WASHINGTON MALARIA AND THE “CATCHING^g^SOB^ 
[Extract from Bulletin No. 41, vol. 3, National Board of Health.] 
[By Samuel C. Busey, M. D., Washington, D. C.] 
Malaria and the catching of cold are undoubted factors in the cau- 
sation of disease, and the morbid manifestations from both causes are 
frequently so much alike that differentiation of cause is not always 
easily made. Physicians as well as laymen constantly mistake the 
effects of one for those of the other, and the ills that afflict us are 
oftentimes attributed to the unavoidable and baneful influences of 
atmospheric contamination, when in fact they are caused by the 
“catching of cold.” In the common language of this locality, the 
prevalent ailments are called malarial, and believed to be the neces- 
sary result of even a temporary sojourn in an atmosphere erroneously 
supposed to be always charged with noxious exhalations from the 
marshes of the Potomac and Anacostia Rivers. 
No one can deny that the extensive river flats along the eastern and 
southern boundaries, the sluggish stream forming the western border 
of the city, and the Chesapeake and Ohio Canal wdiich penetrates 
the western section, until lately known as Georgetown, which is al- 
ways laden with debris washed by the storm-water from the streets, 
and the filthy products of slack-water navigation, present all the 
conditions necessary to the development of miasmata. Nor will any 
one excuse the neglect which has not only tolerated these long-stand- 
ing nuisances, but permitted them to increase to such an extent as 
to become a disgrace to the National Capital, and the cause of many 
forms of disease. Nevertheless, the prevalence and certainty of the 
miasmatic influence does not afford a sufficient explanation of the 
numerous cases of sickness and indefinable ailments which habit and 
fashion ascribe to malaria. 
Whilst, therefore, admitting the existence of conditions necessary 
to the production of malarial diseases, and condemning the inexcusa- 
ble.deljfcV in abating these nuisances, my observation and clinical op- 
portunities induce me to doubt that malarious contaudnatiou of the 
atmosphere is the exclusive cause of certain irregular forms of dis- 
ease which prevail in this city, especially during the autumn and 
winter seasons. 
As yet malaria has not been isolated us a defined clement or quan- 
tity, recognizable either by chemical reactions or microscopic char- 
acters. It is true that Klebs and Tliomassi-Crndelli have announced 
the discovery of a bacillus malarias, but the more recent experimental 
investigations of Sternberg, relating to the cause of malarial fevers, 
fail to establish the active agency of these organisms in the causation 
of them in man, though many circumstances “favor the hypothesis 
that the etiology, of these fevers is connected either directly or indi- 
rectly with the presence of these organisms or their germs in the air 
and water of malarial localities.” Notwithstanding this want of 
positive knowledge in regard to its true nature, numerous well- 
knowrn facts and circumstances have established a belief that a poi- 
son is generated from decomposing vegetable matter under a com- 
bined influence of heat and moisture, which, when introduced into 
the system, either through the respiratory organs or alimentary tract, 
will produce certain forms of disease, which vary in intensity, form, 
and type according to the virulence of the poison, temperature, 
amount absorbed, and individual susceptibility. For the present 
discussion this definition of malaria is sufficient, and excludes all 
other deleterious emanations and morbific agencies, either chemical, 
gaseous, or parasitic. 
The development of this poison is favored by marshes, more espe- 
cially when containing mixed salt and fresh water and resting on a 
substratum of limestone, clay, or mud; by swampy, undrained, and 
delta lands ; extensive excavations; newly turned soils ; rains after 
long-continued drought, and consequent low-water level; careless 
culture of soil; neglect of cultivation where vegetation is luxuriant 
and is permitted to decay on the -surface; and in fact by the requi- 
site combination wherever present of the essential elements—high 
temperature, moisture, and decomposing vegetable matter. Nor can 
it be doubted that it may be diffused in the atmosphere and trans- 
ported by winds and water-courses to lion-malarious localities. 
The circumstances which hinder or prevent the generation of mias- 
mata are high latitudes, high elevations, drainage, sunlight, sandy 
or porous soil, and cold; of these cold is the most powerful. The 
first fall of the temperature below the freezing point in any malari- 
ous region arrests the process of development, and it does not recom- 
mence until the temperature again ranges continuously during day 
and night above 58° Fahr. Malarial diseases are rare beyond the 
sixty-third degree of north latitude and the fifty-seventh degree of 
south latitude. The nearer the equator from either of these lines 
the diseases increase in frequency and intensity. These limits are, 
however, greatly affected by the duration and high average of sum- 
mer heat. ” Hirsch has shown that the average summer heat is a more 
potential influence than the average annual temperature. High ele- 
vation presents many curious exceptions, probably depending upon 
geological formations. Strata of soil or other impermeable geological 
formations which obstruct or prevent the percolation of the water, 
and retain it in a loose surface soil or in deeper layers containing 
decomposing vegetable matter, are frequently the cause in many 
malarious localities. In such regions subsoil drainage is the only 
effectual preventive. Sewers, with water-tight conduits (as they 
ought to be in all cities) for the conveyance of the tilth and storm- 
water, cannot accomplish much towards soil drainage. The cleavage 
of impermeable strata caused by the necessary excavations may 
facilitate percolation to a limited extent, but is altogether insufficient 
in those cities standing upon soils where tire conditions exist which 
render soil drainage necessary. 
Miasmata are generated more rapidly and the poison is more in- 
tense during night than , during sunlight, and a humid atmosphere 
and rapid evaporation favor its production. Hence the salutary in- 
fluence of solar light is modified by the moisture of the air, the 
rapidity of evaporation, and the total movement of the wind. 
An analysis of the conditions and circumstances favorable and un- 
favorable to the generation of miasmata; and their application to 
this locality lead to the conclusion that this city presents other con- 
ditions favorable to the production of miasmata in addition to the 
constantly increasing river flats, which are so universally condemned 
as the chief cause of malarial diseases. The city is located in a basin 
surrounded by a range of hills, broken on the east by the Anacostia 
River and its damp and swampy lowlands; on the north by Rock 
Creek; and on the west by the Potomac River, which washes the 
entire southern boundary of both cities, and emerges from the basin, 
after uniting with the Anacostia at a sharp bend toward the south, 
below the flats, leaving along its southern shore an extensive area of 
swampy land, subject to occasional overflow, and usually, during 
the summer, covered with luxuriant vegetation under careless culti- 
vation, over w hieii the prevailing southern winds of that season must 
come. Under the center of the city flow's Goose Creek to its sewer 
connection. This was formerly a tributary of the Tiber, but is now 
the common sewer qf a densely populated portion of the city, quite 
equal in territorial area to the original drainage limits of this stream. 
Farther eastward is the Tiber, a large and sluggish stream, which 
has its source in the hills above the city. It was the main and natu- 
ral drainage stream of a large part of the northern and northeastern 
sections of the city, into which several lesser streams, lying wholly 
within the city limits, empty. After passing the west front of the 
Capitol park it originally turned abruptly westward and emptied into 
the Potomac south and Vest of the Executive Mansion. This part 
of the stream was diverted by the construction of the Washington 
City Canal, which occupied its bed from its mouth to the bend before 
referred to, and from thence extended in a southeasterly direction 
along the valley at the base of the elevated plateau upon which the 
Capitol stands. The canal is now replaced by the B-street sewer, 
running westward to the Potomac from West Sixth street; thence 
eastward by another sewer connecting at the Botanical Garden with 
the Tiber Creek sewer, which, from this point, follows the course ot 
the eastern division of the canal to its intersection with the valley 
of James Creek. Below and southeast of the latter point the canal 
remains open, and is the common receptacle of the sewage, soil drain- 
age, storm-water, and tilth ot that neglected section. It was built 
for commercial and drainage purposes. By its construction (the earth 
from the excavation having been used for Ailing) the marshes and 
low lands, which occupied for the most part the area lying south of 
Pennsylvania avenue and north of the reservations known as the 
Mall, have been reclaimed and are now appropriated in-part for parks, 
but mainly for commercial and industrial purposes. Throughout 
the extent of this reclaimed territory the soil drainage is inadequate. 
The cellars of the buildings are damp, and constantly subject to over- 
flow by back-water from the Potomac and from heavy rains. During 
the spring of 1881 Pennsylvania avenue from the Capitol grounds as 
far west as Tenth street was inundated ; and in some places the water 
reached several feet in depth, and passengers were conveyed to and 
from the Baltimore and Potomac depot in boats. 
Previous to the construction of the storm-water conduit along New 
York avenue from West Seventh street, down west Fifteenth street, 
and thence through the grounds south of the President’s house to its 
outlet into the Potomac at the foot of West Seventeenth street, the B- 
street sewer was the carrier of alithe sewage and fall-water from the 
central and most populous part of the city included within the lines 
of West Seventh and Seventeenth streets north to Vermont and 2 
Rliode Island avenues. The construction of this conduit was a very 
important improvement, because of the incapacity of the B-street 
sewer, and the contemplated diversion to the Boundary intercepting 
sewer of the rainfall and sewage of the area between West Four- 
teenth, North N and Boundary streets, will be an additional relief to 
the sewer mains emptying into the Potomac. In the B-street area, 
the carriage-ways are, for the most part, paved with concrete and 
asphalt. Through it runs Goose Creek sewer. Its subsoil drainage 
is limited to the percolation along the sewer excavations and distri- 
bution. 
