THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 OF CALIFORNIA 
 
 PRESENTED BY 
 
 PROF. CHARLES A. KOFOID AND 
 MRS. PRUDENCE W. KOFOID 
 
MALARIA: 
 
 WHAT IT MEANS AND How AVOIDED. 
 
OTHER BOOKS BY 
 
 DR. JOSEPH F. EDWARDS. 
 
 How a Person Threatened or Afflicted 
 with Bright's Disease Ought to Live. 
 
 i2mo. Cloth. Price 750. 
 
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 Sent to any address, postage paid, upon receipt 
 of the price. 
 
 PRESLEY BLAKISTON, 
 No, 1O12 WALNUT STREET, 
 
 PHILADELPHIA. 
 
MALARIA: 
 
 WHAT IT MEANS 
 
 HOW AVOIDED. 
 
 JOSEPH F. EDWARDS, M.D., 
 
 AUTHOR OF "HOW A PERSON THREATENED OR AFFLICTED WITH 
 BRIGHT'S DISEASE OUGHT TO LIVE/' " CONSTIPATION PLAINLY 
 
 TREATED AND RELIEVED WITHOUT THE USE OF DRUGS," 
 " DYSPEPSIA, HOW TO AVOID IT," ETC. 
 
 PHILADELPHIA: 
 
 PRESLEY BLAKISTON, 
 
 1012 WALNUT STREET. 
 
 1881. 
 
Entered according to Act of Congress, in the year 1881, by 
 
 PRESLEY BLAKISTON, 
 In the Office of the Librarian of Congress at Washington, D. C. 
 
 Press of WM. F. FELL & Co., 
 
 1220-1224 SANSOM ST., 
 
 PHILADELPHIA. 
 
- RC 75*6 
 
 CONTENTS. 
 
 PREFACE, 7 
 
 WHAT is MALARIA, 9 
 
 WHERE is MALARIA FOUND, 28 
 
 SYMPTOMS OR SIGNS OF MALARIA, . . . . 58 
 
 How TO AVOID MALARIA, 63 
 
PREFACE. 
 
 Of all preventable diseases, of all human suffer- 
 ing that can be avoided by a litttle general knowl- 
 edge, the myriads of symptoms ascribed to mala- 
 ria stand pre-eminently high. Of all affections 
 about which public misapprehension is very great, 
 malaria is entitled to the highest rank. Of all 
 unsatisfactory terms, this title of malaria is by far 
 the most unsatisfactory. Whenever a person feels 
 out of sorts, biliousness or malaria receives the 
 blame. This term is made the shield by many in- 
 competent physicians, to hide their want of pene- 
 tration in diagnosis, and is accepted by the patient 
 as the true cause of all his suffering. This gene- 
 ral belief in the great pre valance of malaria and 
 the public notion that quinine is a specific for the 
 disease in all its forms, has caused the unintelligent 
 use of enormous quantities of quinine by an un- 
 advised and uninstructed public, much to the 
 vii 
 
Vlll PREFACE. 
 
 general detriment of the human race. In mala- 
 ria, probably more than in any other disordered 
 state of the system, an ounce of prevention is worth 
 a pound of cure. Therefore it seems to me, that 
 mankind can be improved in general health and 
 benefited physically, by a better understanding 
 of the true nature of malaria and the best means 
 of avoiding it. 
 
 JOSEPH F. EDWARDS. 
 
 Saint George Hotel, 
 
 Broad and Walnut Sts., Philadelphia, 
 
 September, 1881. 
 
WHAT IS MALARIA? 
 
 I have undertaken a herculean task, when I 
 attempt to answer this question. So diverse are 
 the views entertained on this subject, and so com- 
 paratively meagre the accurate knowledge which 
 we possess, that it will be a very difficult matter 
 to give an explanation of the nature of malaria 
 that will be universally satisfactory; so that, while 
 I feel sure that the views expressed in this chapter 
 will receive some rough handling and severe criti- 
 cism, yet I am equally certain that what I will 
 tell you will be the means of enabling you to 
 avoid very much of the suffering which is directly 
 or indirectly traceable to malaria. There was a 
 time when the name malaria was applied to a cer- 
 tain specific poison, which possessed the power of 
 producing Intermittent Fever, Chills and Fever, 
 Ague. Thus Professor Flint, of New York, in 
 the third edition of his Practice of Medicine, pub- 
 lished in 1868, says, " The causation " (of Inter- 
 mittent Fever) " involves a special morbific agent, 
 commonly known as malaria." In 1717, Lan- 
 cisci, an Italkn writer, called this special poison 
 B 9 
 
10 WHAT IS MALARIA? 
 
 marsh miasm, and described its origin as due to 
 vegetable decomposition. In Dunglison's Medi- 
 cal Dictionary, published in 1868, malaria is de- 
 fined as follows : ' ' The word miasm (malaria) 
 has by some been employed synonymously with 
 contagion. It is now used more definitely for any 
 emanation, either from the bodies of the sick, or 
 from animal and vegetable substances, or from 
 the earth, especially in marshy districts, which 
 may exert a morbid influence on those exposed to 
 its action. To these terrestrial emanations the 
 Italians give the name aria cattiva, but more com- 
 monly, malaria (bad air). Of the miasm which 
 arises either from the animal body or from the 
 most unhealthy situations, we know, chemically, 
 nothing. All that we do know is, that under 
 such circumstances emanations take place, capable 
 of causing disease in many of those who are ex- 
 posed to their action." 
 
 A very indefinite definition, but as accurate as 
 any that have hitherto been offered in our present 
 limited knowledge of the exact nature of these poi- 
 sonous emanations. In his "Practical Hygiene" 
 Dr. Parkes, the late eminent English sanitarian, 
 says, ' ' The most important organic impurity of 
 the atmosphere is malaria." Dr. F. T. Roberts, in 
 his Practice of Medicine, says, " Certain other dis- 
 eases are attributed to it (malaria), such as dysen- 
 tery, diarrhoea, gastric disturbance, etc., and also 
 
WHAT IS MALARIA? 11 
 
 a general state of ill health and low cachexia, with 
 ultimate degeneration of the race. ' ' He also tells 
 us that ' ' The essential conditions for the produc 
 tion of the malarial poison are, vegetable decom- 
 position, a certain temperature, with a certain de- 
 gree of moisture. ' ' You can now understand how 
 much uncertainty exists concerning the true nature 
 of malaria. Until we accumulate exact informa- 
 tion on any subject, theorizing is not only permis- 
 sible, but, by giving us a platform upon which to 
 conduct our experimental researches, becomes a 
 very important factor in the accumulation of this 
 knowledge, provided always, that we do not rest 
 content with the mere theory, but accept it as a fact 
 only when it has been indubitably proven to be 
 such by the crucial test of the severest scrutiny, 
 the most intimate research and the weight of 
 overwhelming experience. Therefore, premising 
 that what I am about to say is only theory, and 
 warning you against regarding my theories as 
 facts, until they have been amply proven to be 
 such, I will conduct you through a process of rea- 
 soning, by which I hope to make it seem at least 
 probable that the origin and true nature of ma- 
 larial poison, as we now call it, has been shrouded 
 in unnecessary mystery, thus preventing us from 
 comprehending its true nature, and at the same 
 time, that the term malaria is improperly applied. 
 Even if I do not succeed in theoretically estab- 
 
12 WHAT IS MALARIA? 
 
 lishing my position, at any rate, there can be no 
 question but that the information I will give you, 
 if properly utilized, will be productive of very 
 much physical good. These few words of expla- 
 nation I have deemed necessary, because, as this 
 book is more especially intended for the non-pro- 
 fessional public it becomes imperative that I should 
 exercise the greatest care not to mislead them, nor 
 to give them erroneous ideas, nor to cause them 
 to accept as settled fact that which is in doubt. 
 Therefore, I again say, the reasoning I will now 
 furnish is my own, the ideas I will give are 
 my own ; whatever is to blame in them or to com- 
 mend, I alone, and not my profession, am respon- 
 sible for. The profession recognizes the uncer- 
 tainty of our knowledge concerning the malarial 
 poison, and speaks of it in doubtful and uncertain 
 terms ; I also recognize this uncertainty, but I am 
 at the same time endeavoring to erect a theoretical 
 framework, to be filled in with the accumulations 
 of research and experience, until either a clear case 
 is made out for my theory, order springs from the 
 present chaotic notions of malaria, and from un- 
 certainty we possess a certain and accurate knowl- 
 edge of the nature and origin of malarial poison, 
 or, on the other hand, my theory dies for want 
 of experimental support, and sinks out of sight 
 unsupported by the research and experience of 
 observers. Medical readers will now understand 
 
WHAT IS MALARIA? 13 
 
 my position and non-professional persons will be 
 prevented from falling into the error of accepting 
 a theory as an admitted fact, by the explanation 
 I have made. Now to our reasoning. In the first 
 place, let us examine whether the term malaria is 
 properly applied. In my opinion it has not been, 
 and is not. Its.application is too liberal and hence 
 has been misleading. In a more restricted sense, it is 
 an eminently appropriate and expressive terni, and 
 its nature can be much more readily comprehended. 
 The word malaria has been derived from the two 
 words mal aria, bad air, and considering its 
 derivation, its present broad application is entirely 
 too broad, and is calculated ,to leave its exact 
 nature forever in doubt, since it necessitates the 
 impossible achievement of tracing too many effects 
 to the same cause. The word miasm has a different 
 origin, being derived from the Greek, tua<;p.a, a 
 stain from /jLiatow, I contaminate. Now, although 
 Dunglison in his medical dictionary refers the defini- 
 tion of the word malaria to miasm or miasma, and 
 so confounds the two and makes them identical in 
 their meaning, yet it will be seen, from their deri- 
 vation, by the meaning of the parent words from 
 which they have been formed, that they are dis- 
 tinct. While malaria really means bad air, and 
 is a comprehensive term for atmospheric impuri- 
 ties of various kinds ; miasma conveys the idea of 
 an effect and not a cause ; it is a stain, a contami- 
 
14 WHAT IS MALARIA? 
 
 nation of some portion of the human body, which 
 contamination must be the result of some causative 
 action. Hence the terms malaria and miasma, 
 which are generally used synonymously, are not 
 only not the same in meaning, but the only rela- 
 tion that they can possibly hold to each other is 
 that of cause and effect, the malaria or bad air 
 being the cause and the miasma or contamination 
 the effect of this cause. Here, then, we see one 
 important error in the application of the word 
 malaria. Again, nearly all medical writers tell 
 us, as Professor Flint has done, that the causation 
 of intermittent fever, chills and fever, ague, etc., 
 involves a special morbific agent, commonly 
 known as malaria. Had they said a special mor- 
 bific agent commonly believed to constitute one of 
 the elements of malaria, they would have been at 
 least more accurate. Since malaria really means 
 bad air, this causative influence of malaria on 
 Chills and Fever is evidently exaggerated and 
 misinterpreted, since bad air will not in every 
 instance give rise to intermittent fever, simply 
 because the air is bad ; in order to produce the 
 characteristic symptoms of this disease, the mala- 
 rial poison or bad air must contain some particu- 
 lar deleterious agent, capable of producing these 
 characteristic symptoms, and without the pres- 
 ence of which they are not developed, no matter 
 how bad and impure the air may be. There- 
 
WHAT IS MALARIA? 15 
 
 fore it would seem that the application of the 
 term malaria had become entirely too compre- 
 hensive, since the poisoned condition of the 
 atmosphere which is generally indicated when we 
 say bad air, cannot of itself alone produce the 
 phenomena of Intermittent Fever, which depend 
 for their existence on the presence of a special 
 poisonous element in this bad air. To illustrate 
 this point, that the presence of the special poison 
 of Intermittent Fever is necessary in the atmos- 
 phere, in order that this disease may be developed, 
 I will quote from the July bulletin of the Secretary 
 of the Connecticut State Board of Health, which 
 says, . ' ' Malarial diseases appear to have taken a 
 step eastward and northward, as a death from 
 malarial fever is reported from Norwich. I have 
 not yet learned of any east of the Thames river. 
 In many places they are reported as increasing, 
 as in Bloomfield, New Canaan, Unionville, and 
 other towns in various parts of the State, while 
 others report decrease, as in Clinton and Guil- 
 ford. Collinsville claims entire exemption from 
 malaria in every form, unless imported, as thus far 
 no cases have originated there. If flowing large 
 areas and alternately covering and exposing the 
 bed of the pond produced malaria, we should have 
 it here. If vegetable decay alone produces it, 
 we should have a fearful epidemic at this Po- 
 quonnoc Bridge, instead of Scarlet Fever, as the 
 
16 WHAT IS MALARIA? 
 
 river was absolutely choked with vegetable sub- 
 stances, decaying, and alternately covered and ex- 
 posed. Yet no case of malaria has ever originated 
 in this town" In this communication the Sec- 
 retary of the State Board of Health does not 
 mean what I do, and am endeavoring to make you, 
 understand by the term malaria. He clearly re- 
 fers to some one of the forms of Intermittent 
 Fever, as nearly all writers now do. You will 
 observe that he shows many causes for air im- 
 purity, for malaria or bad air, yet he says that no 
 cases of malaria, of his malaria, have originated 
 there. Yet my malaria, bad air, surely would be 
 found there; but the special poison capable of 
 producing Intermittent Fever was wanting. So 
 that it is entirely too liberal to ascribe the produc- 
 tion of Chills and Fever to Malaria in its true 
 sense. Smallpox is caused either by the inhalation 
 from the surrounding atmosphere of a particular 
 poison capable of producing this disease, or by the 
 reception of this poison from the closer contact 
 of a person already afflicted with the disease. In 
 either case the air acts as the medium of commu- 
 nication. Typhoid Fever is caused, in many 
 cases, by sewer gas; this impurity contaminates 
 the air we breathe, and so entering the body gives 
 rise to this particular disease. Cholera is likewise 
 propagated. The same is true of all the infec- 
 tious diseases. Now the air which is capable of 
 
WHAT IS MALARIA? 1.7 
 
 giving rise to Smallpox, Typhoid Fever, Cholera, 
 and the like, surely must be mal aria; it must of 
 necessity be bad and impure air, since it contains 
 noxious elements capable of producing a diseased 
 condition of the human body, which elements do 
 not exist in pure air. Therefore, since malaria 
 really means nothing more than bad or impure 
 air, is it not misleading and confusing to speak of 
 malaria as the cause of intermittent fever, as the 
 active agent in the production of chills and fever ? 
 Does it not seem more correct to hold the view 
 that malaria means simply impure air, rendered 
 unwholesome by the presence of a great variety of 
 impure elements, which elements are capable of 
 producing various 'disordered and unhealthy con- 
 ditions of the system ? In one instance the im- 
 purity may be of such a nature as to give rise to 
 the phenomena of chills and fever, in another to 
 cholera, in a third to smallpox, in a fourth to 
 diphtheria, and so on ; but that in each case it is 
 absolutely necessary that the special impurity 
 should be present to give rise to the special dis- 
 ease, which cannot be produced merely by the in- 
 halation of foul air in which this particular special 
 impurity does not exist. It would, therefore, be 
 more proper to speak of the poison of Smallpox, 
 of Typhoid Fever, of Dysentery, of Chills and 
 Fever, as elements of malaria or of impure air, if 
 we desire to bring malaria into a causative relation 
 
