ZYMOTIC DISEASES 
Considered xvitfi Reference to tfieir 
Cause, Extent and Prevention. 
BY 
R. FRENCH STONE, M. D., 
INDIANAPOLIS. 
Reprinted from the Report of Indiana State Board of Health. 
WM B. BURFORD, PRINTER AND BINDER. ZYMOTIC! DISEASES CONSIDERED WITH REFERENCE TO 
THEIR CAUSE, EXTENT AND PREVENTION. 
R. FRENCH STON'D, M. D., INDIANAPOLIS. 
Zymotic disease has been defined by our leading medical authorities as any 
epidemic, endemic, contagious or sporadic affection which is produced by some 
morbific principle acting on the system like a ferment. It is now generally con- 
ceded that the peculiar and mysterious process of zymosis acting presumably upon 
the blood causes profound changes in the system, and produces widespread con- 
stitutional affections among the human race throughout the world. We have two 
theories in regard to tire initial factors of the zymotic process. The one which 
seems to be the most generally believed in is known as the cryptogamic or bacterian 
method of development. But recent speculation and the alleged discoveries as to 
the origin of certain specific diseases in certain minute vegetable organisms is still 
unproved, and has no basis except the barren and absurd analogy that such dis- 
eases may be propagated like plants or animals. It is a theory which assumes 
that disease is an entity, and no matter how powerful are the predisposing causes 
of disease, or how susceptible individuals are to the invasion of disease, it can not 
be established until a certain vegetable organism has gained entrance from without 
the system, and that the character of disease is then determined by the form of the 
vegetable parasite which may then be discovered. In this connection it is fair to 
state that while the theory of the mycrophytic origin of specific diseases has met 
with a widespread popularity, it promises to be of brief duration. It has failed to 
meet the indorsement of many of the leading medical men throughout the world, 
and in fact an earnest skepticism prevails among many prominent medical sci- 
entists as to the real significance of micrococci, bacilli, etc. Their existence in 
the blood at the outset of disease is denied. Their development a few hours after 
death is conceded, but their appearance is considered as the result of decomposi- 
tion, showing nothing as regards the specificity of constitutional infectious dis- 
ease. The bacillus tuberculosis of Koch, to which so much importance has re- 
cently been attached, is fast losing its diagnostic and prognostic significance, as it has 
been found in the non-tuberculous, affected with bronchitis, pneumonia, etc., and 
shows nothing as regards the specificity of disease, and thus far has led to only 
visionary and impracticable measures of sanitation or treatment. The discovery 
of the part played by certain vegetable parasitic organisms in the etiology of cer- 
tain local diseases is fully recognized; but the analagous explanation of the origin, 
development and transmission of constitutional infectious disease is to be rejected. 
The etiological influence of such agencies in the production of the latter class of 
maladies must soon or late be looked upon as a fallacy and a delusion, and which, 
by ignoring and supplanting the known factors of disease and the application of 
appropriate hygienic or curative measures of treatment, as deplorably misleading 
and impracticable. Viewing the causation of zymotic or constitutional infectious 
diseases from the standpoint of physiological perturbation, the writer believes that 
the only “germs” that should be recognized as an etiological factor in this class of 
maladies are those which are natural to and evolved from the animal body itself 
while subject to the influence of abnormal conditions, and that all others found 2 
(such as the various forms of vegetable organisms) are the effect and not the cause 
of disease. The reader will observe that while both the theories enumerated may 
be called “ germ theories,” that they are widely different in many respects. The 
first embodies the idea that the true disease germs are entirely foreign to the body, 
and received into it from without, in fact parasitic vegetable organisms. The 
second attempts to define the origin, development, progress and transmission of 
zymotic disease by means of living germinal cells, normal to and evolved from the 
animal body itself, and which, so far as facts of growth, movement and prolifera- 
tion are concerned, correspond in power and properties with the lymphoid cells, or 
white corpuscles of the blood, and which may, in fact, be considered as identical 
with these bodies. The published microscopical demonstrations and investigations 
of Beale, Sanderson, Bastian, Richardson and others, seem to render this the most 
reasonable and conclusive of all the so-called “germ ” theories hitherto promul- 
gated for the elucidation of the etiology and pathogenesis of this class of maladies. 
INFLUENCE OF “WASTE” PRODUCTS IN ZYMOTIC DISEASE. 
It is known that during the visitation of the severest epidemics of infectious 
disease, that the number attacked is, in reality, small in comparison to the entire 
population, and it is unquestionable that a large pi’oportion of those who are as 
fully exposed as those attacked by the disease do not become the subjects of it. It 
is evident that there must he some “predisposing condition” which determines 
zymotic action in the individuals who manifest its effects. This fact has been 
recognized by all who have at various times scientifically studied the etiology of 
epidemics, and it has been universally noted that unwholesome food, bad water 
and foul air have exerted a singular potency in favoring zymosis on individuals 
and communities. But the most common condition which all these agencies tend 
to produce, which experience has shown to be especially favorable to the develop- 
ment of zymotic disease, is the presence in the blood of the individual attacked of 
an excess of those decomposing, effete matters with which the circulating current is 
normally charged to a limited amount during their passage from the parts of the 
body in which they are poured into it to the excretory organs by which they are 
eliminated and cast forth. If the amount of these matters be limited to that 
which is being continually generated in the ordinary waste of the body, and if the 
great emunctories (the lungs, the liver, the intestinal glandulfe, the kidneys and 
the skin) all do their proper work, the products of that “ waste ” are drawn off 
from the blood current as fast as they are poured into it, so that the nutrient fluid 
is kept pure. But if, on the contrary, such decomposing matters be either abnor- 
mally introduced from without, or be generated in abnormal amount within the 
body, or if, on the other hand, the normal process of elimination be in any way 
obstructed; or if, still more, an abnormal excess of the one process concurs with 
deficient activity of the other, a rapid accumulation of these matters takes place 
in the blood, and then by providing the pabulum—nitrogenous matter in a decom- 
posing or readily decomposable state--supplies the very condition, both, in cause 
and effect, necessary to complete the cycle of morbific activity. Of the effectiveness 
of the introduction of putrescent organic matter, either in food, water or air, the 
cholera epidemics of former years afford the most ample proof “Of even more 
marked potency of the excessive generation of effete material within the body, we have a 
typical example in the extraordinary proclivity of puerperal female to suffer from 
the action of any septic poison to which she may be exposed.” Nothing can be 
plainer to the physiologist (says the late Dr. Carpenter, of London) than that the return of the uterus, after parturition to its non-pregnant condition, involves a 
rapid “ waste ” of its muscular substance, the products of which will be poured 
into the blood current far more rapidly than can be eliminated, this state being 
continued until the process is completed. The like condition exists in subjects of 
severe injuries and surgical operations, and not only do these exhibit a special pro- 
clivity to the action of specific poisons like scarlatina, but they show a peculiar 
liability to suffer from the ordinary septic poisons which have no effect upon the 
healthy carriers of them, erysipelas and adynamic “surgical fever” being then 
communicable. Excessive exertion, again, whether bodily or mental (such excess be- 
ing marked by the sense of fatigue), has always ranked among the most potent pre- 
disposing causes of zymotic disease, and its action is clearly traceable to the same 
source, the abnormally rapid “waste” of the tissues, whereby the blood current 
becomes unduly charged with the products of their disintegration. It is within 
the experience of every one that the sense of fatigue bears no constant proportion to 
the amount of exertion put forth, and that an unusually severe and prolonged 
strain may be sustained without its induction, when the excretory apparatus is 
stimulated to increased activity ; and, on the contrary, any obstruction to the elim- 
inating processes (as bad ventilation of the sleeping apartment), preventing the re- 
moval of “ waste products,” develops this sensation to a marked degree. There is 
strong reason, therefore, for regarding this feeling as indicative of the degree in 
which the blood is charged with the products of nervo-muscular “ wasted’ Ample evi- 
dence is afforded by army experience of the special liability of soldiers to zymotic 
diseases when on loug and fatiguing marches; and this especially in hot climates, 
where the activity of the respiratory process, being reduced by the high external 
temperature, the products of the “waste” tend to accumulate in the blood current. 