The Tiber to the northern boundary of the city has been arched 
and converted into a sewer, and now finds its exit into the Anacostia 
through the recently built open sewer along the bed of James Creek. 
The area of the Tiber valley system of storm-water drainage and 
sewerage is very large, extending westward to the east line of the 
B-street area, north and northeastward along the Boundary-street 
sewer to its intersection of Maryland avenue, and is hounded on the 
east and south by Maryland avenue, East Sixth street, and North 
Carolina avenue to its southern terminus at the crossing of New 
Jersey avenue and E street south. The sewage, rainfall, and waters 
of the numerous springs formerly scattered throughout this territory 
and the tributaries of the Tiber south of the boundary intersecting 
sewer are carried by the same conduits. The valley of the Tiber 
and its tributaries originally extended far into the eastern and 
northern sections, aud even beyond the northern limits of the city. 
It constituted the largest siugle drainage area in the basin. Within 
its borders were several marshes covering large areas, notably the 
h c ilities formerly known as “Swampoodle,” the vicinity of the Pub- 
lic Printing Office and St. Aloysius Church, and the larger part of the 
“slashes.” The latter was a long and narrow strip of boggy and 
swampy land stretching eastward and westward along the base of 
the hills ou the northern frontier, insufficiently drained by two small 
streams, one now known as Slash-run sewer, emptying into Rock 
Creek, below the P-street bridge, the other a branch of the Tiber. 
It thus appears that the surface of that portion of the floor of the 
basin upon which Washington now stands was originally traversed 
by extensive valleys, and that the central and most densely popu- 
lated part, lying between the Capitol and Rock Creek, was, in fact, 
an island, surrounded by streams of running water, marshes, and 
boggy lowlands. Its surface was uneven and Irregular, broken by 
numerous elevations, depressions, and natural drainage courses, either 
surface or subsoil, which have been mostly obliterated. 
The foregoing description of the-soil, marshes, running streams, 
and springs, which were unusually numerous in such a small terri- 
tory as that included within the city’s limits, has been introduced 
to show that the natural drainage of the subsoil was insufficient, and 
that consequently there were formed large tracts of marshes and 
swampy and boggy lands. The conversion of the streams into sewers, 
with water-tight conduits, has diminished their subsoil drainage 
capacity, and in fact has limited the soil drainage to the sources of 
the streams and such additional percolation of water as may take 
place in the excavations through the earth rammed along the" walls 
of the conduits. How far this disturbance of natural drainage made 
necessary by the sewerage system may compensate for the innu- 
merable subsoil pores and erevictft which must have discharged on 
either side into the open water-courses cannot be ascertained. It 
cannot, however, be complete. It is true the conveyance of the 
storm-water from the surface by grading, paving, and sewerage, 
the diminution of the open and exposed area by buildings, pavement 
of streets and sidewalks, and especially by the impermeable pave- 
ments, has greatly lessened soil saturation from fall-water. The ex- 
teut of evaporating surface has also been greatly diminished. 
Whether these artificial interferences have contributed to the sani- 
tary improvement of the underlying earth is an unsettled problem. 
A porous soil forming the greater portion of the floor of a great basin, 
the surface of which, for the most part, is but slightly elevated above 
the water-level of the great streams lying along three-fourths of its 
circumference, aud at the foot of a range of high hills on the other 
fourth, must be subject to constant capillary filtration, even to satu- 
ration, at a depth not far above the water-level in the contiguous 
and surrounding rivers. This capillary circulation is increased by 
high temperature, to which the extensive surface of impermeable 
asphalt and concrete pavements is probably a very considerable 
contributor, especially during the season when the solar heat 
ranges above an endurable temperature. Thus, notwithstanding 
the diminution of storm-water percolation and superficial area of 
soil-saturation, conditions are present, during the greater part of the 
year, which promote the capillary circulation throughout the porous 
strata. The exposed evaporating surface being lessened by the means 
before referred to, the exhalations must find their escape mainly 
through the uncovered parks and spaces, permeable pavements, and 
cellars, basements, and foundations of houses not protected by con- 
creted floors and cemented walls. The evidence of this constant fil- 
tration may be noted at any time (even though no rain has fallen 
for days or weeks) by comparing the relative dryness of the brick 
sidewalks on the north and south sides of streets running east and 
west (most marked at uiglit), and in many localities the same con- 
dition is shown by the walls of buildings for several feet above the 
level of the sidewalk. It is more observable along the streets where 
the carriage-ways are paved with impermeable material. In the cel- 
lars, basements, and ground stories of bouses unprotected by imper- 
meable walls and floors the evidences are even more apparent. I 
will not assert that these emanations are laden with the poison of 
miasm, but the supposition of its presence is not without some show 
of reason, inasmuch as heat and moisture are certainly, and decom- 
posing vegetable matter presumably, present, more especially in 
those localities where the surfaces have been changed by considera- 
ble filling. The water which oozes through the system of capillary 
irrigation may he impregnated, as it is mainly derived from streams 
that have coursed through many miles of malarious territory. Even 
if the exhalation is free from miasmatic poison, the increased humidity 
of the air surrounding and permeating the walls of dwellings and 
diffused through the apartments of the occupants is unsanitary, and 
becomes au important and prevalent factor in the causation of the 
morbid processes incident to the catching of cold, which will he con- 
sidered further on. 
It must not he forgotten also that our summers are long and hot. 
The temperature throughout the months of June, July, August, and 
September—some years a month earlier and later—runs continuously 
during day and night above the elevation necessary for the genera- 
tion of miasmata, and also that during the months of greatest heat 
the total movement of the wind is less than during other months of 
the year—circumstances favorable to a rapid production and concen- 
tration of miasmata. 
The section of the city west of Rock Creek, formerly known as 
Georgetown, presents conditions no less favorable to the generation 
of miasm. It is located upon a slope rapidly ascending from the 
water-level of the Potomac to an elevation of several hundred feet 
above the sea-level; is surrounded on three-fourths of its circumfer- 
ence by water, with Analostan Island and its contiguous marshes in 
front; is penetrated by the Chesapeake and Ohio tbfyal; its sewerage 
is insufficient; it is without subsoil drainage, and is closely and com- 
pactly built, with streets narrow and insufficient for ventilation and 
evaporation. The houses are mostly built of brick with unprotected 
foundations and cellars, and upon a surface with underlying imper- 
meable strata. High above its most populous portion are two large 
cemeteries, in which the number of interments is daily increasing. 
If the result of investigations recently promulgated by Pasteur in 
his address before the Loudon International Medical Congress should 
be confirmed, that the germs of diseasedo not die with the death aud 
burial of the victim, but retain vitality and the power of reproduc- 
tion for years, the question of the removal of cemeteries bey«ud the 
limits and suburbs of cities will soon agitate the popular mind of 
large municipalities. I would not utter one word which could les- 
sen the love and respect so universally shown to the dead by the pro- 
tection and embellishment of burial places, but we live for the liviug 
and not for the perishable bodies of the dead, from which poisonous 
emanations may be constantly permeating the earth and be diffused 
in the air we breath and the water we drink. Cremation is repulsive 
to our devotional and emotional sensibilities, but may yet become a 
necessary sanitary reform. Life and health is the sum of all values 
to the human being. 
For cleanliness of its streets and general surface this city is not 
excelled, if equaled, by any other known to the writer. The admi- 
rable system of street sweeping, the smooth pavements, undulating 
surface, prohibition of deposit of refuse in the streets, and acquies- 
cence of the people in every effort to improve its sanitary condition, 
contribute to prevent collections of dirt, filth, and foul and extrane- 
ous matter in the streets. The garbage department is probably as 
well executed, and the alleys are kept in better order than is usual 
in large cities. There are comparatively few localities where masses 
of squalid and vicious people are huddled in filthy, insufficient, and 
unfit habitations. There is comparatively little poverty, want, and 
suffering, notwithstanding the large proportion of indigent and idle 
negroes. The climate is temperate and salubrious. The plan of the 
city, with its wide streets and avenues, and its numerous parks and 
open spaces, affords great protection against the extension and viru- 
lence of contagious and infectious diseases. 
The escape of sewer gas into private dwellings is one of the most 
frequent alleged causes of disease. No intelligent physician will deny 
its deleterious influence. It is a fact, however, in this city, that the 
greatest number of deaths from zymotic and pulmonary diseases (see 
maps showing distribution of deaths in the annual reports of the 
health officer for the years 1879 and. 1830) occur in those parts corre- 
sponding with the localities of former soil saturation and now defi- 
cient soil drainage, as, for instance, the extensive area originally 
traversed by the valley of the Tiber and its branches, the Slashes, 
Slash Run aud its contiguous lowlands, and that part now known as 
South Washington. In the latter district the drainage is surface and 
bad, “ many of the gutters do not carry away the storm, slop, and 
waste water, and it is left to evaporate or find its way into the soil.” 
