On the After-Dangers of Floods: Their Nature and Remedies.* BY E. D. PAYNE, M. D., Of Towanda, Pa., Medical Inspector to the State Board of Health of Pennsylvania. In case of a flood, after the waters have subsided, after the dead have been gathered in and disposed of, after the driftwood and carcasses have been burned, there is still work for the State Boards, demanding the exercise of sound judgment, large discretion, and not a little labor. This work may not take the public so readily, nor produce so profound an impression on the public sense as that which precedes it, but it is not less important, and in many ways, requires greater care and more constant vigilance. The first is like fighting an open enemy who constantly presents his front; the latter is fighting no less an enemy, but one that lurks in ambush, who strikes in secret, who is invisible and intangible, and yet whose blows are none the less deadly. We are struck with horror at the rush of the waters, the giving way and sweeping down the stream of large buildings, the piling of wreck on wreck, the struggle and agony of men, women and children fighting for their lives; a feeling of awe and dread takes possession of us, and he must be strong of heart and steady of hand who dares make an effort to save life. The after-fight with disease and death requires different qualities; moral courage now takes the place of physical; a keen eye, a pleasant and persuasive tongue, a firmness in enforcing commands, which in many instances must appear like requests, some knowledge of disease and its derivation, some knowledge. of State law, a moderate amount of that quality of mind which dares assume responsibility. The waters have not only carried death and destruction in their path, but they have left behind broken sewer pipes, emptied vaults, wells deluged with waters holding in solution or suspension the filth of the flooded district. The walls of houses have a deposit of filth adhering to them, and the cellars are filled to greater or less depth with slime and mud. The weather is hot and sultry, or becomes so before the situation is rectified. Nor is this all; poor or scanty food and improper clothing assist in depressing the system and rendering it an easy prey to disease in one who has been demoralized by the catastrophe, and breathes in with his sleep the foul odors which surround him. Under these conditions it is not unreasonable to say sickness may be expected -sickness of the most deadly type, that known as filth disease, from which comes fevers, specific and non-specific, fluxes without fever, adynamia, that peculiar form of the mucous membranes which is accompanied by a train of symptoms "Variable as the shade By the light quivering aspen made," and which we call malaria, perhaps, because we do not know what else to call it. Not only this, but the place becomes a centre of infection; the breezes catch up the germs and float them in the air to other localities; the waters carry them *Read before The Tri-State Sanitary Convention, at Wheeling, W. Va., Feb. 27 and 28, 1890. down the streams to some point where an economic water company thinks filters bring additional expense without additional safety; and many accept the dispensations of Providence without a thought of fighting against them. Kind friends come to nurse the sick, and carry away infection to some point where each becomes a new centre of it. People, actuated by various interests or simple curiosity, do the same. Public funerals are held where the simplest services and quietest interments should only be allowed. The first question in this respect is, Do the conditions justify the statements above made? To my mind they are so plain as to need no supporting argument. I think the specific nature of certain diseases is so universally accepted among scientific men, and that in any one case of a specific disease it has had for a parent the same form of disease, that an apology is needed in such a meeting as this, for introducing the question; and I only do it, and give some illustrations, as a basis upon which to build my statements as to the nature of the duties of the State Boards after floods, and the duties of citizens in co-operating with them. Strange as it may seem, I have known instances in late years of a physician in large practice, telling the families under his care that they need not take pains to isolate the children sick with scarlatina—conveying the impression that scarlatina was a mild form of scarlet fever, and giving that name to those cases which appeared in a mild form; that it often appeared to but one child in a family; that in very many instances persons were exposed without contracting the disease. I will add to this statement another, viz. That within the past few years, I have known otherwise intelligent members of the community to take the same position, and not only laugh. at the efforts of the physicians to establish good quarantine and good hygienic surroundings, but to do so honestly, and honestly regard the efforts to produce disinfection as one of the fads of the day-one of the popular crazes to be met. It is a matter for congratulation that the great daily papers have given space to science for the furtherance of the new ideas. The country papers take up the subject, and, not to be thought to be behind the new ideas, reproduce the subject until it reaches the quiet valleys and distant hill-tops. A great change has taken place in the minds of the people in a few years. So long as we could only say, "I believe that certain diseases which are ordinarily called catching,' are the result of the reception into the system of a germ, which produces the disease," we were at a disadvantage; for we were immediately told to produce the germs. If asked what it looked like, we could not tell. We were laughed to scorn, if a case of diphtheria, scarlatina, measles or typhoid appeared in a community as the first case, and no apparent connection existed between it and any other. Unpleasant experience may have been had with the itch. Did they not know they "got" it from another? Had they not actually put a "magnifying glass" over the ascarus and seen it? They know they must not come in communication with smallpox, but exactly why they did not know. They know that in case of scabies they need not fear if they did not come in contact with it. But in the case of variola they know that they must neither come in contact with it nor in communication with it; but why, they didn't know. They could understand contagion, but not infection. This, however, they did know; that contact with scabies did not produce variola, and that communication with variola meant something more serious than rubeola; that exposure to the mumps, which they know to be "catching," did not mean to them a case of scarlet fever. In other words, they were able to demonstrate that like always produces its like, and that exposure to disease did not mean that the resultant might be any one of a dozen forms, as individual characteristics and environments might decide. They also knew that to "take the breath" in a case of mumps, meant an attack of the disease, if they had never had it before. But why did not taking the breath from an ordinary cold produce mumps? Evidently, because they thought a certain something was conveyed in the breath of one sick with the mumps to the healthy individual. How many stopped to consider that that certain something must be of material substance and form, we probably will not know. So, when we come to consider the matter, we do not wonder that investigators have been hunting for and trying to identify this individual certain something which when passed from