18 WHAT IS MALARIA? 
 
 with these diseases at all. This is not, however, 
 my intention. It will be better and will cause less 
 misunderstanding and confusion, if we speak of 
 the poison of Smallpox, of Dysentery, Chills and 
 Fever, and so on, and leave malaria entirely out 
 of consideration. Let us endeavor to form an 
 accurate view of this very popular word, and to 
 have a definite idea of its meaning. The use 
 which has been and is made of this word is truly 
 ridiculous. The very fact that it has been util- 
 ized to designate so many diverse conditions, 
 plainly indicates the indefinite and uncertain 
 views of its true nature and properties which have 
 been and are entertained alike by the Medical 
 Profession and the general public. Superficial 
 physicians, when baffled by the intricacies of an 
 obscure chronic case of disease, fearing to confess 
 their inability to penetrate the difficulties of the 
 case, and make a correct diagnosis, lest their 
 honest confession may cost them their patient, 
 fall back upon this mysterious malaria, and their 
 patients having a very vague and visionary notion 
 of the nature of this wonderful affection, accept 
 the diagnosis, and another case of malaria is 
 added to the already immensely long list of cases 
 of this hydra-headed disease. The medical pro- 
 fession are commencing to realize the absurd and 
 ridiculous position which this undefined word occu- 
 pies, and our medical journals now contain many 
 
WHAT IS MALARIA? 19 
 
 articles on the subject, some ridiculing the preva- 
 lent ideas concerning it, while others are seriously 
 endeavoring to find a proper place and mean- 
 ing for it. Some of the most wonderful and 
 apparently most mysterious tricks performed by 
 the great magicians, are, when explained, exceed- 
 ing simple and easy of performance. It is their 
 very simplicity that saves them from detection. 
 Apparently wonderful, it seems to the uninitiated 
 that they must be very difficult of comprehension, 
 and a laborious process of thought and reasoning 
 fails to elucidate them, while, when understood, 
 one is ashamed of his former obtuseness, and 
 wonders how he could have been so stupid as not 
 to penetrate such an obvious and childish trick. 
 So it is with many more serious questions. Man 
 seems determined to mystify himself. Instead of 
 endeavoring (where possible) to explain the phe- 
 nomena of nature as easily as possible, he seems 
 to think it necessary to surround his investigations 
 with all the difficulties and obstructions that he 
 can possibly invent. Imagining that everything 
 which he does not already know concerning 
 nature's workings and scientific truths must be 
 very obscure, and can be elucidated only by the 
 most profound and circuitous reasoning, he fails 
 to try first to explain them by simple, practical 
 common sense, but straightway rushes into scien- 
 tific theorizing of the most sublime character, and 
 
20 WHAT IS MALARIA? 
 
 interprets every ordinary occurrence of nature, not 
 through the eye of common sense, but views it with 
 the high power microscope of science. As a 
 result, many things are shrouded with mystery 
 and but imperfectly comprehended simply because 
 a tremendous effort is made to understand them, 
 instead of explaining them in a simple, practical, 
 common sense, matter-of-fact way. This point is 
 particularly true of the question under consider- 
 ation. There is nothing wonderful or mysterious 
 about malaria. No deep reasoning or intimate 
 scientific research is necessary to comprehend its 
 nature. If properly viewed, its nature is as clear 
 as the clearest spring water. What, then, is the 
 nature, what are the properties of this much- 
 abused word ? Simply what the word means. I 
 have already told you that malaria is derived 
 from two words, mal, bad, and aria, air ; put them 
 together and you have a perfect definition of this 
 hitherto mystic word, malaria, which does mean, 
 and can mean, nothing more nor less than bad air. 
 Let us do away with all the uncertainty surround- 
 ing this word, and comprehend it properly. Do 
 not let us any longer say that Chills and Fever 
 are produced by malaria (bad air), that Typhoid 
 Fever is due to malaria (bad air), or that Small- 
 pox owes its production to malaria (bad air). 
 Some critics will say, "who ever claimed that 
 malaria did cause Typhoid Fever or Smallpox? " 
 
WHAT IS MALARIA? 21 
 
 All of you who claim that malaria causes 
 Chills and Fever (and nearly every physician 
 is wont to ascribe this disease to the cause 
 under consideration) must, if you be honest, 
 admit that malaria has just as much influence in 
 producing Typhoid Fever and Smallpox, as it has 
 in causing Chills and Fevers, because bad or im- 
 pure air is the causative agent in each case. But 
 in each case the malaria or bad air must contain 
 some particular impure or bad element which is 
 capable of producing the particular disease under 
 'consideration. Therefore, the idea which at 
 present prevails of malaria is very erroneous and 
 misleading. For instance, if we speak of Typhoid 
 Malaria, of Smallpox MALARIA, of Diphtheritic 
 MALARIA, and so on, we are correct, because we 
 here convey the idea of an impure air or atmos- 
 phere, the principal impurity in which is capa- 
 ble of producing Typhoid Fever, Smallpox or 
 Diphtheria, and so we denominate the special 
 poisonous ingredient as well as the whole of which 
 it forms a part, and in which it constitutes the 
 most active ingredient. To illustrate : the family 
 of SMITH is an exceedingly extensive one. 
 Scarcely any, in fact, I imagine none, of my read- 
 ers are denied the acquaintanceship of very many 
 of the name. The word Smith is no less nor more 
 familiar than the word malaria. If a friend de- 
 sires to tell you something about a certain man, 
 
22 WHAT IS MALARIA? 
 
 and after describing his characteristics, informs you 
 that his name is Smith, he leaves you with a very 
 vague and illy defined notion of whom he has 
 been talking about. You have a very indefinite 
 idea of the individuality of the person "referred to, 
 and should you afterwards meet the man whose 
 characteristics had been described to you, and be 
 told that his name was Smith, you would still, in 
 many cases fail to recognize the man about whom 
 you had been told. But should your informant, 
 after describing the characteristics and personal 
 appearance of the man, finish by telling you 
 that his name was Abraham Smith, you would 
 then have a very definite idea of the whole nature 
 of a certain individual, who would be represented 
 to your mind by the words Abraham Smith, and 
 upon hearing these words you would at once feel 
 intimate with and perfectly capable of describing 
 the elementary characteristic points and personal 
 peculiarities, the grand combination of all of 
 which would be represented to your mind by the 
 two words constituting the name of the individual 
 possessing these characteristics. So it is with 
 Malaria. There is no doubt that many diseases 
 are developed through the agency of impure air, 
 but when we come to special diseases, characterized 
 by special symptoms,' we must look for a special 
 cause, and finding it, give it a special name. 
 TThe disease popularly known as " Chills-and- 
 
WHAT IS MALARIA? 23 
 
 Fever" when properly developed, possesses for 
 its chief peculiarity periods of intermission in 
 the manifestation of its symptoms, hence the 
 name of Intermittent Fever, a most appropriate 
 one ; if we desire to give a name to the causative 
 agent of Intermittent Fever, and if we designate 
 this cause as malaria, we open the door to untold 
 misunderstandings and confusions. One person 
 is exposed to the evil influences of malaria, or 
 bad air, and is seized with Intermittent Fever, 
 while his neighbor, also exposed to bad air or 
 malaria, suffers from Typhoid Fever, and a third 
 from Smallpox. It is just as correct to assign the 
 production of Typhoid Fever to malaria as it is to 
 claim it as the cause of Intermittent Fever, since 
 in each instance bad air has caused the disease. 
 But in order that our nomenclature may be intel- 
 ligible and non-confusing, it becomes necessary, 
 when using the comprehensive term malaria, to 
 qualify it with a prefix, as we have seen was neces- 
 sary in the case of the comprehensive name of 
 Smith, and to speak of Intermittent malaria, 
 Typhoid malaria, and so on. Thus, then, the 
 proper definition of Typhoid Malaria, is or should 
 be as follows, "Bad or impure air; the impure 
 element, or if there be many, the chief and most 
 potent impure element of which is capable of giving 
 rise to Typhoid Fever. ' ' We have been discussing 
 what malaria is not, let us now see what it is. In 
 
24 WHAT IS MALARIA? 
 
 order that the functions of the human body may 
 be properly carried on, it is absolutely necessary 
 that pure air should be supplied to the body. 
 Typically pure air is composed as follows : seven- 
 ty-nine per cent, nitrogen gas, twenty-one per 
 cent, oxygen gas, some watery vapor, and ammonia. 
 This is the composition of ideal atmospheric air. 
 Such air is the best adapted for the maintenance 
 of healthy life ; but such air, with exactly such a 
 composition, is rarely found. In some localities 
 and on some occasions particles of dust, of ashes, 
 of coal and the like, will be found in the atmos- 
 phere. The air of a city like Pittsburgh will con- 
 tain many other impurities resulting from the 
 burning of coal. The air in certain buildings 
 used for manufacturing purposes will contain 
 certain foreign elements derived from the manu- 
 facture carried on therein. Thus, in steel factories 
 the air will be found to contain small, almost 
 microscopic particles of steel. In chemical labor- 
 atories the atmosphere will contain certain foreign 
 gases or vapors liberated during the manufacture 
 of certain drugs. In bone-boiling establishments 
 the air will be rendered very impure by the de- 
 composition of the fragments of animal tissue 
 adhering to the bones, as well as the animal por- 
 tions of the bones themselves. < In a large city it 
 is almost an impossibility to discover an atmos- 
 phere which approaches at all near to the ideal 
 
WHAT IS MALARIA? 25 
 
 one given above. So numerous and so various 
 are the sources of impurity, that even the healthi- 
 est portion of the city must have its air vitiated 
 more or less. Where, then, can typically pure air 
 be found for our use ? Nowhere. A most as- 
 tonishing, but a true statement. Such air as we 
 have described as typically pure does exist, but 
 we cannot now and never can find it for our 
 use. It exists in virgin plains, forests, and moun- 
 tains uninhabited by animal life. It may be 
 found in mid-ocean. But let man approach to 
 hunt for this beautiful atmosphere, and like the 
 frightened fawn it eludes his grasp and rushes with 
 the velocity of the deer from his presence. This 
 is literally true. Man contaminates that which 
 he uses. Let conceited and foolishly egotistical 
 people remember this in the midst of their self 
 adulation. That they are absolutely so rotten 
 that they instantly render foul the purest air if it 
 merely enters their worthless bodies. This is true, 
 and I will prove it to you. Suppose you are in 
 the presence of such an ideal atmosphere as I have 
 described to you ; you inspire and receive into 
 your lungs a. certain amount of this air ; in the 
 next instant you expire and give forth a bulk equal 
 to that which you received. But how changed. 
 Instead of the pure and vivifying oxygen gas 
 which formed the vital principle of the air which 
 you inspired but a few seconds before, the air 
 c 
 
26 WHAT IS MALARIA? 
 
 given out is laden with carbon, a most impure 
 and ^poisonous element, and this impurity has 
 been derived from your rotting body. You can 
 now understand what I mean when I make the 
 statement that perfectly pure air can be nowhere 
 found for our use, since the very instant we com- 
 mence to use it, we render it foul by the admix- 
 ture with it of the impurities from our bodies. 
 By a wise provision of nature, however, this 
 carbon impurity, as well as all other impuri- 
 ties, is soon removed from the air, which is ren- 
 dered once more fit for use. While, as I say, we can 
 nowhere find typically pure air for our use, yet air 
 sufficiently pure to maintain healthy life can be 
 found everywhere ; and it is a deviation from, a 
 deterioration of, this ordinarily pure air which I 
 propose to call Malaria. Now, then, in con- 
 clusion, I will define Malaria for you, and will 
 furnish the definition in two words, BAD AIR. 
 Finally, let me say that throughout this little 
 book, when talking about Malaria, I am not talk- 
 ing about Intermittent Fever. I have already 
 given my reasons for saying that it is an erro- 
 neous and misleading view to hold that Malaria 
 is the cause of Chills and Fever. There is no 
 specific relation between them. This book has 
 nothing to do with Chills and Fever. I believe, 
 as all of my professional brethren do, that the 
 active causative agent of intermittent fever is still 
 
WHAT IS MALARIA? 27 
 
 a mystery, but, differing with some, and with the 
 sanction of others, I say that it is erroneous to 
 apply the comprehensive term malaria to this 
 special, mysterious, unrecognized agent. Again, 
 I have nothing to do here with Intermittent Fever 
 nor its cause ; I do not discuss either. I am enun- 
 ciating and explaining what I believe to be the 
 proper condition expressed by the word malaria, 
 and helping you to avoid the many evils which 
 will result from this condition. 
 
28 WHERE IS MALARIA FOUND? 
 
 CHAPTER II. 
 
 WHERE IS MALARIA FOUND? 
 
 Malaria CAN be found everywhere and SHOULD 
 be found nowhere. Malaria is entirely and com- 
 pletely under human control. Give me the 
 healthiest locality in the world, and I will develop 
 there malaria in twenty-four hours. Give me the 
 most malarious district of the globe, and in time I 
 will remove from it every trace of malaria. In 
 this bold statement I include malaria according 
 to my definition of it. Let us imagine a house in 
 the country, situated on an eminence, from which 
 the ground slopes in every direction. Suppose 
 the water supply to be perfect and plenty, while 
 the drainage is beyond reproach. Imagine the 
 surrounding atmosphere to be of that typical 
 degree of purity described in the last chapter ; 
 allow that all the rooms are sufficiently large and 
 the ceilings high enough to admit of perfect ven- 
 tilation and to insure to each occupant of the 
 house a liberal supply of air. Would you not 
 think such a house impregnable to disease ; would 
 you not imagine such a locality the greatest foe to 
 malaria; would you not consider bad air an im- 
 possibility ! If you did, you would be right. 
 