Even if sewer gas was not an active agency in the production of 
disease, it is a nuisance that ought not to be tolerated in any habit- 
able dwelling. In some houses the odor from foul and improperly 
cleansed fixed wash-stands, water-closets, privies, and insufficiently 
ventilated rooms is mistaken for sewer gas ; nevertheless in many 
others the air is rendered impure and unhealthy by its admixture 
with sewer emanations. This is most usually due to the imperfect 
plumbing and house drainage, and not to defects iu the system aud 
construction of the sewer mains. The rainfall and sewage are car- 3 
riedoff in the same conduits, and “the principal main sewers (see 
Lieutenant Hoxie’s report, 1880), following the line of natural drain- 
age,” discharge at intervals along the water front, thus securing 
diffusion and dilution of the sewage. The combination of the sys- 
tems of sewage and storm-wrater drainage, and the transference of 
the running streams into the same conduits, promote constant agita- 
tion aud admixture with pure water, and a more rapid conveyance 
and greater aeration of the sewage, thereby diminishing the genera- 
tion and promoting the innocuousness of the gases. Lieutenant Iloxie 
says “nearly all the gas not due to defective plumbing in houses is 
generated in the tidal sections of” the principal main sewers. He 
believes “ the motion of the tides driving back these gases at the 
flood” is advantageous, inasmuch as it induces motion, and promotes 
their withdrawal and replacement by fresh air. The oval “shape 
of the sewers concentrates (Hoxie) the dry-weatlier flow in the in- 
vert, aud the large air space above is favorable to a prompt oxidation 
of such gases as may form during the short time occupied in flowing 
to tide water.” Ventilation is effected by grated manfioles at short 
intervals. The chief defect of the system is, perhaps, the deficient 
fall of the sewer mains. This is partially, if not wholly, compen- 
sated for by the combination of the two systems. It is believed that 
if the engineer department could be clothed with authority to adopt, 
free from the trammels of individual and speculative interests, and 
be supplied with funds sufficient to execute a plan of improvement 
and extension, the sewerage of this city would be as complete as 
possible, and far in advance of that of most large cities. Even in 
its present unfinished condition it must be admitted that the con- 
stantly alleged danger from escape of the gases into private dwell- 
ings is overstated, except so far as it is due to faulty plumbing and 
house drainage, defects not attributable to the general plan or to the 
engineer department, but directly chargeable to the negligence of 
the owners and builders of the houses. This evil can only be cor- 
rected by the vigilance and supervision of the health department, 
which has several times inwked the necessary authority, but as yet 
without securing the assent of Congress. Such emanations, though 
productive of disease, do not often cause malarial diseases. Typhoid 
fever and diphtheria most frequently, probably, find their origin in 
tliis manner. 
If not demonstrated, it is very generally believed that the soil of 
malarious regions contains the malarious poison in great quantity, 
even during the season when malarial diseases do not affect human 
beings. It is also believed, and medical topography supplies abun- 
dant affirmative testimony, that moist subsoils, with surfaces exposed 
to high temperatures and rapid evaporation, present all the condi- 
tions necessary for the generation of this poison. In such places the 
ground air may become contaminated and the poison may be gath- 
ered in the strata of air near or on the surface. Nature’s method of 
drainage is by streams and rivers. Ground water seeks the level of 
the drainage streams. Rivers receive the waters of their tributaries, 
the tributaries of the lesser streams, each of which is the confluent 
of smaller branches, until we reach the rills and rivulets which are 
formed by the storm-water which penetrates the earth and percolates 
through the interstices and pore canals. The rainfall flows from the 
surface towards the sea. The larger and smaller streams drain larger 
and smaller areas; these areas are interspersed, more or less, with up- 
lands and lowlands, hills and valleys, mountains and plains, prairies 
and forests, and arid and swampy lands. Every such tract, however 
small, has its natural drainage course; it may be a mere depression 
of the surface, a running rill or a majestic river. As the larger are 
made of the waters of the smaller streams flowing from sources of 
varying elevation, even up to the plane of the pore canal, so must 
the height of soil saturation of the different parts of -a given area 
vary with the water-level of its drainage course, but it can never 
sink below the plane of the nearest running and never-failing stream, 
and will always be affected by the frequency and amount of precip- 
itation, the nature of the strata of the earth, and the slope of the 
wa-tershed. The Potomac and Anacostia Rivers, which wash the 
shores of this great basin, fix the plane below which soil saturation 
can never sink. This, in many places, is but a few feet below the 
natural surface. But, because of the nature of the geological strata 
and other peculiarities of the situation, there are numerous localities 
where the point of soil saturation is far above the plane thus estab- 
lished and so near the surface as to be reached by the excavations 
necessary for building purposes. The preceding description of the 
original topography points out such parts, marked by depressions, 
marshes, swamps, springs, and surface streams; the maps of the 
health department, showing the distribution of deaths from certain 
diseases, prove the unhygienic condition of such situations and their 
unfitness for purposes of habitation. The diminution of the super- 
ficial area of storm-water percolation has certainly lessened the 
amount of ground water, and the construction of water-tight con- 
duits has facilitated the conveyance of the surface water to the river 
channels. While the transfer of the drainage streams to the sewers 
has its advantages, it is, nevertheless, manifest that such conduits 
are not subsoil drains, and that the modes of escape of the ground 
water, especially in certain parts, are wholly inadequate for sanitary 
purposes. The filling of depressed parts, and the attempt of the 
late board of public works to reduce the surface of the basin to a 
common level, have obliterated unsightly ponds and marshy low- 
lands, but have not lowered the plane of soil saturation. In fact, in 
many places the distance between the surface and this plane has 
been diminished, as may he seen after seasons of wet weather, when 
whole squares of unoccupied ground are submerged and adjacent 
cellars, basements, and foundations are inundated by soil water. 
This is more constantly observed in the localities of former marshes 
and places insufficiently drained previous to any artificial disturb- 
ance of the natural topography, and where the natural drainage has 
been transferred to the sewer mains, and such precolations as may 
take place along the excavations. To correct these natural unsani- 
tary conditions, and to remove the obstructions interposed both by 
nature and art, is a matter of grave interest to the permanent popu- 
lation and to the national Government. As the general surface of 
the door of the basin is but little above the elevation of the tidal 
wave, it is not probable that engineering skill will ever successfully 
obviate all of the obstacles presented, but there can be no doubt of 
the value and practicability of a system of subsoil drainage which 
will lower the subsoil saturation throughout those parts of the terri- 
torial area wliei’e it is made necessary by the geological structure 
and artificial interference. That such a system will contribute 
greatly to the mitigation of the natural defects and promote the 
healthfulness of the city there can be no doubt, as is illustrated in 
the improved sanitary condition of certain towns and cities iu 
England where the subsoil has been effectively drained. As shown 
on the maps previously referred to, and demonstrated by Dr. H. I. 
Bowditch, of Boston, by observations made throughout the State of 
Massachusetts, pulmonary consumption bears a positive and constant 
relation to soil saturation. The same fact has been shown in Eng- 
land by a series of observations made under the direction of Mr. 
Simon, by Dr. Buchanan; and the additional fact, also, that this 
disease had decreased in those towns after the drainage of the sub- 
soil, most markedly so in those where the level of subsoil saturation 
was most lowered. Dr. Mead, the medical sauitary inspector of this 
city, makes the emphatic statement (report of health officer for 
1880) that in certain localities in this city where better drainage has 
been secured a marked decrease has taken place in the number of 
deaths from phthisis, acute respiratory and diarrheal diseases. The 
city of Detroit was built upon a low and wet soil, and it was a very 
sickly town, but since the improvement iu the drainage it has become 
one of the healthiest cities in the country. Dr. Elliot has shown 
that iu New Orleans, in which city there is constantly present the 
condition of excessive soil moisture, the mortality from pulmonary 
consumption for the years 1869 to 1879, inclusive, nearly doubled 
that of either yellow fever, malarial fever, or-diarrheal diseases, and 
that the excess of deaths from that disease occurred during the six 
warmer months of the year. 
