REPORT OF THE COMMITTEE ON METEOROLOGY AND EPIDEMICS

OF THE PHILADELPHIA COUNTY MEDICAL SOCIETY.

YOUR Committee rejoice to be able to congratulate the Society that our city has, during another year, maintained its well-established reputation for healthfulness.

The mortality for the year 1874 was almost identical with that for the year previous, which, estimating the annual increase of population at twenty-five thousand, shows a considerable diminution in the death-rate. If we remember, then, that the number of deaths for that year was actually less than for any year since 1869, we shall see ample reason for belief in an improvement in our sanitary administration.

METEOROLOGY.-The atmospheric conditions which have prevailed in this region during the past year, have, it is true, been generably favorable to the preservation of the public health. A reference to our tables shows that it might be called on the whole a mild and dry year. The temperature was 2° above the average for the last twenty-three years, but this was not owing so much to an increase of summer heat as to a decrease of winter cold-the mean summer temperature having been but half a degree higher than that of the year previous, while the mean winter temperature was 7° higher. There were but thirty-two days on which the mean temperature was below 32°, as compared with forty-three days in 1873. January and February, however, were unusually vexed by those sudden temperature variations, which are so characteristic of the climate of our seaboard and so dangerous to persons in feeble health or with constitutional tendencies to pulmonary affections. We find no less than ten of these changes recorded in the period referred to, six of which were in February-one a rise of 39° in seven hours on the twenty-third, and one a fall of 34° on the same and the following day, in twenty-four hours. The mean temperature was above 81° on seventy-eight days, seventy-two of which occurred in the months of June and July, the heat abating very noticeably in August. The hottest day and the highest tem

perature were both recorded in June, the former falling on the ninth, the mean temperature of which was 89°, and the latter occurring on the twenty-eighth, when the mercury rose to 98°.

The autumn was remarkably mild and delightful, but five days showing a mean temperature below 32° until the end of the year. There were, therefore, no great extremes of either heat or cold. There were but one hundred and seven days on which rain (or snow) fell, and the total fall for the year was only 41.64 in., 5.43 in. less than the average. The early summer was extremely dry, vegetation suffering much in consequence. With August came copious rains and a great reduction of temperature. The relative humidity was .06 per cent. below the average. The force of vapor was also less than usual, attaining its maximum in July. The mean daily average of the barometer was high. Electrical disturbances were rare and not of a violent character. Auroral displays were almost entirely wanting.

The only exception to the generally moderate character of the meteorology of the year was to be found in the month of April, which was even more capricious than usual and less sunny. It offered but four entirely clear days, while rain fell on fifteen and snow on two, the day preceding the end of the month being marked by a snow-storm of considerable severity. It was the coldest April for seventeen years, its mean daily temperature being but 45°.67, less than 3° higher than that of March. Notwithstanding this fact, thunder and lightning were observed during its course. Its rain-fall was tremendous, amounting to 7.75 in., nearly one-fifth of that of the entire year.

Let us now glance at the general mortality in its relation to the period of the year and the atmospheric vicissitudes, premising that it is reasonable to expect that, except in the case of insolation, or death from direct exposure to the sun's rays, the effects of general conditions of this nature should not show themselves immediately in the bills of mortality. A certain persistence of such impressions is usually necessary to produce any general disturbance of public health, and the diseases thus inaugurated must have time to run their We should not look, therefore, for simultaneous or immediately consequent variations in the mortuary chart as compared with the meteorological. The former should follow the latter after a short interval, or, the conditions unfavorable to health persisting, should not make their appearance at the commencement of the unhealthful period. These remarks are not intended to apply to specific causes of disease in the atmosphere, although even in this case they are not without pertinency. It is also generally conceded that sudden

course.

variations in thermometric and barometric conditions, especially the former, are less favorable to a high standard of health than an equable state of the atmosphere; and we may add that as the effect of extreme cold on the system is devitalizing and depressing, it would not be strange if sudden falls of temperature should prove more potent factors in swelling the death-rate than sudden rises. Thus August and September of 1873 were remarkably equable in temperature, October and November were characterized by frequent rapid rises, and we find in November and December of that year the extremely low monthly mortality of about 950. In December, however, although the cold was not severe, there having been but four days whose mean temperature was below the freezing point, there were four great and sudden falls of the mercury. We should not be surprised then to find January of the present year, although by no means a severe month itself, presenting a mortality of over 1500, an increase of 550 on the month immediately preceding, or to discover that these deaths were not in any great degree from epidemic diseases but from consumption, acute affections of the air-passages, and acute inflammations generally. A more even range of temperature in January was followed by a diminished death record in February, while the extreme vicissitudes of that month, already referred to, carried the list of March even above that of January, the number of deaths being 1533, the greatest of any month during the year except July. The number of deaths from pulmonary phthisis during this month was 284, the largest for the year, as is usually the case. September was the month most favorable to those suffering from this class of affections, but 129 consumptives having died during its course. The whole number of deaths reported from them for the year amounted to 2304, only thirteen more than in the year before, and about the average for the last five years, as seen in the following record:—

To this and allied affections involving a perversion of nutrition and characterized by wasting are to be attributed about 3000 deaths, or about 8 per diem.

