Economic loss to the people of the United States through insects that carry disease


Material Information

Economic loss to the people of the United States through insects that carry disease
Series Title:
Bulletin / U.S. Dept. of Agriculture. Bureau of Entomology ;
Physical Description:
40 p. : ; 23 cm.
Howard, L. O ( Leland Ossian ), 1857-1950
U.S. Dept. of Agriculture, Bureau of Entomology
Place of Publication:
Washington, D.C
Publication Date:


Subjects / Keywords:
Insects as carriers of disease   ( lcsh )
Insect Vectors   ( mesh )
Insects as carriers of contagion
Pamphlet   ( local )
Govt Pub, Federal   ( local )
Pamphlet   ( local )
Govt Pub, Federal   ( local )
federal government publication   ( marcgt )
non-fiction   ( marcgt )


Statement of Responsibility:
by L.O. Howard.
General Note:
"Issued March 18, 1909."
General Note:
Includes index.

Record Information

Source Institution:
University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
aleph - 029642579
oclc - 12821431
lccn - agr09000800
ddc - 632
System ID:

Full Text
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L. 0. HOWARD. Etomologist and Chief of Bureau.




L. 0. HOWARD, PH. D.
Entomologist and Chief of Bureau.

ISSUED MAY 27, 1909.



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L. 0. HOWARD, Entomologist and Chief of Bureau.
C. L. MARLATT, Entomologist and Acting Chief in absence of Chief.
R. S. CLIFTON, Executive Assitant.
C. 3. GILLISS, Chief Clerk. :
F. H. CHrITTENDEN, in charge of truck crop and special insect investigations. .'
A. D. HOPKINS, in charge of forest insect investigations.
W. D. HUNTER, in charge of southern field crop insect and tick investigations. :
F. M. WEBSTER, in charge of cereal and forage plant insect investigations.
A. L. QUAINTANCE, in charge of deciduous fruit insect investigations.
E. F. PHILLIPS, in charge of apiculture. :
D. M. ROGERS, in charge of gipsy moth and broumwn-tail moth field work.
A. WV. MORRILL, in charge of whitefly investigations. :
W. F. FISKE, in charge of gipsy moth laboratory.
F. C. BISHOPP, in charge of cattle tick life history investigations. :
A. C. MORGAN, in charge of tobacco insect investigations.::1
R. S. WOGLUM, in charge of hydrocyanic-acid gas investigations.
R. P. CURRIE, in charge of editorial work. :
MABEL COLCORD, librarian.:


Washington, D. C., April 20, 1909.
SIR: I have the honor to recommend for publication as Bulletin 78,
revised, of this Bureau the accompanying slightly revised copy of the
original edition of this bulletin, entitled Economic Loss to the
People of the United States Through Insects that Carry Disease,"
the supply of which is now almost exhausted.
The United States is just awakening to'a knowledge of the disas-
trous results following a lack of appreciation of the danger arising
from the unchecked development of mosquitoes and the typhoid fly,
and it is hoped that this bulletin will not only emphasize this danger,
but will also lend support to movements, both local and widespread,
toward the destruction (often so easy) of these carriers of disease.
Entomologist and Chief of Bureau.
Secretary of Agriculture.





Introduction -------------------------------------------------------- 7
Mosquitoes ------------------------------------------------------- 8
Malaria ------------------------------------------------------- 8
Yellow fever --------------------------------------------------17
Work on the Isthmus of Panama --------------------------------- 21
The typhoid fly, commonly known as the house fly ---------------------- 23
Endemic disease as affecting the progress of nations -------------------- 36
Index ------------------------------------------------------------39






It has been definitely proven and is now generally accepted that
malaria in its different forms is disseminated among the individuals
of the human species by the mosquitoes of the genus Anopheles, and
that the malarial organism gains entrance to the human system, so
far as known, only by the bite of mosquitoes of this genus. It has
been proven with equal definiteness and has also become generally
accepted that yellow fever is disseminated by the bite of a mosquito
known as Stegormyia calopus (possibly by the bites of other mos-
quitoes of the same genus), and, so far as has been discovered, this
disease is disseminated only in this way. Further, it has been sci-
entifically demonstrated that the common house fly is an active agent
in the dissemination of typhoid fever, Asiatic cholera, and other
intestinal diseases by carrying the causative organisms of these dis-
eases from the excreta of patients to the food supply of healthy indi-
viduals; and that certain species of fleas are the active agents in the
conveyance of bubonic plague. Moreover, the tropical disease known
as filariasis is transmitted by a species of mosquito. Furthermore, it
is known that the so-called "spotted fever" of the northern Rocky
Mountain region is carried by a species of tick; and it has been dem-
onstrated that certain blood diseases may be carried by several species
of biting insects. The purulent ophthalmia of the Nile basin is
carried by the house fly. A similar disease on the Fiji Islands is
conveyed by the same insect. Pink eye in the southern United States
is carried by minute flies of the genus Hippelates. The house fly
has been shown to be a minor factor in the spread of tuberculosis.
The bedbug has been connected with the dissemination of several dis-
eases. Certain biting flies carry the sleeping sickness in Africa. A
number of dangerous diseases of domestic animals are conveyed by
insects. The literature of the whole subject has grown enormously
during the past few years, and the economic loss to the human species
through these insects is tremendous. At the same time, this loss is
entirely unnecessary; the diseases in question can be controlled, and
the suppression of the conveying insects, so absolutely vital with
certain of these diseases and so important in the others, can be brought

"* 'F ?.'".:E":E


Entirely aside from the loss occasioned by mosquitoes as careries.:J
of specific diseases, their abundance brings about a great monetary:".:
loss in other ways. ::I
Possibly the greatest of these losses is in the reduced value of reald:
estate in mosquito-infested regions, since these insects render abso-. ...
lutely uninhabitable large areas of land available for suburban homes,i
for summer resorts, for manufacturing purposes, and for agricultural :
pursuits. The money loss becomes most apparent in the vicinity of i
large centers of population. The mosquito-breeding areas in the ..
vicinity of New York City, for example, have prevented the growth !
of paying industries of various kinds and have hindered the props ,'1
development of large regions to an amount which it is difficult to 'I
estimate in dollars and cents and which is almost inconceivable. Tie I
same may be said for other large cities near the seacoast, 'and evea I
of those inland in low-lying regions. The development of the whole :
State of New Jersey has been held back by the mosquito plague.
Agricultural regions have suffered from this cause. In portions of
the Northwestern States it has been necessary to cover the work horses
in the field with sheets during the day. In the Gulf region of Team n
at times the market value of live stock is greatly reduced by the
abundance of these insects. In portions of southern New Jersey there
are lands eminently adapted to the dairying industry, and the markets
of New York, Philadelphia, and the large New Jersey cities are at
hand. In these localities herds of cattle have been repeatedly estab-
lished, but the attacks by swarms of mosquitoes have reduced the yield
of milk to such an extent as to make the animals unprofitable, and
dairying has been abandoned for less remunerative occupations. The i
condition of the thoroughbred race horses at the great racing ceter1
Sheepshead Bay, Long Island, was so impaired by the attacks of ,
mosquitoes as to induce those interested to spend many thousands of
dollars a few years ago in an effort to abate the pest. i
All over the United States, for these insects, and for the house fly ;
as well, it has become necessary at great expense to screen habitations ;
The cost of screening alone must surely exceed ten millions of dol- -
lars per annum.
The west coast of Africa, portions of India, and many other tropic .j
cal regions have always, at least down to the present period, bee*
practically uninhabitable by civilized man, owing to the presence
of pernicious malaria. The industrial and agricultural development j||
of Italy has been hindered to an incalculable degree by the prevalence ..
of malaria in the southern half of the Italian peninsula, as well as in i
4**.'. i



I the valley of the Po and elsewhere. The introduction and spread of
malaria in Greece is stated by Ronald Ross, and with strong reasons,
to have been largely responsible for the progressive physical degen-
eration of one of the strongest races of the earth.
In the United States, malaria, if not endemic, was early introduced.
The probabilities are that it was endemic, and it is supposed that the
cause of the failure of the early colonies in Virginia was due to this
disease. It is certain that malaria retarded in a marked degree the
advance of civilization over the North American Continent, and
particularly was this the case in the march of the pioneers through-
out the Middle West and throughout the Gulf States west to the Mis-
sissippi and beyond. In many large regions once malarious the disease
S has lessened greatly in frequency and virulence owing to the reclama-
d ion of swamp areas and the lessening of the number of the possible
breeding places of the malarial mosquitoes, but the disease is still
enormously prevalent, particularly so in the southern United States.
There are many communities and many regions in the North where
malaria is unknown, but in many of these localities and throughout
many of these regions Anopheles mosquitoes breed, and the absence
of malaria means simply that malarial patients have not entered these
regions at the proper time 9f the year to produce a spread of the
malady. It has happened again and again that in communities where
malaria was previously unknown it has suddenly made its appearance
and spread in a startling manner. These cases are to be explained,
as happened in Brookline, Mass., by the introduction of Italian labor-
ers, some of whom were malarious, to work upon the reservoir; or,
as happened at a fashionable summer resort near New York City, by
the appearance of a coachman who had had malaria elsewhere and
had relapsed at this place. In such ways, with a rapidly increasing
population, malaria is still spreading in this country.
To attempt an estimate of the economic loss from the prevalence
S of malaria in the United States is to attempt a most difficult task.
Prof. Irving Fisher, in one of his papers before the recent Inter-
national Tuberculosis Congress, declared that tuberculosis costs the
people of the United States more than a billion dollars each year,
In this estimate Professor Fisher considered the death rate for con-
sumption, the loss of the earning capacity of the patients, the period
of invalidism, and the amount of money expended in the care of the
sick, together with other factors. In making these estimates he had
a much more definite basis than can be gained for malaria. The
death rate from malaria (as malaria) is comparatively small and is
apparently decreasing. Exact figures for the whole country are not
S available. From a table comprising 22 cities it appears that two-
i thirds of the deaths from malaria in the United States occur in the
S South-one-third only in the North. The death rate from malaria
83434-Bull. 78-09--2


