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of the 

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V 



Proceedings of 

The Second Pan American 

Scientific Congress 



WASHINGTON, U. S. A. 

Monday, Decemb^ 27, 1915 
to Saturday, January 8, 1916 



ad wlltod aBdw the dlwcdwi af 
GIm L»Tta Swigg0tt, iiriitmf Sec rtt y G«Mnl 



SECTION vm 

(IN TWO PABT8) 

PART 1 
PUBUC HEALTH AND MEDICINE 

WILUAM C GOBGAS, SOBOKON OBNBBAI. U. & A^ CHAIBMAN 




VOL. K 



WASHINGTON 

GOVERNMENT PBINTING OmCB 

1917 



21 i903 

^EC 10 i9i7 

/^/4 CONTENTS. 

T 

fnST PART. pj^gg^ 

Letten of tiuttinittal ▼" 

Register by writers of papers ^^" 

Foreword ^^ 

Executiye committee ^ 

Organizatioii oflBcers ^ 

Committees of Section VIII ^ 

Aims and purposes of the congress 5 

Program statement of Section VIII 5 

Adopted resolutions and recommendations of Section VIII & 

M/tODhig wearion of December 28, 1915 t 

Yellow fever and its eradication, by Gen. William C. Goigas T 

S^ifermedades transmitidas por insectos en Pan AmMca, by Juan Guiteras — d' 

Immunity to yellow fever, by H. R. Carter 4> 

Filaiiads in the Americas, by Allen J. Smith -.. 48> 

Afternoon session of December 28, 1915 77 

The ei»demic of typhus ezantiiematicus in the Balkans and in tiie prison 

camps of Europe, by Bert W. Caldwell 77 

Present views in respect to modes and periods of infection in tuberculosis, by 

llasyck P. Ravenel 86 

The perasitic diseases in the American tropical countries and their effect upon the 

progress of civilisation among the Latin-American people, by D&maso Rivas. 95 

A review of the present yellow-fever situation, by Arlstides Agramonte 100 

liceaga and yellow fever, by Maj. T. C. Lyster 106 

Gttlos Finlay on the house mosquitoes of Habana, by Frederick Kuab 107 

CoDsiddrations sur bt fi^vre dite "fi^vre de firuits," by C. Matiion and L.Audain. 110 
La profilaxia de la fiebre tifoidea pot medio de la vacunaci6n, by Justo F. 

QoosfleB 115 

La bubs (Leishmanioris americana), by Luis £. Migone 117 

Nota sobre a extinct completa da febre amaiella no Estado de S. Paulo 

(&«flil), by Emilio Ribas 12a 

La ll^vrety^de en Bolivie, by Nestor Morales Villaa6n 126^ 

Homing 1888100 of December 29, 1915 14^ 

The alcohd and drug habit and its prophylaxis, by Harvey W. Wiley 146' 

Ob fumadofes de maconha; effeitos e males do vido, by Jo86 Roddgues da 

Costa Doria 161 

Lodia contia el alcohdismo, by Ricardo Sanniento Laspiur 1(12' 

El ptoblema del alcobolismo y su posible soluci6n, by Luis L6pes de Mesa. ... 166 

An inquiry into the causes of crime, by R. B. von KleinSmid 181 

Ptaporism: An analysis, by Edwatd T. Devine 187 

AftenuKm aeaaion of Decenaber 29, 1915 195< 

Mechanical appliances in the treatment of pyotihea alveolaris, by Felipe 

QaU^gos '. 195- 

Beb^Higiene del embaiaso y de la primera infancia, by AtiUo Naranelo 196 - 

Poffieultnra, by P. Raeda. 288 

La novocaina gtfcsfo-yodada, by Juan D . Susini 285* 

m 



IV CONTENTS. 

rage. 
Los diapensarios para lactantes (gotas de leche), como medio para disminuir la 

mortalidad infantil, by Julio A. Bauz4 242 

O erro esencial de peasda na lei brazileira do casamento civil, by Jos^ Rodrigues 

da Coflta Doria 247 

M^todos modemos para la prevencidn de la mortalidad instil, by Artuio L. 