Ground-air (*) is perhaps neither a less potential nor a less fre- 
quent factor than ground-water in the causation of disease. The 
popular belief is that the atmosphere ends where the ground begins, 
but the fact is that the pores of the earth when not filled with 
water are filled with air. The quantity varies according to the nat- 
ure of the soil. The greater its porosity the more air it can con- 
tain. Rubble soil, gravel, or sand will hold about 35 per cent, of its 
mass of air. The degree of humidity of a soil represents the amount 
of ground-water, and soil saturation begins at the lowest limit of the 
air. Ground-air contains a larger proportion of carbonic acid than 
either the atmosphere or the ground-water, and, at a few feet below 
the surface, even more than is usually found in badly ventilated dwell- 
ings. The quantity is greater during winter than summer, and in- 
creases with the depth, except during the months of June and July, 
when the percentage is in versed. Pettenkoffer concludes from liisin- 
vestigations that the soil is the source of this gas, and is yielded by it 
to the ground-water and ground-air, most freely to the latter ; and 
he believes that it finds its origin iu organic processes taking place 
in the soil. Huxley, Haeckel, aud others have shown that organic 
life exists everywhere in every porous soil, as well as at the bottom 
of the sea. The more porous the soil, the greater the quantity and 
more rapid the diffusion of air; the more active the processes of de- 
cay and putrefaction, the greater the development of low organisms 
and the more abundant underground life. The ground is not only 
permeable, but the air it contains is iu constant motion, produced 
by the pressure of the atmosphere and wind against the surface; by 
differences of temperature ; by any and every cause which can pro- 
duce movement; and by the general law of diffusion of gases. The 
leakage of coal gas from street mains has frequently been known to 
permeate the earth beneath the street, penetrate walls, vaults, and 
foundations, and escape into dwellings at considerable distances from 
the leak. So, also, has the poison of disease been transported by 
underground conveyance. Whatever impurities and pollutions may 
contaminate the ground-air will be diffused by the current and con- 
stant change going on. It may be impregnated with noxious ema- 
nations generated either on or below the surface. All forms of filth, 
the excreta of animals, aud the processes and products of putrefac- 
tion collected upon or under the surface, or deposited in vaults, cess- 
pools, or pits, constitute foci from which deleterious exhalations are 
disseminated throughout the ground. In cities and other places 
where people are massed iu large numbers in circumscribed areas, 
the soil-water and ground-air will be, to a great degree, unfitted for 
*Tliese data have heen summarized from Pettenkoffer’s lecture ou “ The rela- 
tiou of the air to the soil or ground-air.” 4 
the purposes of human life by such poisonous and, oftentimes, dis- 
ease-bearing effluvia. They are more detrimental to life when re- 
ceived into the system through the ground-air than when conveyed 
through the atmosphere, because more concentrated, and mixed 
with larger percentages of carbonic-acid gas. When exhaled into 
the free atmosphere they are more easily diffused and diluted, are 
blown away by the winds, and, probably, more speedily oxidized 
and rendered inert. But how can the ground-air reach us ? Currents 
are created by differences of temperature, aud will be in the direc- 
tion of the higher. It should then constantly oscillate up and down 
toward the atmosphere and into the earth. Fortunately for human 
life it does this, and in the process the earth is ventilated, aud the 
deleterious constituents of the ground-air are diffused into space. 
But this movement and change of air between the atmosphere and 
the earth is only partial, aud is influenced by many conditions and 
circumstances, such as the currents and force of the wind; forma- 
tion of the soil; amount and frequency of precipitations; degree of 
soil humidity, and depth of soil saturation. It comes to us when 
least expected, and when least resistance can he offered to its influ- 
It comes with high percentage of carbonic-acid gas, with 
relatively high humidity, and, perhaps, laden with the germs of dis- 
ease. It conies in our dwellings, in our sleeping apartments, during 
the hours of rest and repose, and is most apt to do so when we are 
most securely protecting ourselves frdm the external atmosphere,, 
either because we fear its injurious contaminations or its chilling in- 
fluences. It comes under the surface, passes through the earth, and 
the permeable walls, foundations, and floors of our houses, and poi- 
sons the air we breathe. Every house unprotected by foundations 
and walls impermeable below the surface is a draft-flue for the 
earth. The penetration of the airthrough the earth ispromoted and 
facilitated by every such house. The warmer the air inside, and the 
more securely protected against the external and free atmosphere, 
the more rapid the current of ground-air through the foundations 
and ground floors of such dwellings. It is a more cons.ant evil 
during the colder .than during the warmer seasons, because of the 
greater difference between the temperature of the houses and of 
the ground-air. Freezing of the surface offers hut little obstruc- 
tion to the circulation of ground-air, and none at all to its hori- 
zontal movement. In fact it has been supposed by some to favor 
its escape into dwellings and through the warmer surfaces. No ex- 
planation entirely satisfactory has yet been presented for the greater 
prevalence and in tenser forms of small-pox, scarlet fever, and other 
exanthematous diseases during the colder than during the warmer 
seasons. The greater number of persons in, and the more constant 
occupancy and diminished ventilation of dwellings are admitted and 
important agencies. Why may not the ground-air, carrying these 
contagions and penetrating these dwellings, prove a factor in their 
dissemination equally as constant and potential ? If it be a fact, as 
announced by Klebs and Thomassi-Crudelli, that the malarial poison 
is found in the soil of malarious regions during the seasons when the 
temperature of the atmosphere is below that believed to be neces- 
sary for the generation of this miasma, why may not the greater fa- 
cility and certainty of the admission of ground-air into houses at 
such times explain the prevalence and constantly recurring attacks 
of malarial diseases during these periods ? The fact is easily demon- 
strated that many occupants of houses standing upon made or insuf- 
ficiently drained lands are sufferers from persistent and ill-defined 
ailments, from which relief is only secured by change of dwelling. 
Aud, surely, if the discoveries announced by Pasteur have any sub- 
stantial basis, the conveyance of the germs of disease in this manner 
is not only possible but probable. It may not be practicable to pre- 
vent entirely the pollution of the ground-air, hut it can be reduced 
to a minimum, and the air of dwellings can be securely protected 
from such contamination by proper construction. Greater cleanli- 
ness of the soil can be secured by the prohibition of cess-pools, privy 
boxes, and pits, and of other collections and deposits of decaying 
and putrescible material, either upon or beneath its surface. A 
properly arranged and adequate system of sewerage, and compulsory 
legislation requiring a connection with every such depository and 
receptacle will accomplish much in preventing soil tilth. A system 
of underground drainage will dispose of the surplus soil-water, lower 
the level of soil situation, and purify the earth by promoting ven- 
tilation and a more rapid percolation of the rainfall to greater depths. 
The pipes of such a system when not carrying water will carry air, 
and thus aeration and ablution of the soil, and dilution and diffu- 
sion of the filth will accomplish at least a partial disinfection. 
The air of dwellings must be considered in its relation to the sur- 
rounding atmosphere as well as to the ground-air. This relates 
especially to the study of the processes of catching cold. The air 
of a dwelling cannot be purer than the atmosphere which surrounds 
it, and is altered (Pettenkoffer) and deteriorated by whatever goes 
on in it. It is polluted by the admixture of substances, and altered 
in chemical composition after it enters the house. Oxygen is con- 
sumed by respiration, lights, and fires. Carbonic acid and water 
are exhaled from the lungs and skin, and various other extraneous 
matters are derived from the uncleanly and careless management 
and disposal of the waste and refuse. These alterations are partly 
unavoidable. Interchange is constantly taking place between the 
air outside and inside. No house can be protected against this change 
of air, and if the atmosphere was excluded it would not be habita- 
ble. Ventilation is, however, in very many habitations insufficient, 
because of overcrowding, defects of construction, and neglect of pre- 
ventable sources of pollution; and it is a great waste to consume 
• fresh air in the aeration and dispersion of such unavoidable contam- 
inations. 
The air, both inside and outside of dwellings, is always in motion, 
though this is not always manifest to our senses. Ventilation is 
effected by the constant interchange due to motion produced by 
differences of temperature and by the force of the wind, and is reg- 
ulated by the porosity of the walls and the size and number of the 
apertures and architectural openings. The difference of tempera- 
ture and the force of the wind frequently supply the insufficiency of 
the one or the other. By these means spontaneous ventilation ought 
to be sufficient for the purposes of health, provided the greatest 
cleanliness and abstention from superfluous pollutions are observed. 
There are, however, many circumstances and conditions which in- 
terrupt and impede this necessary and wholesome interchange. In 
this city damp and wet walls are among the most frequent disturb- 
ances of ventilation. Water Alls the pores of the brick, stone, and 
mortar, and closes the inlets and outlets of these porous materials so 
generally used in the building of houses. This water is mainly de- 
rived, through the permeable foundations, from the ground-water, 
which in so many places is excessive and near the surface. But 
damp walls not only prevent the passage of air, but disturb the 
heat economy of the bodies of the dwellers. Water is a better con- 
ductor of heat than air, and wet clothes are colder than dry. Wet 
walls abstract and absorb more heat than dry walls. They reduce 
the temperature of the room and accelerate the loss of animal heat, 
thus producing a too rapid cooling of the whole or parts of the 
body. In this circumstance many cases of sickness find their cause. 
Colds, catarrhal inflammations, rheumatisms, aud kiudney diseases 
(prevalent forms in this city) are quite common among the occu- 
pants of damp dwellings. 
Ventilation and draught are not the slime. Both imply motion of 
the air. Ventilation is the necessary cliange-of air in a closed space 
taking place without perception of its movement. Draught is the 
motion of air made manifest to sensation, and differs from wind only 
in force and velocity. The occupants of wet and damp houses fre- 
quently complain of and ascribe their ailments to draught, when in 
fact there is insufficient exchange of inside and outside air, because 
of the filling of the pores of the walls with water. In addition to 
vitiation of the air in such houses, there is more rapid absorption of 
heat and lowering of the temperature, causing local and one-sided 
radiation of the hody-heat and the consequent disturbances of the 
heat-economy, thus producing ailments which are ascribed to ma- 
laria. 