by States is available only for the following registration t8i44
California, Colorado, Connecticut, District of Columbia, Ind ibU
Maine, Maryland, Massachusetts, Michigan, New Hampshire, No*i
Jersey, New York, Pennsylvania, Rhode Island, South Dakota, a d:I
Vermont, all of which are Northern States. For these States It4
census reports from 1900 to 1907, inclusive, give the following deth I
rates: "I
TABLE I.-Deaths due to malaria in the registration States, 1900-1907. h mm
:E: ":' :.: E:. "iiih
Number Number ,:
of deaths Total of deaths .e..
fromma- deaths fommea- dg
Year. laria per fprom Year. lari per 2
o100,O00 100,00 .... h
lnaa popua-:
tpon, t urn. "ii
... . : :::*.:. .,!
------- -----z1
1900..................... ... 7.9 2,434 1906 .......................... 9 1, K::I
1901........................... 6.3 1,791 1906 .......................... 3.5 ,
1902..................... ... 5.4 1,738 1907 .......................... 2.5 L
1903........................... 4.3 1,410 -. ...
1904........................... 4.2 1,391 ..........
Estimating, from the preceding table, the average annual death'
rate due to malaria at 4.8 per 100,000 population, and considering:'
that the registration area includes only 16 of the Northern States'....:
(assuming fairly, however, that the death rate in the other Northetrn
States is the same), it seems reasonably safe to conclude that the death
rate from malaria for the whole United States must surely amount.
to 15 per 100,000. It is probably greater than this, since the statistics:
from the South are city statistics, and malaria is really a country :
disease. Thus it is undoubtedly safe to assume that the death rate,
for the whole population of the United States is in the neighborhood ::|
of 15 per 100,000. This would give an annual death rate from/
malaria of nearly 12,000 and a total number of deaths for the 8-yea:.
period 1900-1907 of approximately 96,000.
But with malaria perhaps as with no other disease does the death&:.
rate fail to indicate the real loss from the economic point of view. Li3
man may suffer from malaria throughout the greater part of his life B']
and his productive capacity may be reduced from 50 to 75 per cent'l
and yet ultimately he may die from some entirely different immediate.
cause. In fact, the predisposition to death from other causes broughtJ
about by malaria is so marked that if, in the collection of vital stati8AX
tics, it were possible to ascribe the real influence upon mortality tha.i
malaria possesses, this disease would have a very high rank in-mor0a
tality tables. Writing of tropical countries, Sir Patrick Manst
declares that malaria causes more deaths, and more predisposition to
death by inducing cachectic states predisposing to other affectiaoio
than all the other parasites affecting mankind together. Moreovetr||
it has been shown that the average life of the worker in m



places is shorter and the infant mortality higher than in healthy
But, aside from this vitally important aspect of the subject, the
effect of malaria in lessening or destroying the productive capacity
of the individual is obviously of the utmost importance, and upon the
population of a malarious region is enormous, even under modern
conditions and in the United States. It has been suggested that the
depopulation of the once thickly settled Roman Campagna was due to
the sudden introduction of malaria by the mercenaries of Scylla and
Marius. Celli, in 1900, states that owing to malaria about 5,000,000
acres of land in Italy remain-not uncultivated, but certainly very
imperfectly cultivated. Then also, in further example, in quite recent
years malaria entered and devastated the islands of Mauritius and
Reunion, practically destroying for a time the productiveness of these
rich colonies of Great Britain and France.
Creighton, in his article on malaria in the Encyclopaedia Britannica,
states that this disease has been estimated to produce one-half of the
entire mortality of the human race; and inasmuch as it is the most
frequent cause of sickness and death in those parts of the globe that
are most densely populated, the estimate may be taken as at least
rhetorically correct." a
Is it possible to make any close estimate of the ratio between the
number of deaths from malaria and the number of cases of the same
malady? No perfectly sound basis for such an estimate is apparent.
In the English translation of Celli's work on Malaria According
to the New Researches," published in London in 1900, it is stated
that the mortality from malaria in Italy from 1887 to 1898 varied
from 21,033 in the first-named year to 11,378 in the last-named year,
and the mean mortality for the period is assumed to, be about 15,000.
In 1896 a count of the patients in the hospitals in Rome was made,
and the mortality rate of 7.75 per thousand of the actual patients was
established. Calculating then on this basis, and at this rate, the num-
ber of cases per year for Italy was placed at about 2,000,000. Accord-
ing to this estimate, and with the average mortality for the United
States of 12,000 as above indicated, the approximate number of
cases for the United States would be about 1,550,000. It seems obvi-
ous, however, that Celli, in using the basis of hospital patients only,
must have underestimated the number of cases for the Kingdom,
since of the people in the country suffering from malaria the propor-
tion entering the hospital must be relatively small. Therefore the
death rate from malaria of malarial patients in the hospital must be
greater than the death rate from malaria of the people who suffer
from this disease in the whole country. In fact, so great must this
SSee "Darwinism and Malaria," by R. G. Eccles, M. D., Medical Record,
New York, January 16, 1909, pp. 85-93.


discrepancy necessarily be that it would not seem at all unlikely .A
the writer if the number of persons suffering from malaria in Itf|
were in reality nearer 3,000,000 than 2,000,000.
The same argument will hold for the United States, and' mee:
especially so since as a rule malaria in this country is of a light .4
type than in Italy; in fact an estimate of 3,000,000 cases of malarial.
in the United States annually is probably by no means too high. I::t
will not be an exaggeration to estimate that one-fourth of the prodn 2:
tire capacity of an individual suffering with an average case of maf.:i
laria is lost. Accepting this as a basis, and including the loss through
death, the cost of medicines, the losses to enterprises in malarious.::
regions through the difficulty of securing competent labor, and other.:
factors, it is safe to place the annual loss to the United States from:
malarial disease under present conditions at not less than one hundred
millions of dollars. Celli has shown that in Italy the great railway'
industries, for example, feel the effect of malaria greatly. Accord-
ing to accurate calculations one company alone, for 1,400 kilomete::rs::
of railway and for 6,416 workmen in malarious zones, spends on ac-i
count of malaria 1,050,000 francs a year. The same writer states that
the army in Italy from 1877 to 1897 had more than 300,000 cases of.::
The loss to this country in the way of retardation of the develop-'
ment of certain regions, owing to the presence of malaria, is extremely :i
great. Certain territory containing most fertile soil and capable of
the highest agricultural productiveness is practically abandoned.-::
With the introduction of proper drainage measures and antimosquitoa'
work of other character, millions of acres of untold capacity could.l
be released from the scourge at a comparatively slight expenditure. :"
These regions in the absence of malaria would have added millions
upon millions to the wealth of the country. Drainage measures are:.:
now being initiated by the United States. Parties of engineers are:::
being sent by the Government to make preliminary drainage su.r1.:'
veys in the most prominent of these potentially productive regionas.i1
The following statement concerning the effect of malaria on the"ie-'
progress of this work has been made to the writer by Dr. George Otis::|
Smith, director of the United States Geological Survey:::
"In one of the Southern States 11 topographic parties havebeen atsk;
work during the past field season. The full quota for these parti a:i
would be 55 men, but I believe that something over 100 men have!:j
been employed at different times during the season. While I have.I::.
not exact figures before me, I feel warranted in the statement that aV.9
least 95 per cent of these employees have been sick, for periods rang-M 1
ing from a few days up to two weeks, in the hospital. Many of thec:-
have been able later to return to work, but at least 30 per cent has&
to leave the field permanently. By reason of this sickness the effVi



ciency of the parties was reduced, at a very conservative estimate, by
25 per cent.
In my recent visit in this field I found one man sick in each of
the parties I saw and one man who had just returned from the
hospital leaving the field for good. A similar state of things was
reported from the other parties. I regard the sickness as practically
all of a malarial nature, as extreme care was taken in all the camps
to use nothing but boiled water except in a few instances where arte-
sian water from great depths was available. In all the camps the
tents have been screened, and in every case where the topographer has
lived for any time 'on the country' there has been infection. As
illustrating the value of the precautions generally taken by our camp
parties, I might cite the fact that last year in West Virginia with 30
men living in camp, with typhoid fever prevalent in the neighborhood,
no cases developed, while with 6 men living on the country where
the same care could not be taken regarding the water supply, two
cases of typhoid developed."
In estimating the weight of Doctor Smith's statement, it must be
borne in mind that the men of his field parties are exceptionally in-
telligent and prepared to take all ordinary precautions.
Throughout the region in question malaria is practically universal.
The railroads suffer, and at the stations throughout the territory it is
practically impossible to keep operators steadily at work. This re-
duction in efficiency in the surveying parties and in the local railroad
officials is moreover probably very considerably less than the reduc-
tion in the earning capacity of the entire population, which, however,
is necessarily scanty.
In an excellent paper entitled "The relation of malaria to agricul-
tural and other industries of the South," published in the Popular
Science Monthly for April, 1903, Prof. Glenn W. Herrick, then of
the College of Agriculture of Mississippi, after a consideration of
the whole field, concludes that malaria is responsible for more sick-
ness among the white population of the South than any disease to
which it is now subject. The following forcible statement referring
to the States of Louisiana, Mississippi, Alabama, Georgia, and South
Carolina is in Professor Herrick's words:
We must now consider briefly what 635,000 or a million cases of
chills and fevers in one year mean. It is a self-evident truth that it
means well for the physician. But for laboring men it means an
immense loss of their time together with the doctors' fees in many
instances. If members of their families other than themselves be
affected, it may also mean a loss of time together with the doctors'
fees. For the employer it means the loss of labor at a time perhaps
when it would be of greatest value. If it does not mean the actual
Joss of labor to the employer it will mean a loss in the efficiency of



his labor. To the farmers it may mean the loss of their crops ..
want of cultivation. It will always mean the noncultivation t:
imperfect cultivation of thousands of acres of valuable land. 1
means a listless activity in the world's work that counts mightily.
against the wealth-producing power of the people. Finally it meaxirsi
from two to five million or more days of sickness with all its attendanC'm.
distress, pain of body, and mental depression to some unfortunate .I
individuals of those five States." .,
Referring to the Delta region in Mississippi, which lies along tdah::",
Mississippi River in the western part of the State of Mississippi,
extending from the mouth of the Yazoo River north nearly to the 21,N
Tennessee line, Herrick says that it is the second best farming land.'...:i
in the world, having only one rival, and that is the valley of the Nile. :i:
" Still," says Herrick, this land to-day, or at least much of it, can
be bought at ten to twenty dollars an acre. Thousands of acres in
this region are still covered with the primeval forest, and the bears *.
and deer still roaming there offer splendid opportunities for the.:
chase, as evidenced by the late visit of our Chief Executive to those :
regions for the purpose of hunting. Why is not this land thickly I
settled? And why is it not worth from two to five hundred dollars-:..:
an acre? If it produces from one to two or more bales of cottonto.. :
an acre, and it does, it ought to be worth the above named figures. '
A bale of cotton to the acre can be produced for thirteen dollars;,1
leaving a net profit of twenty to forty dollars for each bale, or forty
to eighty or more dollars for each acre of land cultivated. Moreover,.: :
this land has been doing that for years, and will do it for years to.
come, without the, addition of one dollar's worth of fertilizer. Land :
that will produce a net profit of forty to eighty dollars an acre is a
splendid investment at one, two, or even three hundred dollars an ,
acre. Yet this land does not sell in the market for anything like so
much, because the demand is not sufficient, for white people positively `:
object to living in the Delta on account of malarial chills and fevers. :
A man said to me not long ago that he would go to the Delta that day '.
if he were sure that his own life or the lives of the members of his :.
family would not be shortened thereby. There are thousands exactly...:.:
like him, and the only reason that these thousands do not go there to":.::"
buy lands and make homes is on account of chills and fevers. But: :::..
there is a time coming, and that not far distant, when malaria in the .i.
Delta will not menace the would-be inhabitants. When that. time::::::,
comes it will be the richest and most populous region in the United :
Malaria is a preventable disease. It is possible for the human :;i
species to live and to thrive and to produce in malarious regions, but ..
at a very considerable inconvenience and expense. The Italian inveu':.
tigators, and especially Celli and his staff, have shown that -by Ti.