Of the tendency to zymotic diseases, induced by the accumulation of effete mat- 
ter consequent upon obstructed elimination, we have a marked example in that which 
results from overcrowding. “The effect of defective air supply is not only to reduce 
the quantity of carbonic acid got rid of by expiration, but also (which is probably 
of greater importance in relation to zymotic disease), to diminish the normal oxida- 
tion of those nitrogenous effete matters of which (when thus metamorphosed) it is 
the special function of the kidneys and the skin to eliminate.” The accumulation 
of these waste products within the body speedily makes itself manifest in the offens- 
iveness of the halitus of respiration (the condensation of the breath showing the 
presence of fetid matter), and the same condition existing in a marked degree with 
reference to the cutaneous, renal and intestinal excretions; and then, although 
there may be no introduction of decomposing matter into the body, or specially 
rapid internal production of it, the blood-current becomes as effectually charged 
with the pabulum of the zymotic poison as if this had been directly injected into it. 
There is one factor in zymosis which we fear is too much overlooked, even by 
the medical profession. We refer to the strong predisposition to zymotic diseases 
induced by intemperance. For the habitual presence of alcohol, a readily oxidizable 
hydrocarbon in the blood-current, undoubtedly diminishes the oxidation of the 
waste products of the system, and thus occasions their accumulation as effectually 
as from overcrowding; and this result will occur sooner in a hot than in a cold at- 
mosphere on account of the reduced activity of the respiratory process in the 
former. Where, again, the rate of “waste” is abnormally increased, as during 
protracted physical labor, the evil influence of alcoholic liquors is still more 
strongly manifested, and this will be again aggravated by overcrowding in ill-ven- 
tilated apartments. The connection between famine and pestilence is another argu- 
ment in favor of the fact that a state of general blood contamination is produced 4 
by the accumulation of the non-eliminated products of tissue metamorphosis. 
When people are suffering from starvation, the vital powers are too depressed to 
carry on the normal excretory functions. The fetid excretions from the skin, the 
rapid supervention of general putresence after death, and its manifestations even 
previously, and the frequent termination of life by colliquative diarrhea, all evi- 
dence the peculiar fitness of the body so conditioned for the development of a 
zymotic disease, or in augmenting the severity of the attack, as well as in lowering 
the healthy vigor of the body generally, by which individuals are rendered more 
easily affected by all those diseases to which they may be constitutionally liable. 
Where any form of malnutrition exists, whether resulting from imperfect per- 
formance of the primary digestive processes, producing ill-made blood, or from 
imperfect conversion of blood into tissue, there must be premature degeneration 
and augmented waste, and the rate of this.augmentation must tend to increase, if 
special attention be not given to the eliminating processes. The fundamental impor- 
tance of pure fresh air (as cool as can be borne) to the scrofulous subject, and the 
remarkable cures sometimes effected in individuals in whose lungs tubercular de- 
posits have already commenced, by the hazardous discipline of a hardy out-door 
life, can be easily explained upon sound physiological reasoning. “ When any 
serious malady has once established itself the degeneration of tissue, as shown by 
the rapid wasting of the body, takes place with augmented rapidity, and the neces- 
sity for the removal of its products is proportionately urgent. And this is no less 
important when the progress of the disease is stayed, for the purification of the 
blood from the contamination it has received is absolutely essential to the estab- 
lishment of those recuperative processes on which the final issue depends. Of the 
due elimination of the waste products their oxidation is the first and most funda- 
mentally important act, and of the direful consequences of past ignorance and 
neglect of this principle, evinced on a large scale in the overcrowding and bad ven- 
tilation of the tenement buildings, hospitals, poor houses and prisons, their records 
and sanitary investigation too surely demonstrate.” And even now our supervision 
is far from perfect in this particular, and we may safely affirm that not only the 
public but the medical profession have still much to learn as to the importance of 
pure air, and of wholesome food and drink, for the prevention as well as the cure of 
disease. On careful study of these circumstances we must admit that we are thus 
furnished with a scientific rationole for all that experience has taught as to the con- 
ditions for the development and spread of zymotic disease, which, by giving greater 
definiteness and consistency to medical doctrine, will afford a surer and more pos- 
itive basis for preventive hygiene, both public and individual. 
THE SPECIFIC CAUSES OF DISEASE. 
By specific causes are meant those which not only engender distinct diseases, but 
which are supposed to be the only causes of the maladies which follow their appli- 
cation respectively. But some affections, which belong to the zymotic class of 
diseases, which are ordinarily supposed to arise from a particular cause and from 
that alone, do in exceptional cases proceed from another cause. Thus several 
diseases, whose rule of propagation is from individual to individual, in exceptional 
cases appear to be spontaneously generated, and still more, upon the other hand, 
those which seem to be ot atmospheric origiu are at times undoubtedly dissemi- 
nated by contagion. Experience and observation teache that many diseases of 
this class are autogenetic and in no sense derived from an antecedent disease of 5 
the same kind. This view is especially applicable in regard to such an affection as 
erysipelas, which, although certainly contagious, is also on very good grounds 
judged to be generable, especially during certain states of lowered health, induced 
by renal disease and some other visceral affections. Though not so certainly-known 
it is by many deemed probable that a similar conclusion may he held in regard to 
more generally contagious affections, such as diphtheria, typhoid and typhus 
fever, scarlatina and cholera, which, though certainly contagious, may also be 
autogenetic, or developed from bad hygienic environments. Among zymotic 
diseases we might still further mention several others, which, although their ordi- 
nary or normal mode of spreading is by contagion, yet, beyond reasonable doubt, 
do sometimes arise spontaneously, and, notwithstanding the arbitrary assertions 
of the followers of Koch and Pasteur, this is probably the case with yellow fever, 
small-pox, gonorrhea and syphilis, and unquestionably so in regard to hydropho- 
bia and glanders, the latter diseases in fact being only of spontaneous origin in the 
lower animals, from which they are communicated to man. 
The so-called “specific ” cause of disease has ever been one of the most mysterious 
questions that the medical mind has attempted to explain. It is true that the 
advocates of the “ bacterian ” theory of diseases claim that certain scientists and 
microscopists, laboring and investigating outside the domain of medicine, have 
demonstrated the specific cause of three diseases, splenic and relapsing fever and 
tuberculosis, and while it is also true that two-thirds of the field of recent medical 
literature has been occupied in promulgating this visionary hypothesis of pseudo- 
medical men, and while notwithstanding the attempt is now being made to estab- 
lish and endow chairs or professorships in certain medical schools to further the 
interest of this novel doctrine, yet it should be said to the credit of the great body 
of our profession that it is not yet disposed to receive as admitted fact that which 
is as yet but simple conjecture. It is not yet disposed to cast aside all that long 
experience and observation has taught in regard to the many potent etiological 
factors in the development of zymotic disease, whether relating to those of a gen- 
eral predisposing character, such as seasons, climate, locality or the temperature, or 
hygrometric condition of the atmosphere, or the effluvia which it holds in suspen- 
sion, or those special predisposing causes relating to the temperament, constitution, 
occupation and habits of life, or hereditary influences to which the individual 
may be subjected, or those acquired predisposing causes having reference to food 
and drink, and those due to defective excretion, already enumerated, and proclaim 
to the world that all these influences are to be disregarded as inoperative, and that 
we have nothing to fear from this class of maladies so long as the system is not 
invaded by those low, self-multiplying vegetable organisms sometimes found in 
the depraved excretions of those subject to this class of diseases And its skepticism 
has been still further strengthened by the fact that such organisms have been found 
where no disease existed, and in some of the most infectious maladies their presence 
have not been demonstrated. And admitting the fact, says Bastian, that they have 
often or generally been seen in the morbid products and tissues of persons with 
zymotic disease, this would not by itself be a proof or nearly a proof that bacteria 
are causative of the morbid change, for obviously they might be mere attendants 
on the necrosis and decomposition of bodily material availing themselves of the 
process, just as certain insects would, to feed and multiply; and, as a matter of 
fact, where such organisms have been seen in morbid material, no direct proof can 
be given that the meaning of their presence is more than this. 6 
THE NATURE OE CONTAGION. 
It may be affirmed that we know nothing yet as to the specific poison, if we 
may so call it, which produces scarlatina, yellow fever, or cholera. The chemist 
can not detect in the atmosphere the causes of those infectious diseases which 
spread only through this medium, or chiefly in this way, nor can he with certainty 
detect any peculiar substance in the blood of the most pestilential malady other 
than the proliferation of its normal cell elements, or that due from the contamina- 
tion of defective excretions. Neither by the microscope nor by the minutest chem- 
ical analysis, can we distinguish the pus globule of small-pox or of syphilis from 
the most laudable pus of the surgeon. Nothing distinctive has yet been seen in 
the lymph of fresh vaccine fluid, nor has the most delicate tests as yet shown any- 
thing especially abnormal in the saliva of a rabid animal, by which specific dis- 
eases of this class are communicated so certainly and positively by direct contact. 