WHERE IS MALARIA FOUND? 29 
 
 Such a location ought to be entirely free from 
 malaria; but see how soon and how easy bad air 
 can be produced in this temple of health. Sup- 
 pose this house faces north and south ; suppose the 
 kitchen is at the southern end ; outside of the 
 kitchen door you have constructed a wooden 
 trough with a lid, in which you place your slop 
 pail. After dinner the cook empties the remnants 
 from your table into this pail, and with the pro- 
 verbial carelessness of servants, neglects to shut 
 down the lid. The hot July sun beats down on 
 this mass of organic matter, decomposition takes 
 place, and foul gases are liberated ; if the wind is 
 blowing from the south, these poisonous gases are 
 carried in the back kitchen door, are blown 
 through the house, they mingle with the atmos- 
 phere there, and the air of your supposed healthy 
 house becomes malarious, it is bad. Again, your 
 privy may be situated some distance, sufficiently 
 far, from your house. It may be on sloping ground 
 and may be well drained. The solid evacuations 
 deposited therein remain there and decompose, 
 liberating poisonous gases which ascend and min- 
 gle with the atmosphere. If you know anything 
 about hygiene, you instruct your hired man to 
 throw dry earth into your privy well two or three 
 times a week, according to the frequency with 
 which it is used, which will have the effect of 
 disinfecting the privy and destroying these pois- 
 
30 WHERE IS MALARIA FOUND? 
 
 onous gases. In the majority of cases he neglects 
 to do this, and these impurities are allowed to 
 mingle with and contaminate the atmosphere 
 and to produce malaria. You have water closets 
 in your house, the drainage from which is perfect, 
 the water supply to them is also good ; you never 
 suspect that they can possibly be a cause of evil, 
 and therefore never use any disinfectants. Some 
 particles of solid matter may cling to a joint or 
 bend in the pipe, and decomposing, produce ma- 
 laria in the room in which your water closet is, 
 from which it is wafted all over the house. Your 
 drain pipe terminates in a well, a long distance 
 from your house; you are busy, and neglect to 
 examine this well ; it gradually fills, until 
 finally its contents reach up to the opening 
 of the drain pipe. Foul gases ascend this pipe 
 and pass along unobstructed until they reach 
 the trap under the water closet ; here they are 
 halted for a time by the water in the trap, but, 
 by degrees, and particularly if the closet is not 
 often used, the water becomes saturated with them 
 and soon commences to liberate them from its 
 upper part, and the air of -the room and the house 
 becomes malarious. How common is it for cooks 
 to throw the water in which they have been wash- 
 ing dishes out on the ground. This water contains 
 particles of organic matter ; the water soaks into 
 the ground and leaves the organic matter on the 
 
WHERE IS MALARIA FOUND? 31 
 
 surface, where it decomposes and poisons the at- 
 mosphere. Many persons use the bed chamber 
 before retiring at night, and allow it to stand in 
 their bed rooms uncovered all night. Its contents 
 decompose and render malarious the air of your 
 sleeping room. Manure heaps are frequently al- 
 lowed to accumulate very near the house ; they 
 consist of organic matter, which, decomposing, 
 makes the atmosphere bad. It is a very common 
 and very erroneous notion that all residents of the 
 country must, because they live in the country, be 
 very healthy. I am practicing among country peo- 
 ple, and I know whereof I speak. From the many 
 illustrations I have given, you can readily under- 
 stand how easily atmosphere naturally pure may 
 become contaminated and unfit to support healthy 
 life. Such, unfortunately, is the case among the ma- 
 jority of country people. They know nothing about 
 hygiene, and consequently fall into the very errors 
 I have pointed out to you, all of which really de- 
 pend on the imperfect and incomplete removal 
 from their vicinity of decomposing organic mat- 
 ter. In cities these matters are regulated and at- 
 tended to by competent persons, hence, strange 
 as it may appear, the residents of the better por- 
 tions of our large cities suffer less from the effects 
 of malaria or bad air than country people do. 
 While in the country we find a lesser propor- 
 tion of serious and special diseases than in the 
 
32 WHERE IS MALARIA FOUND? 
 
 city, yet we find a much larger proportion of 
 persons suffering from depraved health, and de- 
 pressed functional activity, as a result of the use 
 of impure air. Now, malaria, or bad air, is always 
 produced by the decomposition of organic mate- 
 rial, hence, to put the matter in a nut-shell, mala- 
 ria will always be found wherever we find dead 
 organic matter, and since dead and decomposing 
 organic matter must, as a necessity of life, be found 
 everywhere, so, therefore, malaria must be found 
 everywhere. True, as an abstract principle, but 
 a statement admitting of qualification and expla- 
 nation. The gases resulting from organic decom- 
 position, must, of course, exist everywhere ; this is 
 true. Their presence must contaminate the air; 
 true enough. But, as I have already told you, the 
 air will admit of a certain amount of impurity, 
 without becoming unfit to sustain healthy life. It 
 is only when these impurities become concen- 
 trated and intensified to an injurious extent, that 
 they have the power to make air malarious or bad. 
 This is well illustrated in the contamination of 
 air from respiration. I have already told you 
 that at every expiration, you give out from your 
 lungs into the surrounding air a certain amount 
 of carbon, which is poisonous ; in the course 
 of twenty-four hours the amount of this poi- 
 son given off from an average healthy man, if 
 all collected, would amount to about eight ounces 
 
WHERE IS MALARIA FOUND? 33 
 
 of solid carbon. Given off gradually, as it 
 is, it mixes with the surrounding air and be- 
 becomes so diluted, and finally so altered in com- 
 position, by the vegetable life about us, that it 
 becomes perfectly harmless. On the other hand, 
 shut yourself up in a room ten feet square and ten 
 feet high, hermetically seal all openings, and 
 varnish with some impervious wash the walls, in 
 order that there may be neither ingress nor egress 
 of air. This room will contain one thousand cubic 
 feet of air . At the end of one hour all of the oxygen 
 in this room will have been used, and in its place 
 will be found carbon. At the end of a second 
 hour you will in all probability be dead, from char- 
 coal or carbon poisoning. Had this same little 
 room been ventilated, you might have lived in it 
 with impunity, without ever leaving it, for fifty 
 years. Hence you see the danger of impurity in 
 the air is not so much from the mere presence of 
 the impurity as it is from the concentration and 
 accumulation of it, which can only result in the 
 impure gases displacing and substituting the pure 
 elements of natural air. I could hold my head 
 over a privy well and suffer no ill effects from the 
 poisonous gases arising therefrom, if a fan were 
 revolving near me, constantly forcing a copious 
 stream of pure air across my face, thus diluting 
 the privy impurities to such an extent as to render 
 them harmless. This point is remarkably well 
 
34 WHERE IS MALARIA FOUND? 
 
 illustrated in the city of Chicago. The Chicago 
 river runs through the centre of the city. Of all 
 foul streams that ever were found this is surely the 
 foulest. So intensely foul are the odors arising 
 from it, that any one who has not lost all sense of 
 smell must necessarily hold his nose when crossing 
 it. And yet, strange as it may seem, vital statistics 
 prove Chicago to be one of the healthiest cities in 
 the United States. Every once in a while a 
 strong wind coming in from the lake will blow 
 these foul gases away from the city and carry them 
 off to the boundless prairies of the west, where 
 they become diluted down to a healthy degree. 
 Were it not for these life-saving winds, Chicago 
 would soon be depopulated by a malarious plague. 
 It is not necessary that the organic matter whose 
 decomposition gives rise to malaria should belong 
 to the animal world. The vegetable kingdom 
 will furnish it equally well. Thus it is that the 
 atmosphere is rendered malarious or bad in the 
 vicinity of marshy districts. During the rainy or 
 wet season this land is covered with water ; the 
 vegetation thereon becomes water-soaked. The 
 hot sun beats down upon it and we have the two 
 prime factors of decomposition, heat and moisture. 
 On high and well drained land this cause for 
 malaria will not be found, since the water will 
 run off and soak away as fast as it falls, leaving 
 but little remaining when the sun appears, so 
 
WHERE IS MALARIA FOUND? 35 
 
 little that it is soon absorbed by the sun and carried 
 away, thus removing one of the essential elements 
 for the organic decomposition and the production 
 of malaria. It has often been said, and with truth, 
 that new settlements are particularly prone to be 
 unhealthy, are in a particular manner afflicted with 
 malaria. Bearing in mind what I have said about 
 the nature of malaria, and discarding all consider- 
 tion of that particular malarial element which is 
 capable of producing Intermittent Fever, of the 
 nature of which I have confessed our present igno- 
 rance, this phenomena is very easy of explanation. 
 All land, all soil that has never been before worked 
 is particularly rich in organic matter. The leaves 
 from the trees have for centuries been dying, de- 
 composing and yielding their organic constituents 
 to this earth. The birds and wild animals which 
 from the beginning of time have roamed over 
 this virgin land have deposited their organic ex- 
 crement upon it. The winds have wafted organic 
 material from far-off cities to it ; while countless 
 myriads of animals have died and decomposed on 
 this land, yielding up their component parts to it. 
 The rains and snows of centuries have washed all 
 this organic material into the earth, until this land 
 fairly teems with organic wealth ; like the untrod- 
 den prairies of our western country it is black with 
 organic richness. Some little of this material is 
 utilized in giving nourishment to the grass and 
 
36 WHERE IS MALARIA FOUND? 
 
 trees which grow on this soil ; 4 still, but a very 
 small proportion of this organic matter is thus 
 consumed, and what little is used is returned a 
 hundredfold in the manner I have indicated above, 
 until the subsoil of this region is fairly reeking 
 with organic elements not exposed to the sun, 
 while that very near the surface is consumed by 
 the grass and trees, as I have already pointed out. 
 This soil contains moisture. Man and civilization 
 come along; the plough turns up this land; this 
 enormous accumulation of organic matter is ex- 
 posed to the sun. What have we? Organic ma- 
 terial, heat and moisture. What results / Organic 
 decomposition and malaria. In addition to this 
 fact, poisonous gases will be developed also from 
 the decomposition of the organic waste which 
 always necessarily attends the presence of man, 
 and which, owing to the imperfect methods of drain- 
 age or removal which always obtain in new settle- 
 ments, will not be taken from, but allowed to re- 
 main in close proximity to the residents, there to 
 decompose and render the air malarious. In 
 course of time, as the ground becomes more cutli- 
 vated and successive crops are taken from it, the 
 locality loses its malarious character, the air be- 
 comes purer, because the excess of organic mat- 
 ter is consumed in giving nourishment to veget- 
 able life ; until finally this depletion becomes so 
 great that it is necessary to furnish to this same 
 
WHERE IS MALARIA FOUND? 37 
 
 soil decomposing organic matter in the shape of 
 manure, else the land will be too poor in these 
 elements to furnish nutrition to vegetable life. 
 Again, I find it stated that malaria is very preva- 
 lent in the northwestern parts of the city of Phila- 
 delphia and in West Philadelphia. That it occurs 
 on high ground, where a large amount of soil is 
 continually disturbed in grading streets, draining, 
 etc. Here, again, we have the conditions to 
 which I have already referred, the exposure to 
 the heat of the sun of large masses of moist organic 
 matter (which has hitherto been buried away from 
 the sun's influence), and its consquent decomposi- 
 tion, with the liberation of poisonous gases and 
 the production of bad air. In cities a great and 
 prominent cause of malarious or bad air is found 
 in the method now in use of illuminating the streets 
 and buildings with our ordinary gas. Illumi- 
 nating gas is a compound of the two gases, carbon 
 and hydrogen. When the match is applied to this 
 compound a chemical change takes place. The 
 carbon unites with the oxygen of the surrounding 
 atmosphere and carbonic acid results. Not only 
 is a very poisonous gas thus formed, but the vivi- 
 fying element of the air, the oxygen, the principle 
 which is so requisite to healthy life, is consumed 
 in large quantities. You have very little idea how 
 great this source of contamination is in large cities. 
 To impress it on your memories, I will quote from 
 
38 WHERE IS MALARIA FOUND? 
 
 an article in the Revue Scientifique, by M. G. 
 Robinet, who says: " The combustion of illumi- 
 nating gas, in Paris (218,813,875 cubic metres) 
 alone, produced last year a quantity of carbonic acid 
 thirty-five hundred times more considerable than 
 all the dead buried in the cemeteries during five 
 years could give at the maximum rate of exhala- 
 tion. The grand Opera House alone gives out 
 every year thirteen times more carbonic acid from 
 its gas lights than could be disengaged from all 
 the cemeteries put together, even if all their carbon 
 were converted into gas. ' ' Will you wonder any 
 more at the sense of languor and oppression, some- 
 times amounting to a positive headache, which 
 you so often experience after a long evening passed 
 in a crowded theatre ? Will you wonder at the 
 pale, anaemic, cachectic appearance of so many of 
 the residents of a large city? The electric light 
 now coming into such general use seems to prom- 
 ise a relief from this source of impure air, and this 
 alone should be a great argument in its favor. 
 Another source of impure air in cities may arise 
 from the ice supply. If this ice be cut from im- 
 pure water, it will necessarily contain some of the 
 impurities of the water from which it has been cut, 
 and melting, will liberate these particles, allowing 
 them to be wafted through the house. To illus- 
 trate this means of contamination, I will quote 
 from the Louisville Medical News, in which, in 
 
WHERE IS MALARIA FOUND? 39 
 
 the course of an article on " The Sources of Ice 
 Supply," the editor says, " Again, any one who 
 has traveled from Joliet to Chicago, on the St. L. 
 A. and C. R. R., cannot have failed to notice the 
 long line of ice storehouses which stretch for miles 
 along the banks of the Des Plaines river. This 
 beautiful stream is one of the sources of the Illi- 
 nois. It runs through miles of rich prairie land, 
 and formerly drained nothing worse than the many 
 farmers' barnyards, and a dozen thrifty villages 
 along its banks ; but now, alas ! it is disgraced 
 for a considerable part of its course by the com- 
 panionship of the Illinois and Michigan canal, the 
 outlet for the sewage of Chicago a sluice of filth 
 which might well put in a claim for rivalry with 
 the Thames, after London is passed. Not a fish 
 dares venture into its water ; not a stranger ap- 
 proaches its bank without holding his nose ; and 
 upon either side of it is a strip of country where 
 filth diseases abound ; diphtheria, for instance, 
 being a perpetual heritage to the unfortunate in- 
 habitants. A curious situation for the sanitarian 
 to contemplate. On one side is the loveliest of 
 the ' laughing rivers that run in haste to form the 
 Illinois ; ' upon the other, and at a higher level, 
 the open sewer of a mighty city rolls its stinking 
 sheet of suspended filth sluggishly on to the same 
 destination, and between the two a narrow strip of 
 land covered with houses wherein is stored the ice 
 
40 WHERE IS MALARIA FOUND ? 
 
 for Chicago. It may be urged that there is no 
 surface communication between the waters of the 
 river and the canal ; but who can doubt that there 
 are many subterranean courses of contact ; and at 
 times of freshet, when the Des Plaines overflows 
 its banks and the canal is high up in its walls, 
 there is doubtless a commingling of the waters at 
 some points above ground. Besides, if direct com- 
 munication could be proved to be impossible, who 
 will say that nightly the clean water of the river 
 does not absorb myriads of disease-producing 
 germs from the vapors and exhalations that arise 
 from this uncovered sewer ? All the laws regula- 
 ting the diffusion of microscopic organisms testify 
 to the truth of the proposition ; and if there is any 
 warrant for the statement that diseases of a zymotic 
 character can be propagated through drinking 
 water, the dweller on the banks of the Des Plaines, 
 from the point where the canal first approaches the 
 river to its mouth, had, during a fatal epidemic in 
 Chicago, better say his prayers before placing a 
 cup of its innocent-looking water to his lips. We 
 believe that the ice supply of Chicago is chiefly 
 derived from this source ; and if so, does it not ac- 
 count, to some extent, for the present unusually bad 
 health of that metropolis?" Fortunately for the 
 residents of Philadelphia this danger does not 
 .exist in ice cut from the Schuylkill river, since 
 Professor Leffmann tells us some interesting facts 
 
WHERE IS MALARIA FOUND? 41 
 
 concerning the purity of this water, which will 
 possess so much interest for all residents of the 
 city that I give his remarks in full : " It is my pur- 
 pose to take only a few minutes to give some 
 results, or rather conclusions, which have been 
 derived from recent analyses of our water supply. 
 Very little is heard about the hygienic relations of 
 Schuylkill water, probably because public opinion 
 has long since settled to the conclusion that it is a 
 good water. Nevertheless, as visitors sometimes 
 complain of it, and as newspapers in their flings at 
 the Water Department not infrequently condemn 
 the quality as well as the quantity of the supply, I 
 have ventured to take up the Society's time long 
 enough to say that examinations made at various 
 times during the winter and spring have shown 
 that the water is of fair quality and cannot be re- 
 garded as an active cause of disease in our city. 
 It is an insipid water, lacking the pleasant taste and 
 sparkling character of spring water, especially of the 
 so-called hard waters, and this lack is often taken 
 as evidence of impurity. During the periods of 
 freshet it becomes quite turbid, from the suspen- 
 sion of particles, mostly silicious, but such suspended 
 matter rarely exceeds a grain or two to the gallon, 
 and the individual particles are too minute to cause 
 any irritation. In the turbid water several species 
 of harmless animalculae can usually be detected. 
 In making any brief statement of a composition of 
 
42 WHERE IS MALARIA FOUND? 
 
 a water we are embarrassed by the fact that the 
 modern methods of water analysis are very strictly 
 technical ; they give us, not the impurities them- 
 selves, but the amount of certain indications of 
 impurity. Without stopping to explain the mere 
 chemical phase of the question, I will simply give 
 a comparison of a recent analysis of Schuyl- 
 kill water with that of two samples of London 
 water analyzed by the same method and considered 
 excellent waters: 
 
 Schuvlkill Kent Company, Chelsea, 
 bcnuylkill. London. London. 
 
