lines of the railways by local surgeons, which would give a larger percentage than one in every four.

According to these statistics here presented, the total number of employes on all these railways during the year 1901 was 9241. For the six years, from 1896 to 1901, inclusive, the total number of employes was 55,446. If a day's labor is valued at $1.50, and each patient lost an average of ten days from work on account of sickness from chills and fever, the total financial loss to the employes of these three railways during the year 1901 was $138,610, and for the six years, from 1896 to 1901, inclusive, the total loss was $831,660.

These three railways traverse the State in three different directions-1400 miles. The United States army posts extend all along the western boundary of Texas, a distance of 600 miles.

Thus, it will be seen that the statistics have been collected from all portions of Texas, and therefore give a fair general average of the proportion of all people affected by malarial fever.

The results go to show that the proportion of employes of the three different railways affected by malarial fever was one to every four, and the United States army posts one to every seven, or a general average of one to every six persons in the State of Texas. If we say that one person in every twelve suffers each year from chills and fever, and that each man loses on an average ten days from sickness, and valuing a day's labor at $1.50, and considering the population of the State to be 3,200,000 (census of 1900 gave it over 3,200,000), and estimating that each patient pays $5 for medical fees, the financial loss to the people of the State of Texas, during the year 1901, amounted to the enormous sum of $5,333,32018

Just how many people die every year in Texas from chills and fever would be hard to determine, but, if the city of San Antonio be taken as an index, and if the year ending May 31, 1898, be selected (when there was no yellow fever, and when the mortality of the city was quite low, or 14.5 per thousand, based on a population of 55,000), and when the number of deaths from malarial

fever were only 43, it will be seen that in Texas each year upwards of 3074 of its citizens die of chills and fever.

What a commotion it would cause in Texas were it announced that yellow fever destroyed over 3000 of its people annually! And what great haste there would be for capitalists to withdraw their money from us. If we say that yellow fever must go, then why not go one step further and say that malarial fever must go with it?

When we compare the cost of malarial fever with the crop statistics for 1903,19 it is found that the hay crop of Texas amounted to only $6,750,000, so that malarial fever in Texas cost quite as much as the hay crop; the oat crop was valued at $14,636,896, so that malarial fever cost as much as the oat crop; the rice crop amounted to $7,500,000; malarial fever cost nearly as much; the wheat crop was worth $15,182,950, but one-third of this went to feed the malarial parasite. The boll weevil destroyed several millions of dollars worth of cotton last year, and $50,000 was appropriated to get rid of the weevil; while the malarial parasite cost over $5,000,000, and snuffed out the light from 3000 of its people, but nothing was appropriated to get rid of the malarial parasite.

The Prevention of Malarial Fever. From the standpoint of political economy, it may be asked, is it necessary that 3000 people in Texas should die of malarial fever; and is it necessary that $5,000,000 be spent annually for the luxury of having chills? I think not, and I believe the day will come in Texas when this disease will be regarded as being totally unnecessary for the general welfare of us all.

Two facts should be borne in mind-malarial fever is a "catching" disease; and malarial fever can be prevented. The only way which has ever been proven that the disease can be communicated from the sick to the well is through inoculation, and the most common way is by inoculation from an infected mosquito. All else is theory, devoid of proof.

There are two direct methods of getting rid of malarial fever.

First to destroy all malarial parasites with quinin, and the second to destroy all mosquitoes. There are several indirect ways of lessening malarial fever in Texas. The best practical subsidiary method is offered by a campaign of education among the laity which would show them just what the disease really is, how it is transferred from the sick to the well, and how the sick person becomes a menace to his neighbor. In the cities, boards of health should place the disease among the list of infectious or contagious diseases, and the law should require all cases of malarial fever to be reported. The different cities and towns in this State must make appropriations of money to carry on this work. In the rural districts where no boards of health exist, and where the disease is more prevalent than in cities, local clubs should be organized to work in unison with boards of health of cities, to look for and to compel the proper precautions to be taken in guarding against the disease. In those cases who are in destitute circumstances, if nothing else be done, a closely fitting mosquito bar should be furnished free of charge to the patient, together with a sufficient amount of quinin to destroy the parasites which produce the disease. The patient who already has chills and fever, especially during the early spring months (these are usually the chronic cases which continue during the winter), should at once be placed under a mosquito bar which fits closely around the bed (not one which is simply spread over the face, which, of course, would do no good), so that the malarial-carrying mosquito can not get at him, while at the same time quinin should be given the patient to destroy the parasites. In this way the mosquito can not convey the disease to all the neighbors and friends. Infected mosquitoes which still remain around the bed-room should be caught and killed. They may be easily caught by placing a wide-mouth bottle over them as they hang on the wall or ceiling. They may be driven from the sleeping room by burning sulphur or camphor.

