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might be of service in determining the to determine the presence of two verpresentation, but when it is remem- tebral columns or two fetal heads, thus bered that in these cases presentation making the diagnosis settled. changes from time to time, thus de- In feigned pregnancy the rays would creasing the value of one examination. be of value in showing the absence In women with fat abdominal walls, of a fetus, providing the examination some good is derived from an X-ray were made at a time when if there examination, but even in these cases were a fetus it could be determined by careful palpation usually yields satis- this means. But palpation or palpation factory results.

in conjunction with anaesthesia would In ectopic pregnancy there seems to be more simple and wholly reliable. be no advantage gained by their use. Walsham's experiments, which went It would be very difficult to determine to show that in the case of still birth whether the fetus was outside or in- the lungs were opaque to the ray, may side the uterine wall.

delegate to this method medico-legal In twin pregnancy the author feels importance, but the older practice of that there is a field for this method floating the lungs in water is more of examination, as it might be possible simple and equally trustworthy.

Original

Articles.

Preventive Medicine,
By Edward H. McIntyre, M. D,, Minneapolis.

were

This branch of medical science has the two schools; to systematize the received such an impetus since the preventive part of medicine; to bring ral nature of many diseases has be- the preventive entirely in accord with come known that many regard it as of the remedial; to let the world know the recent origin. History shows, how- inter-relationship which exists between ever, that in a very early time public the two parts and by the sympathy of health was made a subject of legisla- action, based upon knowledge, to ention, and that very early the principles able every man and woman to assist in of hygiene were practiced by the Egyp- that part which tends towards preventians and Hebrews. The Greeks and tion. It has been a long and difficult the Romans paid particular attention task to trace the diseases from their into physical culture, and general sani- cipiency, to seek out the conditions tary measures

introduced into from which they originate, and finally Athens at a very early period of her to point out means by which these history. It was not, however, till the affections can be avoided or combatted. beginning of the last century that the The working out of these problems in idea that disease is more or less pre- Preventive Medicine has required of ventible gained firm hold upon the its servants analytical power of the minds of the scientists and the more in- most painstaking type in conjunction telligent people. Then as the nature with a practical design as to the availof the various diseases became studied, ability of the knowledge. there grew along with the progress of It is in the field of infectious diseases the school for cure, weak efforts at pre- that the principles of preventive medivention. The results of the former cine have won their victories. The school were so much more brilliant eradication of these so-called preventhat the workers in other fields were tive diseases is the highest aim of scienfewer and less enthusiastic. At the tific medicine to-day. The public must present time, when the origin of dis

be educated regarding the nature of ease is better understood, there is a these diseases, in order that it may cotendency to harmony and unity in operate with the sanitarians in effecttheir progress.

ing a decrease of the prevalence of When investigators began to learn these suppressible diseases. and study the antecedents of the phe- It is a lamentable fact that the pracnomena of disease, and the reasons tical application of the truths of scienwhy disease existed at all, then there tific medicine is deeply inferior to what sprang into light those elements which it should be. When it is known that were essential to the formation of a tuberculosis, typhoid fever, smallpox new and powerful principle, that of the

that of the and dysentery are all preventive, and prevention of disease.

The grand are permitted to devastate humanity, work of this era has been to reconcile a serious reflection is cast upon the general intelligence of the people.

the people. ing the cholera epidemic in 1872-3, and Higher medical education and a sup- the yellow fever epidemic in 1878, napression of quackery must precede a tional and international quarantine syssuccessful dissemination of facts

tems sprang up which involved the among the laity regarding infectious inspection of vessels and their passendiseases.

gers, isolation of the sick, and the treatSanitary Conditions.