 Chlorine 0.53 1.2 0.51 
 
 Ammonia, from organic 1 
 
 matter J 0.0028 0.0022 0.0035 
 
 Total solids 7.00 34.00 17.64 
 
 All the figures are grains to the imperial gallon. 
 The Society of Public Analysts, of England, has re- 
 cently proposed a system by which each factor in the 
 composition shall be valued by an arbitrary num- 
 ber, and all the numbers being added will give us 
 a figure representing the standard of the water. 
 In good waters this sum will not exceed 35. 
 Schuylkill water varies from 17 to 23, so that it 
 comes decidedly below the limit. In regard to 
 Delaware water I may remark that, so far as I have 
 examined it, it is not as good as the Schuylkill 
 water. The amount of organic matter is higher 
 and the microscopic examination shows forms of 
 life which are frequent in decomposing materials. " 
 
WHERE IS MALARIA FOUND? 43 
 
 This question of water is a very important one in 
 connection with the production of malaria, as 
 evidenced by the testimony of many writers, the 
 most recent observation I have found on the subject 
 being as follows : " In reference to the increasing 
 distribution of malaria, it is worth noting that 
 water is often the vehicle by which the malarial 
 poison reaches the system, and that it is often 
 charged with malaria at points distant from the 
 places where it comes to the surface and is used. 
 Thus, it happens that soils are often reputed ma- 
 larious, when, in reality, the unhealthiness is due 
 to the fact just stated." Another prolific cause 
 of malaria or bad air is the occupancy of a sleeping 
 or sitting room by too many persons. Experience 
 teaches that while life can be supported with a 
 lesser quantity, yet in order that the various func- 
 tions of the human body may be carried on prop- 
 erly and without let or hindrance, each adult 
 should be supplied with three thousand cubic feet 
 of air every hour. This amount of air will be 
 contained in a room ten feet wide, thirty feet long 
 and ten feet high. Natural ventilation, that 
 is to ' say, the interchange of air through the 
 cracks of doors and windows and through the 
 walls of a room or house, will change this volume 
 of air, will renew it, three times in the course 
 of an hour. If special means for ventilation exist, 
 if sufficient ingress for pure and egress for impure 
 
44 WHERE IS MALARIA FOUND? 
 
 air be provided, this volume of air will be renewed . 
 six times in every hour. So that under the first 
 condition not more than three, and under the second 
 condition no more than six persons should occupy 
 a room of the dimensions given above. How sel- 
 dom this rule is observed, you all know. These 
 calculations do not take into consideration, you 
 will notice, the consumption of oxygen by the 
 carbon of illuminating gas, to which I have 
 referred. And when you realize that one burner 
 will consume more oxygen in a given time than 
 one man, you will appreciate how important a fac- 
 tor this may become in deteriorating and rendering 
 malarious or bad the air of a room. The brightly 
 lighted sitting room, with its cheerful log fire, all 
 the windows and doors tightly closed against Jack 
 Frost, and the crevices hermetically sealed and 
 stuffed, so that not a particle of the pure and 
 bracing air of the cold and wintry night may enter, 
 with the family of ten or twelve passing the long 
 evenings of winter in a room but little if any 
 larger than the one I have described, may be very 
 cosy and comfortable, but it is terribly unhealthy. 
 Again, many persons have a habit of making their 
 own soap, for washing purposes, using the waste 
 fat in this way. This is a most reprehensible and 
 unhealthy custom ; the fat has been kept for some 
 time, until it is in a state of decomposition, and then 
 put into the pot to boil, it sends foul gases all 
 
WHERE IS MALARIA FOUND? 45 
 
 through the house. Better dispose of your fat in 
 some other way, it will be more economical and 
 much more sensible ; will be more healthy and 
 will greatly reduce your doctor 's bills. Slops left 
 standing in an uncovered bucket in the back street 
 for hours, until removed in the swill cart, will gene- 
 rate bad air. The sun beats down on this moist 
 mass and the gases of decomposition are liberated. 
 Foul and exceedingly poisonous gases often gain 
 admittance to a house where the plumbing is not 
 perfect, through the outlets for waste water and 
 the overflow. If you have reason to suspect this, 
 indeed, whether you have or not, it will be a wise 
 precaution to have a metallic slide arranged to the 
 overflow outlet, and keep it always in position un- 
 less using this opening, and to always have the 
 stopper of all your basins and bath tubs in position, 
 with an inch or two of water in the basin. While 
 it is true that much disease is caused from foul air 
 entering the house from 'the drain pipes, yet such 
 ought not to be the case, there is no necessity for 
 it. The hue and cry against wash stands and 
 water closets is an unjust one. If properly arranged 
 and drained they are perfectly harmless. This 
 prejudice against them has arisen, not from the fact 
 that the system is wrong or injurious in itself, but 
 because it is not properly carried out. How 
 can you expect an ordinary plumber, who, as an 
 apprentice, has mechanically learned his trade 
 
46 WHERE IS MALARIA FOUND? 
 
 from his master, to know anything about scientific 
 plumbing ? He may do his work in a masterly 
 and perfect manner, so far as the mechanical part 
 of it is concerned. But what does he know about 
 the principles of hygiene. I make the assertion that, 
 if properly arranged, water-closets and sinks are 
 by far the healthiest means of getting rid of refuse 
 matter, and will support this assertion by the state- 
 ment, that I would be perfectly willing to live in a 
 house with a water-closet, sink and bath tub in 
 every room, provided I had personally superin- 
 tended the plumbing of the house. I will have 
 more to say on this subject in the last chapter. 
 The slop jar in a bed chamber is a common cause 
 of impure air. You wash your bodies and empty 
 the water into this jar. The water contains scales 
 of your skin, as well as many of the dead particles 
 of your body given out through the pores of your 
 skin. This matter is organic, and undergoes de- 
 composition. Unless the slop jar is thoroughly 
 washed out every day it soon becomes foul, and is 
 then an unhealthy article of furniture. Keep it 
 covered all the time. Another prolific source of 
 bad air in winter time arises from the modern 
 method of heating houses by furnaces in the cellars. 
 In the majority of instances the air chamber of the 
 furnace derives its supply of air from the cellar, 
 which must of necessity be very impure, since it is 
 impregnated with the ashes and coal dust and the 
 
WHERE IS MALARIA FOUND? 47 
 
 various impurities usually found in a cellar. If 
 the air chamber is supplied with pure air from 
 outside of the house, if a receptacle with water is 
 placed near the register, and if a proper outlet in 
 each room, for the air when it becomes foul, exists, 
 I can see no valid objection to furnaces. They 
 certainly heat a house more thoroughly than any 
 other system in vogue in ordinary dwelling houses, 
 and if their drawbacks be reduced to the minimum 
 their use is to be commended. Soiled clothing 
 allowed to accumulate in a room will vitiate the 
 air of the apartment. The soiling is due to 
 dead organic matter derived from the body, and 
 it will decompose and give rise to malarious or 
 bad air. In this connection a most reprehensible 
 practice in common use must be emphatically 
 condemned. I refer to the habit of hanging wet 
 diapers over a chair, before the register, to dry. 
 Children are particularly susceptible to the noxious 
 influences of bad air, and this practice will so vitiate 
 the air of their rooms as to work serious injury to 
 their little bodies. Wash each diaper as it is 
 soiled and hang it out of doors, in the sun, to dry. 
 There is a very important factor in the production 
 of bad air which is so common and ought to be 
 so thoroughly appreciated, that it seems almost 
 foolish to refer to it here, still, as it does exist and 
 as very little effort seems to be made to remedy 
 it, it may do soiree good to dwell on it for a 
 
48 WHERE IS MALARIA FOUND? 
 
 little while ; I mean dirty streets. Street dirt is 
 principally derived from two sources ; slops and 
 refuse from houses, and excrement, both solid and 
 liquid, from horses, dogs and the like. All this 
 matter is organic and undergoes organic decom- 
 position, with the consequent production of mala- 
 rious or bad air. This is really the principal 
 source of air contamination in large cities, as, wit- 
 ness the city of New York last spring and the city 
 of Philadelphia at present. Does it not seem 
 strange that intelligent men will go to all the 
 trouble and expense that they do, to remove from 
 their neighborhood all human excrement, and yet 
 seem so indifferent to the presence of such enor- 
 mous quantities of animal excrement in the streets, 
 which is, in reality, nearly, if not quite as poison- 
 ous as the former. Consistency, thou art, indeed, 
 a jewel, a jewel possessed by but very few inhabit- 
 ants of our large cities. In my last chapter I will 
 propose a remedy for this state of affairs, which 
 may, indeed, seem Utopian in conception and im- 
 possible of achievement, as it really is under our 
 present selfish and corrupt system of government, 
 but a plan that would be perfectly practicable were 
 our city governed by intelligent men, who had the 
 welfare of its inhabitants to guide them in their 
 administration. Whatever city does first adopt 
 this plan will find a wonderful diminution in its 
 mortality rate, and will deserve and receive the 
 
WHERE IS MALARIA FOUND? 49 
 
 gratitude of the whole country for setting them an 
 example, by following which the health of the 
 nation will be greatly benefited, and the life of 
 man prolonged. Having cursorily discussed the 
 principal causes of bad air in the city, let us return 
 again to the country, and see in what localities 
 and under what conditions we will there find 
 malaria. I have told you that malaria can exist 
 everywhere. I have told you how malaria can and 
 will be produced in houses, from what might be 
 called hygienic defects of living. Let us now see 
 what localities in the country are particularly prone, 
 I might say naturally, to be malarious. Let me 
 again say that I am not discussing the poisonous 
 element of bad air which is capable of producing 
 Intermittent Fever, and about the nature of which 
 we know really nothing ; this poison is developed 
 and exists in certain localities which I could men- 
 tion, and does not exist in others ; but the malaria 
 of which I am writing, the bad air I am telling 
 you about, may be found anywhere, as a result of 
 man's negligence or want of knowledge. A 
 healthy cduntry locality might be described as fol- 
 lows : High ground, without too much shade, 
 and with a rather loose and porous soil, prefer- 
 ably a gravelly or gravelly and clayey soil. Such 
 a briefly described locality will be naturally free 
 from malaria, and if bad air does there exist, it 
 will surely be the fault of the resident or of some 
 
50 WHERE IS MALARIA FOUND? 
 
 neighbor. When I say high ground, I mean com- 
 paratively, and not positively high. Country loca- 
 tions may be very high when compared with the 
 neighboring city or river from which the compari- 
 sons are made, and yet be very low when com- 
 pared with the country immediately surrounding 
 them. Such a spot will not be, naturally, free from 
 malaria or bad air. A pen picture of a country 
 location which would be naturally malarious, would 
 read as follows : Ground low when compared 
 with the surrounding country, basin-like in char- 
 acter, with a hard, clayey, or otherwise impervious 
 soil. Into such a location the refuse from the 
 surrounding country would naturally drain. The 
 rain descending from above would, of course, 
 flow down from all directions into this basin, and in 
 its downward course would carry along all the dead 
 organic matter for some distance around, which 
 would accumulate in a rotting mass on this low 
 ground. The hard, impervious soil would refuse 
 to allow this water to drain away through it, 
 thus compelling it to lie on the surface until, in 
 the rainy season, it would almost form a small 
 lake. This, in the first place, would be unhealthy, 
 since it would, of necessity, render the location 
 very damp. But a still greater danger here exists. 
 This mass of water, with its load of organic mat- 
 ter, lies on the surface of the ground. After a 
 while the sun appears, and you can anticipate what 
 
WHERE IS MALARIA FOUND? 51 
 
 I am going to tell occurs. Here, again, we have 
 the dead organic matter, the heat and moisture. 
 Decomposition necessarily ensues, and the air be- 
 comes bad. I am sufficient of a farmer to tell 
 you that such soil will produce very indifferent 
 crops. The dead and decomposed organic mat- 
 ter, which in porous soil would soak into the 
 ground and furnish nourishment for vegetable 
 life, will here lie on the surface, and furnish 
 poison for human animal life. How can you 
 expect a locality that is too poor to grow potatoes 
 to be rich and good enough to grow children. 
 Just here, I will enunciate a rule, which is almost 
 universally correct. It will serve as an almost in- 
 fallible guide in selecting a country home. When 
 you have found a high location, look into the 
 character and nature of the crops produced. If 
 you find them first class, you can, in the great 
 majority of cases, make up your mind that such 
 a location will make a healthy residence. Of 
 course, you must find out whether these crops are 
 derived from the natural soil, since almost any 
 ground can be made to produce very good 
 crops if thoroughly worked and manured. Apart 
 from the nature of the locality, the same care- 
 lessness in properly disposing of organic matter 
 will produce malaria in the country that I have 
 indicated in speaking of the city. But in the 
 country there are some particularly dangerous 
 
52 , WHERE IS MALARIA FOUND? 
 
