association. 5th. That the Committee, through its chairman, be authorized to draw on the Treasurer of this Association for such sums as may be found necessary for the proper execution of the work assigned to it, the aggregate amount of which shall not exceed five hundred dollars during the ensuing year; and a detailed report of all sums drawn and expenditures made, must be presented to the next annual meeting of the Association. In submitting the foregoing report your Committee are not unmindful of the magnitude of the work proposed, and of the VOL. XXXII.-32 difficulties that will be encountered in its presentation. But if it is undertaken and presented with prudence and caution combined with persevering industry, much aid may be obtained from the local medical societies and boards of health, and results of great value will be obtained, that, from the nature of the problems involved, cannot be obtained without such combined action of many working on parallel lines under a uniform supervision. And should the foregoing recommendations meet your approval, it will inaugurate a change in medical society work by substituting, in part at least, carefully devised plans for continuous investigations for adding to the stock of medical knowledge and establishing more complete methods, instead of depending wholly on individual and fragmentary contributions, and will thereby greatly enhance the value of social organizations in the profession. All of which is respectfully submitted, N. S. DAVIS, J. M. TONER, NOTE. Drs. S. M. Bemis and W. H. Geddings, the other members of the Committee, not being here, have not had opportunity to sign the report.-N. S. DAVIS. |