EVENING SESSION.

The time of the evening session of the first day was occupied by the usual greetings on the part of the city government, which were followed by the president's address.

The first portion of President Hewitt's address was devoted principally to the power delegated to local health boards, and how it can best be used. The second portion of the address was devoted to a running discussion of certain of the more obvious aspects of public sanitation. There was especial stress laid upon the need of a daily, practical, and, so to speak, petty activity of health officers; so that by clearing away minor abuses one by one, and preparing for larger exigencies by forefending detail work, panics may be avoided at critical times, if, indeed, it be not possible by such "forehandedness" to forestall the crisis itself. Several excellent practical suggestions were also made in regard to this very detail work itself, regarding the fuller, more efficient and instructive handling of vital statistics; the providing for proper isolation and refuge in the case of "catching" diseases; simple, cheap, common-sense devices for disinfection and ventilation, and the crying need of preventive sanitation in behalf of young children, whom modern society, in the hamlet as well as the metropolis, slaughters far more effectually than Herod succeeded in doing. Referring briefly to the paper of the morning, the speaker dwelt on the criminality of water-supply contamination, pointed out the impotency of the chemical decomposition of sewage, and approved of the disposition of garbage by cremation, a process being more and more perfected at present. A deserved compliment was paid to the health authorities of Massachusetts for the advanced state of their work; and among the most efficient methods pointed out the fact that greater and better results were in many, if not in most, instances achievable with individuals, corporations, communities, and legislative bodies by force of enlightenment and suasion than by the infliction of penalties. In conclusion the president's address treated exhaustively of the need of a more intelligent and far-seeing co-operation and independence of local, state, and national health boards, insisting that the first was the integral unit, and that the last should properly be evolved out of the demonstrated and experienced needs

of the second. In other words, that the highest efficiency of local boards, rural as well as urban, is of the last consequence, and that the true function of the national board should, on the one hand, be to facilitate and cement the interdependent helpfulness of the state boards among one another, and, secondly, to provide for a thorough extra-national system of sanitary inspection in connection with our consular system. This portion of the address will be sure to provoke lively discussion as soon as its subject matter can be properly referred to in the consideration of the late yellow fever epidemic and the inefficiency of our system of international and interstate quarantines.

The program for the first session of the second day embraced the following papers:

Paper on "Remarks on the Classification of Diseases,” by Henry B. Baker, M. D., secretary of the Michigan State Board of Health.

Paper on "Yellow Fever; Panics and Useless Quarantines; Its Limitation by Temperature," by John H. Rauch, M. D., secretary of the State Board of Health of Illinois.

Paper on "Memoranda of Visits to the Quarantine Stations of the Atlantic Coast, Made During the Summer of 1888," by Benjamin Lee, M. D., secretary of the State Board of Health of Pennsylvania.

The paper by Dr. Baker was an exhaustive report on the classification of diseases, and a valuable and interesting resumé to those who have such work to do.

Dr. Rauch devoted considerable time to panics and useless quarantines, as they were instituted at the South during the year 1888, and referred incidentally to his own work during the epidemic, as well as to the useless suggestions that were brought before the public. The impotence of Congress, which offered a $100,000 prize for a cure for yellow fever, instead of providing for an efficient national board of health, was sharply castigated in a neat aside; and he boldly avowed himself as having acted in the interests of the Illinois Central road during the late panic over the yellow fever epidemic. "And of all other business interests," the doctor added. For he showed clearly that with his finger on the thermometric pulse, no man in his position need place any barrier in the way of the freest commercial

intercourse with fever-stricken communities so long as the mean temperature of his own remained below seventy degrees. The heartless, senseless brutalities of the "shot-gun quarantines" were in this connection made as manifest as was the criminal culpability of those Florida municipal and so-called sanitary authorties who for weeks suppressed, as did even the Marine Hospital Service "from business considerations," all information that Yellow Jack had found a lodgment in the United States. Being an exotic disease, its importation should be provided against by the most careful expert consular espionage, and kept out by rationally efficient and cool-headed coast quarantines, such as that at New Orleans. What fear is to the individual, that panic is to the community, a debilitant and predisposer to epidemic influences. Hence, if despite all extra-national and coast quarantine precautions an epidemic disease like yellow fever, cholera, or small-pox enters our borders, it is of the last importance that absolutely frank and accurate publicity be promptly and authoritatively given to the facts such as they are; and that efficient and harmonious co-operation prevail among the various state boards of health.