 practices in vogue which demand a moment's con- 
 sideration. Thus, in many cases where a house 
 stands on high ground, surface drainage is resorted 
 to. The drain pipe from the water closet and 
 bath tub will discharge its contents on the surface of 
 the ground some twenty or thirty feet away from the 
 house. This is most reprehensible. The suppo- 
 sition is that because of the sloping ground this 
 refuse will all drain away. While very nice in 
 theory, this is not the case in fact. At first most 
 of this matter will drain away ; but in time, and 
 especially if the closet and bath be much used, the 
 ground in the vicinity of the open mouth of the 
 drain will become so saturated with this water 
 that it will be unable to absorb any more. It will 
 then be compelled to run along the surface. The 
 grass and weeds will entangle and hold some of 
 the organic matter, which will decompose, and 
 when the wind is blowing towards the house, this 
 poisoned air will be carried into it. To avoid 
 this really great danger; great care and intelli- 
 gence should be exercised in arranging the drain- 
 age. If a swift flowing stream, in which there is 
 always plenty of water, even during the greatest 
 drought, pass at all near the house, your drain 
 pipe should empty into it. But unless there is 
 always plenty of water and a sufficiently strong 
 current to carry the waste away, do not think of 
 draining into it. Because when the dry spell comes, 
 
WHERE IS MALARIA FOUND? 53 
 
 and the bottom of the small stream or creek is 
 exposed to the sun, there will be found the accumu- 
 lations of your winter's drainage,ready to decompose 
 and poison the air. If you have no convenient 
 stream, select the very lowest point on your land 
 and dig there a deep well. Brick the sides of it, 
 from top to bottom, and cement it thoroughly, so 
 as to render it strictly water proof. Let your 
 drain pipe empty into this well. The bottom of 
 the well, being earth, will allow the liquid portion 
 of the waste to drain off out of harm's way. 
 The solid portion will accumulate, and the well 
 should be emptied when it becomes full. An air- 
 tight covering should be always in position on top 
 of the well. If you take these precautions, and if 
 your plumbing be good and your water-closet trap 
 efficient, you need fear no danger whatever from 
 this source. It would be well, if possible, for the 
 family to absent themselves from home when the 
 well is being emptied, and for you to employ a man 
 for this work who makes a regular business of it, 
 because such a man will not be affected by the 
 poisonous gases, since usage breeds a tolerance. 
 While, if you were to employ a man unaccustomed 
 to such work, you might become the innocent and 
 unwilling cause of his sickness, and may be of his 
 death. Finally, to sum up, you must understand, 
 from what I have said, that. malaria will always be 
 present wherever dead and decomposing organic 
 
54 WHERE IS MALARIA FOUND? 
 
 matter is, and that if such matter is allowed to 
 accumulate in the vicinity of human habitations, 
 and if proper measures to destroy it are not in- 
 stituted, malarious or bad air will surely be the 
 consequence, and the inhabitants of such a locality 
 will surely suffer from its baneful influences. You 
 also understand, to some extent, how really diffi- 
 cult it is, in many cases, to avoid the production 
 of this bad air, how easily it is generated and 
 how insidious may be its approach. To make you 
 realize still more how insidious may be the march 
 of this arch-enemy of health and longevity, I will 
 conclude this chapter with a quotation from the 
 British Medical Journal, in which Messrs. Maguire 
 & Son, of Dublin, who have had great experience 
 in the examination of dwelling houses say : " In 
 endeavoring to awaken public attention to the 
 importance of sanitary reform, we here enumerate 
 thirty of the dangers to health which we most fre- 
 quently detect in our sanitary examination of 
 houses. Any one of these defects, by admitting 
 foul air, constitutes a real danger to health ; but, 
 in the large majority of houses many of these de- 
 fects may be found existing together, and in some 
 houses they may nearly all be found, rendering those 
 houses pestilential: (i) Common built drains 
 under houses; large built drains under or near 
 mansions. (2) Pipe drains with leaking joints, or 
 broken, laid under houses j saturating the basement 
 
WHERE IS MALARIA FOUND ? 55 
 
 with sewage. (3) Pipe drains laid under houses, 
 without sufficient fall, or with fall the wrong way. 
 (4) Drains of every kind, without proper inter- 
 cepting traps, admitting foul air from sewers or 
 cesspools. (5) Drains of every description, with- 
 out a constant free current of fresh air through 
 them. (6) Rat burrows from built drains or sew- 
 ers undermining flags and floors, and admit- 
 ting foul air to house. (7) Rat burrows worked 
 alongside perfect pipe drains from street sewers, 
 and into houses. (8) Defective connections 
 between soil or waste pipes and sewers, ad- 
 mitting foul air to houses. (9) Soil pipes 
 passing through interior of house, under almost 
 any circumstances. (10) Soil pipes inside or out- 
 side houses, without any or sufficient ventila- 
 tion. ( 1 1 ) Defective water-closet apparatus. (12) 
 Water-closet cisterns with overflows joined to soil 
 pipe or drain. (13) Safe trays under closets, 
 connected to soil pipes or drain. (14) Two or 
 more water closets or sinks on same soil pipe, un- 
 trapping each other when used. (15) Sink over- 
 flow pipes joined to soil pipes untrapped, or with 
 trap liable to un trap. (16) Water supplies to sinks 
 taken from water closet or other contaminated 
 cisterns, and used by careless servants to fill bed 
 room caraffs for drinking. (17) House cisterns 
 and tanks with overflows direct into soil pipes or 
 drains. (18) Traps of every description with- 
 
56 WHERE IS MALARIA FOUND ? 
 
 out ample ventilation to guard them. (19) Scul- 
 lery sinks connected direct to drains, admitting 
 foul air to houses, not only through traps, but 
 through joints of brickwork all round, as shown 
 by our smoke test. (20) Bell traps, with loose 
 covers, on scullery sinks connected to drains. 
 (21) Gullies or traps in sculleries, laundries, lar- 
 ders, etc., connected to drains, usually dry and 
 untrapped. (22) Rain pipes used as ventilators 
 to drains, delivering foul air near bedroom win- 
 dows, or under eaves or roofs. (23) Ash pits 
 near larders and pantries ; ash pits liable to soak 
 foul moisture through house walls. (24) Defects 
 of drainage and rat burrows, from neighbors' 
 houses. (25) Water tanks in areas, near ash pits 
 or sculleries, and with overflows direct to drains. 
 
 (26) Wash-stand basins in dressing rooms, con- 
 nected directly in any way to drains or soil pipes. 
 
 (27) Water-closet cisterns in return rooms, fre- 
 quently under bedroom or parlor floors, perhaps 
 with overflow direct to drain. (Sixteen years ago 
 the writer thoughtlessly used a room of this kind, 
 and was attacked with Typhoid.) (28) Cess- 
 pools near houses, and cesspools or defective 
 drains near wells. (29) Neighbors' drains cross- 
 ing under houses or joining drains. (30) Drink- 
 ing water defects, and all impurities likely to con- 
 taminate milk, meat, or food of any kind." After 
 reading this long list, you may wonder how it is 
 
WHERE IS MALARIA FOUND ? 57 
 
 possible for any house to be healthy, when disease 
 has so many avenues of entrance. Truly, our life 
 is one long, continual warfare against disease. But 
 you will notice that all these indications, as well 
 as all the others which I have pointed out to you, 
 depend upon the presence of decomposing organic 
 matter. If such matter is not present, no matter 
 how defective the drainage may be, poisonous 
 gases cannot enter the house, because they cannot 
 exist. Therefore, once more, in conclusion, ma- 
 laria means bad air, and the most frequent cause 
 of this bad air is organic decomposition. 
 
58 SYMPTOMS OR SIGNS OF MALARIA. 
 
 CHAPTER III. 
 
 SYMPTOMS OR SIGNS OF MALARIA. 
 
 Typhoid Fever has its special symptoms ; so has 
 Smallpox, Diphtheria and Intermittent Fever. 
 And by these special signs or landmarks, as it 
 were, is each particular disease recognized and 
 differentiated. When called to a patient, who 
 at regular intervals has a well marked chill fol- 
 lowed by fever, succeeded in turn by profuse 
 sweating and a subsequent restoration to health, 
 the physician at once recognizes a case of Inter- 
 mittent Fever. So it is with every other special 
 disease. There are certain definite signs and 
 symptoms, the presence of which make known the 
 nature of the disease. It is not so with malaria. 
 The conclusion that a person is suffering from 
 malaria must be arrived at rather by a system of 
 exclusion of the symptoms of other diseased con- 
 ditions, than by the presence of any special char- 
 acteristic symptoms of this trouble. This is be- 
 cause malaria or bad air will produce, and does 
 produce, such a great variety of symptoms, that it 
 frequently simulates many other diseases. I have 
 told you that pure air is an absolutely essential 
 agent to the healthy performance of duty on the 
 
SYMPTOMS OR SIGNS OF MALARIA. 59 
 
 part of your organs. If,' instead of pure, bad air 
 or malaria enters your lungs at every inspiration, 
 and from your lungs enters your blood, the poison- 
 ous elements act injuriously on your system at large 
 and interfere with the functions of healthy life. 
 Acting thus on all parts of the body, you can 
 understand how diverse may be the symptoms 
 presented. Every one of us has some particularly 
 weak spot ; in you it may be the lungs, in another 
 the stomach, in a third the kidneys. Whatever 
 injurious agent may act on the body of each par- 
 ticular being will make itself most manifest on 
 this weak spot. So that in one malaria may pre- 
 sent symptoms referable to the stomach, in another 
 to the lungs, and in a third to the kidneys. In 
 still another class of cases it seems to exert a de- 
 pressing and debasing influence on the system at 
 large ; lacking the healthy stimulus of pure air, all 
 the organs of the body seem'to imperfectly perform 
 their duty, and a low state of vitality, a depressed 
 condition of the general health, without any defi- 
 nite or peculiar symptoms of any special disease, 
 exists. This is the most common form in which 
 bad air manifests its evil influence. And when you 
 bear in mind the fact that a wholesome supply 
 of fresh air is an absolute essential of healthy life, 
 you can easily comprehend how impure air, even 
 that which does not contain the germ of any 
 special disease, may produce this condition of de- 
 
60 SYMPTOMS OR SIGNS OF MALARIA. 
 
 pressed health, of lowered vitality. So that when 
 a person complains of ill health it becomes neces- 
 sary, in the first place, to carefully examine him for 
 any special disease that may give rise to the symp- 
 toms of which he complains. If after a careful 
 and thorough examination all specific diseases are 
 excluded, the hygienic conditions and surroundings 
 of the individual must be inquired into, and most 
 likely malaria or bad air, from some cause or other, 
 will be found. How many people are there in the 
 world who are constantly complaining. They 
 have no organic disease. They are not confined 
 to the house, but are able to go about. They are 
 not addicted to excesses of any kind. They do 
 not suffer from dyspepsia, neither are they afflicted 
 with constipation. They do not absolutely suffer 
 from headache, but are always verging on that 
 condition. They do not exactly experience 
 nausea, but feel as though almost anything would 
 make them vomit. They feel hungry, and yet 
 when they go to the table an unconquerable loath- 
 ing for food, takes possession of them. They feel 
 sleepy, and yet when they go to bed they lie 
 awake for hours. They do nothing . to exhaust 
 themselves, yet are always tired. They take 
 interest in nothing. Their minds are clouded and 
 their memories poor. Such is a description of a 
 person afflicted with malaria. If such a person 
 lives in the city, let him walk, ride or drive in the 
 
SYMPTOMS OR SIGNS OF MALARIA. 61 
 
 pure air of a healthy country neighborhood, and 
 immediately he feels better, the old symptoms re- 
 turning, however, when he again reaches his mala- 
 rious residence. So that when one is not in robust 
 health, yet has neither special nor organic disease, 
 but feels as though (to put it vulgarly) he were only 
 half living, if he can discover no other cause for 
 this unfortunate state of affairs, let him look care- 
 fully about him and see whether he be not living 
 in a poisoned atmosphere. Let him remember and 
 realize how many and how unsuspected may be 
 the causes of this impure air, and let him diligently 
 search for, and when found remove, the particular 
 cause in his case. Let him remember the various 
 causes for the bad air I have pointed out ; let him not 
 forget how profoundly this malarious atmosphere 
 may affect his system, and let him be ever mindful 
 that I have said that the principal source of this 
 impurity is organic decomposition. I have pur- 
 posely curtailed this chapter on the symptoms of 
 malaria, for two reasons. First. Were I to enum- 
 erate all the symptoms producible by bad air, I 
 would be obliged to name every sign of every 
 deviation from health, since, as I have told you, 
 bad air, by interfering with the healthy functions 
 of life, is capable of producing, at times, the symp- 
 toms or some of the symptoms of every disease. 
 This would be confusing, unintelligible, and pro- 
 ductive of no general good. Second. The two 
 
62 SYMPTOMS OR SIGNS OF MALARIA. 
 
 important points for the general public to learn 
 about malaria are, how it is produced and how it 
 can be avoided. Therefore, with this short hint at 
 the symptoms, we will close this chapter and go 
 on to the last and very important one, "How to 
 avoid malaria " 
 
HOW TO AVOID MALARIA. 63 
 
 CHAPTER IV. 
 
 HOW TO AVOID MALARIA. 
 