,, screening the huts of the peasants on the Roman Campagna and by
i furnishing field laborers with veils and gloves when exposed to the
r night air, it is possible even in that famous hotbed of malaria to
S conduct farming operations with a minimum of trouble from the
disease. Moreover, Koch and his assistants in German East Africa
have shown that it is possible, by stamping out the disease among
Human beings by the free use of medicine, that a point can be gained
S where there is small opportunity for the malarial mosquitoes to become
infected. Moreover, the work of the parties sent out by the Liverpool
School of Tropical Medicine and other English organizations to the
west coast of Africa has shown that by the treatment of malarial-
mosquito breeding pools the pernicious coast fever may be greatly
reduced. Again, the work of Englishmen in the Federated Malay
States has shown that large areas may be practically freed from
malaria. The most thorough and the most satisfactory of all mieas-
ures consists in abolishing the breeding places of the malarial mos-
quitoes. In regions like the Delta of the Mississippi this involves
extensive and systematic drainage, but in very many localities where
the breeding places of the Anopheles mosquitoes can be easily eradi-
cated, where they are readily located and are so circumscribed as to
admit of easy treatment, it is possible to rid the section of malaria
at a comparatively slight expense.
With a general popular appreciation of the industrial losses caused
primarily by the malarial mosquito and secondarily by the forms
which do not carry malaria, as indicated in the opening paragraphs,
it is inconceivable that the comparatively inexpensive measures neces-
sary should not be undertaken by the General Government, by the
State governments, and by the boards of health of communities, just
as it is inconceivable that the individual should suffer from malaria
and from the attacks of other mosquitoes when he has individual
preventive and remedies at hand. Large-scale drainage measures
by the General Government involving large sections of valuable terri-
tory have been planned and are practically under way; certain States,
notably New Jersey and New York, are beginning to work; communi-
ties all over the country through boards of health are also beginning
to take notice, while popular education regarding the danger from
mosquitoes and in regard to remedial measures is rapidly spreading.
But all of this interest should be intensified, and the importance of
the work should be displayed in the most emphatic manner, and relief
from malaria and other mosquito conditions should be brought about
as speedily as possible.
A few excellent examples of antimalarial work may be instanced.
The latest reports on the measures taken to abolish malaria from
Klang and Port Swettenham in Selangor, Federated Malay States,
indicate the most admirable results. These measures were under-

taken first in 1901 and 1902, and have been reported upon from V
to time in the Journal of Tropical Medicine. The expmdituj
undertaken by the Government with a view to improving the heiMf ,:
of the inhabitants of these towns has been fully justified by the:,
results, which promise to be of permanent value. The total expendi- ..i.
ture for the town of Klang down to the end of 1905 was 8.40::iM.
($15,086), and the annual permanent expenditure is about 60 ($S9) .
for clearing earth drains and 210 ($1,022) for town gardeners. Fart .....
Port Swettenham the total expenditure to the end of 1905 was 27( I
($34,065), and the annual cost of keeping up the drains, etc., is up-..
proximately 40 ($195) for clearing earth drains, and 100 ($4f): '
for town gardeners. A:
The careful tabulation of cases and deaths and of the results at:.
the examination of blood of children in especially drained aRns ;4
indicates the following conclusions: (1) Measures taken systematicay !
to destroy breeding places of mosquitoes in these towns, the inhabit-
ants of which suffered terribly from malaria, were followed almost i
immediately by a general improvement in health and decrease in ,j
death rate. (2) That this was due directly to the work carried out .
and not to a general dying out of malaria in the district is clearly .
shown by figures pointing out that while malaria has practically |
ceased to exist in the areas treated it has actually increased to a
considerable extent in other parts of the district where antimalarial ..
measures have not been undertaken.
The statistics for 1905 are even more favorable than those for 190I, j
which gives a very strong evidence in favor of the permanent nature
of the improvement carried out. In fact it seems as though malaria..
has been permanently stamped out at Klang and Port Swettenham
by work undertaken in 1901, and this experience in theMalay States .
should be of value to those responsible for the health of communities"
similarly situated in many other parts of the world. .
Another striking example of excellent work of this kind is found ji
in the recently published report on the suppression of malaria in ';
Ismailia, issued under the auspices of the Compagnie Universelle du
Canal Maritime de Suez. Ismailia is now a town of 8,000 inhabit- '
ants. It was founded by De Lesseps in April, 1862, on the borders -I
of Lake Timsah, which the Suez Canal crosses at mid-distance be- .S|
tween the Red Sea and the Mediterranean. Malarial fever made itsi
appearance in very severe form in September, 1877, although the `7
city had up to that time been very healthy, and increased so that |
since 1886 almost all of the inhabitants have suffered from the fever. ,
In 1901 an attempt to control the disease was made on the mosquito
basis, and this attempt rapidly and completely succeeded, and after
two years of work all traces of malaria disappeared from the city. :|
The work was directed not only against Anopheles mosquitoes, but |

'j 1
. . . . . . . . . .. :-..-
'F :.


against other culicids, and comprised the drainage of a large swamp
and the other usual measures. The initial expense amounted to
50,000 francs ($9,650), and the annual expenses since have amounted
to about 18,300 francs ($3,532).
The results may be summarized about as follows: Since the be-
ginning of 1903 the ordinary mosquitoes have disappeared from
Ismailia. Since the autumn of 1903 not a single larva of Anopheles
has been found in the protected zone, which extends to the west for
a distance of 1,000 meters from the first houses in the Arabian
quarter and to the east for a distance of 1,800 meters from the first
houses in the European quarter. After 1902 malarial fever obviously
began to decrease, and since 1903 not a single new case of malaria
has been found in Ismailia.
A very efficient piece of antimalarial work was accomplished in
Havana during the American occupation of 1901 to 1902, incidental
in a way to the work against yellow fever. An Anopheles brigade
of workmen was organized under the sanitary officer, Doctor Gorgas,
for work along the small streams, irrigated gardens, and similar
places in the suburbs, and numbered from 50 to 300 men. No exten-
sive drainage, such as would require engineering skill, was attempted,
and the natural streams and gutters were simply cleared of obstruc-
tions and grass, while superficial ditches were made through the irri-
gated meadows. Among the suburban truck gardens Anopheles bred
everywhere, in the little puddles of water, cow tracks, horse tracks,
and similar depressions in grassy ground. Little or no oil was used
by the Anopheles brigade, since it was found in practice a simple
matter to drain these places. At the end of the year it was very diffi-
cult to find water containing mosquito larvae anywhere in the suburbs,
and the effect upon malarial statistics was striking. In 1900, the
year before the beginning of the mosquito work, there were 325
deaths from malaria; in 1901, the first year of the mosquito work,
171 deaths; in 1902, the second year of mosquito work, 77 deaths.
Since 1902 there has been a gradual though slower decrease, as fol-
lows: 1903, 51; 1904, 44; 1905, 32; 1906, 26; 1907, 23. These results,
although less striking than those from Ismailia, involved a smaller
expense in money and show surely an annual saving of 300 lives, and
undoubtedly a corresponding decrease in the number of malarial
cases, which may be estimated upon our earlier basis at something
less than 40,000.
Yellow fever has prevailed endemically throughout the West In-
dies and in certain regions on the Spanish Main virtually since the
discovery of America. Barbados, Jamaica, and Cuba suffered
epidemics before the middle of the seventeenth century. There were
83434-Bu ll1. 78-09--3

.. EE.EE !i
outbreaks in Philadelphia, Charleston, and Boston as early as 1692.
and for a hundred years there were occasional outbreaks, culminate" :
ing in the great Philadelphia epidemic of 1793. Northern cities were
able, by rigid quarantine mesures, to prevent great epidemics after
the early part of the nineteenth century, but from the West Indies:
the disease was occasionally introduced and prevailed from time to
time epidemically in the Southern States. In 1853 it raged through-
out this region, New Orleans alone having a mortality of 8,000. The
last widespread epidemic occurred in 1878, chiefly in Louisiana, Ala.-
bama, and Mississippi, but spreading up the Mississippi Valley as far
as Cairo, Ill., and attacking with virulence the city of Memphis, Tenn.
In this year there were 125,000 cases and 12,000 deaths. In 1882
there were 192 deaths at Pensacola; in 1887, 62 deaths in the Southern
States; in 1893, 52 deaths; in 1897, 484; in 1898, 2,456 cases with
117 deaths; in 1903, 139 deaths were recorded, mostly at Laredo,
Tex., and in 1905 there was a serious outbreak at New Orleans and
in neighboring towns, including one locality in Mississippi, in which
911 deaths were recorded for the whole country.
The actual loss of life from yellow fever during all these years,
when compared with the loss from other diseases, has been compara-
tively slight, but the death rate is perhaps the most insignificant fea-
ture of the devastation which yellow fever epidemics have produced,
and the disease itself has been but a small part of the affliction which
it has brought to the Southern States. The disease once discovered in
epidemic form, the whole country has become alarmed; commerce
in the affected region has come virtually to a standstill; cities have
been practically deserted; people have died from exposure in camping
out in the highlands; rigid quarantines have been established; inno-
cent persons have been shot while trying to pass these quarantine
lines; all industry for the time has ceased. The commerce of the
South during the epidemic of 1878, for example, fell off 90 per cent,
and the hardships of the population can not be estimated in monetary
terms. With such industrial and commercial conditions existing
from Texas to South Carolina, many industries at the North have
suffered, and, in fact, the effect of a yellow fever summer in the' South
has been felt not only all over the United States, but in many other
portions of the world.
All these conditions, as bad as they have been, do not sum up the
total loss to the national prosperity during past years. Cities like
Galveston, New Orleans, Mobile, Memphis, Jacksonville, and Charles-
ton, subject to occasional epidemics, as they have been in the past,
have not prospered as they should have done. Their progress has
been greatly impeded by this one cause, and thus the industrial
development of the entire South has been greatly retarded.