The materies morbi of these diseases in our present state of knowledge is still an 
unsettled problem. At all events, in the vast majority of infectious and contagious 
diseases, the poisons by which they are called into activity are as yet unseen and 
unknown. Spectroscopic examination of contagious fluids, anatomical alterations 
and microscopic and chemical study of the blood upon the living and the dead 
having furnished no notions sufficiently precise to draw any practical deductions, 
having furnished little or no positive evidence toward elucidating this question, it 
is not yet possible to say what is the essential constitution of “contagious matter,” or 
what is the intimate nature of the transforming power which the particle of such 
matter exercises on the particles which it infects. Nor are we able, by actual 
demonstration, to say that contagion is a material substance. We know that the 
ancients, in investigating the nature of heat, regarded it at first as a kind of subtle 
matter which insinuates itself into the substance of bodies, and resides there with 
greater or less manifestation of its presence;.but that heat is now regarded and 
proved by scientific observers to be not a material substance, but simply a condition 
of matter, a force, or a molecular motion, and from the nature of contagion, 
like the force caloric, appears to us to be a mere condition of matter, and not a 
material substance. And in that most interesting but most difficult and hitherto 
almost uninvestigated branch of chemical dynamics we are supposed to have our 
nearest clue to the scientific problems connected with the subject under considera- 
tion. Hence, any theory which tends toward a more' clear explanation of the 
rationale of these processes becomes a matter of great interest. The theory which 
we present assumes the identity of the physical and vital forces. The physical 
forces embrace magnetism, chemical affinity, heat, electricity, and motion. The 
so-called vital forces are, assimilation, combustion, animal heat, nerve force, and 
muscular contractility. All scientists now concede the correlation of the physical 
forces; that they are convertible the one into the other, and that force, like matter 
in any form, can neither be created nor destroyed, and as presented to us in the 
universe, they are both indestructible and inseperable, perpetually existing and 
unchanging in quantity yet ever changing in form. The ultimate nature of force, 
however, is the greatest mystery of nature, visible only in its effects as revealed to 
our senses. We can only judge of its presence by the peculiarity of its action and 
the effects which it produces. 
If we accept the teachings of modern science, all matter is the vehicle of 
change, motion the result of change, and force the cause of change. Life, as we 
understand it, depends upon the presence of a material substance operated upon 7 
by force resulting in movement, and the harmonious interaction of these condi- 
tions, when applied to the animal body, would not only constitute life, but health—- 
while its derangement would as surely eventuate in disease and death. According 
to the demonstrations and conclusions of modern investigators of physical science, 
the “vis viva," or life force, is simply the combined influence of this physical force 
which is constantly changing its form in the so-called vital processes, while its 
supply is maintained by the food we eat, the fluids we drink, and the air we breathe. 
Thus, for example, the nutrient fluid charged with oxygen is placed in an electro- 
positive; at the same time the tissues are in an electro-negative, or magnetic, con- 
dition, by which assimilation (or chemical affinity) is induced; this involves 
combustion, oxidation and molecular motion. Molecular motion is converted into 
(animal) heat, and heat is converted into (animal) electricity, or nerve force, and 
nerve force induces muscular contraction, or mechanical motion, which, in turn, 
serves to assist and perpetuate the operation of the other forces, in that it main- 
tains the respiratory function, contracts the heart and arteries, propelling the blood 
to all parts of the system, and thus supply tissue waste, equalize temperature and 
maintain the secretory and excretory functions of the body. Such are the different 
manifestations of the so-called vital forces, the normal and harmonious operations of 
which constitute life and health; but when perverted will not only occasion disease 
and disorganization, but death, either local or general, as the conditions may deter- 
mine. To illustrate: If the blood from any cause becomes contaminated or 
deficient in oxygen, the forces governing nutrition, such as assimilation and com- 
bustion, will be perverted in their operation, waste material, or materies morbi, will 
be developed, which may eventuate in morbific effects, such as malnutrition and 
disorganization of tissue of various degrees and varieties, according to the natural 
or acquired susceptibility of the subject; or the materies morbi thus accumulated 
may remain in a latent condition until equilibration is commenced by increased 
oxygenation, and then the increased oxidation augments the amount of animal 
heat within the body, causing fever, which may in its turn induce pathological lesions, 
which may vary in character with its intensity, ten degrees of which mark the dif- 
ference between life and death. Force can only manifest itself by molecular 
motion, but it may exist in two general forms, known as potential energy and 
actual energy. Force stored up in certain conditions of matter, as in the tension 
of the particles of an explosive compound, as nitro-glycerine, or in a combustible 
body, such as wood, coal, and food of animals, is called potential energy—that is, 
power capable of being liberated for the production of effects. But when the nitro- 
glycerine explodes, the fuel is burned, or the food is oxidized in the animal body, 
the force they contain is given out in the form of effects produced, and the potential 
energy becomes actual energy, or in animal bodies living force. Such we hold to 
be the nature of unoxygenized material in the blood, constituting materies morbi, in 
that it represents potential energy—becoming actual energy, producing morbid 
effects when subjected to zymotic action. 
Force acting upon different forms of material substance will manifest itself in 
different wavs— as chemical affinity, combustion, electricity, heat, etc. Also force 
in different forms acting upon the same material substance may give rise to a 
multiplicity of effects, as quantity and local conditions may determine. But force 
operating in a certain direction, producing certain results, lends to continue in that direction 
and in the production of the same results so long as conditions favorable to its action obtain; 
thus the molecular motion imparted to a conducting wire from a galvanic battery 
may continue for thousands of miles; a spark of fire may destroy a city, and so 
the smallest quantity of zymotic force which may be embodied in a mere trace of 8 
serum, derived from the blood in a state of change, and thus conve yed by means of 
its own elements, may set up the same morbid action in other individuals whenever 
their blood becomes of a suitable zymotic condition, and sometimes giving rise to 
our widest spread and most pestelential epidemics. It is the operation of this law 
that gives us the rationale of contagion, and which confirms the opinion that it is 
a phase of force and not an entity. But we find—as in the physical forces, so in 
the vital forces; as in the great laboratory of nature, so in the individual organism 
—that action is met by counter-action, and that force, however manifested, sooner 
or later tends to equilibration. For this reason galvanic batteries became exhaust- 
ed, fires must be fed with fuel, and zymosis ceases and disease ends in the infected 
individual and in communities when the material suitable for its action has been 
extinguished. Strictly speaking, therefore, contagion is a morbid influence, a per- 
turbation of vital functions, and does not imply the existence animated germs any 
more than that of any other vehicle, vital or otherwise, which may serve to convey 
zymotic action. The essence of contagion is not a material substance, but a phase 
of force, imponderable in its nature, as heat, light, or electricity, specific only so 
far as it naturally tends to operate in the same direction upon the blood of another 
individual, when it contains certain constituents identical in character with those 
upon which it has been operating in the blood of the infecting individual. And 
it appears reasonable that the “specific” or determining causes of infectious disease 
involve an acquired personal predisposition for their development, an essential 
condition of which is the accumulation of “waste” products—of azotized or un- 
oxygenized material within the blood due to defective excretion or other causes 
already mentioned, 'and if such material be retained in the system a sufficient length 
of time, or exist in a sufficient quantity, it may itself assume a state of change, or 
induce a condition of change in the normal cell elements of the blood and thus 
give rise to an autogenetic origin of disease, which, when of sufficient virulence, 
may reproduce the disease by contagion of zymosis in another individual, provided 
his blood is in a similar abnormal condition, which is likely to be the case when 
individuals and communities are alike subjected to the same general and special 
predisposing causes of disease. And it would seem possible that while the force 
zymosis generally induces disease identical to that from which it originates, it 
might yet establish a zymotic action sufficient to engender other diseases, and in 
case we assume the nature of zymotic force to be common to all of the infectious 
maladies, still its effects would differ as other factors might determine. Thus the 
degree of virulence and the types and varieties of infections would then depend 
upon the present condition of the individual, his powers of constitution, age, sus- 
ceptibility, weakened condition of certain organs or tissues from previous diseases 
or tolerance from like causes, as well as the character of the defective excretion, 
its degree and the impression it has made upon the nervous sj’stem and nutritive 
functions, and also the route or channel by which nature attempts its elimination 
as influenced by that elective attraction or repulsion which one tissue or part of 
the body may have in excess over another for materies morbi in the blood. And for 
these reasons it would be possible, with a common contagion or zymotic influence 
and a common blood contamination, for one individual to be attacked with one 
form of infectious disease, and one another during the prevalence of a special 
epidemic, and thus not only afford an explanation of the tendencies of certain 
maladies to diversify in their characters, as well as the frequent prevalence of 
different infectious diseases at the same time, and in the same locality, but also 
those of different types to occasionally blend and merge the one into the other, or 
develop complications in individual casts—facts observed, but not otherwise easily 
accounted for. 9 
Those who believe in the bacterian origin of infectious disease, tell us that a 
certain form of these organisms is required to act as the proximate cause of a cer- 
tain disease, but they have never yet explained why this is the case. The theory 
which the writer advocates and which has been more fully set forth in a recent 
publication (Elements of Modern Medicine), attempts to explain the specificity of 
disease upon physiological grounds. His conclusions are, that as the normal cell 
elements of the body become poisoned through defective excretion, it necessarily 
follows that the character of an infectious disease depends upon the variety or na- 
ture of that glandular excretion which is most defective; and hence it also follows 
that when those normal cell elements become poisoned by an excrementitious ma- 
terial which has accumulated in the blood, they are most prone to elimination 
through those glands whose defective function has produced the blood contamina- 
tion, and thus explains the glandular involvement of infectious disease, and that 
zymotic affections are propagated and determined or made “specific” in obedience 
to the natural law of elective attraction which one tissue or part of the body has 
over another for the normal germinal or tissue-building cells of the blood, on the 
one hand, and on that repellent force exercised by various excretory glands by means 
of which material unfit to serve the purpose of nutrition is eliminated from the 
system. Hence it necessarily follows that in any so called specific disease these 
embryonic cells for special tissues, now infected by the general toxic condition of 
the blood from “waste” material becoming unfit for assimilation, may yet remain 
living, organic germs, capable of proliferation or multiplication, and thus by their 
presence and final regressive metamorphosis or elimination, produce, in part at 
least, those lesions which characterize the particular forms of infectious disease. 