The paper by Dr. Benjamin Lee, of Philadelphia, was, in that gentleman's unavoidable absence, read by Dr. George H. Rohé, of Baltimore. It comprised a series of synoptical memoranda of actual and personal observations made at various quarantine stations along the Atlantic coast, including those of New York, with a $2,000,000 plant fallen into dilapidated neglect and hampered by antiquated and inadequate methods because resting under the curse of political spoils-grabbing and assessments, owing to the enormous income from fees and fines attached to the office; of Philadelphia, abutting on a sewer-polluted marsh; of Baltimore, situated too near the city and lacking proper means for disinfection; those of Norfolk, Cape Charles, and Wilmington, - one and all but sanitary sepulchres not even whited for appearance' sake. From these observations Dr. Lee has derived the following critical estimate of the entire system:

"1. Want of uniformity in quarantine regulations placing one port at a disadvantage, either commercially or sanatively, as compared with another.

"2. Conflict of authority, owing to the methods of appointing officers.

"3. Entire lack of appreciation on the part of local legislatures, whether state or municipal, of the importance of the expenditure of considerable amounts of money in order to render quarantines at once efficient and inoppressive.

"4. Tendency on the part of local civic and sanitary authorities to limit their responsibility to the protection of their own city, reckless of the consequences which may ensue to inland communities if they permit infection, which circumstances render harmless to themselves, to pass unchallenged to the latter."

This was followed by a voluntary paper by Crosby Gray, health officer of Pittsburg, Penn., on the contamination of that city's south side water supply by surface drainage. This paper, in a very interesting form, gave the results of a very careful topographical, chemical, and biological examination into the general causes of a 6-per-cent higher death rate on this said south side than obtains in the remaining portions of the city, and as to the origin in particular of last winter's virulent and widespread typhoid epidemic in that territory. These investigations proved to a demonstration that the water supply drawn from the Monongahela was being seriously polluted by sewage, factory refuse, and by other nuisances, and that the epidemic in question had been caused by the sudden downwash, through rainwater surface drainage, of typhoid excrements from certain gulleys far above the in-take- the disease having for some time been endemic in those localities, in a small way. In his recommendations he said:

"The cash value of a human life to a community has often been computed, and it is a moderate estimate of the average value of the 260 lives lost on the south side over and above its just percentage of the current death rate in Pittsburg, at $1,275 each, or $331,500 together. To this should be added the burial expenses at $50, or $13,000 in all. But, as for every death there are many ill who recover, it would be a juster estimate to capitalize the sick at ten times that of the death rate. That would mean 2,600 people ill. The average time these people would be compelled to remain unemployed would be say thirty days. This would give us 78,000 days' work lost. From this deduct 15 per

cent for those below the productive period of life, which would leave 66,300 days lost. Averaging the value of a day's work at $1.25, the total loss in productivity would be $82,875. Add a quarter to this sum, on the basis of but 31 cents per day for otherwise productive time devoted to nursing, etc., that amounts to $20,718 more; to which should be added certainly not less than $2 per case for medicine, i. e., $5,200 more. And finally there should not be forgotten the legitimate profit (of, say, one third a day's wages) on its putative product, to wit, all of $27,625 more. These amounts tally $480,918 per annum, which literally fatal waste might be stopped once for all by the establishment of an improved water service drawing its supply from unpolluted sources one hundred miles off, by the timely and wise investment of this sum for two or three years."

No disposition was shown to gainsay either the substantial accuracy of the estimates, or the soundness of the conclusion. For if the ratio of illness to death be thought too high at ten, and the average loss of time on that account held to be probably less than thirty days, it will not escape the notice of attentive readers, any more than it did that of Health Officer Gray's auditors, that no provision at all was made in the computation for "professional charges," whether through oversight or because of an altogether laudable anxiety to keep the figures within the bounds of seeming reason, does not appear.

AFTERNOON SESSION.

During the intermission, the members were taken for a drive about town, embracing a grand tour of the east and west sides of the city, and it was about half-past four when they returned, well pleased with the excursion.

The afternoon's program contained three papers :

Paper on "The Canadian System of Maritime Sanitation," by F. Montizambert, M. D., quarantine officer at Grosse Isle, St. Lawrence river.

Paper on "The Quarantine System of Louisiana, and its Improvement," by Lucien F. Salomon, M. D., secretary State Board of Health of Louisiana.