In whatever respect soil saturation may he considered, its influ- 
ences and effects are detrimental to health. 'Agriculturists have 
long since recognized the injury-of surplus soil moisture to plant 
life, and experience has shown that such lands, usually the richest 
in the elements of plant food, can only be made available by under- 
drainage. But not until recently, and only by comparatively few 
even now, have its dangers to human health and life been clearly 
understood. Only by the study of the topographical distribution of 
diseases and deaths has the direct connection between soil satura- 
tion and pulmonary consumption been ascertained. And though 
shown to he true in regard to lai'ge regions and sections, hut few are 
yet willing to believe it equally true of single habitations. Until 
the doctrine that diseases are more frequently attributable to per- 
sonal and domiciliary unhygienic conditions than to natural causes 
is more universally accepted, but little can he accomplished by pre- 
ventive medicine. 
Morbility and mortality bear a constant relation to the density of 
population. This is a factor in all cities. When to a superabund- 
ant and unclean population are added the effects of an inadequate 
provision for the removal of the various excreta, the air becomes 
permanently laden with noxious elements. This is a city for politics, 
{esthetics, and the sciences, and not for commercial aud industrial, 
pursuits, aud hence ought to he comparatively free from many, foul 
matters aud effluvia, which are the unavoidable accessories of the 
latter occupations. The plan of the city secures constant agitation 
of the air aud free ventilation. Its wide streets and broad avenues 
with their numerous iutersections forming large open spaces, create 
interchanging currents. These, together with the large area of 
public reservations, promote the diffusion, dilution, and escape of 
the insalubrious and detrimental exhalations. As a cause of disease 
the density of the population can never become, as in more popu- 
lous cities, the predominating influence. The area of unoccupied 
territory will always be largely in excess of the occupied. Never- 
theless, as the value of real estate advances, the cupidity of owners 
will, in small districts or single squares, unless restrained by law, 
establish numerous foci for the germination and dissemination of in- 
fectious germs by the subdivision of lots, the opening of new streets, 
the conversion of alleys into others, and the erection of tenement- 
houses upon every available space. I might even now cite such 
localities. The proper adjustment of the number of residents to 
the area, together with the rigorous enforcement of sanitary regu- 
lations, would greatly lessen the morbility and mortality, especially 
in those districts where overcrowding and filth prevail. It is a great 
mistake to suppose that we have no personal concern in nuisances 5 
on neighbors’ premises They can poison the ground, air, water, 
and atmosphere, and this poisoned air may permeate the earth and 
convey to other dwellings the germs of disease. Our senses may 
not detect the noxious effluvia, but the enemy may find its victim 
all the same. 
It maybe asked, how abate the evils complained of? The answer 
is easy. Reclaim the river Hats; complete the system of storm-water 
conveyance and city sewerage; hasten to completion the grading 
and improvement of the streets; elevate the bed of Pennsylvania 
avenue from the Capitol to west Fifteenth street; discontinue the 
use of impermeable material in the pavement of carriage ways and 
sidewalks; establish and execute a system of subsoil drainage ; ob- 
literate or subsoil the parks along the building lines; improve and 
adorn the reservations; extend the Capitol park south to the river 
shore and connect it with the reclaimed flats along the Potomac; 
prohibit by stringent regulations the erection of buildings with per- 
meable ground or underground floors and walls below the surface of 
the streets; straighten the channel of Rock Creek, by cutting across 
the horseshoe bend at P street; hide its filthy shore by an arch, and 
open a park along its course ; and empty the Chesapeake and Ohio 
Canal into the Potomac above the limits of Georgetown, and destroy 
the unsightly observation of this cesspool of filthy water and many 
stenches.* 
This is the capital of a great, growing, and prosperous nation, 
beautiful in design, and susceptible of greater and more magnificent 
embellishments. Every citizen shares the wish for its substantial 
improvement and adornment commensurate with its importance and 
capabilities. .The time may not be very remote, and will be hastened 
by the speedy execution of the necessary sanitary reforms, when the 
surrounding elevations will be covered with winter residences and 
summer villas, rivaling in beauty and grandeur the taste and display 
exhibited along the cliffs at Newport. Under the present form of 
government the sanitary condition has been greatly improved, hut 
this great nation cannot afford to permit the longer continuance of 
the manifest and admitted causes of disease, which environ and un- 
derlie its capital, furnishing a constant menace to the health and 
lives of itschosen agents and legislators. Nor should the permanent 
residents stand by idle and unconcerned, while the rising genera- 
tions are growing up under the baneful and enervating influences, 
with their multiform phases of disease, interrupted development and 
broken constitutions. The expenditure required to complete the 
necessary sanitary reform, under the direction of the most skillful 
supervision would he a magnificent contribution by a nation of fifty 
millions of people to sanitary science, preventive medicine, and the 
welfare of a common humanity. 
In the foregoing I have endeavored to set forth the natural and 
artificial unhygienic conditions of this locality, and have indicated 
in the title that I ascribe the prevalence of two classes of disease to 
these causes, one being due to the contamination of the air with a 
special poison, and the other to the catching of cold. I have also 
stated that the clinical pictures frequently presented by-cases and 
forms of these different classes of diseases were so alike that differen- 
tiation of cause, so necessary for success in treatment, was not always 
easily arrived at. I approach the discussion of the clinical branch 
of the subject with diffidence, because I am well aware that the con- 
clusions to which my studies have led me will antagonize the opin- 
ions of some of my most distinguished professional brothers ; never- 
theless I have no new theories to promulgate, and will confine myself 
solely to the narration of my own clinical observations. 
The detrimental influences which environ our population do not 
belong exclusively to this locality. One could not travel far in any 
direction from this center without finding other communities no less 
unfortunately situated. Many cities, towns, and neighborhoods 
throughout the land present natural conditions equally and even 
more unsafe to health and life, and exhibit graver errors in hygiene, 
which yield annually a richer harvest in deaths than we have as yet 
offered. But if others have suffered more or less, it is no reason why 
we should delay in securing all that science can promise in the pre- 
vention of disease. To accomplish this we must first ascertain the 
cause or causes. If in the preceding picture I have depicted the work 
of nature and operations of man in their proper colors, I may hope to 
interest those concerned sufficiently to arouse them to the dangers 
which beset the present and may befall future generations, and will 
have discharged a duty which professional observation, experience, 
and opportunities have imposed. 
Of the presence in this locality of the two causes and two classes of 
disease referred to there can he no doubt. But our knowledge of the 
nature and infectious quality of the malarial poison does not permit 
an exact determination of the relation of this agency to the effects 
ascribed to it. We witness certain results in constant association 
and connection with an unbroken chain of known conditions and cir- 
cumstances, and from these data deduce an hypothesis which affords 
a reasonable explanation. This hypothesis involves two unascer- 
tained quantities, the genesis and modus operandi of miasma. 
