SECTION ON GENERAL MEDICINE.

CHAIRMAN'S ADDRESS.

JOHN T. MOORE, M. D.,

GALVESTON, TEXAS.

When asked to accept the chairmanship of the Section on Practice of Medicine and to present a report in the place of our Chairman, who is now away, I did so with some hesitation, owing to the short time that it gave me for preparation. I felt that I could hardly do justice to the Association.

Many subjects presented themselves, but none seemed to equal the importance of the one I have selected. I feel sure this Association acknowledges it as one of great importance to the Southern States, and to Texas especially.

Tropical diseases can not but appeal to all of us as of great concern to those of us who have lived in Texas long enough to see the prevalence of diseases peculiar to warm climates.

We are situated on the Gulf of Mexico, with a very extensive coast plain; and then our nearness to the West Indies, the Central and South American countries, and Mexico, put us practically within the influence of all of these tropical countries.

In discussing, for the short time at my disposal, tropical diseases, one must necessarily limit himself to certain phases. The subject is of so great magnitude that I have decided to consider only the following divisions:

1. What are tropical diseases?

2. Their importance.

3. The opportunity for their study in Texas.

4. The obligations to provide facilities for their study.

I. TROPICAL DISEASES.

The world has become so completely cosmopolitan that it is becoming more and more difficult to say just what diseases are limited to certain localities or climates.

At first glance one might say that the division into tropical diseases seems artificial, but when we study the fauna and flora we must come to agree that plants and animals seem fixed quite fast in their localities.

The study of disease is, and must necessarily be, a study of the fauna and flora. These are determined largely by the temperature, the moisture and the character of the soil. We are coming more and more to understand that in order to make progress in the study of disease one must be a biologist of the first rank. We must get a deeper insight into the plants and animals that inhabit different localities. Mason (Tropical Diseases) employs the term "tropical diseases" to include all those that occur in, or which from various circumstances are specially prevalent in warm climates.

Disease-producing organisms are either transmitted directly from one infected individual to another, where they rapidly multiply if the soil is suitable; or they are communicated through an intermediary host, such as the tick in Texas fever or the mosquito in malarial fever.

Thus it becomes a question, not only of a suitable climate for the disease-producing organism, but also of the necessary host which acts as an intermediate agent through which the organism may develop and be distributed to other individuals. Many of these intermediate agents are peculiar to, or are limited to, certain areas having a suitable climate.

For the prevention of disease in these localities one must have knowledge of a particular kind.

The habits and confines of the secondary host here become as important as the disease-producing agent itself.

No questions are more pregnant with interests of vital importance to the people of this section than that of tropical diseases.

Malarial fever, although not confined to tropical climates, yet on account of the increased productiveness of tropical climates in growing the intermediate host-the mosquito-becomes the most important disease of warm climates.

When we consider the number of deaths caused by the disease and the amount of suffering consequent upon it, we can not but admit that too little is being done to stop its ravages.

In addition to both deaths and great suffering, much wealth-producing power is lost.

The total number of deaths from malarial fever was 38 per 1000 for all known causes for the year ending May 31, 1900.

This, I am sure, was too much, as I feel certain many cases that are reported as dying from malaria died from some other cause. There are no records worth anything kept on vital statistics in Texas. Then, again, a diagnosis of malaria is often made on clinical symptoms only, and this method of diagnosis is unreliable.

The proportion of deaths was 14.9 to 1000 of all known causes in the United States. These estimates are more nearly correct because the figures of registration States are included. Of these deaths the total per 1000 from the different sections is shown below:

Taking our statistics in John Sealy Hospital, where routine blood examinations are made, we find that in 1901 there were 1115 cases treated in the wards-72 of these were malarial. This gives 1 to 15.5 of the pateints affected with malaria.

Galveston is not strictly a malarious locality. Of 481 cases admitted to the John Sealy Hospital in 1900, where a blood examination was made, 153 were malaria. More than 90 per cent. could be traced to outside infection (Moore, Journal of Tropical Medicine, March 15, 1902.) From January 1, to

November 1, 1901, I made a more careful inquiry as to the point of probable infection. Of the 421 cases admitted to the medical wards, 53 were malaria.

Four cases, or 7 per cent. contracted the disease in Galveston. This is presented here just for the purpose of showing the great prevalence of the disease. If Galveston, a practical malarial free city, has treated in the hospital one case of malaria to every 155 of the other diseases, how must it be in malarial localities?

Woldert (American Journal Medical Sciences, November, 1092) estimates that one person in every twelve is affected. Our population in 1900 was 3,048,110 (U. S. census). One-twelfth would give 237,392 persons in the State sick of this disease. Now supposing one-fifth of these are heads of families, it would give 47,478 men sick each year of this disease. Think of the economic loss here!

Since the discovery of the means of infection by the secondary host, the mosquito, the prevention of malaria resolves itself largely into operations against that agent.

Rice growing in the coast region will increase the number of cases of malaria many times. What is the remedy? These are but suggestions.

Yellow Fever-The relation of our position with reference to the very habitat of this fever puts it next to malarial fever in importance among the insect-borne diseases.

The older members of this Association can easily remember how it swept away many of the citizens of this State in 1867.

We have the stegomya faciata, the proven carrier of the yellow fever organism in our chief port city in great numbers. I have several times caught them while sitting in my office. They must be abundant all along the coast. They ought to be studied, i. e., we ought to know the localities in which they live and breed, and also know more of their habits. Were yellow fever introduced into our midst, it would spread with great rapidity, unless we could quickly avail ourselves of the means now at our command to fight it.

The whole question seems to resolve itself into a campaign against this particular mosquito.

In Havana (Gorgas, Journal of Association of Military Surgeons, April, 1903), the average number of deaths from yellow fever for 30 years was 706.

During the year preceding the mosquito campaign there were 310 deaths. The number during the first year of the work was 18, and 13 of these occurred before the work began.

Havana is now, and has been for two years, free from yellow fever. We are to dig the Panama canal and establish a close relationship with countries in South and Central America, where this disease is epidemic. There are vast interests at stake. Then again, the United States is not only to protect herself against this disease entering and preying upon her people, but she is to fit medical men to make Central and South America as habitable as Havana has become, and prevent the spread of this scourge to the densely populated tropical countries of the East.

The work of Carroll, Reed, Lazear and others must not be wasted.

Amabic Dysentery.-Here we have hundreds of cases of this disease. The total number of deaths from this disease in 1900 was 6112. The total deaths per 1000 from diarrhoeal causes in the gulf coast region was 89.9. The highest mortality area for this disease that we have is about central over Texas.

Bubonic Plague.-This disease carries off thousands of victims in districts where it has been introduced, especially in overcrowded and filthy cities. It has been introduced into this country at several points. There has been 94 cases at San Francisco since the outbreak in March, 1900. There has been quite an outbreak in Mazatlan, Mexico, during this year.

Dengue. This disease, which is strictly limited to the tropical climates, attacked about one-third of the entire population of the coast country in 1897.

Wilkinson (History of the Dengue Epidemic in Galveston) estimated that half of the population of Galveston were attacked.