And should these semi-vitalized, normal germinal cells, subject to this morbid or 
zymotic influence or while undergoing this regressive change, be transplanted to an- 
other individual, whose blood is also contaminated with excrementitious material 
favorable for its continuance, similar phenomena and lesions are liable to be de- 
veloped as were present in the individual from whom these diseased germinal par- 
ticle's have been derived. These morbid cell elements charged with excrementi- 
tious material being still under the dominance of the natural laws of elective at- 
traction which apppopriates certain elements to certain tissues or parts of the 
body, or that normal repellent force peculiar to certain excretory glands, secure 
their deposition in those localities or ultimate elimination (if the patient survives) 
through those excretory organs and parts of the body iden'ical with those from 
which they have been derived. And thus again are stamped upon the disease its 
“ specific” characters. 
It is evident that if the above views be correct that the “ waste ” products consti- 
tuting the initial factor of the zymotic process, not only exerts poisonous influence 
upon the nutrient elements of the blood, but also upon the nerve centers as well, in 
consequence of which many diseases of this class are known to manifest a periodicity 
in their symptoms and their course, which seems to be in obedience to what ob- 
servation teaches concerning that general law of periodicity which regulitesall 
the vital movements. If we inquire into the causes of these periodical changes, 
we find reason to believe that they are in part dependent upon cyclical processes 
inherent in the system, and partly upon periodic agencies acting from without, or 
hat resulting from a combination of the two. With regard to the external agen- 
cies it is to be remembered how closely the periodical changes connected with the 
vital movements are linked to the periodic phenomena observed in nature at large. 
Thus, digestion and fasting, wakefulness and sleep, correspond with day and 
night, light and datkness, and its accompanying changes of temperature. It is 
known that vital activity is at its lowest between the hours of 1 and 3 a. m. After 3 10 
A. M. the activity increases, at first slowly, and then more quickly, until a maximum 
is reached between the hours of noon and 2 p.m. A progressive decline follows, 
rapid at first, slower as the evening draws on and falls into night, until the minimum 
again is reached between 1 and 3 A. M. These influences, of a periodical charac- 
ter in health, not only tend to invite or resist the invasion of disease at such times, 
but continue to exert their impression in morbid states of the system by intensify- 
ing disease at certain times and lessening its effects at others, either as the activity 
of the vital forces may be greater or their excitability diminished. Most, if not 
all, paroxysmal attacks of zymotic disease are probably due to the gradual accu- 
mulation of contaminating material in the blood from deficient excretion. This, in 
the so-called malarial affections, within a certain length of time, will “begin to 
exert a toxic influence upon the nerve centers, ordinarily producing rigor, fever 
and sweating, or culminating in some other eliminative action, and these morbid 
phenomena will be repeated at certain definite intervals corresponding with the 
rate of re-accumulation of the blood poison, and partly with the state of excitability 
of the nervous system. Reasoning from this standpoint, it is fair to assume that 
prophylactic or medicinal agents may act as anti-periodics in one of three ways: 
(1) by increasing the activity of the excretory functions, as by the use of emetics, 
cathartics or diaphoretics; (2) by blunting the excitability of the nervous cen- 
ters, by the use of narcotics given before the expected paroxysm, and (3) by brac- 
ing up the nervous system during the intervals of the paroxysms by the use of 
quinine, arsenic, and other excitant neurotics, until nature, assisted by other 
means, can have time to eliminate the matcries rnoi'bi, or else to enable the system 
to become tolerant to the toxic element in the blood, which exerts a causative in- 
fluence. It is evident, therefore, that the remedies of the first division are the only 
ones pathogenetic in character, the other being symptomatic, not specifics, not 
chemical antidotes to malarial infection, but their action is due to a physiological 
antagonism, valuable in that they act upon the nervous system in an, inverse 
sense to the morbid influence, and thus serve to annul its effects and counteract or 
prevent its more dangerous consequences. 
EXTENT OF ZYMOTIC DISEASE. 
The term zymotic has been admitted into standard medical nomenclature as con- 
veniently expressive of the elements or factors giving rise to many of the condi- 
tions incident to infectious disease, and is, therefore, employed to designate all 
those diseases which can be communicated from existing foci, or which are capa- 
ble of being prevented by hygienic or other conditions. As has been stated, this 
class comprehends those disorders which appear to involve a morbid condition of 
the blood, and which present, for the most part, but not all of them, the follow- 
ing characters: They run a definite course, are attended by fever, and frequently 
by eruptions of the skin; are more or less readily communicable from person to 
person, and possess the singular and important property of generally protecting 
those who suffer them from a second attack. They are apt to occur epidemically, 
and some of them manifest a tendency to transmission by inheritance. The latest 
and most approved nosology includes over twenty of our principal diseases in the 
zymotic class—such as small-pox, measles, scarlet fever, diphtheria, croup, whooping- 
cough, the essential fevers (including typhus, typhoid, cerebro-spinal, yellow fever, 
and the different forms of so-called malarial fever), quinsy, erysipelas, puerperal 
fever, carbuncle, influenza, dysentery, diarrhea, cholera, rheumatism, pyaemia, etc. 
The reports of the Registrar General of England show that about one-fourth of the 11 
whole number of deaths is from zymotic disorders. An examination of the returns 
of the Surgeon General and of the Marine Hospital Bureau, as well as the health 
reports from the principal cities in the United States, will establish about the same 
ratio; and if we include tuberculosis and pneumonia in this class of maladies (and 
they certainly fill the essential conditions of zymotic disease), we find that the mor- 
tality is more than fifty per cent, of that which occurs from all causes. 
An examination of the volume devoted to mortality and vital statistics of our 
last United States census, 1880, shows that our total mortality for the year was 
756,893. Of these more than half died from zymotic disorders, as may be set forth 
in the following table : 
ANNUAL DEATHS FROM ZYMOTIC DISEASES IN THE ORDER OF THEIR FATALITY. 
Consumption 91,270 
Pneumonia 63,053 
Diphtheria. 38,143 
Cholera infantum 24,983 
Enteric fever 22,854 
Malarial fever 20,231 
Croup 17,966 
Scarlet fever 16,388 
Dysentery 13,427 
Enteritis 12,640 
Whooping cough 11,064 
Bronchitis 10,984 
Diarrhoea 10,825 
Measles 8,072 
Septicaemia 5,828 
Scrofula 5,000 
Erysipelas 4,275 
Rheumatism 3,399 
Cerebro-spinal fever 2,898 
Cholera morbus 2,116 
Venereal diseases . . .' 1,217 
Small-pox 871 
Other diseases of this order. 12,474 
Total 402,897 
There are 1,146 diseases which affect mankind and require the study and atten- 
tion of the physician, but less than twenty-five of these diseases, all of which are 
zymotic, are known to cause nearly two-thirds of the total mortality. Every intel- 
ligent physician will admit that, by the application of the well-established princi- 
ples of sanitary science, we have absolute power to either wholly prevent or miti- 
gate every one of these meladies. Let any medical man examine closely the above 
table, and he can not fail to be amazed at the mortality from avoidable diseases, as 
compared with those which are non-avoidable. Let us consider these diseases 
brielly in the order of their fatality. 