The “ catching of cold,” induced by the unusual removal of animal 
heat, either through the external or internal surface, has long been 
recognized as an etiological factor. The functions of heat produc- 
tion and dissipation are regulated by nerve centers. In health, the 
equilibrium is maintained within certain physiological limits, and 
though the temperature of the body is subject to frequent fluctua- 
tions within these limits the changes are speedily equalized. The 
temperature of all parts of the same body is not uniform at the same 
time, owing to the different amount of heat carried by the blood to the 
various parts,to the varying conductivity of tissues, and the difference 
in local production and loss of heat; but a normal range is preserved 
in health, though between lesser maxima and minima in parts remote 
from than in those parts near the heat-regulating centers. Heat 
production is increased by muscular effort, lessened by rest, and least 
during sleep. The increased production must be compensated by in- 
creased loss, and the lessened production by greater protection of the 
body, else the heat-economy becomes disturbed and injury ensues, 
affecting either the whole or a portion of the body. The body loses 
heat by radiation, conduction, and evaporation, which may he influ- 
enced unfavorably by external and internal agencies. The external 
influences may be expressed in low temperature, motion of the air, 
and moisture. Either may prove sufficient, but disorder more cer- 
tainly follows their combined influence. It is not necessary that 
either or all should be of maximum intensity, for slight cooling of 
the surface by constant change of surrounding air, increased evapo- 
ration from the skin moistened perspiration, or increased conduc- 
tion, promoted by a cooler medium in contact, does in numerous 
instances produce some one of this group of maladies. Nor is it re- 
quired that the whole surface should be cooled ; a leg or arm, the 
head or back of the neck may be sufficient. Numbers of persons 
have felt the pangs of toothache rekindled by a puff' of cold air upon 
the cheek over a decayed tooth, or contracted a cold in the head from 
cutting off the hair in cold weather, or a bronchitis from wetting the 
feet, even in midsummer. While it is usual that the part contigu- 
ous to the chilled surface suffers, it is not the invariable law. The 
place or part of least resistence, the weaker organ or tissue, though 
remote from the part exposed to the chilling, will frequently exhibit 
the injury sustained. Subject a number of persons of equal age and 
vigor and of average health to the same cooling influence, one will 
escape unhurt, another with a slight sore throat, a third will suffer a 
severe rheumatism, a fourth will pass the ordeal of an acute pneu- 
monia, and a fifth will succumb to a pleurisy, the localization in each 
case depending upon individual susceptibility and the lesser resist- 
ance of different parts. If, says Seitz, a sensory nerve tract be im- 
plicated, rheumatic pains or neuralgia may follow ; should the vaso- 
motor center be involved, congestion of a special vascular area may 
ensue ; inflammatory processes may be ascribed to the transfer of the 
impression to the nutritive nerves, and if the heat-regulating center 
be depressed fever may result. It is not necessary that the surface 
refrigeration should belong continued. The sudden transition from 
a warm to a cool medium, as the passing from an overheated room 
to a cold entrance hall, or into a strong current, even though the 
change be of momentary duration, will suffice in a susceptible per- 
son, or a person otherwise healthy, who may be the unfortunate 
possessor of a locus minoris resistentife. It is, nevertheless, a fact 
that few can resist the influence of an active and protracted loss of 
body heat. When at rest or during sleep, surface cooling is more 
certainly and quickly injurious than during exercise, because the 
loss of heat, even though it may not be manifest to our senses, is not 
compensated by increased production. During exercise the circula- 
tion of the blood is stimulated and surface heat is maintained, but 
if perspiration is induced evaporation is increased, and this contrib- 
utes to a more rapid cooling, especially if the exercise is followed 
by sudden rest, and the cooling is promoted by the removal of over- 
garments, and the rest he sought in currents of air. Nor is it neces- 
sary that the sufferer should be admonished by a rigor. The cases 
of sickness following loss of heat are more frequent without than 
with the occurrence of a chill, and it is this class of disorders which 
is so prone to assume chronic and masked forms, finally developing 
either into intractable or incurable diseases. A bronchial catarrh, 
especially in one inheriting the predisposition to phthisis pulmonalis, 
so trifling as not to attract attention, may leave hidden in the lung 
structure a caseous focus too small to be recognized and located, but 
which by constant accretions from subsequent equally trivial and 
repeated attacks, each succeeding one the more probable because of 
one or more having preceded, until finally the caseous formations 
break down, and the previous unsusnected disease passes beyond 
recovery. This chain of unrecognized beginning, imperceptible pro- 
gress, and final explosion may have had its cause in constantly re- 
peated slight surface coolings during rest and sleep, in apartments 
securely protected against wind and storm, but surrounded by walls 
resting upon soil saturated with water. The early history of such a 
case is usually that of enfeebled health, with recurring losses and 
gains, trivial discomforts, passing indisposition, unusual suscepti- 
bility to atmospheric changes, digestive irregularities, summer im- 
provements and winter relapses, and gradual but progressive blood 
changes, marked, in the further progress, by amende and masked 
disorders of graver import, all of which are frequently ascribed to 
malarial contamination, and the methods of prevention and cure, 
based upon a mistaken cause, promote and aggravate the morbid 
processes. The respiratory are not the only organs which suffer from 
equally slight surface coolings, The alimentary tract is quite aq 
* These additions, with the Monument grounds, Mall, and Botanic Garden, 
would make an immense national park and pleasure ground, encircling South 
"Washington, and extending from the Capitol to the Executive Mansion, 6 
often affected, and among very young cbildren the mortality from 
this group of maladies is even larger than from diseases of the respi- 
ratory organs. No one can doubt the agency of sudden refrigeration 
in producing catarrh of the mucous membranes; and the complex 
conditions of alimentation and digestion, which so constantly im- 
peril the life of infants at all seasons of the year, exposes the alimen- 
tary tract especially to the detrimental influences of sudden loss of 
body heat. In those cities throughout the climatic region of this 
country where infantile diarrheas are most prevalent and fatal, the 
fluctuations of temperature during the summer season are most acute 
and intense, and there seems to be a correspondence between the per- 
centages of mortality and the frequency and violence of the sudden 
falls of temperature.* In this city the maps showing the topo- 
graphic distribution of deaths show a constant connection between 
the number of deaths from diarrheal disease and inadequate soil 
drainage. The causes of attacks of cold are not, however, limited 
to the unavoidable depressions of the temperature of the atmosphere, 
excessive soil moisture, wet cellars and foundations, and damp sleep- 
ing apartments. The mother or nurse will insist that the child could 
not have taken cold because it was well wrapped when taken out, 
or was in a carriage with all the windows closed, or had not been out 
for several days, but had been kept in a thoroughly warmed room. 
In the closest and warmest rooms there are draughts. The hotter the 
tire in the grate the stronger the draughts converging from the various 
openings toward the chimney. Usually they are strongest near the 
floor, the cold air finding entrance through the spaces about the 
doors and windows. In an over-heated room the child may have 
been confined and passed the greater part of the day playing on the 
floor, exposing first one and then another heated and moist surface 
to the draughts traversing the floor; or it may have been out on a 
long walk clad with unusual care and too warmly, and immediately 
upon returning, fatigued and perspiring, its outer garments had been 
removed, and it had rested quietly or slept; or the infant, rolled up 
in cloaks and furs, may have been carried out closely hugged in the 
arms of the nurse, from whose body additional heat was supplied. 
On returning, asleep, and moist all over, its outer wrappings were 
quickly removed, and the child placed to sleep in the crib. In either 
case a notable and rapid cooling would take place, and the detri- 
mental effect may be quickly exhibited in a sore throat, an earache, 
a rapidly developed fever, or during the night by croup, or the next 
day by a nasal, intestinal, or bronchial catarrh, or, even worse, a 
pneumonia. 
The defined forms of malarial disease belong to the class of inter- 
mittent and remittent fevers, and the indefinite forms comprehend 
many of the neuralgic, gastro-intestinal, amende, and masked affec- 
tions. The febrile conditions are usually easily distinguished by 
their forms and course. It is, however, a well-known fact that in 
malarious regions many diseases to which malaria bears no casual 
relation frequently exhibit disturbing perturbations, in great variety, 
due to its detrimental influence. It is also a recognized fact that in 
such localities the catching of cold will produce, in those who have 
previously suffered, relapses and recurrent attacks, and will hasten 
and promote the development of some form of malarial disease in 
those in whom the poison may have, apparently, remained dormant. 
These circumstances long ago led to the hypothesis, which has been 
occasionally revived, that the diseases ascribed to marsh miasm were 
due to the disturbances of the heat economy caused l>y temperature 
changes; that malaria was nothing more than the sudden chilling 
of the body previously subjected to a continuous high temperature. 
The few advocates of this theory have not submitted it to a crucial 
test, but have mainly relied upon the discrepancies iu the testimony 
in support of the generation and absorption of a miasm, and the 
aberrant occurrences of paroxysmal fever under circumstances and in 
localities where the casual relation of miasm could not only not be 
established, but seemed to be negatived by the environment. It is 
undoubtedly true that many cases have appeared at places and times 
which, either because of lack of knowledge in regard to the develop- 
ment and dissemination of the poison or of omissions in the clinical 
histories of the cases, could not be accounted for upon, or reconciled 
with, the facts believed to be established in regard to miasmatic con- 
tamination. But as yet there is no instance of malarial fever, as 
understood by physicians, having been produced in a person known 
to be free from the poison, either at sea, t away from the reach of 
the land breezes, on high altitudes, or in situations exempt and 
sufficiently remote from the sources of generation, by temperature 
changes, however sudden, violent, and frequent their occurrence. 
This theory is, furthermore, distinctly contradicted by the wide- 
spread prevalence of malarial diseases during those seasons and in 
those places where the conditions necessary for the generation of 
miasm are known to be present, as well in those places subject to 
small as in those subject to larger ranges of temperature; by the in- 
vasion of sections previously exempt, where artificial disturbances of 
the natural topography or long-continued occupancy and cultivation 
may have supplied the needed element, but where the conditions of 
temperature do not now differ from those in times past; by the greater 
prevalence and more intense forms as the equator is approached, 
where the temperature is more uniformly high, the diurnal changes 
less marked, and the total movement of the wind is small; by the 
marked variations in prevalence in different years in well-known 
malarious regions subject annually to the same, or, at most, but in- 
appreciable differences of thermal conditions, but characterized by 
larger areas of soil upheaval and by greater exposure of miasmatic 
foci; by the comparative protection afforded by intervening hedges 
and groves to the occupants of dwellings which, like others, are 
situated in close proximity to marshes and subject to like conditions 
and changes of temperature ; * by the lesser prevalence, under simi- 
lar climatic influences, along the bold shores of large bodies of run- 
ning water than along the delta, boggy, and low lands of smaller 
streams with far less evaporating surfaces; by the intinence of dif- 
ferent exposures of human habitations to the prevailing winds in 
malarious districts, the occupants of those exposed to the direct cur- 
rent of the wind will suffer more than those of the dwellings sheltered 
by position or otherwise ; and, lastly, by the well-known fact that 
the inhabitants of the territory contiguous to malarious marshes, 
swamps, ponds, and rivers suffer less in those seasons when such places 
are filled or overflowing with water, when the thermo-hygrometric 
conditions are most pronounced, than during those seasons when 
only partially filled and more or less of their area, covered, as it 
usually is, with luxuriant growth and decaying and decomposing 
vegetable matter, is exposed to high temperature, moisture, and soil 
conditions favorable to the generation of miasm. These and many 
other facts are inexplicable, except upon the assumption of the gen- 
eration of a miasmatic poison. 