Guerra 254 

Frophylaxia do ophldumo na America, by Vital Brazil 258 

2^ota sobre tratamiento de la infecci6n puerpeiml por los bafios tabios prolongados, 

^ by Arfstidee Fiallo Cabral 261 

A.cci6ii respiratoria del depressor cordis, by Teodoro Muhm 262 

Lepra y autosangioterapia— Necesidad de una liga panamericana antileprosa, 

by Luis Zanotti Cavazzoni 274 

Joint sesaion of Subsection C of Section Vm and the American Aasooia- 

tion for Labor Legialation 276 

Child labor and public health, by Owen R. Lovejoy 276 

Legal protection of female wage earners, by John B. Andrews 280 

El trabajo de la mujer embarazada, by Augusto Turenne 283 

Factory sanitation, by E. R. Hayhurst 288 

Morning seaaion of December 80, 1915 299 

The etiology and prevention of tuberculosis from the sociological points of view, 

b y William Charles White 300 

Tratamiento de la tuberculosis por el pneumo-t6rax artificial, by Joaquim de 

Oliveira Botelho 305 

Housing of wage earners, by Lawrence VeiUer 314 

La influencia de la habitaci6n en la lucha contra la tuberctilosis, by Juan 

Monteverde 322 

La inspecci6n m^ica en las escuelas pdblicas de Centro America-— Necesidad y 

X>osibilidad de establecerla en vista de las condiciones existentes en Costa 

Rica, by Louis Schapiro 330 

Joint session of Subsection B of Section vm and the American Sta- 
tistical Association 335 

The nature and significance of the dianges in the birth and death rates in recent 

yeaiB, by Walter P. Willcox 336 

The potential influence of vital statistics on the conservation of human life, by 

W.S.Rankin 344 

The relation of sickness reports to health administration, by John W. Trask. . . 347 
Informes referentes a la morbosidad infecto-contagiosa-— Disposidones y pro- 

cedimientos adoptados por la administmci^n sanitaria para su obtenddn, by 

Julio Etchepare 352 

Vital statistics in relation to Ufe insurance, by Louis I. Bublin 355 

Infant mortality statistics, by Lewis Meriam 365 

Cooperation by the Bureau of the Census with State authorities in securing the 

enactment of adequate laws for the registration of births and deaths, by 

Richard C. Lappin 374 

Joint session of Subseetion D of Seotlon Vm and the American Ohrlc 

Association 377 

Town and dty planning, by F. L. Olmsted 377 

The human side of dty planning, by J. Horace McFarland 385 

The effect of land subdivision upon housing and public health, by John Nolen . 387 

Rural hygiene, by J. N. Hurty 393 

Joint sssslou of Subsection B of Section Vm and the American Sta^ 

tistical Association 400 

The Federal registratbn service of the United States; its devdopment, prob- 
lems, and defects, by Creesy L. Wilbur 400 



CONTENTS. V 

Ihe incidence of the different causes of mortality in Providence during 65 years, 

1856 to 1910, by Charles V. Chapin 403 

Vital statistics in cities, by \^illiain H. Guilfoy 411 

Desarrollo de la estadistica demogr&fica en la Isla de Cuba, by Jorge Le-Roy y 

Cassi 415 

Cinco alios de demograffa uruguaya, by Joaquin de Salterain 456 

The accuracy and completeness of compiled vital statistics in the United 

States, by John S. Pulton 464 

Afternoon sesaioii of December 80, 1015 477 

Ph)phylaxis of venereal diBeases, by Edward L. Keyes, jr 477 

Educaci6n sexual de los ]6venes como medio profiL&ctico de las enfermedades 

ven^reas, by Alfredo P^rsico 483 

Public health measures in relation to venereal diseases, by William F. Snow. . 486 
International agreements in relation to the suppression of vice, by James 

Bronson Reynolds 49^ 

Proyecto de la ordenanza reglamentaria de la prostituci6n, by Silvestre Oliva. . 518 
Joint session of Subsection C of Section viii and the American Socio- 
logical Association , 526 

Ways and means of bringing matters of public health to social usefulness, by 

Wlliam C. Woodward 526 

What can unofficial effort do for public health? by Irving Fisher 529 

What can unofficial effort do for public health? by Hoyt £. Dearholt 533 

La medicina social y los problemas del trabajo en la Repdblica Aigentina, by 

Eniique Feinmann 540 

La inflnenda de la ankylostomiasis sobre la prospeiidad de la agricultura y 

sobre la mortalidad in&mtil, by Louis Schapiio and Mauro Fem&ndez 587 

Afternoon session of December 81, 1015 590 

Medical preparedness for campaign, by Edward L. Munson 590 

A contributiom to the study of artificial illumination, by James D. Gatewood. 599 

Thesanitation of the Panama Canal, by D. F. Reeder 610 

£1 pabell6n modelo de cllnica m^dica del Hospital Rawson, by Tom^ S. Varela 612 

Climate and hygiene of Rio de Janeiro, by Joaquim de Oliveira Botelho 613 

Buildings for human occupancy, by Robert W. de Forest 615 

The means by iddcb. infectious diseases are transmitted and their extermina- 
tion, by Alvah H. Doty 623 

Joint session of Subsection C of Section viii and the American Psycho- 
logical Association 628 

The defective child and the prevention of feeble-mindedness, by Henry H. 