 This little book is intended for intelligent and 
 thinking people. It would be impossible of 
 achievement, and therefore useless to undertake in 
 so small a volume, the exhaustive discussion of any 
 subject, so I am endeavoring merely to give you 
 the outline, as it were, of the question, the details to 
 be filled in by the thought and reasoning abilities 
 of the intelligent reader. These small popular 
 books on matters pertaining to health would be 
 dry, uninteresting, unintelligible and uninstructive 
 reading, were all the small details and minutiae 
 thoroughly discussed. They would then partake 
 more of the nature of medical text-books, and 
 would be interesting and instructive only to the 
 student of medicine. The busy man of the world 
 would not have time to read them. When, how- 
 ever, this information is condensed, and the salient 
 points selected from it given to the public in a 
 small volume, which can be read in a short time, 
 it will be productive of much good. The unedu- 
 cated and unintelligent classes will not, of course, 
 read these books; they know nothing and care 
 nothing about the means of preserving bodily 
 
4 HOW TO AVOID MALARIA. 
 
 health. The intelligent classes, who will read 
 these books, do know and do care about health. 
 They value it, and are anxious to preserve it to its 
 utmost limit. Such people are blessed with the 
 power of reasoning, and all that is necessary is to 
 direct this power into the proper channel. There- 
 fore I will point out to you the main indications 
 for the avoidance of malaria, and will give certain 
 hints which, aided by your reason, will enable you 
 to avoid in every instance this bad or malarious 
 air. Let us first look into the city. Do not 
 occupy a house until you have had the whole 
 drainage system carefully examined by a thorough- 
 ly competent expert. If found defective, do not 
 move into the house, even though you may get it 
 for nothing ; if you do you will have more than the 
 amount of the rent to pay in doctors' bills. From 
 what I have told you in the second chapter, you 
 can understand that defective drainage is the most 
 prolific cause of malaria or bad air. Therefore 
 it is of paramount importance that this matter 
 should be carefully attended to. If you intend 
 to build a house, it behooves you to employ only a 
 first-class plumber to do your work. Even if you 
 are close and mean, and desire to economize in 
 other ways, do not begrudge expense in this di- 
 rection. If you look around, get many estimates 
 from different parties, and finally decide on the 
 cheapest, you may have your foundations, your 
 
HOW TO AVOID MALARIA. 65 
 
 brick work, your plastering and your wood work, 
 done for very little money. In a short time the 
 defective workmanship will make itself known, 
 and you will be put to additional expense to have 
 it remedied. The only ill effects, however, 
 arising from this mistaken economy will be some 
 personal discomfort and an additional expense, 
 which, with the original cost, will foot up a sum 
 greater than would have been requisite to have 
 done the work properly in the first place. But 
 how different it will be with the plumbing. If 
 you look about you, and get one plumber bidding 
 against another, you can, beyond doubt, have the 
 plumbing of your house done very cheaply, that 
 is, for a very small sum of money, comparatively 
 speaking. But if it is imperfectly done, the dam- 
 age resulting cannot be measured by mere person- 
 al discomfort or increased expense. Probably the 
 first intimation you may receive of imperfect 
 drainage will be when a serious case of sickness, 
 mayhap a fatal case, appears in your family. The 
 pipes and system of drainage may be sufficiently 
 complete, mechanically speaking, to carry off all 
 the refuse from your house ; there may be no leaks 
 and nothing prominently calling your attention 
 to defective drainage. After a while, maybe, some 
 one member of your family, or even possibly the 
 majority or all of them, may become unwell. 
 Without exhibiting any definite symptoms of any 
 
66 HOW TO AVOID MALARIA. 
 
 particular disease, they are out of sorts. Formerly, 
 before removing to your present house, they have all 
 been hearty and robust. You cannot account for 
 the change. They may sleep well and yet awake 
 unrefreshed. They may sleep, and have their 
 sleep disturbed by hideous dreams. They may 
 arise in the morning with a dull, heavy feeling in 
 the head, a sense of nausea, a coated tongue, a bad 
 taste in the mouth, and a general sense of lassitude 
 and unrest altogether inconsistent with a healthy 
 body after a night of healthy sleep. They are 
 not sick enough to require the doctor, yet they are 
 not well. They have good appetites, may be, 
 but its full gratification distresses them. In a 
 word the functions of life are imperfectly and 
 improperly performed. The vital power is de- 
 pressed. For a long time you speculate as to this 
 cause of ill-health, and reason and wonder in vain. 
 Finally your attention is directed to your drain- 
 age, and upon careful examination you find it so 
 defective that great volumes of foul sewer gas are 
 allowed to enter the house, and, mingling with the 
 air in your living rooms, to render the atmosphere 
 you use malarious or bad. Now will come in the 
 extra expense, and I can assure you that by the 
 time you have brought your plumbing to that de- 
 gree of excellence necessary to render your house 
 healthy, you will have spent very much more 
 money than you would have done had your 
 
HOW TO AVOID MALARIA. 67 
 
 plumbing been properly attended to in the first 
 place. In England, this question has been con- 
 sidered of sufficient importance to have had legal 
 enactments for its solution, and to-day the whole 
 of Great Britain is divided into sanitary districts, 
 with a medical officer of health in each. This 
 officer is empowered by law, and is obliged, to ex- 
 amine every new building in course of erection. 
 If it is being constructed according to the most ap- 
 proved hygienic rules, all is well ; if not, he has 
 the authority to point out in what it is deficient, 
 and direct these defects to be remedied, possessing 
 at the same time the necessary legal power to en- 
 force the fulfillment of his directions. This and other 
 sanitary reforms in England have been so beneficial 
 in their influence on the life of man, that within a few 
 years the annual death rate in that country has 
 been reduced from about eighty-four in every 
 thousand, to only twenty-four in every thousand. 
 In time, it is to be hoped that we will have such 
 beneficial laws in this country, compelling persons, 
 against their own foolishness, to live as they 
 should. At present our people are so busily oc- 
 cupied developing the enormous resources of our 
 great country, that they have but little time to 
 bestow upon the preservation of health. But 
 when we are more developed and commence to 
 have leisure in which to become cultivated, our 
 attention will be given more in this direction. 
 
68 HOW TO AVOID MALARIA. 
 
 In the meantime, it becomes the duty of physi- 
 cians to use all the persuasion of which they are 
 capable, to induce people to live in accordance 
 with the doctrines of hygiene. To still further 
 illustrate the importance of this point, I will 
 quote from the Medical Times and Gazette, of Eng- 
 land, where, under the heading of " Noteworthy/ 1 
 I find that "The Local Board of Eastbourne have 
 got a clause in their Bill, whereby they are en- 
 abled not only to regulate the junction of house 
 drains with the sewer, but to go inside the house 
 and see that it is constructed on sanitary princi- 
 ples, without which permission will not be given 
 for occupation." As I have already indicated, 
 the two great causes of impure air in cities are, 
 ist. Defective dramage, in its most liberal sense. 
 Any imperfections that may interfere with the 
 thorough removal of dead organic matter, or 
 that may allow the gases resulting from the decom- 
 position of this matter to be returned to the house. 
 2d. Dirty streets. To remedy this latter condition 
 comes in my Utopian plan, already referred to. 
 The most thorough sweeping alone will not and 
 cannot completely clean the streets, more particu- 
 larly when, as in Philadelphia, they are horribly 
 paved with rough and unsightly cobbles. No- 
 tice, some day, when the street sweepers are at 
 work in your neighborhood, what a perfect farce 
 their work is. They sprinkle the streets a little, a 
 
HOW TO AVOID MALARIA. 69 
 
 very little, and then a number of men commence 
 to sweep. In a short time they raise a tremendous 
 dust, full of dead organic matter, which finds its 
 way into the lungs, eyes and ears of passers by, 
 and is carried by the wind hither and thither, 
 through open windows into houses, and much of 
 it is deposited at some point in the street a short 
 distance away. After a while, these antiquities 
 (street sweepers are always aged and decrepit) 
 succeed in accumulating piles of dirt along the 
 street. As fast as built, they are partially de- 
 molished by the horses' feet and wheels of wagons 
 passing over them. In time, a filthy cart ap- 
 pears, and what remains of these dirt mounds 
 is lifted on a shovel and thrown toward the 
 cart. Probably a goodly proportion is deposited 
 in the cart, while the balance falls back into 
 the street, or is carried off by the wind. When 
 the cleaning of a street is finished, it is, of course 
 comparatively cleaner than it was before, but it is 
 far from being positively clean. There is sufficient 
 dirt, enough dead organic matter, to poison the 
 air and render the city unhealthy. How can we 
 do away with this dirt. I will tell you. In the 
 first place, some of the enormous sums of money 
 annually wasted by the administration of our large 
 cities should be utilized to largely increase the 
 water supply, the reservoir system of our cities, so 
 as to make it equal to the demand I am presently 
 
70 HOW TO AVOID MALARIA. 
 
 going to make upon it. In Philadelphia, a few of 
 the millions foolishly expended upon our new 
 public buildings would suffice to give us this in- 
 creased water supply. As far as possible, cobble 
 paving should be done away with, and our streets 
 laid with a smooth, even pavement of some kind, 
 Belgian block, Asphalt, or the like. The stream 
 of water from the fire plugs should have sufficient 
 pressure to throw it with great force more than 
 half across the streets. Every morning at three 
 o'clock, or thereabouts, it should be the duty of 
 every policeman to turn on every fire plug in his 
 beat and to let them run with full force until five 
 o'clock, or for two hours. Let us glance for a 
 moment at the advantages of this plan. Every 
 morning, every single particle of the decomposing 
 organic material which had accumulated the day 
 before would be washed from the surface of the 
 streets, into the sewers. This large and powerful 
 flow of water, rushing through the sewers, would 
 carry everything before it. This daily washing 
 out would so purify and cleanse these previously 
 dirty sewers, that sewer gas would be unheard of; 
 thus not only would the streets be daily thoroughly 
 cleaned, but the air of dwellings would be de- 
 prived of its most dangerous impurity, sewer gas. 
 This gas is generated in sewers from the decom- 
 position of organic matter accumulated therein. 
 If this matter were removed daily, and the sewers 
 
HOW TO AVOID MALARIA. 71 
 
 thoroughly washed out, the production of sewer 
 gas would be an impossibility. The only addition- 
 al expense attendant upon this plan would be for 
 the extra water supply, and this would be infinitely 
 more than counterbalanced by honest city gov- 
 ernment. Making the policemen turn on and 
 off the water would do away with the necessity 
 for contractors and their antiquated horde of 
 sweepers. If, however, it was considered necessary, 
 for political purposes, that this army of men should 
 be supported by the city, let me suggest a more 
 useful way than the one in which they are at pres- 
 ent employed. Ten years ago, in Florence, Italy, 
 I was struck by the remarkable cleanliness of the 
 streets in the better portions of the city. They 
 were laid in asphalt, and were immaculate. I 
 was at a loss at first to account for this great puri- 
 ty, since horses and wagons were continually 
 passing to and fro. The mystery was solved 
 when I met a man walking in the middle of the 
 street, with a large hamper-like basket strapped to 
 his back and a shovel in his hand. Every particle 
 of horse manure, every piece of paper, in fact, 
 everything excepting the asphalt pavement itself, 
 was dexterously lifted on the shovel and deposited 
 in the basket. Thus, with but little trouble 
 and no attendant dust, were the streets of the bet- 
 ter portion of Florence kept marvelously clean. 
 With the flooding in the early morning and the 
 
72 HOW TO AVOID MALARIA. 
 
 constant daily gathering of this refuse, dirty 
 streets would be impossible, while epidemics 
 would be unheard of. How beautiful, on a bright 
 morning, to look out of your window and gaze on 
 streets absolutely free from impurity, streets that 
 positively smell sweet. Let me beg any newspaper 
 editors who may read this book to think over my 
 plan, and having recognized the great good to be 
 derived from it, to set apart a space in their papers 
 for the furtherance of this grand sanitary reform. 
 Let them urge the matter upon the attention of 
 the city authorities, and do not rest until the 
 proposition is an accomplished fact. 
 
 Dr. Richardson, of London, a Sanitarian of 
 eminence, has printed an address called "Jfygeia, 
 a City of Health. ' ' There are so many valuable 
 suggestions contained in it, concerning our sub- 
 ject, that I will make a few quotations therefrom. 
 He says, "The most radical changes in the houses 
 of our city are in the chimneys, the roofs, the 
 kitchens, and their adjoining offices. The chim- 
 neys, arranged after the manner proposed by Mr. 
 Spencer Wells, are all connected with central 
 shafts, into which the smoke is drawn, and, after 
 being passed through a gas furnace, to destroy the 
 free carbon, is discharged, colorless, into the open 
 air." " Considering that a third part of the life 
 of man is, or should be, spent in sleep, great care 
 is taken with the bed-rooms, so that they shall be 
 
HOW TO AVOID MALARIA. 73 
 
 thoroughly lighted, roomy and ventilated. Twelve 
 hundred cubic feet of space is allowed for each 
 sleeper, and from the sleeping apartments all un- 
 necessary articles of furniture and of dress are 
 rigorously excluded. Old clothes, old shoes, and 
 other offensive articles of the same order, are 
 never permitted to have residence there. " " The 
 houses, being built on arched subways, great con- 
 venience exists for conveying sewage from, and 
 for conducting water and gas into, the different 
 domiciles. All pipes are conveyed along the sub- 
 ways and enter each house from beneath. Thus 
 the mains of the water pipes and the mains of the 
 gas are within instant control on the first floor of 
 the building, and a leakage from either can be im- 
 mediately prevented." I could go on thus for 
 pages, making interesting and valuable quotations 
 from this excellent little book, but instead of 
 doing so, I will recommend to any one who de- 
 sires to build a truly model house, from a sanitary 
 standpoint, the careful study of this little essay, en- 
 titled " Hygeia, a City of Health," by Benjamin 
 Ward Richardson, M.D., F.R.S. In addition to the 
 few measures I have indicated, let me impress 
 strongly upon you what I have already said, that 
 outside of mechanical impurities, malarious or bad 
 air will be produced, in the majority of instances, 
 by the decomposition of dead organic matter, and 
 since the death of organic matter is one of the 
 F 
 
74 HOW TO AVOID MALARIA. 
 
 necessary conditions and outcomes of the life of 
 the world, it must always take place and its de- 
 composition must ensue, during which process it 
 is separated into its original elements, which ele- 
 ments are unfit to sustain healthy animal life. So 
 that I will make the broad and sweeping state- 
 ment that, in order to avoid malaria, all dead or- 
 ganic matter must be removed from the vicinity of 
 man while it is undergoing decomposition. This 
 can be accomplished by attending to the following 
 indications. Perfect drainage. Removal of ex- 
 crement of all kind. Perfect cleanliness of house, 
 person and clothing. Free ventilation. Abund- 
 ance of sun-light. Immediate removal of all 
 soiled articles. Frequent removal of table 
 slops, and the limited use of gas, or if freely 
 used, an abundant supply of oxygen. I have 
 told you that carbonic acid gas, which is produced 
 in so many ways, is a very important element of 
 atmospheric impurity. The phenomena of the work- 
 ings of nature, I must also tell you, are very beauti- 
 ful and very complete, and in no instance is this 
 remarkable adaptability of means to ends more 
 perfectly illustrated than in the disposition of this 
 very carbonic acid gas which is so liberally pro- 
 duced in nature. You now know that this gas is 
 a combination of carbon and oxygen. The car- 
 bon, I have told you, is very poisonous to human 
 life, but according to the wise provisions of na- 
 
HOW TO AVOID MALARIA. 75 
 
 ttire it is this very article for which vegetable life 
 hungers. Therefore trees immediately seize upon 
 and appropriate this carbon to themselves and 
 turn loose the oxygen, once more pure and suited 
 to support human life. So that trees growing in 
 front of your house are very healthy and should 
 be encouraged. They act as scavengers, they pu- 
 rify the air. In his model city, already referred 
 to, Dr. Richardson says that he would have trees 
 growing on either side of every street. Now to 
 the country. Here, of course, you will have the 
 same dangers of impurity to contend against as in 
 the city, if you have the same conveniences. 
 Although the greater space around your house and 
 the lesser interference with the currents of air will 
 dilute and render less hurtful these noxious ele- 
 ments. So that, while, as I say, you must be on 
 the alert against these impurities, just as in the 
 city, yet the greatest danger to be considered in 
 the country is from a naturally malarious or un- 
 healthy location. I have already indicated what 
 localities ought to be unhealthy. To point this I 
 will relate an actual case, which is not by any 
 means an isolated one. I had at one time a patient 
 who lived in a very pretty place in the country. 
 But the land was low and the soil was of heavy 
 clay. His place was lower than his neighbor's, 
 all of whose drainage flowed from every direction 
 into his ground. When it rained the water 
 