one individual to another always reproduces itself and its attendant phenomena. It is more than thirty years since Prof. J. K. Mitchell taught his class that he had seen so many instances of apparently healthy husbands or wives sickening and dying of tuberculosis in a short time after burying a tuberculous spouse, that he had come to believe that one contracted it from the other; and, though mildly indulged and mildly chaffed, he taught that, in his belief, the time was coming soon when the germ theory of disease would prevail. It is more than twenty years since Dr. J. H. Salsbury hunted for and thought he individualized the germs of a number of diseases. I knew of these men long before I heard of Pasteur or Koch. En passant, let us honor the names of our countrymen who, though hunting after truth sometimes fail to find it, as much as we would those of foreigners who though they often think they find some new thing are frequently shown it is no new thing at all. For myself, I as firmly believe that any infectious disease is the result of the reception into the system of its own specific germs as I do that any plant that grows in my garden is the result of its own specific seed; and I would as soon expect a pumpkin or a squash to spring up where I had planted a potato, depending upon soil and climate to determine which should appear, as I would typhoid, diphtheria or smallpox to proceed from a germ common to all. More than that, I would as soon expect a plant to grow where I had put the ground in the best possible condition for its growth but had planted no seed, as I would a specific form of disease to appear, no matter how favorable the circumstances for its appearance, if the specific germ of that disease had not found reception in the individual. When asked why do not all persons exposed to specific poison contract the disease represented? I ask, in reply, Why do not all seeds of the vegetable kingdom germinate? Why do not all bullets fired in battle kill? Why do some fuses fail to explode a bomb? vain. I should feel that I was unwarrantably encroaching on your time in this discussion, but for two reasons. If the germ theory of disease is not true, then is your labor in In case of a flood an engineer with his gang of men ; a cartman, with l.is gang; a scavenger with his gang; and an emergency committee, to distribute food and clothing, would answer every purpose. But; believing it true, I use it as a basis for the consideration of the dangers which are likely to arise after a flood. I will illustrate by some examples: A number of years ago scarlet fever appeared in a family in this town. The child was confined to an upper room, where she passed through the disease and made a fair recovery. A year from that time, a young lady came to visit the family and was put in the same room, and on the ninth day came down with the disease. Six years ago, my own little child was attacked with scarlet fever. There was no other case in town, so far as I could discover. She had certainly not been exposed in any known way. But in a town sixteen miles north of us, the disease existed in an epidemic form, and a strong north wind blew for a number of days. A few years ago diphtheria appeared in a family of West Franklin, this county; immediately after, a large number of cases appeared in the neighborhood. Its appearance was inexplainable until it was found that a female relative of the first family had passed through this town, and had slept with a child that had sore throat. A number of years ago the nurse girl in a family in this town was called home to help care for her sister's children, sick with scarlet fever. On arriving home, she went into an unoccupied room, completely changed her clothing, and helped care for the sick. When ready to come back, she went to the same room where she had left her clothing, took a bath and put on the clothing she had worn there. When she arrived at the house where she was in service, the youngest child was delighted to see her. He climbed into her lap, put his arms about her neck, and was fondled. Nine days after, he sickened with scarlet fever. The other children had had the fever previously, and did not take it. It seems probable to me that though the nurse had taken what she thought were good cautionary measures, she had carried the germs in her hair, and, during the fondling of the child, he had inhaled them. I think the reason why in each of these cases the same form of disease was reproduced, was owing to the law long ago given by the Almighty, when he said, Go forth and multiply, each after his own kind. Neither do we grow grapes on thorns, nor figs on thistles. To proceed with the statement of the nature of the work to be undertaken by State Boards after floods, I would say it is manifestly their duty to protect the country from the influence of specific diseases. When I say the country, I speak advisedly; for if the flood of May of last year, is any criterion, disease might be scattered far and wide, but for prompt action. The waters bring to the surface and distribute over large sections, all the filth that has been hidden for years. This was not only the case in the Conemaugh Valley, but in the counties of Lycoming and Tioga, in this State, and the Southern Tier of New York. In reference to the germs of specific disease, I will argue no farther, except to say that I am not aware that the period of viability or ability to reproduce its like has yet been determined for any of them. I have cited a case of scarlatina, which shows the germ to be active after it had apparently lain dormant for a year. How many germs of scarlet fever and diphtheria are packed away in family closets to be brought out and be the origin of sporadic cases, we shall probably never know. That the action of floods, in bringing to open exposure all these germs, is different from any other action I cannot see. I have cited a case to show that the germ of diphtheria can be carried for miles after transient exposure. During an inspection at Trout Run, Lycoming Co., last year, I demonstrated to my own satisfaction that the flood had washed out a vault in which typhoid dejecta had been deposited at least four years previously, and that the water holding in suspension these germs had flooded a section of a town, where water was supplied to the public by driven wells. and that the people so supplied had contracted typhoid. But we will leave the question of specific germs, and inquire whether the waters that simply hold in suspension earthy matter-often foul smelling and disgustingcan, without containing specific germs, produce disease. I do not hesitate to say they can. But I would differ from those who say the form of disease would depend upon personal characteristics and environment. I do not believe this world was made by chance; I do not believe a tree or plant springs up by chance; and I do not believe that any form of disease appears by chance. Certainly these non-specific deposits will produce disease, but not specific disease. The mucous membranes will be affected; resulting in nausea, vomiting, diarrhoeas and dysenterys. The nervous system will be affected; producing malaise, general prostration, adynamia and malaria. Fevers will result, but they will be of an ephemeral or simple continued type, and in no instance will either of them reproduce itself in a fresh subject unaffected by the conditions which produced it in the first. I would say then, that the first duty of State Boards under such circumstances was to take possession of all such flooded districts, and by the judicious use of its inspectors, ascertain the precise conditions which obtain. These inspectors should |