The theory that malarial diseases find their cause in changes of 
temperature involves the negation of all the data in support of the 
doctrine of miasm, and necessarily traces to a common cause and 
pathology the classes of maladies believed to be due to the absorp- 
tion of this poison, and those believed to be due to the catching of 
cold. Chilling of the body and the entrance of a poison into the 
system are different processes. Chill is a common but not a constant 
initial symptom of malarial diseases. The chill of a miasmatic ague 
is not the algor of refrigeration. The former is the cold stage of par- 
oxysmal fever, the latter the shock of heat loss. The onset of one is 
marked by elevation of body temperature, of the other by rapid 
cooling of the whole or a part of the body. One begins with increased 
production, the other with increased loss, of body heat. In one the 
equilibrium of body heat is disturbed by overproduction, in the other 
by increased loss of heat. How miasm introduced into the system 
produces fever, or why too rapid cooling of the body is followed by 
fever, are as yet unsolved problems. The phenomena attending the 
adveut and development of miasmatic fevers denote disturbances 
produced by a poison acting through the blood, which are expressed 
in derangements of nutrition, sensation, secretion, physical and men- 
tal activity, and in consumption of tissue and loss of body weight. 
The phenomena following the catching of cold indicate a febrile re- 
action due to peripheral irritation, and are usually associated with, 
or caused by, local inflammations. The essential element of fever is 
increased production of animal heat. Without it fever cannot exist. 
Wood defines fever to be “simply a state in which a depressing 
poison, or a depressing peripheral irritation acts upon the nervous 
system, which regulates the production and dissipation of animal 
heat.” It seems probable, as has been shown by Billroth and others, 
that inflammatory fevers are due to the absorption of some product 
of inflammation ; nevertheless there are many fevers so trifling that 
such a grave lesion as blood-poisoning would seem to be precluded. 
Their provocation by irritation of peripheral nerves would appear 
more probable, yet with the progress of experimentation the irri- 
tative forms of fever are gradually yielding to the proof of toxaemic 
conditions. As the effect of the refrigeration of the whole or of a 
part of the body is so constantly exhibited in localized inflammatory 
processes, if further research and experimentation shall establish the 
connection of the symptomatic fever of these inflammations with the 
absorption of their products, the sharp lines of a distinct and definite 
pathology will be drawn between the primary fevers of malarial 
origin and the secondary fevers of refrigeration. 
Notwithstanding our limited knowledge in regard to the modus 
operandi of these elements of cause, the differential diagnosis between 
the defined forms of these two classes of disease can usually be made 
*0f the many recorded illustrations, the following may be cited: “Mr. P. E. 
had negro quarters situated on the first prairie elevation above the low grounds of 
a small creek, the fourth of a mile from the houses. This belt of low ground fre- 
quently overflowed, causing water to remain in holes over its entire breadth on 
the subsidence of the stream; hut it was well shaded by a dense foliage, the 
plantation lying on a prairie in the rear of the cabins. In the winter of 1842 and 
1843 the trees between the houses and creek were cleared away, and up to that 
time, some eight or ten years, the negroes living in this quarter had enjoyed unin- 
terrupted health, a case of fever scarcely ever occurring. During the summer of 
1843, the first after the forest had been cleared away, fever prevailed among the 
negroes with great violence, continuing until frost. The negro quarters were 
afterwards removed to the opposite side of the creek, about the same distance from 
it, hut with an intervening growth of timber, and no fever has occurred on the place 
'since.” (Treatise oa Fevers, Bartlett, page 395.) 
* Mortality of Young Children; its causes and prevention. By the Author. 
Sanitary care and treatment of children and their diseases. 
t Sir Gilbert Blane, in speaking of bilious remittent fever, says: “ I have known 
a hundred yards iu a roadstead make a difference in the health of a ship at anchor 
by her being under the lee of marshes in one situation, and not in another. It is 
difficult to ascertain how far the influence of vapors from woods and marshes ex- 
tends, but there is reason to think that it is to a very small distance. When the 
ships watered at Bock Fort they found that if they anchored close to the shore, so 
as to smell the land air, the health of the men was affected, but upon removing 
two cables’ length no inconvenience was perceived. (Treatise on Fevers, Bartlett, 
page 395.) 7 
at a glance. The conditions of the climate, season, endemic consti- 
tution of the locality, initial phenomena, and mode of onset are 
usually sufficient to determine the presence or absence of malarial 
infection. In the further progress of the case the paroxysmal char- 
acter, distinct periodicity, or tendency thereto, type, form, and 
course of the fever, together with the enlargement of the spleen and 
liver, and appearance of pigment in the circulatory system and 
nmny organs, constitute important and usually decisive conditions. 
It is not always easy to determine when or how one catches cold. 
The exposure may not have been accompanied with manifest chilling ; 
it may have been prolonged, or may have been frequently repeated. 
It may have occurred during continuous inclement weather, or may 
have been caused by the abandonment or change of articles of cloth- 
ing. An attack of cold may he ushered iu with high fever, quickly 
followed by localized inflammation of a catarrhal or rheumatic char- 
acter, or the fever may follow the development of a local inflammation. 
This reactionary fever maybe out of proportion to the extent of the 
local mischief, or a simple feverishness. The fever may be unat- 
tended by any local disease, but characterized by general malaise, 
languor, vague and shifting pains and aches, shivering and chilly 
sensations, cold feet and hands. The chilly sensations may yield to 
warmth, but will recur upon contact of colder temperature. The 
patient may he warm in bed, and, upon exposure of a leg, or turning 
over upon an unwarmed part, a shiver will start up from the limb 
exposed, or the part in contact with the cooler surface, and run over 
the entire body, impressing itself most usually with greatest force 
upon the back and lower limbs. There is also, especially in the 
milder cases, a tendency to sweat. Complaint is frequently made of 
alternate sweatings and feverishness, of muscular soreness, espe- 
cially upon changing from a position which has been maintained for 
some time, but which disappears gradually during motion, to return 
again after rest; or of a sense of bruising, as if one had been badly 
beaten, which unfits the patient for exercise and forces him to the 
bed or simply confines him to the house, lolling first on a bed and 
then on the lounge, seeking comfort under adverse circumstances, 
as fretful as a cross baby, and demanding more attention than a 
half dozen ill persons usually require. These attacks usually run a 
brief course and terminate in the restoration of health. Though it 
is not uncommon to witness a protracted convalescence, or frequently 
relapses due to neglect and perverse disregard of the ordinary care 
of one’s self, until finally some intractable condition of ill health is 
firmly established. 
A feverish cold may be marked by the appearance of a group of 
vesicles on the lips, cheeks, or about the nose; by an ephemeral 
fever of very high grade, which may go as suddenly as it came, leav- 
ing only a temporary exhaustion; by a copious and exhaustive 
diarrhea, which may establish a locality of lesser resistance to 
plague the possessor with frequent admonitions of its presence; by 
a slight cold iu the head, altogether too trivial to account for the 
intensity of the fever; by a fever continuing after the entire disap- 
pearance of the local disease ; or by some one of a great variety of 
local manifestations (Seitz) either simultaneous or successive, or 
which may spring up at intervals, in different localities, and assume 
various forms. The fever induced by catching cold may run its 
course unattended with any local manifestations, but after its com- 
plete subsidence a local disease may develop. 
The catching of cold may be the “foils et origo” of very many in- 
definable ailments, which mislead both patient and physician. It 
may be a persistent weariness, a constant feeling of tire, an unre- 
mitting sense of feebleness, lessened vigor, mental and nervous 
perturbations, attended with a depraved appetite, impaired diges- 
tion, and faulty nutrition, followed by blood impoverishment and 
waste, with some one or more of its many, multiform, complex, and 
erratic phenomena. The sufferer seeks relief at summer resorts or 
at special cure establishments ; by drugging with advertised “ cure- 
alls ; ” or by running to first one and then another physician. But 
each attempt in its turn fails, because the cause has remained 
unrecognized. One physician, mistaking effect for cause, attacks 
the stomach; another seeks to replenish waste; a third plies the 
blood with iron and chalybeate waters; and a fourth, of keener 
acumen than either of his predecessors, traces back, link by link, 
the long chain of morbid conditions, and rinds the cause to have 
been a puff of air which had come laden with miasma from the 
river flats, and, true to his instincts, doses with the universal pana- 
cea. These years of more or less suffering may be occasionally in- 
terrupted by a brief period of repair, the result of some fortunate 
occurrence, which had drawn the patient for a time away from the 
coddling care of overzealous friends and the damp and stagnant air 
of the family dwelling. Thus equipped with better blood, an im- 
proved physique, and hopes brightened by the prospects of recover- 
ing, the patient returns to the customary home and habits and soon 
relapses, perhaps even faster than the gains were made, into an 
equally deplorable if not a worse condition. Another change is 
sought, probably a voyage across the ocean and a tour through 
Europe. This chase after health, with its constant change of scenes, 
places, and habits, but mainly from prolonged absence from the un- 
wholesome domicile, may establish a stand-point not far removed 
from the level of the miseries from which nature refuses to recede. 