Physicians have been theorizing about the cause of yellow fever
from the time when they began to treat it. It was thought by many
that it was carried in the air; by others that it was conveyed by the
clothing, bedding, or other articles which had come in contact with a
yellow-fever patient. There were one or two early suggestions of the
agency of mosquitoes, but practically no attention was paid to them,
and they have been resurrected and considered significant only since
the beginning of the present century. With the discovery of the
agency of micro-organisms in the causation of disease, a search soon
began for some causative germ. Many micro-organisms were found
in the course of the autopsies, and many claims were put forth by
investigators. All of these, however, were virtually set at rest by
Sternberg in his Report on the Etiology and Prevention of Yellow
Fever," published in 1890, but a claim made by Sanarelli in June,
1897, for a bacillus which he called Bacillus icteroides received con-
siderable credence, and in 1899 it was accepted in full by Wasden and
Geddings, of the United States Marine-Hospifal Service, who re-
ported that they had found this bacillus in thirteen or fourteen cases
of yellow fever in the city of Havana. There is no evidence, how-
ever, that this bacillus has anything to do with yellow fever. In 1881
Finlay, of Havana, proposed the theory that yellow fever, whatever
its cause may be, is conveyed by means of Cdulex (now Stegomnyia)
fasciatus (now calopus). Subsequently he published several im-
portant papers, in which his views were modified from time to time,
and in the course of which he mentioned experiments with 100 indi-
viduals, producing 3 cases of mild fever. None of the cases, however,
was under his full control, and the possibility of cther methods of
contracting the disease was not excluded. Therefore, his theory,
while it was received with interest, was not considered to be proved.
In 1900 came the beginning of the true demonstration. An army
board was appointed by Surgeon-General Sternberg for the purpose
of investigating the acute infectious diseases prevailing in the island
of Cuba. The result achieved by this board, consisting of Reed,
Carroll, Lazear, and Agramonte, was a demonstration that yellow
fever is carried by Stegomyia calopus, and their ultimate demonstra-
tion was so perfect as to silence practically all expert opposition. The
Third International Sanitary Convention of the American Republics
unanimously accepted the conclusion that yellow fever is carried by
this mosquito, and that the Stegomyia constitutes the only known
means by which the disease is spread. To-day, after abundant addi-
tional demonstration, the original contention of Reed, Carroll, and
Agramonte (Lazear having died in the course of the experiments) is
a part of the accepted knowledge of the medical world. The im-
portance of the discovery can not be overestimated, and its first
demonstration was followed by antimosquito measures in the city



of Havana, undertaken under the direction of Gorgas, with startling^..g:,
results. ..
Yellow fever had been endemic in Havana for more than one hun*.,
dred and fifty years, and Havana was the principal source of infec. ::::i
tion for the rest of Cuba. Other towns in Cuba could have rid3
themselves of the disease if they had not been constantly reinfected.:'!i(
from Havana. By ordinary sanitary measures of cleanliness, im-
proved drainage, and similar means the death rate of the city was :
reduced, from 1898 to 1900, from 100 per thousand .to 22 per thou- 4
sand; but these measures had no effect upon yellow fever, this disease ,
increasing as the nonimmune population following the Spanish war .
increased, and in 1900 there was a severe epidemic. -::
Stegomyia calopus was established as the carrier of the fever .
early in 1901, and then antimosquito measures were immediately .
begun. Against adult mosquitoes no general measures were attemp- i
ted, although screening and fumigation were carried out in quarters
occupied by yellow-fever patients or that had been occupied by
yellow-fever patients. It was found that the Stegomyia bred prin-
cipally in the rain-water collections in the city itself. The city was i
divided into about 30 districts, and to each district an inspector and |
two laborers were assigned, each district containing about a thousand i
houses. An order was issued by the mayor of Havana requiring all
collections of water to be so covered that mosquitoes could not have !
access, a fine being imposed in cases where the order was not obeyed.
The health department covered the rain-water barrels of poor fami.
lies at public expense. All cesspools were treated with petroleum. '
All receptacles containing fresh water which did not comply with the "
law were emptied and on the second offense destroyed. The result of J:
this work thoroughly done was to wipe out yellow fever in Havana
and there has not been a certain endemic case since that time.
In the New Orleans epidemic of 1905, a striking illustration of the *
valueof this recently acquired mosquito-transmission knowledge is seen, j
The presence of yellow fever in the city was first recognized about the
12th of July, and the plan of campaign adopted by the Board of Health
under Dr. Quitman Kohlinke, from the beginning was based on the
mosquito conveyance of the disease. Available funds were rapidly
exhausted, however, and on the 12th of August the Public Health and -
Marine-Hospital Service was put in charge of the situation and pro-
vided with ample means. By that time the increase in the new cases .*
and deaths rendered it practically certain that the disease was as wide- ;...
spread as during the terrible epidemic of 1878. There had been up to J
that time 142 deaths from a total of 913 cases, as against 152 deaths .
from a total of 519 cases in 1878. The work for the rest of the sum- |
mer was continued with great energy under Doctor White, and the *
measures were based almost entirely upon a warfare against the yel- |
low-fever mosquito. The disease began almost immediately to abate, .
and the result at the close of the season indicated 460 deaths, as A.
against 4,046 in 1878, a virtual saving of over 3,500 lives. The


following table of deaths from yellow fever in New Orleans from
1847 to 1905 points out most strikingly the value of this antimosquito
S TABLE II.-Comnparative table of deaths from yellow fever in New Orleans dur-
h ing various years.

i. Month. -I
1D47. 1848. 1853. 1854. 1855. 1858. 1867. 1878. 1905.

M ay ........................ ........ ......... 2 ........ .... .. .. .... ... ..... ..
June........................ ........ 4 31 2 | 5 2 3 ........ ........
July ........................ 74 33 1,521: 29 382 132 11 26 35
August ..................... 965 200 5,133 532 1,286 1,140 255 1,025 236
September ................. 1,100 467 982 1,234 874 2,204 1,637 1,780 107
October .................... 198 126 147 490 97 1,137 1,072 1,065 59
November .................. 12 20 28 131 19 224 103 147 23
December ................. 10 .. 4 7 7 15 26 3 ........
Months unknown .......... 445 22, .......................................................
Total................. 2,804 872 7,848 2,425 2,670 4,854 3,107 4,046 460

The epidemics of 1848, 1854, and 1855 are least comparable with
that of 1905 because they immediately succeeded severe epidemics to
which were due very many immunes.
The population of New Orleans by the United States Census was
130,565 in 1850; 168,675 in 1860; 191,418 in 1870; 216,090 in 1880,
and 287,104 in 1900.


The United States Government has very properly used the services
of Colonel Gorgas, who was in charge of the eminently successful
work at Havana, by appointing him chief sanitary officer of the
Canal Zone during the digging of the canal. In 1904 active work was
begun, and Colonel Gorgas was fortunate in having the services of
Mr. Le Prince, who had been chief of his mosquito brigades in Havana,
and therefore was perfectly familiar with antimosquito methods. In
Panama, as in Havana, the population had depended principally
upon rain water for domestic purposes, so that every house had cis-
Sterns, water barrels, and such receptacles for catching and storing
rain water. The city was divided up into small districts with an in-
spector in charge of each district. This inspector was required to
cover his territory at least twice a week and to make a report upon
Each building with regard to its condition as to breeding places of
mosquitoes. All the cisterns, water barrels, and other water recepta-
S cles in Panama were covered as in Havana, and in the water barrels
spigots were inserted so that the covers would not have to be taken
off. Upon first inspection, in March, 4,000 breeding places were
reported. At the end of October less than 400 containing larvae
L were recorded. This gives one a fair idea of the consequent rapid




decrease in the number of mosquitoes in the city. These op.i. tl
tions were directed primarily against the yellow-fever mosquito, *
incidentally against the other common species that inhabit ran-wte r
barrels. Against the Anppheles in the suburbs the same kind of workt-:I.
was done as was done in Havana, with exceptionally good results i
The same operations were carried on in the villages between PE-an-:'
ama and Colon. There are some twenty of these villages, running|
from 500 to 3,000 inhabitants each. Not a single instance of failure
has occurred in the disinfection of these small towns, and the result i||:
of the whole work has been the apparent elimination of yellow fever :!
and the very great reduction of malarial fever. l
The remarkable character of these results can only be judged acmu -.
rarely by comparative methods. It is well known that during the-::
French occupation there was an enormous mortality among their
European employees, and this was a vital factor in the failure of the
work. Exact losses can not be estimated, since the work was done i
under 17 different contractors. These contractors were charged $1 hi
a day for every sick man to be taken care of in the hospital of the il
company. Therefore it often happened that when a man became i|
sick his employer discharged him, so that he would not have to bear
the expense of hospital charges. There was no police patrol of the
territory and many of these men died along the line. Colonel
Gorgas has stated that the English consul, who was at the Isthmus
during the period of the French occupation, is inclined to think
that more deaths of employees occurred out of the hospital than in it. L
A great many were found to have died along the roadside while en- '
deavoring to find their way to the city of Panama. The old superin*
tendent of the French hospital states that one day 3 of the medical 1
staff died from yellow fever, and in the same month 9 of the medical I
staff. Thirty-six Roman Catholic sisters were brought over as nurse, 9 i
and 24 died of yellow fever. On one vessel 18 young French engiV. :
neers came over, and in a month after their arrival all but one died.
Now that the relation of the mosquito to yellow fever is well uuder:5|
stood, it was found during the first two years under Doctor Gorgas(|,4
that, although there were constantly one or more yellow-fever cases
in the hospital, and although the nurses and physicians were all n
immunes, not a single case of yellow fever was contracted in that."I
way. The nurses never seemed to consider that they were running
any risk in attending yellow fever cases night and day in screened
wards, and the wives and families of officers connected with the hoar
pital lived about the grounds, knowing that yellow fever was con-
stantly being brought into the grounds and treated in near-by build" .:
ings. Americans, sick from any cause, had no fear when beiw gi
treated in beds immediately adjoining those of yellow-fever pa-:
tients. Colonel Gorgas and Doctor Carter lived in the old ward :'*


used by the French for their officers, and Colonel Gorgas thinks it
safe to say that more men had died from yellow fever in that build-
ing under the French regime than in any other building of the same
capacity at present standing. He and Doctor Carter had their wives
and children with them, which would formerly' have been considered
the height of recklessness, but they looked upon themselves, under the
now recognized precautions, as being as safe, almost, as they would
have been in Philadelphia or Boston.
No figures of the actual cost of the antimosquito work, either in
Havana or in the Panama Canal Zone, are accessible to the writer,
but it is safe to say that it was not exorbitant, and that it was not
beyond the means of any well-to-do community in tropical regions.


