THE ADDRESS IN HYGIENE.

BY BENJAMIN LEE, A.M., M.D., PH.D. UNIV. PENN.,

OF PHILADELPHIA.

By a fortunate accident, the Address which I had the honor to deliver before the Society at its meeting of the present year, under the title of "Pittsburgh's Lesson," has been lost. I say a fortunate accident, because in the mean time Dr. Snively, the Registrar of Vital Statistics of that city, has been able to investigate more thoroughly the history and circumstances of the violent epidemic of Diphtheria which prevailed there during the eight months ending March 31, 1878, and to trace with greater precision than I was then able to do, even with his kind assistance, the direct relationship of causation which certain palpable insanitary conditions then existing bore to the outbreak.

A better text from which to preach a sanitary sermon no hygienist could have desired. Following the hint of Shakspeare's sagacious observer who found "tongues in trees, sermons in stones, books in the running brooks, and good in everything," it was an easy matter to read a homily from the four hundred little white headstones which marked four hundred new-made graves on the beautiful hillside above the bank of the rushing river, just outside the city; it required little imagination to hear the leaves whispering together in the night wind a sad requiem over those four hundred little mounds, green with the grass of their first summer; and no imagination whatever to perceive that beneath our feet, as we walked the streets of that busy town, were running, through tortuous subterranean courses, noxious streams, whose pestilential gases would prove, as they had proved, death-angels to many a household. The "good" which we were to look for here was to be found, in a fresh opportunity to educate the public mind and quicken the official conscience in regard to the sin of filthiness.

I felt that no apology was needed to the Society whose guests we were for thus calling attention to the shortcomings of their civic authorities, as I knew that its members had themselves made every

effort to give publicity to the unhappy facts, and were anxious that they should be utilized in the interest of science and humanity. I offered no apology on the other hand to this Society for making the freest possible use of the material generously afforded me by Dr. Snively; for I felt sure that the information which he had collected, arranged in the light of his knowledge of time, circumstance, and place would be a more powerful argument in favor of scientific sanitary engi neering than any that I could frame. The mind that can carefully peruse his plain recital, and consider it in connection with the excellent map which he has been good enough to furnish me to illustrate it, and fail to be convinced that sewer-gas will cause Diphtheria, could not comprehend the simplest proposition in mathematics. The circumstances which give this epidemic its especial importance as an educator and an illustration are its intensity, the rapidity of its rise, its restricted localization, and the proved existence of insanitary conditions together with unusual meteorological exciting

causes.

Sanitarians are often perplexed in their efforts to follow up a chain of evidence, by finding this or that link missing, which, although not needed to satisfy themselves, is essential to convince an unbeliever. In this case none are wanting.

Its intensity may be appreciated when I say that the city of Philadelphia, with a population six times as large, has never had so many deaths from this disease within a corresponding space of time.

As to the rapidity of its rise, its mortality ran up from zero in June to ninety-two in August, and two hundred and sixty-seven in October.

For such a startling increase in the prevalence of a single disease some remarkable cause must have existed. The Board of Health set itself to work to discover this cause and if possible to counteract it. The thoroughness of their investigation might well be imitated in some larger centres of population, in which equally combustible elements are only awaiting the spark which shall kindle them into a wide-spread conflagration. "Except ye reform ye shall all likewise perish."

As to the local conditions, distribution of the disease, and exciting causes, I now gladly allow Dr. Snively to speak.

"During the seven months, immediately preceding the outbreak, there were certified from widely-separated and remote parts of the city, only 35 deaths from diphtheria, distributed according to season as follows:

"January, 9; February, 3; March, 4; April, 3; May, 5; June, 3;

and July, 8. These were distributed topographically as follows: East-end Wards, 8; Old City Wards, 12; South Side Wards, 15. Of the 15 deaths which occurred upon the South Side, but four were located in what we may appropriately designate (in the light of subsequent events) as the infected district, viz., These portions of the Twenty-sixth, Twenty-seventh, Twenty-eighth, and Twentyninth Wards, located contiguous to, or drained by, the Washington Street and the Twentieth Street sewers. The record for the month of August shows 61 deaths, of which number 43 occurred in the infected district, while of the 465 deaths which occurred during the eight months, from August 1, 1877, to April 1, 1878, 174 were located within the limits of the infected district.

"The territory to which I have applied this title is ninety acres in extent and triangular in shape, being bounded by Carson Street, Twenty-first Street, and the base of the hill which rises abruptly to an average height of 450 feet above low-water mark in the river. Carson Street, which may be considered to represent the average level of the district, is 60 feet above low-water mark. Owing to the fact that the streets running parallel with the river, are, as a rule, exceedingly level, the sewers which traverse them are of very low grade.

"In this district, during the month of August, 1877, diphtheria suddenly began to prevail in a manner to attract attention, and in a very short time threatened to assume the proportions of an epidemic. As previously stated, the deaths in this district during the first month of the outbreak numbered 43. Estimating one death to every five cases there must have occurred to produce such a result over 200 cases.

"The evidence is strongly presumptive, that in the sewers, particularly the one traversing Washington Strect, in which a solid mass of filth from one to three feet in depth had accumulated, the specific poison, or whatever you choose to call it, which produces the disease known as diphtheria, had found a lodgment and a favorable soil for its development and multiplication. To the local sewers, undoubtedly, was due the fact that the disease selected this district as its habitat, and from this locality as a centre, radiated, presumably by virtue of its contagious properties, in every di rection.

"The first cases occurred in immediate proximity to the Washington Street sewer. This sewer including its branches is a little over a mile and a half in length. That portion of it running from Tenth to Seventeenth Street was built in 1851. In 1866 it was extended to the river. Beginning at the foot of Eighth Street, its