CONSUMPTION. 
Of all the diseases affecting the human race, tuberculosis is the most general in 
prevalence and fatal in results. It may be developed from hereditary predisposi- 
tion, but a bad hygienic influence is acknowledged to be a far more potent cause, 
the chief factors of which are foul air, exposure to cold and wet with insufficient 12 
food and clothing, unhealthful avocations, damp soils, syphilis and alcoholism. 
The influence of soil moisture in the production of consumption is no theory—it is 
a demonstrated fact. It has been shown by Dr. Bowditch, of Massachusetts, and 
Dr. Buchanan, of England, that soil moisture and soil pollution are directly caus- 
ative of this disease, as well as many other zymotic disorders. It is for this reason 
that New Orleans, with all its climatic advantages, shows a higher death rate from 
consumption than any other city in America. Statistical observations extending 
over a number of years have amply proved the beneficial effects of partial or 
thorough sewerage and drainage in many of the principal towns of England, the 
reduction of mortality from this malady varying from eleven to forty-nine per cent., 
according to the thoroughness with which this sanitary measure was carried out. 
This affection produces a higher death rate than any other except the one last 
mentioned. It deserves a place among zymotic diseases, as it is now recognized as 
a general and not a local affection. Its cause and its course is closely related to 
the essential fevers. Like croup, bronchitis, and pleurisy, it is mainly a disease of 
temperate climates, and its chief cause is exposure to inclement weather and resi- 
dence in a damp locality. It is known to be more common among the poor and 
badly fed, and among those whose occupation necessitates an irregular mode of life 
and great exposure, than among those otherwise better circumstanced. It is also 
known to affect those who breathe an impure atmosphere and who are constitu- 
tionally weak, and those whose general health has been impaired by some tempo- 
rary bad hygienic influence, rather than the strong and vigorous, favored by 
proper sanitary environments. 
PNEUMONIA. 
This disease ranks third in its degree of fatality. It is eminently contagious, 
and the importance of strict isolation of those affected can scarcely be overrated. 
Apart from endemic and epidemic causes affecting its maintenance in foci, and its 
outbursts at particular times and in particular places, there are etiological influ- 
ences belonging to individuals not to be overlooked, such as poverty and its con- 
comitants, unventilated, filthy lodgings, scanty clothing and imperfect alimenta- 
tion, which may not only serve to develop but impart a receptivity for the contagion 
of this disease. A similar receptivity exists in tuberculous persons and in all 
cachectic subjects. Scarlatina, measles and whooping cough peculiarly predispose 
to diphtheria. This is especially true of the former disease. Recently delivered 
women receive easily the diphtheritic poison. During epidemics the influences of 
the predisposing causes are strikingly exemplified. While the malady can not be 
regarded as a hereditary disease, yet observation teaches that a special aptitude to 
receive and develop the poison evidently pertains to certain individuals and fam- 
ilies. It is most common between the ages of two and ten. Few persons are 
attacked after thirty; but there are occasional victims at all ages, from the earliest 
infancy to old age. According to our last census about 20,000, or more than half 
the annual deaths from this malady, occur with children under five years of age. 
DIPHTHERIA. 
CHOLERA INFANTUM. 
This malady follows next in the order of mortality. Over 16,000 annually, or 
more than two-thirds of all deaths from this affection, occur with infants under 
one year of age. How shall we account for this amazing and unwarrantable loss 13 
of human life, for this vast number of children dead before the first anniversary of 
their birthday? Shall we say that thousands upon thousands of precious, helpless 
infant lives are yearly offered as holocausts upon the altar of man’s ignorance or 
carelessness? In considering diarrheal diseases of infants, it must be remembered 
that the most powerful factor in their production and fatality is that of artificial 
feeding, and that the mother’s breast is the generous, sympathetic fount from which 
should flow the nourishment for the babe. It has become fashionable in some 
circles of society for the mother to shrink from and shirk the high and solemn 
duty of nursing her own infant; a diseased or filthy wet nurse or a half-starved 
and tuberculous cow, fed on slops or garbage, is inducted into the office of feeding 
the child, and when it is well nigh dead from inanition, it is fed on farina and the 
numerons forms of infants’ food with which the country is flooded. Where there 
is no other excuse for this than the dictates of fashion, or a matter of convenience, 
it is well said to be a species of moral depravity and inhumanity lower than the 
instinct of the brute, which always tenderly nurse and defend their offspring. 
ENTERIC FEVER. 
This disease stands fifth in the degree of fatality, the annual death rate being 
nearly 23,000. It has been very truly said that of all diseases which are attribu- 
table to filth, that this may be proclaimed as the very type and quintessence; though 
sometimes by hidden processes, yet far more frequently in the most glaring way, 
it apparently has an invariable course in that which of filth is the filthiest, and 
that most generally its infection runs its course, as with successive inoculation from 
one individual to another by instrumentality of the molecules of excrement which 
have been allowed to mingle with air, food and drink. We do not desire to be num- 
bered with those who entertain the opinion, however, that typhoid fever is so 
“specific” in its nature that it can ouly be derived from a pre-existing case of the 
same disease, but believe that it may be developed by fermentation of faecal mat- 
ter independently of any specific germ introduced in typhoid evacuations. The 
outbreak of the malady in villages and in isolated buildings where the causes can 
not be traced to any previous case of the disease warrant this conclusion. For- 
tunately, however, for the bacillus theory of Budd or Klebs, or the pythogenic hy- 
pothesis of the late Dr. Murchison (that this fever may be developed anew by the 
decomposition of sewage, and perhaps of other forms of animal filth), the practi- 
cal issue of both views is the same, namely, that the great preventive measures are 
the prompt removal of fa5cal matters and other forms of animal decomposition, so 
that neither air nor water may be contaminated by them. But it is also well- 
known that individual susceptibility to the disease, and certain predisposing causes, 
are potent factors in its development and dissemination. It is a matter of com- 
mon observation that some persons never contract typhoid fever, however much 
exposed, while others take it readily, and it is almost equally clear that certain 
families are extremely susceptible and liable to have the disease in a severe form, 
and that a formidable attack is to be apprehended if either of the parents have 
died of the fever. This affection may occur at any age, but is very rare in ad- 
vanced life. It is probably more common in infancy than is generally supposed, 
as it is easily overlooked or confounded with common infantile ailments. The 
period of life at which the disease is most common is during adolescence and the 
first decade of adult life. Among the predisposing causes are mental anxiety, de- 
pression or shock, overwork, loss of sleep, lack of ventilation or sunlight and de- 
bility, however induced. 14 
MALARIAL FEVER. 
The annual mortality from diseases of this character is placed in our last census 
at over 20,000. Dr. Parkes has well said that when a climate is called “un- 
healthy,” it is simply meant that is malarious. The Italian word malaria merely 
stands for bad air, and may be employed to express the condition of the atmosphere 
when there is suspended in it any effluvia or abnormal constituent deleterious to 
the functions of animal life, whether this be an earth-born poison, generated in 
soils, the energies of which are not expended in the growth and sustenance of 
healthy vegetation, or whether the product of animal or vegetable decomposition. 
But the latter, in connection with the heat or moisture, has long been considered 
its most usual source. Malaria is. however, generated under conditions apparently 
widely different from the above. Fevers of this closs have prevailed with destruct- 
ive malignity in some of the most sterile regions of the earth, and in countries so 
dry and arid for want of rain as to cause all the rivers and other bodies of water 
to completely disappear. Neither do such fevers always increase in gravity and 
frequency as latitude diminishes. Tropical countries are often exempt, while in 
others of a high latitude they are known to prevail. They are found in Sweden 
as high as latitude 63°, and also on the shores of the Baltic Sea. In addition to 
other causes, unwholesome food, unsuitable drinking water, damp residences, the 
near presence of slops, garbage or defective house drains, bad ventilation, fatigue, 
exposure to atmospheric vicissitudes, such as the morning dew, the midday sun 
and the chill at night are most worthy of mention. That low, moist and warm 
localities are generally noted as malarious, however, is undisputed. The baneful 
effects of undrained soils in cities has already been cited. The unhealtliful influ- 
ences upon rural populations by residence near overflowed, undrained and swamp 
lands is also a matter of common observation. Hence we can not wonder that 
there is still an alarming prevalence of malarial fevers among the people in many 
portions of the country, making our population sallow, weakly, unhealthful, par- 
alyzed in energy, and killing them by thousands with the preventable disease which 
is far more destructive to life than the deadly effects of yellow fever and cholera 
combined. In the etiological influence of undrained lands we not only have a 
waste of productive energy, health and life, but the reclamation of such lands 
would add millions of acres of our richest soil to our cultivable area which, under 
intelligent tillage, would afford sustenance for a population four times as large as 
what it is at the present time. 