The name "typhoid fly" is here proposed as a substitute for the
name "house fly," now in general use. People have altogether too
long considered the house fly as a harmless creature, or, at the most,
simply a nuisance. While scientific researches have shown that it is
a most dangerous creature from the standpoint of disease, and while
popular opinion is rapidly being educated to the same point, the
retention of the name house fly is considered inadvisable, as perpetu-
ating in some degree the old ideas. Strictly speaking, the term
"typhoid fly" is open to some objection, as conveying the erroneous
idea that this fly is solely responsible for the spread of typhoid, but
considering that the creature is dangerous from every point of view,
and that it is an important element in the spread of typhoid, it
seems advisable to give it a name which is almost wholly justified and
which conveys in itself the idea of serious disease. Another repul-
sive name that might be given to it is "manure fly," but recent
researches have shown that it is not confined to manure as a breeding
place, although perhaps the great majority of these flies are born
in horse manure. For the end in view, typhoid fly is considered
the best name.
The true connection of the so-called house fly with typhoid fever
and the true scientific evidence regarding its r6le as a carrier of that
disease have only recently been worked out. Celli in 1888 fed flies
with pure cultures of the typhoid bacillus, and examined their
contents and dejections microscopically and culturally. Inocu-
[ lations of animals were also made, proving that the bacilli which
Passed through flies were virulent. Dr. George M. Kober, familiar
with Celli's researches, in his report on the prevalence of typhoid
Sfever in the District of Columbia, published in 1895, called especial
attention to the danger of the contamination of food supplies by



flies coming from the excreta of typhoid patients. The prevalence s'
typhoid fever in the concentration camps of the United States Ann:a
in the summer of 1898 brought about the appointment of an army..
board of medical officers consisting of Drs. Walter Reed, U. S. Army,.
Victor C. Vaughan, U. S. Volunteers, and E. 0. Shakespeare, U.
Volunteers, to investigate the causes. The abstract of the report
this board, published in 1900, contains (p. 183) the following conclni-l::-.
sions with regard to flies: Fl1
"Flies undoubtedly served as carriers of the infection.
"Flies swarmed over infected fecal matter in the pits and the.n-X
visited and fed upon the food prepared for the soldiers at the mes.3
tents. In some instances where lime had recently been sprinkled'"
over the contents of the pits, flies with their feet whitened with lime a
were seen walking over the food.
"It is possible for the fly to carry the typhoid bacillus in two -
ways. In the first place, fecal matter containing the typhoid germ .,
may adhere to the fly and be mechanically transported. In the H.
second place, it is possible that the typhoid bacillus may be carried ;
in the digestive organs of the fly and may be deposited with its I
excrement." .i
Doctor Vaughan, of the board just mentioned, in a paper read be- i
fore the annual meeting of the American Medical Association at ..
Atlantic City, N. J., June 6, 1900, gives the following additional rea-
sons for believing that flies were active in the dessemination of
typhoid fever:
"Officers whose mess tents were protected by means of screens
suffered proportionately less from typhoid fever than did those
whose tents were not so protected.
"Typhoid fever gradually disappeared in the fall of 1898, with I!
the approach of cold weather, and the consequent disabling of the fly."
There were also many important conclusions which bear upon the :
fly question. For example, it was shown that every regiment in the .
United States service in 1898 developed typhoid fever, nearly all of :,
them within eight weeks after assembling in camps. It not only-`' 3
appeared in every regiment in the service, but it became epidemic '.
both in small encampments of not more than one regiment and in the ',
larger ones consisting of one or more corps. All encampments i,
located in the Northern as well as in the Southern States exhibited
typhoid in epidemic form. The miasmatic theory of the origin of :
typhoid fever and the pythogenic theory a were not supported by.:
the investigations of the commission, but the doctrine of the specific .:
aThis theory is founded upon the belief that the colon germ may undergo !:A :|::
ripening process by means of which its virulence is so increased and altered :.:i:::
that it may be converted into the typhoid bacillus or at least may become the1':ioi-
active agent in the causation of typhoid fever. :



Sorigin of the fever was confirmed. The conclusion was reached that
Sthe fever is disseminated by the transference of the excretions of an
infected individual to the alimentary canals of others, and that a
man infected with typhoid fever may scatter the infection in every
latrine or regiment before the disease is recognized in himself, while
germs may be found in the excrement for a long time after the
apparently complete recovery of the patient.. Infected water was
not an important factor in the spread of typhoid in the national
encampments of 1898, but about one-fifth of the soldiers in the
national encampments in the United States during that summer de-
veloped this disease, while more than 80 per cent of the total deaths
were caused by typhoid.
In 1899 the writer began the study of the typhoid or house fly
under both country and city conditions. He made a rather thorough
investigation of the insect fauna of human excrement, and made a
further investigation of the species of insects that, are attracted to
food supplies in houses. In a paper entitled "A Contribution to the
Study of the Insect Fauna of Human Excrement (with special refer-
ence to the spread of typhoid fever by flies)," published in the Pro-
ceedings of the Washington Academy of Sciences, Volume II, pages
541-604, December 28, 1900, he showed that 98.8 per cent of the whole
number of insects captured in houses throughout the whole country
under the conditions indicated above were Musca domestica, the
typhoid or house fly. He showed further that this fly, while breeding
most numerously in horse stables, is also attracted to human excre-
ment and will breed in this substance. It was shown that in towns
where the box privy was still in existence the house fly is attracted to
the excrement, and, further, that it is so attracted in the filthy regions
of a city where sanitary supervision is lax and where in low alleys
and corners and in vacant lots excrement is deposited by dirty people.
He stated that he had seen excrement which had been deposited over-
Snight in an alleyway in South Washington swarming with flies under
the bright sunlight of a June morning (temperature 92 F.), and that
within 30 feet of these deposits -were the open windows and doors of
I the kitchens of two houses kept by poor people, these two houses
being only elements in a long row. The following paragraph is
Quoted from the paper just cited:
Now, when we consider the prevalence of typhoid fever and that
Virulent typhoid bacilli may occur in the excrement of an individual
,'for some time before the disease is recognized in him, and that the
same virulent germs may be found in the excrement for a long time
after the apparent recovery of a patient, the wonder is not that ty-
phoid is so prevalent but that it does not prevail to a much greater

extent. Box privies should be abolished in every community. e
depositing of excrement in the open within town or city limits hdiEm
be considered a punishable misdemeanor in communities which .
not already such regulations, and it should be enforced more rig
ously in towns in which it is already a rule. Such offenses are gent ..1
ally committed after dark, and it is often difficult or even impossib :LP'I
to trace the offender; therefore, the regulation should be carried e
further and require the first responsible person who notices the do*:
posit to immediately inform the police, so that it may be removed o .
covered up. Dead animals are so reported; but human excrement- .;'
much more dangerous. Boards of health in all communities shouMd!".
look after the proper treatment or disposal of horse manure, primarily
in order to reduce the number of house flies to a minimum, and aEL'
regulations regarding the disposal of garbage and foul matter should:..."
be made more stringent and should be more stringently enforced."
In the opening sentence of the paragraph just quoted attention Wais
called to the activity of bacilli in excreta passed by individuals after *
apparent recovery from typhoid. Since the paper in question wii&
published, more especial attention has been drawn by medical mie'neaS
to this point, and it has been shown that individuals who are chronic: ,:3:p
spreaders of the typhoid germs are much more abundant than wa.-:J
formerly supposed. Dr. George A. Soper recently discovered a strik::-: M|
ing case of this kind in the person of a cook employed successively ::
by several families in the vicinity of New York City, with the result,
that several cases of typhoid occurred in each of these families. In 3E
a paper by Doctor Davids and Professor Walker, read before the.:!
Royal Sanitary Institute of London during the present season, the .
history was given of four personal carriers of typhoid who had corn- :
municated the disease to a number of people. These four carriers,::':.
were detected in one city within a few months, and from this fact I
it can be argued with justice that such cases are comparatively numer-. I
ous. This being true, the presence of unguarded miscellaneous;I!
human excreta deposited in city suburbs, in vacant lots, and in low :'::!
alleyways intensifies to a very marked degree the danger that the food
will become contaminated with typhoid bacilli by means of the ty-.:,
phoid or house fly. It is known, too, that the urine of persons who: ;.|
have suffered from typhoid fever often contains active typhoid baciUi-:i.
for several weeks after the patients have recovered; consequently this,:76
also is a source of danger.
The importance of the typhoid fly as a carrier of the disease in armyi...
camps, as shown in the Spanish war and in the Boer war and in thb"
camps of great armies of laborers engaged in gigantic enterprises like:"
the digging of the Panama canal, is obvious, but what has just bea:.:V
stated indicates that even under city conditions the influence of thit*|'- |
fly in the spread of this disease has been greatly underestimated.
is not claimed that under city conditions the house fly becomes by t,,
argument a prime factor in the transfer of the disease, but it mut
obviously take a much higher relative rank among typhoid conveyOO


S than it has hitherto assumed. Perhaps even under city conditions
it must assume third rank-next to water and milk.a
It is not alone as a carrier of typhoid that this fly is to be feared.
S In the same way it may carry nearly all the intestinal diseases. It is
a prime agent in the spreading of summer dysentery, and in this way
is unquestionably responsible for the death of many children in sum-
mer. One of the earliest accurate scientific studies of the agency of
insects in the transfer of human disease was in regard to flies as
spreaders of cholera. The belief in this agency long preceded its
actual proof. Dr. G. E. Nicholas, in the London Lancet, Volume II,
1873, page 724, is quoted by Nuttall as writing as follows regarding
the cholera prevailing at Malta in 1849: My first impression of the
possibility of the transfer of the disease by flies was derived from the
observation of the manner in which these voracious creatures, present
in great numbers, and having equal access to the dejections and food
of patients, gorged themselves indiscriminately and then disgorged
themselves on the food and drinking utensils. In 1850 the Superb,
in common with the rest of the Mediterranean squadron, was at sea
for nearly six months; during the greater part of the time she had
cholera on board. On putting to sea, the flies were in great force;
but after a time the flies gradually disappeared, and the epidemic
slowly subsided. On going into Malta Harbor, but without com-
municating with the shore, the flies returned in greater force, and the
cholera also with increased violence. After more cruising at sea, the
flies disappeared gradually with the subsidence of the disease."
Accurate scientific bacteriological observations by Tizzoni and
Cattani in 1886 showed definitely active cholera organisms in the
dejecta of flies caught in the cholera wards in Bologna, Italy. These
observations were subsequently verified and extended by Simonds,
Offelmann, Macrae, and others.
With tropical dysentery and other enteric diseases practically the
same conditions exist. In a report by Daniel D. Jackson to the
committee on pollution, of the Merchants' Association in New York,
published in December, 1907, the results of numerous observations
upon the relation of flies to intestinal diseases are published, and the
relation of deaths from intestinal diseases in New York City to the
a Dr. John R. Mohler, of the Bureau of Animal Industry, U. S. Department
of Agriculture, informs the writer that investigations made in his office show
that typhoid bacilli will live in butter under common market conditions for 151
days and still be able to grow when transferred to suitable conditions. In
milk under market conditions they retain active motility for 20 days, after
which time there is a gradual lessening in numbers until, on the forty-third day
of the test, they disappear from view. At certain seasons- of the year large num-
bers of flies collect upon the vats in which milk and cream are being stored
in dairies and creameries. Many of the flies fall in, their bodies being strained
out when the cream is sent to the churn. If any of these flies carry typhoid
bacilli these are washed off by the milk and remain in the butter or cheese
S made from it. Thus the eating of butter contaminated in this way may account
i for very many cases of typhoid fever the cause of which can not be otherwise
K: traced.