Goddard 628 

The training of defectives, by E. R. Johnstone 631 

Youthful offenders— A comparative study of two groups each of 1,000 young 

lecidivistB, by William Healy and Augusta F. Bronner 636 

Mental hygiene — ^Tlie etiology and i^evention of insanity from the sociological 

point of view, by William A. White 645 

Educaci6n de los nifios nerviosos, by Bernardo Etchepare 651 

Regimen de convalecenda en los alienados, by Santin Carlos Rossi 667 

La equivalencia mental entre el hombre y la mujer, mirada del punto de vista 

psU^ddgico, by A. Moiaga Porras 674 

lEL ejercido muscular de la respiraci^n, sistema sueco, es fisiol6gico? by A. 

Moraga Porras 688 

Autofrasias mentalee, by Fernando Gorriti 696 

Higiene mental en sua relaciones con el desarrollo y conservacidn de la energfa 
psfquica y de la &tiga producida por la ensefianza escolar, by A. Moraga 

Ponas 698 



Letters of Transmittal* 



Washington, D. C, May Si, 1917. 

Snt: Punaant to the lecommendatiQn of the e^Focutive committee of the Second 
IVm American Scientific Oongren, which was held in Washington December 27, 191&- 
January 8, 1916, and by the cooperation of the United States Congress (uigent defi- 
ciency bill, Sept. 8, 1916), the papers and discussions of that great intwnational 
scientific gathering have been compiled and edited for publication under the able 
direction of the Assistant Secretary General, Dr. Glen Levin Swiggett. In this 
volume is contained the report of Section VIII, of which General W. C. GorgM, of 
the executive committee, was chairman. 

In my formal report, which has already been submitted, I enlarged upon the 
importajuce of the Second Pan American Scientific Congress, its laige attendance, and 
the high quality of its papers and discussions. I will, therefore, in this letter, which, 
in sli^tly varied form, introduces each volume, make only a few general references. 

All of the 21 Republics of the Western Hemisphere were represented by official 
delegates at the Congress. Unofficial delegates, moreover, from the leading sci e ntific 
associations and educational institutions of these Republics presented papers and 
took part in its deliberations. The papers and discussions may be considered, there- 
fore, aa an expression of comprehensive Pan American scientific efifort and possess^ 
in consequence, inestimable vahie. 

The Congress was divided into nine main sections, which, with their chairmen, 
were aa follows: 

I. Anthbopoloot. W. H. Holmes. 

II. AsTsoNOMT, Mktboboloot, AND Sbismoloot. Robert S. Woodward. 

III. CoNsxBVATioN ov Natitral Rbsourobs, AgricultuTs, Irrigation, and Forestry. 

George M. Rommel. 

IV. Education. P. P. Claxton. 
V. Enqinbbbino. W. H. Bixby. 

VI. IntbbnaxionalLaw, PiTBUoLAW,ANDJuBisPBimBNOB. Jsmss Browu Scott. 
VII. MnnNO, Mbtallubot, Eoonomio Gboloot, and Afpubd Chbmistbt. Hen- 

nen Jennings. 
VIII. Pubuo Hbaiah and Mbdioal Soibncb. William C. Qorgas. 

IX. Tbanspobtation, Commbbob, Pinanob, and Taxation. L. S. Rows. 

These sectkms, in turn, were further subdivided into 45 subsections. 

Over 200 delegates were in attendance from the Latin American Republics, while 
over a thousand from the United States participated in its meetings. The discussions 
and proceedings of the Congress attracted wiurld-wide attention, and it was undoubt- 
«lly the greatest international scientific meeting that has assembled anywhere in the 
history of the Western Hemisphere and possibly of the world. It was, therefore, a 
fitting snc co ssMT to the first Pan American Scientific Congress, which assembled in 
Santiago, the capital of Chile, in 1908, and to its predecessors, confined to Latin 
American representation, which in former years met, respectively, in Rfo de JaneirOy 
Montevideo, and Buenos Aires. Its success was a logical result of these preceding 
gatherings in Latin America and of the hearty cooperation of the Latin American 
Governments and scientists. 

