upon the diphtheritic infection is most remarkable; at once arresting the disease if used in the early stages and properly administered and giving excellent results even when used after the fourth day, though, this cannot be so confidently expected as when the antitoxin is used early.

To appreciate the importance of even greater care in recognizing the causes and enforcing the means of preventing the spread of diphtheria than either in smallpox or Asiatic cholera, it only requires a glance at the mortality list of more than twelve thousand children who have fallen victims to this contagion in our own city within the last decade. Well might it be characterized as a "slaughter of the innocents."

In tracing the rise and subsidence of the various epidemics of diphtheria from the public records, we are impressed with three points as factors in the rapid spread of the disease: 1st. The season of the year.

2d. Local conditions in certain parts of the city.

3d.

The character of the population.

1st. While diphtheria is usually present in our city during the entire year, the rapid increase in the number of cases reported becomes marked in September, the increase continuing throughout October, November and December, beginning to change in character in January and thence subsiding until it reaches a minimum in the month of June, thus pointing out that meteorologic changes are prominent factors in determining the predisposing causes, not only for the spread of the disease but also for the character of the infection, thereby indicating to us some of the steps necessary for its prevention. However, it should be noted that other factors than meteorologic changes should be taken into consideration with the changes of the seasons: (a) diminished exposure to sunlight by indoor occupations, (b) closer

communion of children by the opening of schools, (c) diminished aeration by closing up of houses, and other conditions due to social relations in city life, all tending to diminish vitality and increase the virulence of the infecting germ.

2d. A careful study of a city map which has been marked from day to day to indicate the locality of reported cases of diphtheria, shows that those localities where the population is crowded into close tenements, with poor ventilation, little or no sunlight, defective drainage, outside vaults without proper sewer connections used in common by several families, and dilapidated buildings without modern conveniences, give the largest number of cases of the disease, for reasons which are obvious from the very nature of the infecting germ.

The plain unmistakable nature of the causes for the propagation and spread of the disease in these places, at once suggests the duty of the sanitary officers for the protection of the public.

3d. In a cosmopolitan city like Chicago, where there is a marked tendency on the part of the foreign population to colonize, it is a notable fact that those sections where the population is from the provinces in which diphtheria is almost unknown, as many of the Mediterranean States, there is such a decided indifference to the laws of isolation and infection, that a single case in such a locality may become a center from which, through visiting the schools, or through transactions of fakirs and other indiscriminate commingling, a veritable epidemic may spring.

The following precautions against the spread of diphtheria are recommended:

1st. As soon as the inflamed throat has been recognized to be diphtheria, either by inspection or by bacterial examination, the patient should be placed in a room which can be

isolated from all other parts of the house, and where the best sanitary surroundings and the most sunlight can be obtained.

2d. All unnecessary articles, including carpets, rugs, curtains, books, upholstered furniture and other things which cannot be readily disinfected, should be removed and the room itself thoroughly cleansed with an antiseptic solution. Whatever is used in the room, whether bed or couch, should be covered with washable goods only; and the nurse, if a professional, should wear the regulation uniform; if otherwise, she should select only such garments as can be easily and readily washed.

3d. None but the regular attendant-nurse or motherand the attending physician should be permitted to enter the room, and they should cleanse their hands carefully on leaving with the antiseptic solution always kept in readiness at the door. The door knob should be kept constantly covered with antiseptic gauze frequently changed, or the doorway hung with a sheet kept constantly moistened with euthymol or other antiseptic solution.

4th. All articles of food passed into the room and not consumed, should be destroyed by fire, or thoroughly disinfected in the waste vessel by being immersed in a 1-1000 solution of bichloride of mercury before being taken from the room, and all dishes should be washed and disinfected before being removed.

5th. The simplest method of disinfecting is with boiling water, the article being kept boiling in the water at least half an hour, or in conjunction with this a solution of 1-2000 bichloride of mercury. This can be easily prepared by procuring the bichloride in half drachm powders, carefully labeled, to be dissolved in one gallon of water; or by using the regular antiseptic tablets, kept by druggists with full directions for using.

6th. All cloths, towels, napkins or handkerchiefs used to cleanse the mouth or nostrils, or to receive discharges from the body, if not burned, should be thoroughly boiled or immersed in bichloride solution and afterward washed and ironed, and vessels used to receive discharges should contain the same solution, that the diphtheritic germ shall be destroyed before being taken from the room.

7th. When the sickness has ended, the room should be cleansed as follows: (a) Wash all floors and woodwork with soap and water and then with the bichloride solution; (b) re-paper or calcimine the walls and expose to sunlight and fresh air; (c) treat all articles of furniture in the room with the bichloride solution, and place all washable clothing, linen, etc., in a sheet or pillow-case and immerse in the solution above mentioned, to be washed and ironed afterward, except where clothes have been used which can be readily destroyed, and these should be burned.

On application to the DEPARTMENT experienced fumigators are always sent to the residence and the premises thoroughly fumigated with burning sulphur.

601 WASHINGTON BOULEVARD.

THE ANGINAS OF 1896.

BY W. K. JAQUES, M. D., IN CHARGE SUB-LABORATORY FOR THE BACTERIAL DIAGNOSIS OF DIPHTHERIA.*

WITH all the light that has recently been thrown upon the subject of diphtheria there is still much to be learned concerning it. The germ or germs that are the chief causative factors in producing this disease are most sensitive to environment-by which is meant all the conditions which influence the life of the germ as well as that of the patient who furnishes the soil for invasion.

Environment is continually changing. No two consecutive days have the same amount of sunshine, heat or moisture. Each season brings conditions which have their influence on the germs of the membranous anginas. With a knowledge of these facts, it is readily comprehensible why the anginas of one year or of one season should differ from those of another. If the conditions are favorable to the virulence of a certain germ, it will prove the causative factor of the anginas of that year; then subsiding into a secondary position with new conditions which favor the virulence of another germ.

All anginas manifesting membrane should properly be described as diphtheria since its derivation is from the Greek word meaning membrane. However, since the Klebs-Loeffler bacillus has been found to be the chief cause of mortality in anginas, only those cases where it is present are usually called diphtheria.

It is important to know if a child has diphtheria; it is equally as important to know what germ has caused the lesion. This being determined, the disease may be accurately described by prefixing a part of the name of the germ to the word diphtheria. This has been most satisfactory in the practice of the writer.

*No. 4300 Cottage Grove Avenue.