... *.illlll
activity and prevalence of the common house fly is shown not asiy ]|
by repeated observations but also by an interesting plotting of thie ii
curve of abundance of flies in comparison with the plotted curve of .j
abundance of deaths from intestinal diseases, indicating that the j
greatest number of flies occurred in the weeks ending July 27 ad I
August 3; also, that the deaths from intestinal diseases rose above -,
the normal at the same time at which flies became prevalent, culmi- ;1
nated at the same high point, and fell off with slight lag at the |
time of the gradual falling off of the prevalence of the insects. J |
Similar studies have been carried on during the summer of 19W. .:,,Il
in the city of Washington, and the curve of typhoid-fly abundance IS:
for the whole city, as well as that for a district comprising eight city I
squares in which intensive studies have been made both of flies and [
of disease, will be plotted at the close of the season. At the time
of present writing this work has. not been completed.
The typhoid fly also possesses importance as a disseminator of the
bacilli of tuberculosis. In a paper by Dr. Frederick T. Lord, of
Boston, reprinted from the Boston Medical and Surgical Journal for
December 15, 1904, pages 651-654, the following conclusions are
reached: '
1. Flies may ingest tubercular sputum and excrete tubercle ba-
cilli, the virulence of which may last for at least fifteen days.
"2. The danger of human infection from tubercular flyspecks is
by the ingestion of the specks on food. Spontaneous liberation of
tubercle bacilli from flyspecks is unlikely. If mechanically dis-
turbed, infection of the surrounding air may occur. :
"As a corollary to these conclusions, it is suggested that--
"3. Tubercular material (sputum, pus from discharging sinuses, '
fecal matter from patients with intestinal tuberculosis, etc.) should
be carefully protected from flies, lest they act as disseminators of the
tubercle bacilli.
"4. During the fly season greater attention should be paid to the
screening of rooms and hospital wards containing patients with
tuberculosis and laboratories where tubercular material is examined.
"5. As these precautions would not eliminate fly infection by
patients at large, foodstuffs should be protected from flies which may E
already have ingested tubercular material." 4
From all these facts it appears that the most important part played |
by the typhoid fly or house fly in the human economy is to carry i
bacteria from one place to another. The following table and com-rn
ments are taken from Bulletin No. 51 (April, 1908), of the Storrs ;
Agricultural Experiment Station, Storrs, Conn., entitled "Sources of
Bacteria in Milk," by W. M. Esten and C. J. Mason: :Ai,




TABLE III.-Sources of bacteria from flies.


(a) 1 fly, bacteriological
laboratory .............
(b) 1 fly, bacteriological
(c) 19 cow-stable flies.....
Average per fly......
(d) 94 swill-barrel flies....
Average per fly......
(e) 144 pigpen flies........
Average per fly......
(f) 18 swill-barrel flies....
Average per fly......
(g) 30dwelling-house flies.
Average per fly......
(A) 26dwelling-house flies.
Average per fly...
(i) 110 dwelling-house flies.
Average per fly......
(j) 1 large bluebottle
Total average of 414 flies..
Average per cent of 414
Average per fly of 256
flies, experiments (d),
(e),and (f) .............
Average per cent of 256
flies, experiments (d),
(e),and (f)..............



1,222, 570


Total acid





ing bac-


ing bac-


-- *I. -






Group A.
Class 1.

Class 2.

........... ...... ...
........... ...... ....

4,320,000 4,630,000
46,000 49,300
933,000 1,176,000
6,500 12.200
10,480,000 30,000,000
582,000 1,600,000
...e........ . . .
.....a.. .. . . .
...e........ . . .
... .... ..... .. .
....B....... . . .





a 2,200 mold spores.

"From the above table the bacterial population of 414 flies is pretty
well represented. The domestic fly is passing from a disgusting nui-
sance and troublesome pest to a reputation of being a dangerous
enemy to human health. A species of mosquito has been demon-
strated to be the cause of the spread of malaria. Another kind of
mosquito is the cause of yellow fever, and now the house fly is con-
sidered an agency in the distribution of typhoid fever, summer com-
plaint, cholera infantum, etc.
"The numbers of bacteria on a single fly may range all the way
from 550 to 6,600,000. Early in the fly season the numbers of bac-
teria on flies are comparatively small, while later the numbers are
comparatively very large. The place where flies live also determines
largely the numbers that they carry. The average for the 414 flies
was about one and one-fourth million bacteria on each. It hardly
seems possible for so small a bit of life to carry so large a number of
organisms. The method of the experiment was to catch the flies from
S the several sources by means of a sterile fly net, introduce them into
S a sterile bottle, and pour into the bottle a known quantity of steril-
" ized water, then shake the bottle to wash the bacteria from their
Bodies, to simulate the number of organisms that would come from a
Sfly in falling into a lot of milk. In experiments 'd,' e,' and f/'


July 27
Aug. 6
Sept. 4

!.. .. ......

- - I


the bacteria were analyzed into four groups. The objectionable,
coli-cerogenes type, was two and one-half times as abundant as
favorable acid type. If these flies stayed in the pigpen vicinity the"wi. i
would be less objection to the flies and the kinds of organisms *thy::l.
carry, but the fly is a migratory insect and it visits everything unde<
the sun.' It is almost impossible to keep it out of our kitchens, di*?. ..
ing rooms, cow stables, and milk rooms. The only remedy for this!
rather serious condition of things is, remove the pigpen as far as pci.r "A
sible from the dairy and dwelling house. Extreme care should .be'
taken in keeping flies out of the cow stable, milk rooms, and dwell- |
ings. Flies walking over our food are the cause of one of the worst, :
contaminations that could occur from the standpoint of cleanliness ,:'
and the danger of distributing disease germs." ..i
The danger of the typhoid or house fly in the carriage of disease i
has thus been abundantly demonstrated. Further than this, it is an ..
intolerable nuisance. With mosquitoes it necessitates an annual out- *:.
lay for window and door screens in the United States of not less than .'.:
ten millions of dollars. As a carrier of disease it causes a loss of <
many millions of dollars annually. Dr. G. N. Kober, in a paper pre- "'
pared for the Governors' Conference on the Conservation of Natural '
Resources, held at the Wrhite House in May, 1908, entitled "The Con- ..|
servation of Life and Health by Improved Water Supply," presented
figures showing that the decrease in the vital assets of the country
through typhoid fever in a single year is more than $350,000,000.::
The house fly, as an important agent in the spread of this disease, is
responsible for a very considerable portion of this decrease in vital
assets. As an agency in the spread of other intestinal diseases, this
sum must be greatly increased, and yet it is allowed to breed unre- .
stricted all over the United States; it is allowed to enter freely the ..
houses of the great majority of our people; it is allowed to spread
bacteria freely over our food supplies in the markets and in the
kitchens and dining rooms of private houses, and, to use the happy F
phraseology of Dr. Theobald Smith, "when we go into public restau- :i
rants in midsummer we are compelled to fight for our food with the ..|
myriads of house flies which we find there alert, persistent, and :j
invincible." "-
Even if the typhoid or house fly were a creature difficult to de- ;,
stroy, the general failure on the part of communities to make any
efforts whatever to reduce its numbers could properly be termed::.
criminal neglect; but since, as will be shown, it is comparatively a"n:
easy matter to do away with the plague of flies, this neglect becomes 5
an evidence of ignorance or of a carelessness in regard to disease34
producing filth which to the informed mind constitutes a serious bl t
on civilized methods of life. I



Strange as it may seem, an exhaustive study of the conditions
which produce house flies in numbers has never been made. The
life history of the insect in general was, down to 1873, mentioned in
only three European works and few exact facts were given. In 1873
Dr. A.. S. Packard, then of Salem, Mass:, studied the transformations
of the insect and gave descriptions of all stages, showing that the
growth of a generation from the egg state to the adult occupies from
10 to 14 days.
In 1895 the writer traced the life history in question, indicating
that 120 eggs are laid by a single female, and that in Washington,
S in midsummer, a generation is produced every 10 days. Although
numerous substances were experimented with, he was able to breed
the fly only in horse manure. Later investigations indicated that the
fly will breed in human excrement and in other fermenting vegetable
and animal material, but that the vast majority of the flies that
infest dwelling houses, both in cities and on farms, come from horse
In 1907 careful investigations carried on in the city of Liverpool
by Robert Newstead, lecturer in economic entomology and para-
sitology in the School of Tropical Medicine of the University of
Liverpool, indicated that the chief breeding places of the house fly
in that city should be classified under the following heads:
(1) Middensteads (places where dung is stored) containing horse
manure only.
(2) Middensteads containing spent hops.
(3) Ash pits containing fermenting materials.
He found that the dung heaps of stables containing horse manure
only were the chief breeding places. Where horse and cow manures
were mixed the flies bred less numerously, and in barnyards where
fowls were kept and allowed freedom relatively few of the house
flies were found. Only one midden containing warm spent hops was
S inspected, and this was found to be as badly infested as any of the
stablemiddens. A great deal of time was given to the inspection of
Sash pits, and it was found that wherever fermentation had taken
S place and artificial heat had been thus produced, such places were
Sp: infested with house-fly larvae and pupae, often to the same alarming
V extent as in stable manure. Such ash pits as these almost invariably
contained large quantities of old bedding or straw and paper, paper
mixed with human excreta, or old rags, manure from rabbit hutches,
etc., or a mixture of all these. About 25 per cent of the ash pits
examined were thus infested, and house flies were found breeding
in smaller numbers in ash pits in which no heat had been engendered
by fermentation. The house fly was also found breeding by Mr.
Newstead in certain temporary breeding places, such as collections


