of flies has been well discussed, but I believe that there is another prolific source of infection. In the country districts where different conditions prevail from those in the cities, it is not uncommon for us to have epidemics of typhoid after a long period of dry weather. What is the cause of this? I think the bacilli in the cesspools get scattered by the wind and settle on some article of food. To strengthen this view of the matter, I will tell you a little experience I had. There was typhoid in a family living in an isolated house. The stools were taken out into the back yard and spread on the ground. Rain set in. No typhoid occurred until the next spring, when the May drouth set in. Following that we had an epidemic of seventy-three cases within an area of four hundred yards of that house. All the families affected used different water supplies, and I could only attribute the disease to the effect of the wind in blowing the bacilli. DR. CROUSE: I would like to call the attention of the Association to the fact that we have, through the medium of the government, great opportunities of obtaining literature on entomology, and we are practically not taking advantage of it at all. Dr. L. O. Howard told me recently that there was really no demand for literature on the subject. I got a paper from him in regard to house flies, which I found of great practical use, and I think other members could derive benefit from reading it and other publications of the same kind. We are too prone to leave out the entomological features in considering the spread of infections. That is one reason why I brought up the question of snakes and spiders at an earlier part of the proceedings of this meeting. We have lately heard a great deal about the part which the mosquito plays in spreading yellow fever and malaria, but I believe that if inquiries were pushed a little further it would be found that common house flies are the greatest agencies for spreading most of the infectious diseases. It is very important that we should pay more attention to these matters. About the time I saw Dr. Howard, I had a case which proved a striking illustration of these remarks. A young man returned home ill. No attention was paid to his stools. Finally I was called in and found he had typhoid fever. The other members of the family were separated from him, but five of them developed the disease, and to my mind the evidence was conclusive that the infection was conveyed by the house fly. DR. PASCHAL: We are all aware that this disease is due to the typhoid bacillus, and that it may be conveyed by water and flies, but there is little use knowing that unless we take steps to educate the people to adopt precautions against the spread of the infection. It is the duty of every health officer to distribute information as to the means that should be adopted for preventing the spread of contagious diseases. Two years ago we had forty-nine deaths from typhoid fever and suspicion was imme diately directed to the water supply which came from artesian wells. It was tested, and with this result, that while the water which was drawn directly from the wells was found to be perfectly pure, that which came from the hydrant was full of infection. We were satisfied that the infection came from a particular reservoir. We made the company clean it out. It had not been cleaned out for twenty years, and was in a fearful condition. We ordered the company to cement it or draw the water direct from the wells. They required the reservoir for the purpose of pressure, and ultimately cemented it at a cost of $10,000. The result was that in one year our cases of typhoid fever dropped 50 per cent., and this year they will probably drop 25 per cent. more. Dr. Lord thanked the gentlemen who had spoken for the way in which they had referred to his paper and advised physicians generally to look out for infection whenever gastro-enteric trouble showed itself in epidemic form. On the motion of Dr. Carter, seconded by Dr. Crouse, a vote of thanks was accorded Dr. Lord for his interesting and valuable paper. SYMPOSIUM ON THE SPREAD AND PREVENTION OF TUBERCULOSIS. A BRIEF REVIEW OF THE PRESENT OPINION AS TO THE DIRECT INHERITANCE OF TUBERCULOSIS. ALLEN J. SMITH, M. D., In the older conceptions of tubercular disease the very apparent frequency of the affection in succeeding generations of special families was clearly recognized, and fastened the idea of its hereditary transmission upon the medical profession as one of the most inassailable features of the condition. It was only with the growth of recognition of its essentially infectious nature that this feature became the subject of serious question; the adherents of Koch early insisting that for clear proof of inheritance the disease must be shown present in the fetus at time of birth, either in a certain degree of development or the germs of the disease must be demonstrated in the fetus or the fetal adnexa. The importance of postnatal acquirement from the tuberculous parent or other source was insisted upon. Moreover, it had early been contended that, while the disease in developed degree might be unrecognizable in the child of tuberculous