Those people who have already been exposed to the disease should take quinin for several days in order to destroy the spores of the malarial parasite injected by the mosquito.

We should especially watch those cases of malarial fever which make their appearance during the spring months. These cases are usually relapses of those who have never been cured during the fall months, and, if we are careful to make close inquiry, we will generally be convinced that these cases have had malarial fever during the previous year. In such instances it appears that a certain immunity has been conferred upon the patient, and that during the winter the small number of parasites present in the blood are not sufficient to produce the symptoms of the disease. But at the outset of warm weather the parasite comes out of its hiding place, and the patient develops a chill. In certain chronic cases of malarial fever there appears to be a tolerance upon the part of the system which permits it to harbor a few parasites without giving rise to fever. In fact it has been calculated (Liverpool School of Tropical Medicine-Memoir No. I) that in order to produce an attack of fever there must be present in the body 250,000,000 parasites. Therefore, these early cases should be closely watched. As in the case of yellow fever, people suffering from malarial fever and coming into the State should be kept under surveillance. It is also necessary to remember that the malarial-carrying mosquito seldom bites during the day time. It usually prefers the night, so that it is important that the mosquito bar should fit snugly around all portions of the bed. The malarial-carrying mosquito-Anopheles -only flies upwards of half a mile for its food. It requires about three or four days for the Anopheles to digest its meal of blood.

Another indirect method of combatting the disease is offered by a thorough system of drainage, so that mosquitoes will not multiply. As a general rule, it may be stated that the malarial-carrying mosquito does not breed in barrels, buckets, and receptacles around an inhabited house, but prefers to breed in slowly flowing streams of fresh water, and especially those containing a small amount of greenish moss or algæ. I have found hundreds of the ·larvæ (or wiggle tails) of these mosquitoes lying flat upon the surface of such streams.

To destroy these larvæ, I have found by experiments, carefully

conducted,20 that a strong solution (say one pound to ten gallons) of tobacco in kerosene oil most efficient. On account of the rapid evaporation of the oil, this solution should be applied at least once every two weeks. Wherever marshes or pools of water exist in the neighborhood of cities, such should be drained. The British people have spent upwards of $200,000 in their possessions in the tropics, the German government upwards of $50,000, and the Italians probably the same amount in combatting the ravages of malaria. In America, New York, Massachusetts and New Jersey have all declared war against the mosquito.

Texas has offered a reward of $50,000 to get rid of the boll weevil, and to save its cotton. If it has made any appropriation to get rid of chills and fever, and thereby save the lives of 3000 of its people annually, I have not heard of it. Human nature is a

very strange thing.

Representing as we do the correct idea in this matter, I consider it our duty, whenever the occasion presents itself, to speak on this question of malarial fever and its prevention, in order that we may get rid of a disease which has become so harmful, so very prevalent, and thereby help to make this State what it ought to be, a healthful, grand old State, called Texas.

[NOTE.-My thanks are herewith returned to Dr. W. G. Jameson, of Palestine, Chief Surgeon of the International & Great Northern Railroad; Dr. J. E. Moore, of Marshall, Chief Surgeon of the Texas & Pacific Railway; Dr. C. A. Smith, of Tyler, Chief Surgeon of the St. Louis Southwestern Railway, and Dr. Charles Smart, U. S. A., Washington, D. C., for statistics.]

BIBLIOGRAPHY.

1. The Malarial Fevers of Baltimore. By W. S. Thayer and J. Hewetson. Johns Hopkins Press, 1895. Baltimore.

2. Marchiafava and Bignami in Twentieth Century Practice of Medicine, Vol. XIX, 1900.

3. Nuttall: Die Mosquito-Malariae-Theorie. Centralblatt für Bakteriologie, Parasitenkunde und Infektionskrankheiten, February 14, 21, 28, and March 18, 1899. Also Nuttall: Neure Forschungen über die Rolle der