ment and detention of suspected cases. Since the European invasion of

These systems have been adequate to a cholera in 1830, the English towns

certain degree in enabling us to keep which had been visited by this disease

these diseases from our shores. and those fearing similar scourges, in

Water Supply. view of their sad experiences, were No preventive measure in the field willing to institute sanitary reforms. of medicine, not underestimating the Sewers, public water supplies, and a brilliant achievements of Jenner and general sanitary condition of the home Lister, have been wrought with such became the order of the day, and with magnificent results as have the efforts it the birth of modern hygiene and sani- which have been put forth in the last tation. The example set forth by Eng- half century to improve the water supland was followed by all civilized peo- ply of the world. There is plenty of ples. Efforts at sanitation were dem- evidence showing that the introduction onstrated in the Crimean war, the civil of sewers and public water systems in war, and lastly in the Spanish-Ameri- a number of cities has been accomcan and South African wars.

panied by a decrease of almost fifty per The United States were not slow in cent in mortality. The good effects are adopting sanitary measures and insti- plainly shown in the great decrease of tuting laws governing public health. typhoid fever, cholera, dysentery and The invasion of cholera in 1832 and the tuberculosis. The vital statistics of epidemic of 1848-9, here as in Europe, Great Britain are sufficient proof of aroused public interest in sanitary re- the great good derived from an adeform. Finally health boards sprang quate and pure water supply. The morinto existence, which adopted measures tality rate at Salisbury has been reto deal with infectious diseases; and for duced from 40 to 16 per thousand; at the sanitary inspection of the food sup- Dover from 28 to 14 per thousand; at ply, schools, public institutions and

Rugby from 24 to 10 per thousand; at tenements. Registration of vital stat- Croydon, 28 to 15 per thousand; at istics, supervision of burials, water Vatlock, 18 to 9 per thousand. It is a supply, sewerage disposition, etc., fol

common expression that every sewered lowed.

city shows a lessened typhoid mortalVoluntary organizations such as the ity subsequent to the introduction of American Public Health Association, sewers, and that the typhoid fatality is Section on State Medicine of the Amer- always higher in places supplied with ican Medical Association, the Climato

privy pits and box privies than in lological Association, and the American calities where houses have sewer conSanitary Council, and numerous other nections. The only explanation is, of organizations made impressions upon course, that sewers carry away the inthe public mind which have resulted in fectious material which would other numerous sanitary reforms. Follow- wise contaminate the soil.

The number of towns in 1800 in the lution of the streams, one city being a United States having a public water source of another's contamination. It supply was only sixteen, supplying is estimated that no fewer than 35,000 about 2.8 per cent of the existing popu- deaths occurred last year from typhoid lation ; in 1850 there were eighty-three fever alone. The average duration of public water works, supplying about this disease is thirty days. If we calten per cent of the population; in 1897 culate that on an average $1.00 per there were 3,196, supplying about day is expended for care, treatment forty-one per cent of the census popula- and loss of work, and that the value tion. There is conclusive evidence, of a human life is $5,000, we have a here and abroad, pointing to the fact total loss in the United States of $105,that there has been a great decrease in 000,000 per annum from one of the sodeaths from enteric and other diseases

called preventible diseases. when a pure water supply was substi- Congress appropriated $40,000 to extuted for a contaminated one. For terminate the gypsy moth, but Mr. Barexample, the typhoid fever death rate thold's bill for the appointment of a for Boston from 1846 to 1849 was still commission to look after river pollution 17.4 per ten thousand; in 1890-2 it had was defeated. Such is the attitude of fallen to 3.2 per ten thousand, the city legislation towards' this subject. The in the meantime having expended $25,- pollution of a stream by an individual 000,000 on its water supply. The ty- or community when said stream is a phoid fever death rate in Chicago in source of water supply for the same or 1890-2 averaged 12.5 per ten thousand. another community, is an outrage and After improving the water supply it should be legally considered as such fell at every step of its improvement, Irrigation provides a means for sewtill last year it was only 1.9 per ten age disposal, but when for any reason thousand, a total reduction of 84.8 per this can not be instituted, chemical cent during the decade. London, Ber- means should be used to render sewage lin, Vienna and Munich present similar inert. At the present time over one statistics.

