in common use, brings to it varying and often large numbers of germs which can live and grow in the water. But these small numbers of common bacteria are not of the slightest importance to the salubrity of the water.

Every one should understand that of all the myriads of bacteria about us in earth and air and water, the great majority are harmless. With very few exceptions, the bacteria which can do us harm are those, and those alone, which come from the bodies of men and animals afflicted with disease. So far as water is concerned-and the same. applies to ice-it is only sewage pollution or stagnant filth which we have to fear and shun. Good, pure, uncontaminated water, and ice made from such water either by nature or by man, are entirely wholesome, and they are not made more wholesome by distillation or other purifying procedure they are not more wholesome when germ free.

In point of fact, most of the artificial ice which the writer has examined—and there have been many and abundant samples from various sources collected, and for a period of many months-do contain bacteria in varying numbers. The preliminary distillation, if carefully done, destroys any disease-producing germ forms which might be present in the water used. But a certain number of the more hardy harmless forms may be carried bodily with the steam into the condensers.

In most of the ice manufactories the distilled water is filtered through charcoal before it is run into the freezing cans, for the purpose of removing certain organic compounds which have come into the process of distillation. But these charcoal beds afford breeding places for such germs as may have escaped the ordeal of the heat. The writer has repeatedly found that, while the distilled water, before passing on to the filter beds, was very nearly germ free, the number was increased a thousandfold on leaving them.

So far as the salubrity of the natural as compared with

the artificial ice is concerned, we may rest assured, that, as regards bacteria, one is just as wholesome as the other, provided the water used is pure. If the water is impure from sewage or other unwholesome thing, then the natural ice is never fit for domestic use. If water is impure, the processes of artificial ice making, if carefully performed, are capable of furnishing even from it a product which is harmless and wholesome, whether it be absolutely germ free or not; for absolute freedom from germs-if these are not disease-producing forms-is neither necessary nor especially desirable. It is not bacteria, but disease-producing bacteria, which make of practical significance the invisible flora of either water or ice.

Innumerable analyses have shown that water does not purge itself wholly in the act of freezing, as was formerly believed, from disease germs which may have come into it with human waste. This has been specifically and repeatedly shown to be true for that most dreaded and fatal sewage germ, the bacillus of typhoid fever.

The process of oxidation and sedimentation, which aforetime was demonstrated by most exact chemical analysis to be capable of freeing water in lakes and running streams from organic compounds abundant in sewage, is still urged by belated scientists and frantic tradesmen here and there, in justification of the use of ice cut on sewage-polluted

waters.

Sedimentation does remove many harmful germs from sewage-polluted waters. Dilution does diminish the chances to incur disease for every consumer. Many individuals are, at favored times, practically invulnerable to the incursions of these tiny foes. But, after all, it is safe to say that in thickly inhabited regions sewage-polluted water is not fit for men to drink without purification, no matter how fast and far the river runs, or how wide the lake into which the sewage drains. With the size of the lake and volume of the river, the chances of harm decrease, of course, but they

remain chances where none need to be. As our country becomes more thickly settled and our cities larger, the problems involved in pure water and ice supplies are becoming more and more urgent and difficult.

The manufacture of ice, and its marketing at prices which in many regions easily compete with those of the natural product, have simplified this phase of the water question in the most marked way. Other things being equal, whether the householder decides to use the natural or the artificial ice will depend much upon the climate of his home and the market price of the ice. The natural ice is just as good as the artificial when it comes from pure sources. It is claimed by some that the natural ice melts more slowly than the artificial, and is in this way, other things being equal, cheaper. But similar claims are made for the artificial ice. The writer has tested the relative rapidity of melting of the natural and the artificial ice in New York under the greatest variety of conditions-in small pieces and in large, in the dark and in the light, in diffused light and in the sunshine, in hot places and in cool-and can find no absolute constant difference in the rapidity of melting. One seems to be just about as durable as the other.

15

THE CONTROL OF SCARLET-FEVER.'

BY F. H. HIGGINS, M. D. CORTLAND, N. Y.

When an ambush is unmasked the fear of it is gone. Diseases were mysteries; they were dispensations of Providence; they were punishments to be submitted to. So long as the cause was unknown, and no method of prevention recommended itself, it was the part of philosophy to endure stocially what could not be cured.

By the revolution in our knowledge of the contagious diseases brought about by the germ theory, this position is radically changed. It is within the last decade that a sure basis for our belief in the bacterial origin of disease has been reached. But already so much has been made clear that tame submission to epidemics is criminal.

The first struggle against such diseases as scarlet-fever, diphtheria, and measles, was a defensive one. Long ago it was found that after such a malady had gained an entrance into the system, almost nothing could be done to arrest its course until its force was spent. In spite of a vast amount of experimentation, this fact still remains true. After one of these contagious diseases has once developed, good nursing may help the stricken one, but we are entirely unable to reach the fons et origo in his case.

One of

There is something, however, that we can do. these attacks is as much an accident as to be struck by a rifle ball. It is the result of an extraneous cause acting

1This essay was awarded the prize (a complete set of the Medical and Surgical History of the War), offered by Dr. J. G. Orton, of Binghamton, N. Y., in aid of popular sanitary science.

upon the system. The feeble and the strong are equally liable.

The earliest efforts of physicians and friends were confined to serving as an ambulance corps to care for the wounded. Then as some idea of the direction of the invisible arrows was obtained, defences began to be erected. By isolation, diseases were not allowed to spread so rapidly from one to another, until whole families and communities were laid low. Common observation had taught us this before the microscope had clearly revealed our enemies to us.

Now, by the great increase in the exactness of our knowledge, we may begin an aggressive warfare. We are just beginning to reach that important principle that the best defence is an attack. We are just finding out that there is a possibility of annihilating such diseases as scarlet-fever, so that we need fear its ravages no more. If such an end shall be reached, it is essential that not only physicians, but every member of the community, shall know the plan of attack and assist in carrying it out.

In the first place, it needs to be thoroughly, radically, and once for all understood that scarlet-fever is a contagious disease, and that when any case occurs, it has been contracted from some other case, either directly or indirectly.

Generally by careful investigation this can be shown. Cases do occur, however, in which the connection cannot be discovered. When we remember that the contagium is something unappreciable to the ordinary senses; that momentary contact with a garment that has been worn by a person who has had the disease is sufficient to cause it; that the disease does not manifest itself until some days after it has been received into the system; that it can be carried by the milk we drink, caught in a street car from one just recovering, or brought by a well person from the sick room, it is little wonder that in some cases an exact statement of the cause cannot be given. There was a time