CROUP. 
The annual mortality from this disease is nearly 18,000. About one-third of 
this mortality is with children under one year of age, and almost the entire num- 
ber of deaths occur with those under five years of age. The disease referred to in 
this connection is intended to designate pseudo-membranous laryngitis, which is 
considered of a diplitheretic nature. Its most common cause is cold and moist air, 
mainly during a prevalent epidemic of diphtheria. There are families with what 
appears to be a general tendency to croupous laryngitis. The disease may return. 
Even tracheotomy has been performed twice on the same individual. It is conta- 
gious. In the same family, from a case of true croup, either another case of laryn- 
geal croup may originate, or another form of diphtheria will develop in other 
members of the household. Male are more frequently affected than female chil- 
dren. 15 
SCARLET FEVER. 
The annual deaths from this disease are over 16,000; mostly affecting children 
from one to ten years of age. Children under one year of age often escape, or 
have the malady in a mitigated form. The appearance of the disease in certain 
localities, without known exposure, argues that this disease, like diphtheria, may 
originate from unsanitary surroundings. In the vast majority of instances, how- 
ever, it does not appear except as the result of exposure of one individual to an- 
other sick of the disease, or from contact writh infected lodgings, bedding, clothing, 
etc. Precaution in this regard, and the observance of suitable hygienic measures, 
will generally prevent the development or spread of this malady. Epidemics tend 
to recur every five or six years, as a fresh series of the susceptible arises. They 
often extend with us in dry seasons and subside after w-et ones. A defective 
hygiene from imperfectly drained dwellings and bad ventilation aggravate the 
type and intensify the infection of the disease. Infection attaches to the entire 
period of illness. Greatest at the height of the disease, it may be given off for six 
weeks, and even longer. Strict isolation during this time is of the utmost im- 
portance. 
DYSENTERY. 
The United States census places the annual mortality from this disease at over 
13,000. Mere than two-thirds of the deaths occur with children under live 
years of age. This affection is evidently influenced in frequency and gravity by 
heat, not only of hot countries but by that of the summer and autumn in tem- 
perate climates; but it is generally admitted that the malady depends on a certain 
focus of infection, and that it dies out on the removal of the cause. Diarrhea and 
dysentery are the most frequent scourges of armies. In the United States Army 
the disorder prevailed to the extent of 209 per 1,000 of the mean strength for 1883. 
The causes which produce dysentery are similar, if not identical, with those which 
develop malarial fever, such as moisture, common to habitations on low grounds, 
foul air, exposure to rain and wet, too light clothing and the influence of the sea- 
sons and conditions of the weather, impure Avater, unwholesome food, cold and 
damp nights followed by hot days and rapid changes of temperature. The conta- 
giousness or communicable nature of the malady is an unsettled question, but the 
complete disinfection or destruction of the alvine evacuations may be regarded as 
a sanitary mearsure of great importance.- 
ENTEBITIS. 
The deaths from this affection are more than 12,000 annually. Children under 
one year of age suffer over 25 per cent, of the fatality, and with those under live 
years more than 50 per cent, of the deaths occur. Eo doubt many of the cases 
thus reported might have been classed as cholera infantum. In the majority of 
instances it is due to the same causes that develop this disease, or those which 
induce dysentery. The disease is much more frequent in the summer, particularly 
when there is extreme difference between day and night temperature, or when the 
heat is associated with much moisture. Of exciting causes improper food is by far 
the most common, especially during the first year of life. Cow’s milk alone may 
at that time be sufficient to induce it, and it is rare for infants of this age to escape 
an attack. 16 
WHOOPING COUGH. 
The fatality in this affection is seen from the census table to be far greater than 
that usually supposed, more than 11,000 deaths occurring annually from this cause. 
But of this number nine-tenths of the deaths are under five yeats, and more than 
half under one year of age. This malady occurs in epidemics, chiefly prevalent 
in the spring, extending over a large part of any town or district associated by 
various means of inter-communication or by common educational establishments, 
and spreads as long as young children who have not had the disease before are 
brought within its influence. Certain bodily states—the condition of teething, and 
that left after measles and some other diseases predispose the mucous surfaces to 
infection. The infection is often received with that of measles, and the character- 
istic cough of one disease is not recognized till the rash of the other has passed 
away. Infection persists for six or eight weeks after the disease is declared. 
Whooping cough prevails so extensively in early childhood that it is rare to find 
anyone grown up without having been exposed to it. The wriier, however, witnessed 
an epidemic at Key West in 1866 which affected many of the oldest inhabitants. 
But, as a rule, those who escape infection in childhood mostly escape it altogether. 
It is one of the three diseases most fatal to young infants, and like the bronchitis 
of cold weather and the diarrhea of summer, is, as we have proved, most fatal to 
the youngest. It differs from the two affections named in not being more fatal in 
very hot or very cold years. Its fatality in England with children stands next to 
scarlet fever. In the United States its fatality with children under five years of 
age exceeds that of scarlet fever. It is more fatal with girls than boys. The 
intensity of the disease is increased by overcrowding, bad ventilation and the 
confinement of the sick in close apartments. Guarding young children from 
exposure to the known infectiousness of the malady would doubtless save thousands 
of lives, the disease being mild and comparatively free from danger in after years. 
BRONCHITIS. 
We find from the United States census that nearly 11,000 deaths occur annually 
from bronchitis. This disease is, no doubt, equally prevalent during the active or 
middle period of life, but the extremes of life exhibit the greatest fatality, owing 
mainly to the greater tendency of the inflammation at such periods to extend 
directly from the bronchioles into the lobules of the lungs, thereby complicating the 
bronchitis with lobular pneumonia, and, no doubt, in more than half the cases 
reported under the head of bronchitis the fatal result was caused by pneumonia 
instead of bronchitis. We find from the above report that more than half the 
deaths were with children under five years of age, and more than one-fourth after 
fifty years of age. The chief causes of the malady are exposure to atmospheric 
temperatures too warm or too cold, of the habitual wearing of too much warm 
clothing, or that which is insufficient, and especially the unequal adjustment of 
clothing to different parts of the cutaneous surface. In children especially we 
often see an abundance of warm clothing over the whole body, while the legs and 
feet and neck have but a single covering, and sometimes none. Whenever, in 
order to be fashionable, such children are seen out on cold days with naked legs, 
from short trousers and defective stockings, it may be safely affirmed that they 
either have a quack for a physician or a fool for a mother, and possibly both. If 
the mothers of such children, and others, will persist in sitting by open windows 17 
with low-necked dresses, or on going out loaded with warm clothing, while their feet 
and ankles are protected only by thin shoes and stockings, they will be pretty cer- 
tain to contract bronchitis; but while this may be only an annoying spell of sick- 
ness to them, the same affection may mean death to their children. Besides, 
exposure to sudden and extreme changes of temperature, or that which is incident 
to a cold, damp and variable climate, bronchitis is to be classed among zymotic 
disorders, since it often occurs in an epidemic form without the presence of an 
obvious exciting cause. It also occurs in connection with certain general fevers, 
more particularly with typhoid, measels, influenza, and pertussis. It also some- 
times, though more rarely, accompanies rheumatism, erysipelas and constitutional 
syphilis. 
DIARRHOEA. 