hundred communities have established In 1893, 41 per cent of our population means to rid themselves of sewage, lived in towns having public water there being eighty irrigation plants, supply, and only 28.7 per cent in and about twenty localities employing sewered towns. It is evident from this chemical means. data that the municipal authorities While the public water supply has failed to recognize the fact that public been a great boon in the reduction of water supply and a sewer system must mortality, still, in many cases,

the go hand in hand. The neglect of the source of this supply is decidedly unlatter means sure pollution of soil and safe. The waters are often rendered rivers, in the train of which follows impure and dangerous to life by draincertain disaster.

age from cultivated fields where the The Marine Hospital reports show rains wash the fertilizers into the that cholera, typhoid fever and dysen- streams, and often, too, pollution from tery are more prevalent in those towns shops and factories complicate the situsituated along the great rivers of this ation. The advice furnished by the country, it being at once apparent city to boil the water effects in reality that such a condition is due to the pol- no purification of it, as it is too often

to

so carelessly done that the dangerous while being transported and delivered germs remain undisturbed. The do- to the consumer; (3) after the milk mestic filter is an article only too often is in the hands of the consumer. To a dangerous device, well adapted to avoid such contamination it is necesthe breeding and dissemination of dis- sary to secure intelligent supervision case. The soluble poisons pass through over the entire milk industry, with due and bacteria collect in the filter, multi- attention to its source and the methods ply and are the source of continuous in vogue in its delivery. In view of infection. The efficacy of hard and the immensity of this traffic, its supermineral waters is often exaggerated, vision becomes an important obligawhile indeed they even contribute as tion. It is said that 1,250,000 quarts a cause for premature old age and de- of milk are consumed in ew York cay. The inorganic minerals in the city daily. That would

mean milk water are absorbed and deposited in the from 155,000 cows, and the employtissues, causing sclerosis and loss of ment of 35,000 milkmen.. It can be elasticity. The purest spring waters readily appreciated from these figures and the most popular ones are those that the liability of milk infection is which come nearest, in analysis, to very great. In regard to diseases distilled water. The only absolutely affecting the cow, tuberculosis is the pure water for drinking and culinary most important. In this connection. purposes is the latter; it is the greatest comes up the question of the communisolvent and rids the body of excreta cability of bovine tuberculosis to humore thoroughly and tends man beings, which will have to be left longevity.

at the present timę unanswered. DiFood and Food Legislation.

gestive troubles often affect the cattle From the cradle to the grave the

during periods of drouth when they

are forced to feed upon weeds and question "What to eat” faces human

plants owing to the scarcity of grass. ity. It is the striking fact that onetenth of all infants do not live a month,

It is very well known that such con

ditions in the health of cattle affect the and that one-third do not reach the

dairy products. Not only should the age of three months. This is due, in a

food of cows be of the best, but the large part, to digestive disorders grow

condition of the stables, which are ofing out of improper food. It is a scientific truth that breast feeding is supe

ten disastrously unhygienic, should be rior to artificial feeding, but the for

carefully inspected. Contamination by

the hands of milkmen need only be mer must be suspended in many cases

mentioned. Scarlet fever, diphtheria and resort had to the latter. Cow's milk, plain or modified, has been the

and typhoid fever occur by means of

milk so contaminated, or result from most popular substitute, but it is often unsatisfactory and indeed positively rious preservatives, borax, salicylates

the addition of impure water. The vadangerous. The consideration of the methods by which cow's milk becomes

and paraldyhide, are pernicious. unfit for use and contaminated, in- The multiplication of bacteria in volve: (1) Diseases affecting the cow, milk is stupendously rapid. In very her food and surroundings; (2) con- good milk fresh from the cow there tamination of the milk while it is pre- are usually 3,000 or 4,000 bacteria per pared for shipment at the dairy, and cubic centimeter, while milk such as

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