76 HOW TO AVOID MALARIA. 
 
 would lie in pools, and in dry weather the clay 
 would bake like bricks. His friends would come 
 to see him and admire his place, and comment on 
 the healthy appearance of his family, and think he 
 was so wise to live in the pure country air. This 
 was before the scenes. Now take a peep behind 
 them. The children were apparently healthy. 
 They were never confined to bed by sickness. 
 Neither his wife nor himself ever had any serious 
 illness during their residence in this place. Yet 
 the children were cross, peevish and fretful ; their 
 appetites were fitful and erratic ; half the time they 
 were exhausted and wanted to be nursed. Their 
 sleep did not seem to refresh them. One day they 
 would seem well and hearty, and the succeeding 
 one languid, petulant and feverish, without any 
 apparent cause. His wife was a constant sufferer 
 from dyspepsia, which persisted during her entire 
 residence in this place, in spite of the greatest care 
 in eating and varied medical treatment. While 
 the gentleman himself, though never sick, but 
 young, strong, and ordinarily robust, never felt 
 comfortable. He was always tired, and the slight- 
 est exertion would produce great exhaustion. 
 Although they both retired hardly ever later than 
 half past nine or ten o'clock, and led the most 
 regular kind of lives, yet they were always un- 
 comfortable and depressed. To such an extent 
 did this unhealthy condition go, that the wife, in 
 
HOW TO AVOID MALARIA. 77 
 
 her despondency, was wont to exclaim " What is 
 the use in living, if I must feel so badly au tJie 
 time, AND so UNEQUAL TO EVERYTHING." Yet 
 apparently there was no discoverable cause for this 
 condition. Here was a perfect illustration of the 
 evil and insidious influences of bad air ; typical 
 cases of malaria. Now note what followed. This 
 gentleman had a relation living near by. But 
 his location was of the nature I have described to 
 you as naturally non-malarious. Occasionally he 
 and his wife would visit this place. A wonderful 
 and magical change would occur. A hearty sup- 
 per would not be followed by dyspepsia. A 
 pleasant evening would be succeeded by a long 
 night of sound sleep, and in the morning they 
 would arise refreshed, while a walk before break- 
 fast would be substituted for the customary lan- 
 guid lolling around in their malarious home. This 
 change occurred so frequently and so universally, 
 indeed, there was not one single exceptional in- 
 stance, and the change was so immediate and so 
 marked, that the gentleman commenced to think 
 that his location could not be a healthy one. He 
 commenced to investigate, to consider, and to 
 study, and finally concluded that his place was 
 naturally unhealthy, that it was malarious. When 
 he reached this conclusion, he immediately moved. 
 Like magic, the dyspepsia, the malaria, the lan- 
 gour, the inaptitude for work, the general oppres- 
 
78 HOW TO AVOID MALARIA. 
 
 sion, vanished, and they were once more naturally 
 healthy and robust young persons. This is not 
 a fancy picture; it is drawn from real life, and fur- 
 nishes an excellent illustration of malaria. I 
 have said that this book is intended for intelligent 
 persons. Ignorant people will never derive any 
 benefit from such books, because they cannot 
 comprehend the points made. Were I to enu- 
 merate all the causes of malaria, and all the 
 means recommended for its avoidance, I would 
 write for many months and would make a book 
 so large and so full of dry details that very few of 
 you would undertake to read it. Yet with such a 
 large volume I could not hope to do as much good 
 as with this smaller one. When one endeavors to 
 instruct intelligent and thinking persons, it is 
 proper that he should direct their thoughtful minds 
 in the proper channel. Too many small details 
 not only insult this presumed intelligence, but 
 render a book so tiresome that it is apt to be laid 
 aside. Therefore it has been my purpose, in pre- 
 paring this small volume, merely to throw out 
 certain hints, to erect sign posts as it were, which 
 would enable the intelligent man or woman to 
 avoid malaria. I do not claim to have exhausted 
 the subject, by any means ; I have not enumerated 
 all the causes of, neither have I mentioned all the 
 methods of avoiding, malaria. But I have said 
 enough to make you reflect, and this is the true 
 
HOW TO AVOID MALARIA. 79 
 
 object of all writing. If I have made clear to 
 you the true nature of malaria, if I have estab- 
 lished my theory in your mind, and if I have di- 
 rected your intelligence and your reasoning facul- 
 ties in the right channel ; if I cause you to reflect, I 
 am deeply gratified, for then have I fulfilled my 
 purpose in undertaking this task. If my few 
 words will cause you so to act as to diminish in 
 any degree the immensity of unnecessary suffering 
 produced by malarious or bad air, my ambition 
 will be satisfied, for to do so I have written this 
 little book. Therefore, asking you to remember 
 that I am writing for thinking people, I will con- 
 clude what has been to me a very pleasant duty, 
 summing up in a few words the substance of this 
 little book, which, constituting the essence, so to 
 speak of all that I have told you in it, I will beg 
 you to take seriously to heart, to remember, to 
 ponder over, to reflect about and to act upon. Do 
 so and I assure you we will hear much less about 
 malaria. Malaria means bad or impure air. TJiese 
 impurities are of various kinds. They consist of 
 any substances which are injurious to the health of 
 the human body. They may be of a mechanical 
 character ; but are generally derived from organic 
 decomposition. Everything that has life, be it ani- 
 mal or vegetable, MUST DIE. Everything that dies 
 MUST DECOMPOSE, and everything organic that de- 
 composes MUST PRODUCE BAD AIR, if the resultant 
 
80 HOW TO AVOID MALARIA. 
 
 products of this decomposition become mixed with 
 the air. Bad air depresses the whole system; mala- 
 ria vitiates the body and interferes with the healthy 
 performance of function of every organ. Its symp- 
 toms are innumerable, since it may present some 
 symptoms of every known disease, because, as each 
 specific disease will present symptoms referable to 
 some particular organ or part, according to what- 
 ever organ or part may be the seat of the disease, 
 and as malaria will affect every organ or part on 
 account of its deleterious action on the whole system, 
 it may and will offer symptoms of some disease, 
 when in reality such disease does not exist. Since 
 malaria is principally due to organic decomposition 
 and is always produced by it, it MUST be found, to a 
 greater or lesser extent, wherever organic matter is 
 EXPOSED to decomposition, its severity or mildness 
 depending upon the amount of such matter exposed. 
 Since the principal cause of malaria is organic de- 
 composition, and since it is one of the inevitable laws 
 of nature that organic matter MUST DECOMPOSE, 
 therefore it is self evident that the surest way to 
 AVOID malaria is to remove this matter from your 
 presence while it is undergoing decomposition. You 
 now have the question of malaria concisely placed 
 before you. Reflect and think about it. Use 
 your intelligence and your judgment. Act upon 
 the results of this intelligent reflection, and banish 
 malaria from the haunts of civilization. In final 
 
HOW TO AVOID MALARIA. 81 
 
 conclusion, one word of wholesome advice. If 
 you value your health, do not use quinine with- 
 out medical advice. It is a strong medicine, po- 
 tent for good if properly used, and equally so for 
 evil if improperly employed. It will cure Inter- 
 mittent Fever, when intelligently administered, 
 and is useful in many other conditions of ill 
 health, but on true malaria, such as I have been 
 describing to you, it will have no good effect 
 whatever and may do much harm. If you ask a 
 druggist about the soundness of this view, he will 
 tell you it is false, because a large proportion of 
 his profit is derived from the popular use of qui- 
 nine ; but any intelligent, conscientious and un- 
 prejudiced physician will substantiate my state-- 
 ment. 
 
SELECT LIST OF BOOKS 
 
 FOR GENERAL AND SCIENTIFIC RBAn ERS< 
 FROM THE CATALOGUE OF 
 
 Publisher of Medical, Pharmaceutical, Dental, and Scientific Books, 
 1O12 Walnut Street, Philadelphia. 
 
 Any of the following books will be sent, postpaid, upon receipt of the 
 price, or they will be found in the stock of most booksellers throughout the 
 United States and Canada. 
 
 ON SLIGHT AILMENTS. Their Nature and Treatment. 
 
 By Lionel S. Beale, M.D. Large 12mo. Cloth. Price $1.75. 
 Among civilized nations a perfectly healthy individual seems to be the 
 exception rather than the rule ; almost every one has experienced very fre- 
 quent departures, of one kind or another, from the healthy state ; in most 
 instances these derangements are slight, though perhaps showing very 
 grave symptoms, needing a plain but quick remedy. 
 
 CONDENSATION OF CONTENTS. 
 
 The Tongue in Health and Slight Ailments, Appetite, Nausea, Thirst, 
 Hunger, Indigestion, its Nature and Treatment, Dyspepsia, Constipation, 
 and its Treatment, Diarrhoea, Vertigo, Giddiness, Biliousness, Sick Head- 
 ache, Neuralgia, Rheumatism, on the Feverish and Inflammatory State, 
 the Changes in Fever and Inflammation, Common Forms of Slight Inflam- 
 mation, Nervousness, Wakefulness, Restlessness, etc., etc. 
 OPINIONS. 
 
 44 It abounds in information and advice, and is written for popular use." 
 Philadelphia Bulletin. 
 
 44 Singularly clear and felicitous." Sanitarian. 
 
 44 A valuable work for the family library." Boston Transcript. 
 
 44 A thoroughly practical work for non-professional as well as medical 
 readers." Cincinnati Gazette. 
 
 44 A scholarly book, singularly free from all technicalities, and almost as 
 valuable to general readers as to the profession." Chicago Inter-Ocean. 
 
 44 Clear, practical, and a valuable instructor and guide." Baltimore Ga- 
 zette. 
 
 44 The advice given as to treatment is so excellent, that no student or 
 young practitioner should neglect to read it." Med. and Surgical Reporter. 
 
 44 In a very important sense, a popular book." Chicago Advance. 
 
 44 An admirable treatise upon the minor ills whion flesh is heir to." 
 Springfield Republican. 
 
Presley Blakiston'a 
 
 BRIGHT'S DISEASE. How Persons Threatened or Afflicted 
 with this Disease OUGHT to Lave. By J. F. Edwards, M.D. 16mo, 96 
 pages. Cloth. Price 75 cents. 
 The author Drives, in a readable manner, those instructions in relation 
 
 to Hygiene, Clothing, Eating, Bathing, etc., etc., which, when carried out, 
 
 w'll prolong the life of those suffering from this disease, and a neglect of 
 
 which costs annually many lives. 
 
 WHAT IS SAID OP IT. 
 
 u Every one should read this excellent little volume, in which Dr. Ed- 
 wards describes and defines the disease." Providence Journal. 
 
 "This little book is prepared, not in the interest of the doctor, but of the 
 sufferer." Louisville Christian Observer. 
 
 44 A very valuable work." New York Commercial Advertiser. 
 
 44 Plainly written, and ought to be of great use." Philadelphia Ledger. 
 
 44 What should be done and avoided are clearly shown, and the informa- 
 tion communicated is of general interest." Albany Journal. 
 
 " Plain and straightforward." Baltimore Sun. 
 
 44 An admirable and much needed book.*' Catholic Mirror, Baltimore. 
 
 44 A remarkably able and useful treatise upon an obscure and vital sub- 
 ject." North American. 
 
 44 Should be read carefully by every one." The Voice, Albany, N. Y. 
 
 "It encourages the sufferer as well as instructs bim."Congregationali&f. 
 
 44 An intelligent work." Toledo Blade. 
 
 44 A clear statement of some of the rules of life, which will insure the 
 longest lease of life, and the greatest measure of health." Prov. Press. 
 
 44 A satisfactory treatise." Indianapolis Sentinel. 
 
 <4 Of especial interest and importance, and should be universally known." 
 Lutheran Observer. 
 
 * 4 Will be eagerly welcomed by thousands. The malady is one of a pe- 
 culiarly insidious character, and it may be asserted with confidence that 
 this book will be very valuable for medical men as well as laymen. It 
 is written in good, plain English, and with clearness." StoddarVs Review. 
 
 44 Simple, practical directions that can be easily obeyed." Bookseller 
 and Stationer. 
 
 BY THE SAME AUTHOR. 
 
 DYSPEPSIA. How to Avoid It. By JOSEPH F. EDWARDS, M.D. 
 Discusses Food and Digestion. States How Food Should be Cooked, 
 and plainly shows How and What we Ought to Eat. 16mo, Cloth. 
 Price 75 cents. 
 
 CONSTIPATION. Plainly Treated and Relieved without the 
 Use of Drugs. By Joseph F. Edwards. 16mo. Cloth. Price 75 cents. 
 
Select List oj Books. 
 
 THE MANAGEMENT OF CHILDREN in Health and 
 Disease. By Mrs. Amie M. Hale, M.D. A book for Mothers. Second 
 Edition. 12mo. Cloth. Price 50 cents. 
 
 THE PRESS COMMEND IT AS FOLLOWS! 
 
 " Altogether, it is a book which ought to be put into every baby basket, 
 even if some lace-trimmed finery i3 left out, and should certainly stand on 
 every nursery bureau." Philadelphia Public Ledger. 
 
 "Admirable common, sense ad vice, which mothers would do well to have." 
 Southern Churchman. 
 
 " Contains invaluable instruction." Evening News, Detroit. 
 
 "The importance of this book cannot be over estimated." JV. E. Journal 
 of Education. 
 
 11 A work for mothers, full of wisdom." Congregationalist. 
 
 "Ought to be the means of saving many a young life." Phila Inquirer. 
 
 "Abounds in valuable information." Therapeutic Gazette. 
 
 " Emphatically a book for mothers, and cannot fail to be useful to all 
 who read it." Indiana Farmer. 
 
 " Admirably simple, clear, sensible, and safe in its teachings." Friends' 
 Review. 
 
 " It should be upon every household table." Nashville Jour. Med. and Sur. 
 
 BIBLE HYGIENE ; or, Health Hints. By a Physician. This 
 book has been written, first, to impart in a popular and condensed form 
 
 the elements of Hygiene. Second, to show how varied and important 
 are the Health Hints contained in the Bible, and third, to prove that 
 the secondary trendings of modern philosophy run in a parallel direction 
 with the primary light of the Bible. 12mo. Cloth. Price $1.25. 
 
 NOTICES OF THE PRESS. 
 
 " The anonymous English author of this volume has written a decidedly 
 readable and wholesome book." Philadelphia Press. 
 
 "The scientific treatment of the subject is quite abreast of the present 
 day, and is so clear and free from unnecessary technicalities that readers 
 of all classes may peruse it with satisfaction and advantage." Edinburgh 
 Medical Journal. 
 
 DRAINAGE FOR HEALTH; Or, Easy Lessons in Sanitary 
 
 Science, with numerous Illustrations. By Joseph Wilson, M. D., Late 
 
 Medical Director, United States Navy. One vol. Octavo. Price $1.00. 
 