of fermenting vegetable refuse, accumulations of mau ...........
wharves, and in bedding in poultry pens.
Still more recent investigations were carried on during tiIfl,
Prof. S, A. Forbes, State entomologist of Illinois, who has rearei
in large numbers from the contents of paunches of slaughtered es*,
from refuse hog hairs, from tallow vats, from carcasses of wv..
animals, miscellaneous garbage, and so on.
All this means that if we allow the accumulation of filth we W1
have house flies, and if we do not allow it to accumulate we will laist
no house flies. With the careful collection of garbage in 4a=s
the removal of the contents at more frequent intervals than 10 da*'i
and with the proper regulation of abattoirs, and more par.tieuie4 ..
with the proper regulation of stables in which horses are kept, th ...
typhoid fly will become a rare species. It will not be necessary ti..::
treat horse manure with chlorid of lime or with kerosene or with aI
solution of Paris green or arsenate of lead, if stable men are requint
to place the manure daily in a properly covered receptacle and it it I,
is carried away once a week. .. .
The orders of the health department of the District of Colmnbib .
published May 3, 19061 if carried out will be very effective. The::::".
orders may be briefly condensed as follows:
All stalls in which animals are kept shall have the surface of the
ground covered with a water-tight floor. Every person occupying:2
a building where domestic animals are kept shall maintain, in eel-m
nection therewith, a bin or pit for the reception of manure, and psd.-i
ing the removal from the premises of the manure from the animal:
or animals shall place such manure in said bin or pit. This bin shall .
be so constructed as to exclude rain water, and shall in all other :...."
aspects be water-tight, except as it may be connected with the publiWC
sewer. It shall be provided with a suitable cover and constructa-::4
so as to prevent the ingress and egress of flies. No person ownin!g
a stable shall keep any manure or permit any manure to be kept inM:::;,
or upon any portion of the premises other than the bin or pit do-
scribed, nor shall he allow any such bin or pit to be overfilled : i
needlessly uncovered. Horse manure may be kept tightly rammaSd.:.:
into well-covered barrels for the purpose of removal in such barsla. .,.-
Every person keeping manure in any of the more densely populated |''
parts of the District shall cause all such manure to be removed bfra
the premises at least twice every week between June 1 and October SQ
and at least once every week between November 1 and May 31 4
the following year. No person shall remove or transport any maaiu6
over any public highway in any of the more densely populated pal
of the District except in a tight vehicle, which, if not inclosed, u |
be effectually covered with canvas, so as to prevent the manure
being dropped. No person shall Adeposit manure removed from .


Sbias or pits within any of the more densely populated parts of the
District without a permit from the health officer. Any person
violating any of these provisions shall, upon conviction thereof, be
punished by a fine of not more than $40 for each offense.
In addition to this excellent ordinance, others have been issued
from the health department of the District of Columbia which provide
against the contamination of exposed food by flies and by dust. The
S ordinances are excellently worded so as to cover all possible cases.
S They provide for the registration of all stores, markets, cafes, lunch
rooms, or of any other place where food or beverage is manufactured
or prepared for sale, stored for sale, offered for sale, or sold, in order
to facilitate inspection, and still more recent ordinances provide for
the registration of stables. An excellent campaign was begun during
the summer of 1908 against insanitary lunch rooms and restaurants.
A number of cases were prosecuted, but conviction was found to be
For one reason or another, the chief reason being the lack of a
sufficient force of inspectors under the control of the health officers,
the ordinance in regard to stables has not been carried out with that
perfection which the situation demands. In the summer of 1896, the
S health officer of the District, Dr. W. C. Woodward, designated a
region in Washington bounded by Pennsylvania avenue, Sixth street,
Fifteenth street, and the Potomac River, which was to be watched
by assistants of the writer. Twenty-four stables were located in this
region and were visited weekly by two assistants chosen for the pur-
pose. The result was that on the whole the manure was well looked
after and the number of flies in the region in question was very con-
siderably reduced during the time of inspection.
Were simple inspection of stables all that is needed, a force of four
inspectors, specially detailed for this work, could cover the District
of Columbia, examining every stable, after they were once located and
S mapped, once a week. The average salary of an inspector is $1,147,
S so that the total expense for the first year would be something like
I $4,500. But the inspectors' service is complicated by the matter of
S prosecution. Much of the time of inspectors would be taken in the
prosecution of the owners of neglected premises. Moreover, the health
officer has found during the summer of 1908, in his prosecution of the
owners or managers of insanitary restaurants, that his inspectors were
practically sworn out of court by the multiplicity of opposing evi-
dence. This means that it will be necessary in such cases to send two
inspectors together in all cases, so that the testimony of one may be
supported by the testimony of the other. This, perhaps, would double
the number of necessary inspectors, making the expense of the service
something over $9,000. It is reasonably safe to state, however, that



with such an expense for competent service, or perhaps with a slight i7
added expense, the typhoid fly could be largely eliminated as an elW ?!
ment in the transfer of disease in the District of Columbia, and the ::
difficulty which the authorities have had in locating the cause of a'
very considerable proportion of the cases of typhoid in the District k
for the past two or three years indicates plainly to the mind of the
writer that the typhoid fly is a much more important element than
has been supposed. It is a comforting although comparatively insig-
nificant fact and a matter of common observation that in certain
sections of the city the typhoid fly has been much less numerous dur-
ing the past summer than in previous years. The writer is inclined
to attribute this to the gradual disappearance of horse stables in
such sections, brought about by the rapidly increasing use of motor
A significant paragraph in Mr. Newstead's Liverpool report, re-
ferred to above, contains the following words: The most strenuous -
efforts should be made to prevent children defecating in the courts
and passages; or that the parents should be compelled to remove such
'matter immediately; and that defecation in stable middens should be
strictly forbidden. The danger lies in the overwhelming attraction
which such fecal matter has for house flies, which later may come into
direct contact with man or his foodstuffs. They may, as Veeder puts
it,' In a very few minutes load themselves with dejections
from a typhoid or dysenteric patient, not as yet sick enough to be in
hospital or under observation, and carry the poison so taken up into
the very midst of the food and water ready for use at the next meal.
There is no long, roundabout process involved.'"
The writer has already referred to this general subject in his re-
marks on the depositing of excrement in the open within town or city
limits, but Newstead's specific reference to children reminds one that
in the tenement districts of the older great cities of England and other
parts of Europe there occur opportunities for transfer of disease
which, while probably less numerous in the newer cities of the United
States, nevertheless must still exist and be a constant danger.
We have thus shown that the typhoid or house fly is a general and
common carrier of pathogenic bacteria. It may carry typhoid fever,
Asiatic cholera, dysentery, cholera morbus, and other intestinal dis-
eases; it may carry the bacilli of tuberculosis and certain eye diseases;.
it is everywhere present, and it is disposed of with comparative ease. :::
It is the duty of every individual to guard so far as possible against,|
the occurrence of flies upon his premises. It is the duty of every comn-,:.
munity, through its board of health, to spend money in the wArfarenj
against this enemy of mankind. This duty is as pronounced as thougiii|
the community were attacked by bands of ravenous wolves. g:



As a matter of fact, large sums of money are spent annually in the
protection of property in the United States. Large sums of money
are spent also in health matters; but the expenditure for protection
from flies is very small and is misdirected. There is much justifica-
tion for the following criticism published editorially in the Journal
S of the American Medical Association for August 22, 1908, under the
caption, National Farm Commission and Rural Sanitation:"
"The President calls attention to the fact that all efforts to aid the
farmers have hitherto been directed to improving their material
* welfare, while the man himself and his family have been neglected.
Nowhere is this more marked than in the attitude of the General
Government in matters relating to sanitation. It is a trite saying
that whereas the Government, through the Department of Agricul-
ture, aids the farmer generously in caring for the health of his hogs,
Sheep, etc., it does nothing for his own health. The Government
issues notices to the farmer of the injury done to his crops by the
cotton-boll weevil and the potato bugs and how to combat them, but
Sthe injury the mosquito does in spreading malaria to the people who
pick the cotton and hoe the potatoes is not impressed on him. The
fact that horseflies may carry anthrax to his cattle is dealt with at
considerable length, but the diseases which the house fly spreads to
S the milk and to the farmer's family attract practically no attention.
How to build a hogpen or a sanitary barn is the subject of a number
of government publications, but how to build a sanitary privy which
will prevent the spread of typhoid, hook worm, and many other dis-
eases is regarded as of strictly local interest."
But this criticism is not entirely justified, since there was published
by the Bureau of Entomology of the United States Department of
Agriculture, in 1900, a Farmers' Bulletin, entitled "How Insects
Affect Health in Rural Districts,'"a in which all of these points men-
tioned by the editor of the Journal of the American Medical Asso-
ciation have been touched upon, and at the date of present writing
192,000 copies of this bulletin have been distributed among the
people. Moreover, a number of years ago a circular b was published
S on the subject of the house fly, calling attention to its dangers and
S giving instructions such as are covered in a general way in this
S article, and some 18,000 copies of this circular have also been dis-
tributed. This is an indication that the General Government is by
no means blind to the people's needs in such matters as we have
Sunder consideration, but further work should be done. That the
S English Government is awaking to the same need is shown by the
fact that, in the parliamentary vote of the present year in aid of
a Farmers' Bulletin No. 155.
b Circular No. 35, Bureau of Entomology, 1891, afterwards reissued in revised
form as Circular No. 71.


T O' 1na mtrIn/nTTmr TwTainmfla rml"rlAm n iaTInnTr rTOc M AfI

..,. ii/ ii .
011al j ZjccLLJbJUtXXfl La10%nLJ AID %J inns rzb ua ax zwrna.9VJ
scientific investigations concerning disease, one of the projects a
ported by the General Government was the investigation of Doctos. ii
Copeman and Nuttall on flies as carriers of disease. l
A leading editorial in an afternoon paper of the city of Washing. .!
ton, of October 20, 1908, bears the heading, "Typhoid a Nationa1 ||.
Scourge," arguing that it is to-day as great a scourge as tuberculoeia 4
The editorial writer might equally well have used the heading "Ty- III!i
phoid a National Reproach," or perhaps even "Typhoid a National. -:'
Crime," since it is an absolutely preventable disease. And as for the
typhoid fly, that a creature born in indescribable filth and absolutely
swarming with disease germs should practically be invited to mul- 3.j
tiply unchecked, even in great centers of population, is surely nothing ,"
less than criminal.
In referring to the spread of malaria in Greece, the relation of this
disease to the rise and fall of national power has been touched upon
in an earlier paragraph of this bulletin (p. 9). The subject is one of I
the widest importance and deserves a more extended consideration.
The following paragraphs are quoted from Ronald Ross's addressm.
on Malaria in Greece, delivered before the Oxford Medical Society,
November 29, 1906:
"Now, what must be the effect of this ubiquitous and everlasting
incubus of disease on the people of modern Greece? Remember that
the malady is essentially one of infancy among the native population.
Infecting the child one or two years after birth, it persecutes him
until puberty with a long succession of febrile attacks, accompanied
by much splenomegaly and anemia. Imagine the effect it would
produce upon our own children here in Britain. It is true that our
children suffer from many complaints-scarlatina, measles, whoop-
ing cough-but these are of brief duration and transient. But now
add to these, in imagination, a malady which lasts for years, and may i
sometimes attack every child in a village. What would be the
effect upon our population-especially our rural population-upn :::
their numbers and upon the health and vigour of the survivors? It 5;
must be enormous in Greece. People often seem to think that such a 'I
plague strengthens a race by killing off the weaker individuals; but: ..;
this view rests upon the unproven assumption that it is really thin:':|
weaker children which can not survive. On the contrary, ex perien a,,
seems to show that it is the stronger blood which suffers mostr-th*
fair, northern blood which nature attempts constantly to pour in-o :
the southern lands. If this be true, the effect of malaria will
constantly to resist the invigorating influx which nature has provided;:
and there are many facts in the history of India, Italy, and A i.
which could be brought forward in support of this hypothesis.