It may be that with the changing conditions of life health will 
vibrate between bad and worse until some fortuitous circumstance 
transforms tlie habits of life and changes the place of residence, and 
then the turning-point is reached ; or it may he that some magic 
influence lightens the burden and desolation of long suffering by 
abruptly separating subject and cause, and life rejoices again in re- 
stored health ; or it may be that the rays of hope come and go with 
the transitory improvements of chronic invalidism which progresses 
through the regular gradations of an incurable and fatal disease. 
Many fatal heart affections have found their beginning in slight sur- 
face coolings, produced by the proximity of damp walls in sleeping 
apartments, or the cold air ascending from permeable ground floors 
and foundations. Slight rheumatic pains mark the initial stage, 
then comes a sharp attack of joint rheumatism, with intense fever 
and heart complication ; later the murmur of valve lesion is hoard, 
faint at first but increasing with time, succeeded by degeneration of 
the heart muscle, and Anally general dropsy with its attendant suf- 
fering closes the distressing scene. 
Fortunately for many wayward and indiscreet people the detri- 
mental effects of refrigeration are not always so grave, or so dis- 
astrous to life. The minor ailments, which are so commonly ascribed 
to the unavoidable and baneful influence of malarial contamination, 
most frequently find their cause in the indiscretions of every-day 
life. Women who are accustomed to all the comforts that wealth 
can bestow, and who take special care to protect their persons when 
-going to walk or drive, will go to an evening entertainment with 
bared necks, arms, and heads, with thin boots or slippers, and with 
insufficient underclothing, in conformity to the usages of society. 
But even this reprehensible custom would not so often entail pain 
and disease if ordinary care was exercised during the stay at the 
place of resort. In the crowded and heated rooms, excited by the 
congenial companionship of friends and the exliilaratory influences 
of the general good humor and conviviality, the system becomes a 
bonfire to the emotional excitement and pleasures. Theheart beats 
fast and faster and the blood is driven with increased rapidity 
through the distended vessels. The'whole surface vascular area is 
flushed with hot blood. Thus overheated, and perhaps to rest from 
an animated conversation or a dance, with a glowing and moistened 
surface, the peripheral vascular system overfilled with hot blood, 
and a radiating area equal to the entire surface, the unprotected 
body is suddenly exposed to a draught blowing through an open win- 
dow or door, or to the colder air of the hall, or even to the open atmos- 
phere, and the vast volume of overheated blood is rapidly chilled and 
driven back to the interior. Surface heat is lost too rapidly, and the 
cooled blood, sent back to the overheated organs and tissues, absorbs 
their heat too rapidly. The bonfire is extinguished, but the embers 
smoulder in angry recognition of the willful or thoughtless disregard 
of nature’s plainest precepts. Why wonder, then, that colds, coughs, 
neuralgiai, catarrhs, digestive disturbances, pains, aches, or some 
more serious disorder, should torment the devotee of arbitrary fashion 
and custom? And is it any less surprising that the sufferer should 
ascribe to nature and nature’s methods the cause ? The river flats lie 
in broad expanse along the water front, and marsh miasmata offer a 
convenient and plausible excuse to cover and hide one’s own dere- 
lictions. 
Men are quite as often guilty of even more flagrant abuses of their 
constitutions, not only by excessive excitement of purely physiologi- 
cal functions and processes, but by artificial stimulation of the nerv- 
ous and vascular systems. Alcohol is one of the most diffusible and 
powerful of the heart stimulants. It accelerates the movement of 
that organ and increases the frequency of the pulse. By this in- 
creased action the blood is driven with greater rapidity through the 
vessels. The rapid flow of the alcoholized blood to the heat-regulat- 
ing centers increases heat production, and the temperature of the 
body is elevated. The surface area of radiation is increased by the 
greater quantity of blood flowing into and through the distended 
capillary system. The surface vessels are flooded with overheated 
and poisoned blood. When to this condition is added the influence 
of unusual exercise, the ill effect is augmented. With a greatly 
increased quantity of blood in a greatly increased surface area 
exposed to a colder medium, heat loss is vastly augmented, and 
chilling is much more rapid and effective. Such a condition may 
be produced by a single drink, and certainly will be by frequent 
potations of alcoholic beverages. Alcohol also poisons the intel- 
ligence. The first sense of satisfaction and beatitude is quickly 
followed by intellectual excitation and hyperideation, which is 
characterized by lack of moderation, impaired judgment, and loss 
of will. To these excitant stages others succeed, with which too 
many men are personally so familiar that mention is unnecessary, 
beyond the statement that a drunken person loses heat faster, and 
will freeze sooner, than a sober one. Alcoholism promotes the catch- 
ing of cold. The combination of poisoned intellect, poisoned heat- 
regulating centers, stimulated circulation, poisoned blood, and a 
dilated and over-filled cutaneous vascular system, promotes, facili- 
tates, and augments the chilling influences. It is most frequently 
and far too often illustrated in the daily life of some men, and 
but few are willing to acknowledge that either the trivial or 
graver ailments before referred to ever originate in the pleasures 
of the cup, but ascribe their cause to the emanations from the 
river flats, and base their prevention and cure upon the antidotal 
properties of alcohol. Every bummer in the city and every victim 
of chronic alcoholism claims to he a sufferer from chronic malarial 8 
poisoning, and it is no unusual circumstance to see a group of them 
sunning themselves during the ague stage in front of some saloon. 
But others beside professional bummers delude themselves by this 
ratiocination. The habitual “diner-out” attributes to malaria the 
deluge of ideation and nightmares, and the lightning flashes of pain 
which disturb his rest and make night hideous, and hurls with meas- 
ured deliberation the usual anathemas against a climate which will 
not permit rest at ease and refreshing sleep with a stomach overloaded 
with the good things of life and the blood saturated with the choic- 
est wines. The high liver and overfed man ascribes his stomachic 
troubles, aching and dizzy head, confused mind, languor, and disin- 
clination to exercise, depressed spirits, and irritable temper, which 
make all about him unhappy and himself the most miserable of all, 
to biliousness of miasmatic origin, and cites with intemperate vehe- 
mence the salutary effect of a half dozen after-dinner pills and the 
routine doses of quinta, but he loses sight of the benefit derived from 
the rest and abstemious diet which an injured and overworked stom- 
ach can secure only through much travail and many tribulations. To 
illustrate the frequency of alleged malarial infection as the cause of 
sickness which should be attributed to vices of diet, habits, impru- 
dent exposures, or some one or more of a great variety of excesses, I 
will briefly refer to the cases of four gentlemen from distant and dif- 
ferent parts of the country, winter sojourners here for the first time, 
who were accustomed to the simple habits of prudent people at home, 
unused to late hours, and strangers to terrapin suppers and the usual 
accompaniments. One has lived many years in the valley of the 
Wabash, another near swamps in the Carolinas, a third is from pious 
New England, where malaria was unknown until the rebellion came, 
audthefourtli haspassed thelifeof a cosmopolitan andhasseenmala- 
ria so dense that it could be sliced into blocks. All have, many times, 
had old-fashioned fever and ague, with chills which shook their joints 
loose and made their hair stand on end,but neither had ever before lived 
in a climate where malaria followed people in fierce pursuit at every 
turn during the day, howled under the eaves at night, stole through 
the stomach, and sneaked in under the nether garments. They are 
gentlemen of elegant leisure, equipped with ample means and a 
generous hospitality, and are here for pleasure and intellectual recre- 
ation, and to teach the good people how best to make life’s cares pass 
swiftly and merrily. They have, week after week, gone the round 
of dinners, high teas and suppers, of card parties, theater parties, 
and aesthet ic reunions; and wasted their unoccupied leisure, when 
other people are toiling, in busy preparation for the succeeding en- 
tertainment—one by drenching himself with mineral waters to to®e 
up his stomach, another to clear his head, a third by squeezing his 
liver with some popular nostrum, and the fourth slumbered under 
the gaslight that the sunshine might not disturb his reveries in 
dreamland. This contest of pleasure and excess against physiologi- 
cal endurance has, as is usual, added four to the list of the vanquished, 
and, notwithstanding the antidotal drink and dose of quinine, each 
ascribes his present condition to the horrid atmosphere, which cus- 
tom and habit allege is saturated with malarial emanations from 
the river flats, even during the season of the year when the tempera- 
ture is far below the point necessary for the generation of miasmata. 
Neither will accept the suggestion that the blood alcoholized and 
overheated, the stomach overladen with food and viands, or the 
nervous system overstrained by artificial stimulation, bear even a 
causal relation to the ills which so sorely afflict them. And so thor- 
oughly are they imbued with the popular but erroneous belief, that 
either would rather go to the grave through years of wretched suf- 
fering, penury, and want, or the mad-liouse, than have health upon 
the basis of an abstemious and prudent life. 
It is not probable that the abuses of human life will ever cease, or 
that the defective construction of human habitations will ever be 
wholly prevented, or that the unsanitary conditions of cities will ever 
be completely cured. Nor is there any natural requirement of life 
that necessarily entails disease, yet few of those born die by natural 
decay. To the avoidable causes of disease far the larger number of 
deaths are due. It is only by the education of the masses in the 
methods of prevention that the science of medicine can attain its 
| proper position and influence among mankind.