descent, there might be some diathetic or constitutional defect transmitted, as anatomical or functional peculiarities of other type are transmitted, which should predispose to the affection; and with the growth of the belief in the ninth decade of the last century that actual transmission of the infection was unlikely, if not unreal, the belief in such an hereditary disposition became the more pronounced. From further observation and more recent study, however, this view has been materially modified, a number of demonstrated cases of direct transmission of the disease from parent to child forcing the acceptance of occasional inheritance upon the profession. At present the opinion as to this question stands upon middle ground, denying actual hereditary transmission of the affection as a common means of acquirement, yet acknowledging its reality in exceptional instances; denying the importance of diathetic and dyscrasic predispositon as inherited, yet not refusing absolutely its possible influence. Further, the idea is steadily gaining that among the cases presenting a hereditary transmission of a predisposing structural peculiarity, spoken of under the term scrofula, there are a greater or less proportion of actual tubercular changes already existent, or there are already present, perhaps in a latent condition, the tubercle bacilli; and if such view come to complete acceptance our opinion as to the possibility of the heredity of the disease must be correspondingly and considerably broadened. To the present, particularly since the matter has been receiving direct study, there have been observed among lower animals, especially in cattle, over sixty instances of direct transmission of the disease; and in human pathology over forty similar examples (Twentieth Century Practice of Medicine, XX, p. 126). In cattle the recognition of developed tubercular lesions in the off-spring of tuberculous cows has long been accepted; and this has stood, before the recognition of similar instances in man, as an important argument for the similar possibility in the human species. However, it is an unusual thing that the disease is met in early life in cattle, Nocard (The Animal Tuberculoses) having collected statistics from various abbatoirs in large continental cities which would indicate that the disease is encountered in not more than one case out of above one hundred thousand calves killed. Statistics from other sources would indicate a somewhat higher proportion of occurrence, but in none known to the writer is the proportion of this disease in calves found in even one hundredth the degree as in adult cattle. In case of such slaughtered calves, moreover, it cannot be assumed that each individual was tuberculous at time of birth, the brief time intervening from birth to time of sacrifice being sufficient for acquirement of the affection by some of the ordinary routes. It should be kept in mind, however, that the care of observation about the abbatoir is scarcely that required for certain recognition of lesions of slight development or unusual situation, and that probably all such statistics are too low to be more than approximately true; nevertheless, they suggest the rarity of the actual inheritance of the affection in cattle and at the same time in a measure are confirmatory of its occasional occur rence. Children of early age rarely show recognizable evidence of the disease in life. Personally the writer has seen an indubitable instance of pulmonary tuberculosis in an infant of a little more than two months age in a children's clinic; in which case the mother gave no evidence of the disease and the father, who was not seen, was described as not affected-thus suggesting the possibility of post-natal acquirement, probably by inhalation, in such brief period. This idea of post-natal acquirement may not be set aside in the study of tuberculosis manifesting itself at even such early age, and doubtless explains a considerable proportion of instances of the disease met with in children of tuberculous parentage, thus weakening all statistics as to heredity based upon clinical study of the disease in the living. However, if one will grant the possibility of a latent existence of the germs of the disease in the child, it must be further accepted as a possibility that the disease may have been transmitted from the parent to the child unborn, to become manifest at a greater or less period after birth; and for this reason such statistics cannot be set aside as entirely worthless. Lantigau, for example, in the Twentieth Century Practice of Medicine, ascribes to from twenty to thirty per cent. of tubercular individuals the existence of tuberculosis in the parents, and to sixty per cent. a history of tuberculosis in grandparents and collateral ancestry. Squire (London Lancet, December 15, 1894), from an analysis of the children of a series of tuberculous and a second series of nontuberculous parents, would assert that there occurs an excess of not above nine per cent. in the cases of tuberculosis appearing in the children of tuberculous parents above those of non-tuberculous parentage. (These series include 199 families of tuberculous his |