"We now come face to face with that profoundly interesting
subject, the political, economical, and historical significance of this
great disease. We know that malaria must have existed in Greece
ever since the time of Hippocrates, about 400 B. C. What effect
has it had on the life of the country? In prehistoric times Greece
was certainly peopled by successive waves of Aryan invaders from the
S north-probably a fair-haired people-who made it what it became,
S who conquered Persia and Egypt, and who created the sciences,
I arts, and philosophies which we are only developing further to-
day. That race reached its climax of development at the time of
S Pericles. Those great and beautiful valleys were thickly peopled
by a civilization which in some ways has not been excelled.
Everywhere there were cities, temples, oracles, arts, philosophies,
and a population vigorous and well trained in arms. Lake Kopais,
now almost deserted, was surrounded by towns whose massive works
remain to this day. Suddenly, however, a blight fell over all. Was
it due to internecine conflict or to foreign conquest? Scarcely; for
history shows that war burns and ravages. but does not annihilate.
Thebes was thrice destroyed, but thrice rebuilt. Or was it due to
some cause, entering furtively and gradually sapping away the
energies of the race by attacking the rural population, by slaying
the new-born infant, by seizing the rising generation, and especially
by killing out the fair-haired descendant of the original settlers,
S leaving behind chiefly the more immunised and darker children of
* their captives, won by the sword from Asia and Africa? * *
S I can not imagine Lake Kopais, in its present highly malarious
S condition, to have been thickly peopled by a vigorous race; nor, on
looking at those wonderful figured tombstones at Athens, can I
imagine that the healthy and powerful people represented upon
S them could have ever passed through the anemic and splenomegalous
S infancy (to coin a word) caused by widespread malaria. Well, I
S venture only to suggest the hypothesis, and must leave it to scholars
for confirmation or rejection. Of one thing I am confident, that
causes such as malaria, dysentery, and intestinal entozoa must have
modified history to a much greater extent than we conceive. Our
historians and economists do not seem even to have considered the
matter. It is true that they speak of epidemic diseases, but the
S endemic diseases are really those of the greatest importance. * *
"The whole life of Greece must suffer from this weight, which
crushes its rural energies. Where the children suffer so much, how
can the country create that fresh blood which keeps a nation young?
But for a hamlet here and there, those famous valleys are deserted.
I saw from a spur of Helikon the sun setting upon Parnassus, Apollo
Sinking, as he was wont to do, towards his own fane at Delphi, and
pouring a flood of light over the great Kopaik Plain. But it seemed


that he was the only inhabitant of it. There was nothing thmsr
'Who,' said a rich Greek to me, 'would think of going to livet iWt
such a place as that?' I doubt much whether it is the Turk wh'o
has done all this. I think it is very largely the malaria." i
In considering carefully this suggestive argument of Major Rp:..
does it not appear to indicate the tremendous influence that thi'
prevalence of endemic disease must exert upon the progress of mo4.-!:!.
ern nations, and does it not bring the thought that those nations thist
are most advanced in sanitary science and preventive medicine will:,'
other things being equal, assume the lead in the world's work? Who..
can estimate the influence of the sanitary laws of the Hebrew scrip- .
tures upon the extraordinary persistence of that race through cei- l
tries of European oppression-centuries full of plague years and ....!
of terrible mortality from preventable disease? And what more
striking example can be advanced of the effect of an enlightened
and scientifically careful attention to the most recent advances of
preventive medicine upon the progress of nations than the mortality
statistics of the Japanese armies in the recent Russo-Japanese war as
compared with the corresponding statistics for the British army
during the Boer war immediately preceding, or for the American"
Army during the Spanish war at a somewhat earlier date?
The consideration of these elements of national progress has been
neglected by historians, but they are nevertheless of deep-reaching
importance and must attract immediate attention in this age of
advanced civilization. The world has entered the historical age
when national greatness and national decay will be based on physical
rather than moral conditions, and it is vitally incumbent upon na-
tions to use every possible effort and every possible means to check
physical deterioration.



Abattoirs, regulations to avoid house flies------------------------------ 32
Anopheles mosquitoes (see also Mosquitoes, malaria).
disseminators of malaria------------------------ 7
suppression in Panama---------- -----------------22
S Ash pits containing fermenting material, breeding places of house fly ... 31
' Bacilli, typhoid, longevity in milk, cream, butter, and cheese----------- 27
Bacillus icteroides, not proven to be causative germ of yellow fever----- 19
Bacteria from flies, census----------------------------------- 29-30
Sin milk, sources----------------------------------------- 28-30
S Bedbug, a carrier of disease----------------------------------------- 7
S.Bedding, old, in ash pits, breeding place of house fly------ -------------- 31
Bubonic plague, conveyance by fleas----------------------------------- 7
S Cafes, regulation to avoid house flies--------------------------------- 33
Carcasses of animals, breeding places of house fly---------------------- 32
SCholera, Asiatic, carriage by house fly ----------------------- 7,27,34
infantum, carriage by house fly ------------------------------29
Smorbus, carriage by house fly--------------------- -----------34
Culex fasciatus=Stegomyia calopus-------------------- ------------ 19
Deaths from malaria in United States------------------------------ 9-10
typhoid fever in concentration camps, U. S. Army___--------- 24-25
yellow fever in United States_ ---------------------18,31
Disease, endemic, as affecting progress of nations--------------------- 36-38
Diseases, intestinal, dissemination by house fly------------------------- 7
Dysentery, summer, carriage by house fly---------------------------- 27,34
tropical, carriage by house fly--------------------------- 27,34
Endemic disease as affecting progress of nations--------------------- 36-38
Excrement, human, breeding place of house fly------------------------- 31
Eye diseases, carriage by house fly---- ------------------------------ 34
Fermenting animal and vegetable material, breeding places of house fly-- 31-32
Filariasis, transmission by a mosquito--------------------------------- 7
S Fleas, conveyors of bubonic plague------------------------------------ 7
Flies, biting, carriers of sleeping sickness----------_----------------- 7
Fly, house, breeding places------------------------------------------- 31-32
disseminator of cholera, Asiatic------------------------ 7,27,34
infantum _------------------------- 29
morbus---------------------------- 34
dysentery, summer------------------------- 27,34
tropical----------------------__ 27
eye diseases ------------------------------- 34
intestinal diseases------------------------ 7,27-28
purulent ophthalmia------------------------ 7
Styphoid fever------------------------------ 7
; tuberculosis-------------------------- 7,28,34
Legislation -------------------------------------------32-30
life history------------------ --------------------------- 31
Relation to typhoid fever------------------------------- 23-27
suppression feasible and all-important --------------------- 30
manure, name for house fly ------------------------------------23
typhoid, name for house fly-- ---------------------------------- 23
Garbage, breeding place of house fly--------------------------------- 32
collection to avoid house flies-------------------------------- 32
Hippelates flies, carriers of pink eye ---------------------------------- 7
Hog hairs, refuse, breeding place of house fly-------------------------- 32
' Hops, spent, breeding place of house fly------------------------------ 31
Insects affecting health, publications by Bureau of Entomology------- 35
Lunch rooms, regulation, to avoid house flies------------------------- 33
Malaria, deaths in United States----------------------------------- 9-10
Dissemination by mosquitoes----------------------------- 7,8-17
eradication at Ismailia, Suez Canal-------------------------- 16-17
in Greece---------------------------36-38

**r~~~~~, .,, ,;::::i|! _| ^
Malaria, in Italy, loss therefrom--------------------------
Mauritius--------- -- --------------_ ----- -i"
Reunion -""-,-- J
United States, history---------------------------
loss in United States ......
Italy----------------------- -------------,
mosquitoes. (See Anopheles moseuitoes and Mosquito, majgjlri,
prevention ---------------------- _
relation to agriculture and other industries of the South___i.a_
suppression in Havana --------------------------- -...
Panama-------------- ---------
Selsngor, Federated Malay Satetes ---------..
Manure, disposal, to avoid house flies---------------------- ----- .
horse, breeding place of house fly--------------------- I
rabbit, in ash pits, breeding place of house fly-------------.- --
Markets, regulation, to avoid house flies ---- ------ ---------- .. -----
Milk, sources of bacteria therein -------- ------:j--
Mosquito, disseminator of filariasis---------- -------- ----- --:
malaria --------- ---------- ,
yellow fever -------------------------..
malaria (see also Anopheles mosquitoes).
suppression measures---------------------------i
yellow fever, suppression measures-------------- ....
Mosquitoes, losses in general which they occasion--.--.- ------- .
through malaria which they occasion--------- -
yellow fever which they occasion.----------- it
suppression in Panama-----------------------------s
Nations, endemic disease as affecting progress------------------- .
Ophthalmia, purulent, carriage by house fly------------------ ----- ,
Paper, old, breeding place of house fly-------------------------
Pink eye, carriage by Hippelates flies--------------------------
Plague, bubonic. (See Bubonic plague.)
Poultry-house bedding, breeding place of house fly ---------
Progress of nations as affected by endemic disease--------.----------._ i
Rags, old, in ash pits, breeding place of house fly---------------- .
Restaurants, regulation, to avoid house flies---------------------
Sanitation, rural, necessity for government suppo rt ---------------
Slaughtered cattle paunches, breeding places of house Sly---------- ,,
Sleeping sickness, carriage by biting flies --------------
"Spotted fever," carriage by tick--------------------------
Stable inspection against house flies, probable cost--------------------
Stables, regulation, to avoid house flies ---------------------------
Stegomyia calopus (see also Mosquito, yellow fever). :
disseminator of yeUew fever------ ---- 7,1
Stores, regulation, to avoid house fliesL ---------------------------
Straw, old, in ash pits, breeding place of home fly----------------
Tallow vats, breeding places of house fly---------------- ------!---
Tick, carrier of "spotted fever"--- ------- ---------
Tuberculosis, dissemination by house fly ------------------------ 7,92
Typhoid fever, a "National Reproach --------------- ----------------
dissemination by house fly----------------- --- ,-T,28 -i;
in concentration camps, U. S. Army----------------- A
loss in United States------------------------------. "
Vegetable refuse, fermenting, breeding place of house fly----------- .-
Yellow fever, cause, history of investigation----------------- ----
deaths in New Orleans -----------------
United States ----------:.-, l
dissemination by mosquito -------------
history in America------------------------- -.- i
loss in United States------------- -------------i
mosquito. (See Mosquito, yellow lever.) "4
suppression in Havana and New Orlea.s.--------- .---.
Panama -----------

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