Over 10,000 deaths annually are recorded in the United States census from this 
affection, but if we include those cases under the name of cholera morbus, cholera 
infantum, and dysentery we find a yearly death of more than 50,000 persons from 
this class of diseases, 24,000 of them infants under one year of age. With the latter, 
as we have said, artificial feeding may be recognized as the principal etiological 
factor. But sanitarians universally agree that in all filthy districts that those 
diseases especially predominate which, in respect of their leading symptoms, 
may be generalized as diarrheal. The mucus membrane of the intestinal canal 
seems to especially bear the stress of all accidental putridities which enter the 
blood. Whether they have been breathed, or drank, or eaten, or absorbed from the 
surface of foul ulcers, or directly injected into the blood vessels by the physiolog- 
ical experimenter, this effect may be looked for. Just as alcoholic stimulents, how- 
ever administered, will get into the head, so septic ferment, entering the blood by 
whatever route, is almost certain to find its way thence to the bowels, and there, as 
an inevitable result, produce diarrhea. Rational therapeutics in such cases do 
not consist so much in checking the often symptomatic disorder (which may be 
pature’s only safeguard) by restraining measures, as in strict sanitation against 
all those agencies known to exert a causative influence. 
MEASLES. 
The annual mortality from this disorder is about eight thousand. Of this 
number nearly one-half the deaths occur with children under two years of age. 
After this age the mortality is not greater in proportion to the number of attacks 
than at other periods of life, and there is some advantage in contracting the dis- 
ease at a time when careful nursing and individual attention can be secured. 
Those who escape measles during childhood are very likely to be siezed on taking their 
part in mixed communities. Contagion is the probable cause of measles wherever 
it is now met with. In large towns, where sources of infection always exist, epi- 
demics recur about every four years, chiefly among children, as a fresh series of the 
susceptible become exposed. Extremes of temperature, exposure to wet or dampness, 
malarial soil, vitiated air or crowded dwellings and defective diet are factors which 
contribute to its fatality. Measles, in a school or family, is sure to spread, as the 
catarrhal stage, which is infectious throughout, is generally mistaken for a com- 
mon cold and no timely separation is attempted. Infection begins before the rash 
appears. After an attack of the measles isolation for at least thirty days should 
be required. Infection may cling to articles of clothing or linger in closed rooms 
■even longer than this length of time. 18 
REMAINING ZYMOTIC AFFECTIONS. 
Septiccemia causes nearly six thousand deaths annually. This affection orig- 
inates from the introduction of septic or putrid matter into the blood; a poisoning 
from absorption of the chemical product of putrefaction. Impure air, especially 
that which emanates from decomposing animal matter, crowding together a num- 
ber of persons with suppurating wounds, neglect in removing the discharges and 
excretions from sick persons, and imperfect drainage and the puerperal condition 
favor the development of this disorder. It may also follow disease of important 
excretory organs, as Bright’s disease, great nervous depression, wounds, local inflam- 
mation and is the gravest danger of many surgical operations. Prophylactic 
measures are suggested by the consideration of the foregoing causes. Scrupulous 
cleanliness and the integrity and functional activity of the chief excretory organs 
should be secured in all cases of operation or injury in order that decomposition 
of the discharge or the accumulation of effete material in the blood may be 
guarded against. 
Scrofula causes five thousand deaths annually, and over fifty per cent, of this 
m«rtality is with children under five years of age. But our census does not tell us 
of the many thousand children annually born into the world with frail constitu- 
tions who live on doomed to blindness, deafness and life-long deformity and misery, 
due to this malady, for in a vast majority of instances it is a disease hereditarily 
acquired. Its causes mainly lie beyond the conception of the infant, and prevent- 
ive measures have reference to the marriage of unhealthful individuals, which 
ought to be controlled in every civilized country by legislative enactment. 
Erysipelas causes annually over 4,000 deaths, more than one-third of this fatality 
also occuring amongst children under five years of age. This affection is undoubt- 
edly infectious and inoculable, as hospital experience has amply demonstrated, but 
the development of the disease depends, to a great extent, upon the patient and 
his surroundings. Constitutional predisposition is hereditary, and is increased by 
previous attacks. Disease of some important viscus, especially liver and kidneys, 
and the presence of a wound tend to develop the malady. It is said to be most 
common in women, especially at the menstrual period. Intemperance and want of 
proper food are great predisposing causes. It is said to be most common in spring 
and autumn. Of other predisposing causes to be observed and guarded against, 
overcrowding in hospitals and prisons, lack of ventilation and cleanliness, bad food 
and impure water should be mentioned as of most importance. Meteorological 
conditions, as east winds, low temperature, excessive moisture, cold and heat, with 
attendant perturbation of physiological function may be considered as a cause of 
its epidemic prevalence, and the type of the disease varies in different outbreaks. 
Rheumatism is the cause of over 8,00d deaths annually, the fatality being due, 
no doubt, to hyperpyrexia, affection of the meninges of the brain, but most gener- 
ally to complicating heart disease. This disease, like pneumonia and acute bron- 
chitis, belongs to temperate rather than cold climates. It is met with in tropical 
countries, such as the East Indias and Egypt, but is unknown in the polar regions. 
Of the predisposing causes, more than one-fourth of the cases can be traced to in- 
heritance. Previous attacks increase its liability to return. It is not uncommon 
either in children or in persons past middle life. The great majority of first at- 
tacks occur, howevor, under thirty years of age, and the larger proportion between 
sixteen and twenty-five. Laborious outdoor occupations, in which persons are ex- 
posed to cold and wet, poverty, and the many evils associated with these, contribute 
in furnishing the largest percentage of cases. It is not uncommon in warm weather 19 
on account of frequency of chills from overheating. It may suddenly make its ap- 
pearance after a sprain, or other injury to a joint, which may also determine the 
distribution of the disease in articulations. An attack of acute rheumatism is occa- 
sionally referred to derangement of digestion, and the function of the liver, espe- 
ceially in subjects who have previously suffered. Indulgence in abundant rich or 
indigestible food will certainly determine a relapse in persons convalescing from 
the disease, and may possibly induce an attack in the predisposed. Depressing 
bodily or mental influences, and, possibly, simple mental despondency, may act in 
this way in different instances. 
Cerebro-Spinal Fever is the cause of nearly 3,000 deaths annually. Of this num- 
ber over 50 per cent, occur with children under five years of age. 
Its development is favored by over-crowding residence in damp localities, foul 
air and unwholesome food. It is epidemic, but not contagious. 
Cholera Morbus causes about 2,000 deaths annually; over 25 per cent, of this 
mortality is reported among children under five years of age. This malady prevails 
most extensively in July and August, when the variation of temperature between 
day and night is great. Exhaustion of the nervous system by heat favors its devel- 
opment as well as mental anxiety and overwork. Unwholesome food, impure water 
and offensive exhalations from filthy localities are among its principal exciting 
causes. 
Venereal Diseases are reported as causing only about 1,200 deaths annually, but 
evidently owing to an unwillingness upon the part of individuals or physicians to 
report the true nature of such maladies this estimate must be very inaccurate. 
The deaths are mainly due to syphilis; over one-third are among newly-born chil- 
dren under one year of age. It is estimated that in our large cities fully 5 per cent, 
of all the inhabitants are affected with this disease. The whole number affected 
with the malady in the United States is believed to be about 2,000,000, while 200,- 
000 prostitutes are permitted to cumber the cities and towns of this country and to 
propagate the malady absolutely without an effort being made to suppress or con- 
trol the evil by legislative enactment. It is said that not less than 1,000 persons 
reduced to pauperism by this disease are supported by public expense in this State. 
All physicians of experience have witnessed the withering blight of this loathsome 
disease upon new-born babies, but from considerations of prudence have veiled the 
fact with the patronizing mercy of their silence. It has been estimated that three- 
fourths of the deaths of children under five years of age in our larger cities are 
due to this loathsome malady; surely every thoughtful mind ought to be impressed 
with the necessity of some efficient measures of arresting, by strict sanitary inspec- 
tion, this horrible corruption of blood in the constitutions of our race, which is so 
steadily multiplying the ills and miseries of human life. 
Small-pox was the cause of only about nine hundred deaths in the United States in 
1880. No better argument than this in favor of protective medicine is possible. 
This malady during the'previous century was justly regarded as the greatest 
scourge of mankind. Its fatality decimated in every decade the population of 
Europe. In France, before the discovery of Jenner, the mortality from this disease 
was 30,000 annually. In other countries it constituted fully one-tenth of their 
total mortality. To-day only the most ignorant are responsible for the spread of 
this loathsome plague of former ages. No truth is more fully recognized by all 
intelligent people than that isolation and disinfection will control the spread of 
11 pox, and if preventive medicine has demonstrated anything it has most con- 
clusively shown that vaccination (and re-vaccination every six or eight years),gen- 
erally and systematically performed, will prevent its development. 20 
Two other important zymotic diseases of great fatality did not prevail in 1880. 