 "Dr. Wilson is favorably known as one of the leading American writers 
 
 on hygiene and public health. The book deserves popularity." Medical 
 
 and Surgical Reporter. 
 
 "Easily understood, and briefly and concisely presented." Providence 
 Journal. 
 
 " Will be sure to be a harbinger of good In every family whose good for- 
 tune it may be to possess a copy." Buil der and Wood Worker. 
 
Presley Blakiston's 
 
 THE AMERICAN HEALTH PRIMERS. Edited by W. W. 
 Keen, M.D. Bound in Cloth. Price 50 cents each. 
 The Twelve Volumes, in Handsome Cloth Box, $6.00. 
 
 I. Hearing and How to Keep It. With illustrations. By 
 Chas. H. Burnett, M.D., of Philadelphia, Aurist to the Presby- 
 terian Hospital, etc. 
 
 II. Long Ufe, and How to Reach It. By J. G-. Richardson, 
 M.D., ot Philadelphia, Professor of Hygiene in the University of 
 Pennsylvania. 
 
 III. The Summer and Its Diseases. By James C. Wilson, M.D., 
 of Philadelphia, Lecturer on Physical Diagnosis in Jefferson 
 Medical College. 
 
 IT. Eyesight, and How to Care for It. With Illustrations. 
 By George C. Harlan, M.D., of Philadelphia, Surgeon to the 
 Wills (Eye) Hospital. 
 
 V. The Throat and the Voice. With illustrations. By J. 
 Solis Cohen, M.D., of Philadelphia, Lecturer on Diseases of the 
 Throat in Jeiferson Medical College, etc. 
 
 VI. The Winter and Its Dangers. By Hamilton Osgood, M.T>., 
 
 of Boston, Editorial Staff Boston Medical and Surgical Journal. 
 
 VII. The Mouth sind the Teeth. With illustrations. By J. W. 
 
 White, M.D., D.D.S., of Philadelphia, Editor of the Dental 
 
 Cosmos. 
 
 VIII. Brain Work and Overwork. By H. C. Wood, Jr., M.D., 
 of Philadelphia, Clinical Professor of Nervous Diseases in the 
 University of Pennsylvania, etc. 
 
 IX. Our Homes. With illustrations. By Henry Hartshorne, 
 M.D., of Philadelphia, formerly Professor of Hygiene in the 
 University of Pennsylvania. 
 
 X. The Skin in Health and Disease. By L D. Bulkley, 
 M.D., of New York, Physician to the Skin Department of the 
 Demilt Dispensary and of the New York Hospital. 
 XI. Sea Air nntl Sea BathJng. By John H. Packard, M.D., of 
 
 Philadelphia, Surgeon to the Episcopal Hospital. 
 
 XII. School and Industrial Hygiene. By D. F Lincoln, M.D., 
 of Boston, Mass., Chairman Department of Health, American 
 Social Science Association. 
 
 This series of American Health Primers is prepared to diffuse as widely 
 and cheaply as possible, among all classes, a knowledge of the elementary 
 facts of Preventive Medicine, and the bearings and applications of the 
 latest and best researches in every branch of Medical and Hygienic Sci- 
 ence. They are not intended (save incidentally) to assist in curing disease, 
 but to teach people how to take care of themselves, their children, pupils, 
 employe's, etc. 
 
 They are written from an American standpoint, with especial reference 
 to our Climate, Sanitary Legislation and Modes of Life; and in these re- 
 spects we differ materially from other nations. 
 
Select List of Books. 
 
 NOTICES OF THB PRESS. 
 
 * As each little volume of this series has reached our hands we have 
 found each in turn practical and well-written." New York School Journal. 
 
 44 Each volume of the 4 American Health Primers' The Inter-Ocean has had 
 the pleasure to commend. In their practical teachings, learning, and 
 sound sense, these volumes are worthy of all the compliments they have 
 received. They teach what every man and woman should know, and yet 
 what nine-tenths of the intelligent class are ignorant of, or at best, have but 
 a smattering knowledge of." Chicago Inter- Ocean. 
 
 "The series of American Health Primers deserves hearty commenda- 
 tion. These handbooks of practical suggestion are prepared by men whose 
 professional competence is beyond question, and, for the most part, by 
 those who have made the subject treated the specific study of their lives. 
 Such was the little manual on 'Hearing,' compiled by a well-known aurist, 
 and we now have a companion treatise, in Eyesight and How to Care for It, 
 by Dr. George C. Harlan, surgeon to the Wills Eye Hospital. The 
 author has contrived to make his theine intelligible and even interesting 
 to the young by a judicious avoidance of technical language, and the 
 occasional introduction of historical allusion. His simple and felicitous 
 method of handling a difficult subject is conspicuous in the discussion 
 of the diverse optical defects, both congenital and acquired, and 
 of those injuries and diseases by which the eyesight may be impaired or lost. 
 We are of the opinion that this little work will prove of special utility to 
 parents and all persons intrusted with the care of the eyes." New York Sun. 
 
 44 The series of American Health Primers (now entirely completed) 
 is presenting a large body of sound advice on various subjects, in a form 
 which is at once attractive and serviceable. The several writers seem to 
 hit the happy mean between the too technical and the too popular. They 
 advise in a general way, without talking in such a manner as to make their 
 readers begin to feel their own pulses, or to tinker their bodies without 
 medical advice." Sunday-school Times. 
 
 44 Brain Work and Overwork, by Dr. H. O. Wood, Clinical Professor of 
 Nervous Diseases in the University of Pennsylvania, to city people, will 
 prove the most valuable work of the aeries. It gives, in a condensed and 
 practical form, just that information which is of such vital importance to 
 sedentary men. It treats the whole subject of brain work and overwork, 
 of rest, and recreation, and exercise in a plain and practical way, and yet 
 with the authority of thorough and scientific knowledge. No man who 
 values his health and his working: power should fail to supply himself with 
 this valuable little book." State Gazette, Trenton, N.J. 
 
 44 An unexceptional household library." Boston Journal of Chemistry. 
 
 44 Everv family should have the entire series ; and every man, woman, 
 and child should carefully read each book." Alabama Baptist. 
 
 WATER ANALYSIS For Sanitary Purposes, With Hints for 
 the Interpretation of Results. By E. FBANKLAND, PH.D., D.O.L. With 
 Illustrations, Tables, etc , etc. 12mo. Cloth. $1 00. 
 The name of the author, who is a distinguished Chemist, and has had 
 great experience in Sanitary matters, is a sufficient testimonial to its ac- 
 curacy and its great practical value." Boston Journal of Chemistry. 
 
Presley Blakiston's 
 
 WHAT TO DO FIRST in Accidents and Poisoning. By Charles 
 W. Dulles, M.D. Illustrated. ISmo. Cloth. Price 60 cents. 
 
 PREFACE. 
 
 Whoever has seen how invaluable, in the presence of an accident, is the 
 man or woman with a cool head, a steady hand, and some knowledge of 
 what is best to be done, will not fail to appreciate the desirability of possess- 
 ing these qualifications. To have them in an emergency one must acquire 
 them before it arises, and it is with the hope of aiding any who wish to 
 prepare themselves for such demands upon their own resources that the 
 following suggestions have been put together. 
 OPINIONS. 
 
 "Of special practical value, and we commend it to all." Lutheran Ob- 
 server. 
 
 44 Ought to be in everybody's hands." Times, Philadelphia. 
 
 " Its usefulness entitles it to a wide and permanent circulation." Bost on 
 Gazette. 
 
 44 Just the thing for an emergency." Portland Transcript. 
 
 44 Of great practical value to the public." Wisconsin State Journal. 
 
 " A complete guide for sudden emetgencies." Philadelphia Ledger. 
 
 44 So plain and sensible that it ought to be introduced into every female 
 seminary." Evening Chronicle, Pittsburgh. 
 
 "The suggestions are of priceless value. "The Traveler, Boston. 
 
 44 The book is invaluable." Providence Press. 
 
 EYESIGHT, GOOD AND BAD. The Preservation ofVision. 
 By Robert Brudenel Carter, M.D., P.B.O.S. With many explanatory 
 illustrations. 12ino. Cloth. Price $1.50. 
 
 PREFACE. 
 
 A large portion of the time of every ophthalmia surgeon is occupied, day 
 after day, in repeating to successive patients precepts and injunctions 
 which ought to be universally known and understood. The following 
 pages contain an endeavor to make these precepts and injunctions, and 
 the reasons for them, plainly intelligible to those who are most concerned in 
 their observance. 
 
 WHAT IS THOUGHT OF IT. 
 
 "A very valuable book, and should be in everybody's hands." Nortk 
 American. 
 
 44 A valuable book for all who are interested in the best use and preser- 
 vation of the vision."- A T . E. Journal of Education. 
 
 44 A compact volume, full of information to all classes of people." Book- 
 8 filer and Stationer. 
 
 t4 A comprehensive treatise, well calculated to educate the public." 
 Kansas City Review. 
 
 44 Q-ives excellent advice." Chicago Journal. 
 
 44 To teachers particularly the book is of interest and importance." 
 Educational Weekly. 
 
Select List of Books. 
 
 HEALTH AND HEALTHY HOMES. A Guide to Personal 
 and Domestic Hygiene. By George Wilson, M.A., M.D., Medical Officer 
 of Health. Edited by Jos. G-. Richardson, Professor of Hygiene at the 
 University of Pennsylvania. 12mo. Cloth. 314 pp. Price $1.50. 
 
 WHAT IT TELLS ABOUT. 
 
 How your Body is Made. 
 
 The Hereditary Influences, as well as the self-Induced and Social causes of Dis- 
 ease. 
 
 The Value and Choice of Food, its Preparation, and Sensible Hints on Diet. 
 
 Proper and well Adapted Clothing. 
 
 How to take Exercise, and the best Method of Training. 
 
 Useful Hints about your Home. 
 
 How to Prevent taking the Infectious Diseases which are always at certain seasons 
 so prevalent in cities. 
 
 All sorts of Important Suggestions in Regard to the Everyday Life. 
 
 WHAT IS THOUGHT OF IT. 
 
 " A most useful and, in every way, acceptable book." N. York Herald. 
 
 "Marked throughout by a sound, scientific spirit, and an absence of all 
 hasty generalizations, sweeping assertions, and abuse of statistics in sup- 
 port of the writer's particular views. . . . We cannot speak too 
 highly of a work which we have read with entire satisfaction." Medical 
 Times and Gazette. 
 
 " We warmly commend it to the public." Boston Herald. 
 
 " We have read few books of more interest and value than this." South' 
 ern Practitioner. 
 
 " The book will take a permanent position. It is a sound work by a com- 
 petent writer." London Lancet. 
 
 " Full of good sense and sound advice." Educational Weekly. 
 
 u The book aims at the prevention of Disease. It abounds in sensible 
 suggestions, and will prove a reliable guide." Churchman. 
 
 " Deserves wide and general circulation." Chicago Tribune. 
 
 WHAT EVERY MOTHER SHOULD KNOW. By Edward 
 Ellis, M.D., Author of a Practical Manual on the Diseases of Children. 
 16mo. Cloth. Price 75 cents. 
 
 14 As it is only too true that our children have to dodge through the early 
 part of life as through a sort of pathological labyrinth, we must be thank- 
 ful to meet with such a sensible guide for them as Dr. Ellis. He is emi- 
 nently a practitioner among doctors, and a doctor among practitioners ; 
 that is to say, he is learned and well knows what is known, can do what 
 should be done, and can put what he has to say in plain and comprehensive 
 language." Pall Mall Gazette. 
 
 " The author has a faculty of sketching out the characteristics of dis- 
 eases and their treatment in striking outlines, and of making his points 
 yery clear and im press! ve." N. Y. Medical Record. 
 
8 Presley Blakiston's Select List. 
 
 DRUGS THAT ENSLAVE. The Opium, Morphine, Chloral, 
 and Hashisch Habits. By H. H. KANE, M.D., of New York City. One 
 volume. 12mo. With Illustrations. Price $1.50. 
 
 A curse that is daily spreading:, that is daily rejoicing in an increased 
 number of victims, that entangles in its hideous meshes euch great men as 
 Coleridge, De Quincey, William Blair, Robert Hall, John Randolph, and 
 William Wilberforce, besides thousands of others -whose vice is unknown, 
 should demand a searching and scientific examination. 
 
 ** A vivid and startling expose" of the increase of this form of intemper- 
 ance, and the terrible sufferings endured by those trying to free them- 
 selves from this habit." Pittsburg Telegraph. 
 
 " It is well that such a warning as is contained in this book should be 
 sounded." Albany Evening Journal. 
 
 "The volume seems to be a summary of the resuUsof the most approved 
 practice, both in Europe and this country." New York World. 
 
 " A work of more than ordinary ability and careful research. . . . For 
 the first time, reliable statistics on the use of chloral are classified and 
 published. . . . And it is shown that the use of chloral causes a more 
 complete and rapid ruin of mind and body than either opium or morphine." 
 Druggists 1 Circular and Gazette. 
 
 " The effects of the habits described are set forth boldly and clearly, and 
 the book must have a beneficial effect. It will do still better service in de. 
 terring persons from experimenting 'to see what it is like.' " Charleston 
 (S. C.) Newt and Courier. 
 
 "The subject of the chloral habit has not been investigated by any one, 
 we believe, so thoroughly as by Dr. Kane." Medical Record. 
 
 " There is ground tor a n-jw temperance movement here. The book is a 
 valuable one. It is written in a practical manner, and has nothing of a 
 sensational character." Philadelphia Ledger. 
 
 THE OCEAN AS A HEALTH RESORT. A handbook of 
 Practical Information as to Sea Voyages, for the use of Tourists and 
 Invalids. By WM. S. WILSON, L.R.C.P.. Lend , M.R.C.S.E. With a 
 Chart showing the Ocean Routes, and Illusi rating the Pb/ sical Geos 
 graphy of the Sea. Crown 8vo. Price $2.50. 
 
 Curative Effects of the Ocean Climate ; The Various Health Voyages ; 
 Time of Starting; Choosing a Ship; Preliminary Arrangements; Lile at 
 Sea; Climate and Weather; Management of the Health at Sea; Occupa- 
 tions and Amusements at Sea; Objects of Interest at Sea ; End of the 
 Voyage; Future Plans; The Homeward Voyage; Australia Its Climate, 
 Cities and Health Resorts; South Africa and its Climate; The Meteorol- 
 ogy of theOcean. Appendix A. Outfit Required for a Voyage to Austra- 
 lia. Appendix B.- Names and Addresses of some of the Principal Ship- 
 ping Firms. 
 
 "All the information is supplied by, or based upon, the actual experience 
 of the author ; and the book may be confidently recommended to all who 
 have to undertake, without previous experience, a sea voyage of any 
 length. Medical men may consult it with advantage, and commend it to 
 those patients whom they may advise to try the effect of a long voyage at 
 sea" Med. Times and Gazette. 
 
 " We have read every page of this book, and have derived both instruc- 
 tion and amusement." Lancet.