The temperature of March is comparatively steady; of April, extremely so, although the month was cold and stormy to an almost unprecedented degree, and marked by a most copious rain-fall; May

presents a series of sudden rises. Coincidently with this condition we have a steadily descending death-rate reaching its minimum, 1088, in June. During the entire month of June the thermometer ranged high, the heated term running on until the middle of July. This continued heat began to develop that terrible foe to infantile existence in our large cities at that season, cholera infantum, which made its appearance in the weekly bulletin of the Health Office the second week in June, and continued with varying intensity until it reached its highest point on the 20th of July, the number of its victims for that day being 30. The mortality of July was thus increased by 445, and that of the entire year by 859, the cases originating during the prevalence of high temperature continuing to prove fatal in considerable numbers until the end of September. In view of the "slaughter of the innocents" which thus takes place in our midst every year, the number of lives sacrificed having been last year only about half what it was two years before, the suggestion of one of our most distinguished members, an acknowledged authority on sanitary questions, Prof. Henry Hartshorne, that the city should establish health camps at convenient distances from the city, during the five or six weeks which are characterized by this deadly temperature, as places of refuge for the families of those whose means will not permit them to escape from the excessively insanitary circumstances by which they are surrounded-this suggestion, we say, appears to your Committee to be worthy of most respectful consideration. Until, however, our authorities can be made to appreciate that a human life, even in its earlier and unproductive stage, has an actual cash value, it can scarcely be hoped that they will be willing to undertake an experiment the first cost of which must of necessity be considerable.

EPIDEMICS.-The only diseases which can with any show of reason be said to have prevailed epidemically are croup, and diphtheria, and scarlet fever. The first two closely cognate, if not identical, affections are recorded as having killed 378 individuals, of whom five only were adults. These affections prevailed especially during the last quarter of the year, 101 deaths being assigned to diphtheria alone during that period, and 78 during the remainder of the year. The same fact is true with regard to scarlet fever, which destroyed 354 lives (seven only of adults), an increase of 35 over the previous year, and of which 159 were lost during the last three months of the year.

These figures, though not in themselves large, cannot but lead to the conviction that there is much laxity, on the part both of parents

and physicians, in regard to enforcing quarantine on convalescents from these and infectious contagious diseases. In this connection the following remarks on the Period of Infection in Epidemic Diseases, by Dr. Squire, of England, published in the Practitioner, March, 1875, appear to your Committee to possess great interest.

"For diseases of a long incubation period," says Dr. S., "as typhus, typhoid, smallpox, measles, and mumps, infection would seem not to continue long after the special morbid process of each disease is completed. Three weeks from the height of the eruption in smallpox and measles suffice for the cessation of personal infection, allowance being made for delay from complications; care is required that no effete remnant of a morbid action already over, clinging to the skin or to articles of clothing, should convey a disease from which the convalescent is free. Exception may be made to the short period assigned for the termination of infection in these diseases, but there is proof of this being near the usual limit.

"Very different is the teaching conveyed by the results obtained in the investigation of the group of diseases characterized by a short period of incubation. The old quarantine, i. e. forty days or six weeks of isolation for those who had been infected with plague, represents very nearly the time necessary for the strictest caution to be observed after hooping-cough, scarlet fever, and diphtheria, in guarding against the spread of these diseases. The six weeks should be reckoned always from the height of the disease, and in scarlet fever, where the earliest symptoms are the most obvious, a longer interval must be allowed. Possibly, in some of these diseases, most probably in scarlet fever, infection is given off more at a certain advanced stage of convalescence than in some earlier part of it; when all the functions are more nearly restored to their healthy standard, they may expel the last products of the disease with more activity than when they were in a languid or debilitated condition. For scarlet fever, it has been shown, by the first two cases in the previous paper, how convalescents may communicate. its infection nine weeks after the commencement of the disease; in the second case it seemed as if the infection was more active at the end of this long period than at an earlier part of it."

Dr. Elliott, of Carlisle, in a paper on the "Necessity of Perfect and Prolonged Isolation for Stamping out Contagious and Infectious Diseases," published in 1874, relates a case in which the disease was communicated, by a boy returning home six weeks and a day after being taken sick, to his younger brothers. And in oneof the latter desquamation was noticed up to the end of the eighth.