vehicles and missives, the hypothesis of spontaneous origin of cases de novo is not necessary, though, in my opinion, it is not at all improbable.

66. I believe the contagium is very readily and very soon destroyed by heat. I believe that strict seclusion and as rigid quarantine regulations as are usually adopted in cases of small-pox, would be equally successful, or more successful, in preventing the spread of scarlet fever.

In this community, since I have been here, there have been four or more outbreaks of small-pox. In no one of these has the disease ever spread beyond those exposed prior to the disease being seen by the physician. This I attribute to the facts of rigid quarantine being at once established over the premises; seclusion of all the inmates; and exclusion of all other parties, except some one individual appointed by the authorities to supply the necessary communication with the outside; very great carefulness on the part of the physician in so timing his visits as not to go immediately to other patients; prompt vaccination or revaccination of all who have been exposed prior to his being called in; and usually a general vaccination and revaccination of citizens.

The same rigid seclusion and exclusion in cases of scarlet fever has very often checked the spread of the disease, confining it to the individual or family in which it appeared. But the one great difficulty is with the schools. Here the contagium is sown broadcast, and there is a simultaneous outbreak of cases in different parts of the community, all originating from perhaps a single case of a sickening child in the school.

When a case appears in a family, all other children of the family are at once excluded from the schools until full convalescence.

Any practical and fully sufficient method of meeting this difficulty it is impossible to see in the present state of popular intelligence, or rather lack of intelligence, on the subject. But the State Board of Health is doing a great work in educating the public on these matters. Very truly,

Wyandotte, Wayne Co., Mich., May 4, 1877.

DR. E. P. CHRISTIAN.

REPORT OF ATTENDANCE,

ABSTRACTS AND REVIEW OF THE PROCEEDINGS

OF THE

AMERICAN PUBLIC HEALTH ASSOCIATION,

AT ITS ANNUAL MEETING AT CHICAGO, SEPTEMBER 25-27, 1877.

By HOMER O. HITCHCOCK, M. D.,

AND BY

HENRY B. BAKER, M. D.,

Both Members of the Association, and of the Michigan

STATE BOARD OF HEALTH.

57

AMERICAN PUBLIC HEALTH ASSOCIATION.

ANNUAL MEETING AT CHICAGO, SEPT. 25-27, 1877.

REPORT OF FIRST TWO DAYS' SESSION,-BY HOMER O. HITCHCOCK, M. D.

In accordance with a vote of the members of the Board, I attended the meeting of the American Public Health Association, and respectfully submit the following report of the proceedings of that meeting:

It was held in Chicago, one of the most remarkable cities, in some respects, in the whole world. Certain it is that the city at once presents an example of the needs of sanitary laws, and the beneficial results of such laws vigorously and intelligently executed, such as can be found nowhere else.

After a somewhat elegant and complimentary address of welcome by Hon. Wirt Dexter, Dr. John H. Rauch, the President of the Association, introduced the session of the first day by a paper upon the unfavorable hygienic situation of Chicago.

Prior to 1835, the present site of Chicago was a low, wet, boggy plain, covered with wild water-grass and flags, except where the water was too deep and too constant to permit even these to grow. Through this swamp the north and south branches of the river threaded their sluggish course, until by their junction within a mile or two of the shore of the lake, they formed the Chicago River.

This plain, for seven miles back from the lake, did not have au average elevation above the surface of the lake of eight feet. The original shore of the lake was shown to have been from two to four or five miles from the present shore, and the lake was believed to have had an outlet by a considerable river flowing southward and westward to the Mississippi. So Chicago is built upon the old bed of the lake, gradually filled up and grown over by rank weeds and grasses that, in their decay, have made a vegetable mould or humus—a kind of soil holding a very large amount of water, and filled with substances that, on exposure to the sun's rays, would undergo decay, and set free large amounts of noxious gases.

On such a site, Chicago sprang into existence, a full-grown city, as it were, in a day, needing, to the last degree, the benefits of good drainage, and yet almost entirely destitute of the natural advantages to secure it.

Mr. Chesbrough followed with a paper detailing the manner in which these