We refer to cholera and yellow fever. There is no reason why the former should ever 
be found in this country if its importation is prevented. It can not prevail here 
except by introduction from foreign lands; but when it exists in Europe it has 
never yet failed to come as an unwelcome visitor among us. Entering our great 
seaport towns it is rapidly transmitted by steamboats and railroad cars into the 
numerous towns and cities located on these channels of travel and commerce. But 
it is well known that by proper sanitary measures it can be kept out of our coun- 
try, and even stamped out if by chance it finds lodgment here. Owing, however, to 
negligence and indifference in this regard our mighty nation did but little to pro- 
tect our population during its last visitation, and in 1873 it invaded thirteen States 
and spread terror and desolation among the inhabitants of more than two hundred 
towns and cities. Neither are we powerless against yellow fever. This malady, 
too, can be and has been controlled by rigid sanitation. Prior to 1805 it prevailed 
as far north as Boston, but owing to strict administration of sanitary laws no epi- 
demic of this disease has visited that city during the present generation. The 
same is true of Providence, Rhode Island. Philadelphia suffered seventeen epi- 
demics of yellow fever prior to 1854; but the sanitary government has kept the 
city free from that date to this. In New York, prior to 1822, epidemics of yellow 
fever were frequent and terrible, and in some years destroyed her citizens by thou- 
sands. Though the growth and density of the population of New York has been 
almost the wonder of the world, the sanitary bureau has banished the disease from 
that city, also, and no epidemic of yellow fever has prevailed in the metropolis for 
more than a half a century. This absence in any of these cities is not due to lack 
of facilities for importation. Perhaps not a year passes but what cases of yellow 
fever are taken from the shipping to the quarantine stations. What these cities 
have done against this disease, other cities can do, and this is equally true of other 
contagious and infectious maladies of exotic development. But shall we only 
dread the pestilence that walketh in darkness, and the destruction that wasteth at 
noonday? A distinguished Southern physician has well said that if cholera or 
yellow fever appears in a city in America, the whole country becomes alarmed; 
but we Americans are absolutely indifferent to other preventable diseases, which 
yearly produce one hundred times greater mortality than both of these maladies 
combined. It may be safely affirmed that yellow fever and cholera, which so 
alarm and horrify our citizens are insignificant in death dealing when compared 
with the more common diseases over which man has absolute powers of control, 
and which he makes but little or no effort to prevent or mitigate. In 1873 the 
total mortality from the former was only 8,000, while in the same year the deaths 
from malarial, scarlet and typhoid feyer, from dysentery, diarrhoea, and cholera 
infantum, from consumption, measles and whooping cough, aggregate alone no less 
than 192,000. Is life less valuable because sacrificed by the latter diseases instead 
of the former? “It is true that the havoc of yellow fever and cholera was far 
more rapid in destruction, but these diseases rarely afflict us more than once in a 
decade, while the others are always with us, reaping enormous harvests of death 
each year.” 
CONCLUDING OBSERVATIONS. 
In order to attain health and longevity we must copstantly guard against the 
malific influence of impurity of atmosphere, water and food, the inheritance of a 
diseased constitution and exposure to contagious and infectious maladies. But 
individual effort can exercise but little influence in protection against either of 21 
these factors. The State is the delegated guardian of man’s life, as well as his 
liberty and property. In all sections of this country thousands of infants are annu- 
ally born into the world inoculated with scrofula, syphilis, consumption, epilepsy, 
chorea, insanity, or the alcoholic diathesis, and this often to an alarming extent in 
the highest society of the nation. If the laws of the State are inadequate to pre- 
vent the marriage of diseased persons, and protect children from inherited maladies, 
such wrongs to society should be at least discouraged by an enlightened public 
sentiment. 
Truly has it been said, “The curse causeless shall not come,” and in this day of 
rapid transit the facilities for diffusion of contagious diseases are such as to seri- 
ously threaten the welfare of every community. “ Failure to exert controlling power 
over these affections, either through ignorance or negligence, renders the danger to 
mankind far greater in this period of advanced civilization than in any, even amid 
the gloom and desolation of the dark ages. No nation on the face of the globe is 
so constantly threatened with devastation from portable diseases as America. The 
immigration to this country of people from all the lands of the earth is unprece- 
dented in the history of any other nation. Into our seaports are constantly landed 
enormous vessels filled with human freight, composed largely of the restless, dis- 
satisfied, turbulent, poverty-stricken, diseased and oppressed people of all climes 
and nationalities. Into the great harbors of New York, Philadelphia, New Orleans 
and San Francisco hundreds of thousands of ragged, filthy and penniless new-made 
sovereigns, with their little bundles packed amid the squalor and diseases of the 
dangerous homes from which they emigrated, are hastily thrown upon the wharves,, 
and by hundreds of fast boats are carried over thousands of miles of rivers or over 
the one hundred and twenty-five thousand miles of railroads, and scattered into 
every community in America, and with them are carried the infectious diseases of 
the places from whence they came.” And without national and State sanitary 
surveillance, both at ports of departure and upon arrival in our harbors, the com- 
mercial stability, peace, prosperity and happiness of every community are daily 
jeopardized. Thus are these diseases readily brought into our cities, and as soon 
as one is driven out another stares us in the face, and the only chance for protection 
in this day is for the municipality to keep skilled and faithful guardians on the 
alert to meet and conquer these direful affections. From what has been said con- 
cerning the predisposing influences of zymotic disease, we find that the best local 
sanitation against the development of any one specific disease is almost equally 
valuable against another. For this reason no community is safe from this class 
of maladies as long as any one of them is prevalent and will afford the best evidence 
for improved sanitation. No maxims are more true than a “Nation’s health is a 
nation’s wealth,” and that “ Nothing is so costly in all ways as disease.” 
But public health can only be advanced by organized effort upon the part of 
municipal, State and National authorities, and fully empowered by law to enforce 
the requirements of their important trusts. The members of all organizations to 
secure these results should be chosen entirely with reference to ability and integ- 
rity. Children in all public schools should be educated to understand the ele- 
mental principles of physiology and hygiene. Legislators should be educated to 
understand that the prosperity of our nation depends upon the health of its citi- 
zens. Engineers and architects should be educated to understand the most perfect 
sanitary arrangements for sewerage and ventilation in the construction of all resi- 
dential or public buildings. “ Ministers of the Gospel should be educated to know 
that a violation of the laws of health is a violation of the laws of God, and that 
when the consumptive, the syphilitic or scrofulous man or woman enters the holy 22 
bonds of wedlock and the issues of such marriages die in infancy and they are 
called upon to conduct the funeral services, that it is blasphemy to speak of such 
a dfeath as a manifestation of Divine Providence and loving care of the infant in 
removing it from future temptation and sin. When zymotic disease is decimating 
a filthy community, let them not insult God by praying that He will cease to kill 
the people.” Let them remember that nature’s inexorable laws are not suspended in 
this world for man’s benefit, and that petitioning for a day of fasting and prayer, 
to induce the Heavenly Father to save them from pestilence, is inexcusable, if not 
blasphemous ignorance, as long as towns and cities are reeking with those causes 
and sources of contagion which breed such maladies. 
On the great plains of plague-stricken Asia, centuries before the Christian era, 
the query : “Shall such ills come by chance?” was then answered 
“Like the sly snake they come 
That stings unseen; like the striped murderer 
Who waits to spring from the Karunda bush, 
Hiding beside the jungle path; or like 
The lightning striking these and sparing those, 
As chance may send.” 
Shall the intelligent clergymen of to-day meet this problem with no more 
rational interpretation than the ancient Buddhists in the earliest dawn of the 
world’s history? We trust not. But it is the physician after all who, by long 
experience and the acquisition of the accumulated knowledge of the past, who 
knows concerning the causes and prevention of disease, and to him alone is in 
reality delegated the high and sacred obligation to preach the gospel of health. All 
accomplished and successful physicians are in these days also intelligent sanitarians. 
And recognizing that the health of communities and even of nations often depends 
upon the health of individuals, they, with unselfish devotion to public interest, 
seek to inculcate among “the laity” all knowledge that experience and observation 
have taught relating to personal and domestic hygiene, in order that the greatest 
good may result to the greatest number. Under this policy results of the most 
important character are constantly being obtained in what is termed public hygiene. 
Even by the most rudimentary or imperfect methods of sanitation, which as yet 
alone is practicable, the most terrible forms of disease have been banished. The 
plague and leprosy have been practically obliterated in every civilized country, and 
other contagious and infectious diseases have assumed a much milder form. 
With more efficient sanitary measures all of the so-called zymotic and specific forms 
of disease which have so scourged the world will certainly become more and more' 
rare, if they do not altogether disappear.