To those who may have their attention brought only to the individual volumes 
covering the papers and discussions and who wish to know more of the proceedings o f 
the Congress and the results accompUshed by it, it is recommended that they should 

vn 



Vni LETTERS OF TRANSMITTAL. 

also read ''The Final Act— An Interpretative Commentary Thereon/' prepared under 
the direction of Dr. James Brown Scott, reporter general of the Congrefls, and the report 
of the secretary general, prepared by the latter and the assistant secretary general, 
Dr. Glen Levin Swiggett. In these will be found not only the final act and the 
illuminating comment thereon but lists of del^;ates, participating Governments, 
societies, educational institutions, and other organizations, together with a careful 
story and history of the Ccmgrese. They can be obtained by addressing the Director 
General of the Pan American Union, Washingttm, D. C. 

In conclusion, I want to briefly repeat, as secretary general of the Congress, my 
apinreciation, already expressed in my formal repent, of the hearty cooperation in 
making the Congress a success given by everyone concerned from the President of 
the United States, yourself as Secretary of State, and the del^iates of Latin America 
and the United States, down to the office employees. The great interest manifested 
by the i>ermanent executive committee, headed by Mr. William Phillips, then Third 
Assistant Secretary of State, the Carnegie Endowment for International Peace through 
its secretary. Dr. James Brown Scott, and the executive aid of Dr. Oleai Levin Swig- 
gett, as assistant secretary general, were vitally instrumental in making the gathering 
memorable. The Pan American Union, the official international organization of all 
the American Republics, and whose governing board is made up of the Latin American 
diplomats in Washington and the Secretary of State of the United States, lent the 
fav<»rable influence of that powerful organization to the success of the Congress and 
authorized me as the director general of the Union to also take up the duties of secretary 
general of the Congress. 
Yours, very truly, 

(Signed) John Babrbtt, 



The Honorable The Sbcrbtart op State, 

WashmgUm, D, C. 



Secretary General. 



Washinoton, D. C, si de mmo de 1917. 

ExMO. Snb.: Em cumprimento de uma recommendagfto emanada da Oommissfto 
Executiva do Segundo Congresso Scientifico Pan Americano, que teve lugar em 
Wadiington, de 27 de dezembvo de 1915 a 8 de }an«iro de 1916, e, devido ao auxilio do 
Congresso dos Estados Unidos (Lei para Or^amentos extnordinarios de 8 de setembro, 
1916) as memorias e as discussdes deesa assemblda scientifica intemacional, foiam 
colligidas e preparadas para publicaySo sob a proficiente direc9So do Secretario Geral 
Adjuncto, Dr. Glen Levin Swiggett. Este volume comprehende o relatorio da secgfio 
VIII que foi presidida pelo General W. C. Gorgas, da Gommiaafto Executiva. 

No meu relatorio official, que j& tive a honra de apreeentar, me detive sobre a impor- 
tanda do Segundo Congresso Scientifico Pan Americano, da sua grande concorrencia 
e da alta importanda das theses e das discussOes. Na presente nota, portaato, de uma 
maneira muito ligeira, destinada a apresentar cada um doe volumes, eu farei apenas 
algumas referendas muito geraes. 

Todas as Republicas do Hemispherio Occidental, vinte e uma em numero, se 
achavam repreeentadas por delegados officiaes ao Congresso. Delegados sem nomea- 
^ dos GovonoB, mas repreeentando as mais notaveis sodedadee sdentificas e 
institcd^Oes de ensino dessai republicas apreeentaram theses e tomaram parte nas 
deliberagOee. As memorias e discussdes devem ser conaderadas portanto, como a 
expresBfto de um justificavel trabalho sdentifico Pan Americano e poesoe, por esse 
motive, um valor sem egual. 

O CongreoK) foi dividido em nove secedes prindpaes, que a segoir enum^ro, com 
OS nomee dos sens presidentee: 

I. Anthropolooia. W. H. Holmes. 
II. AsTRONOMiA, Mbtbreolooia b Sismolooia. Robert S. Woodward. 



LBTTBBS OF TBANBMITTAL. IX 

111. CONSEBVA^jIO da RiQUBZA NaCIONAL, AoRIGULTUBA, iRRIOAglO B SiLVI- 

cuLTURA. George M. Rommel, 
rv. Is&TRvoglo. P. P. Claxton. 
V. Engbkhabia. W. H. Bixby. 
VI. DiBBiTO Intbbnacional, DntETro Publico b Jubibpbuobncia. James 

Brown Scott. 
VII. MiNAs, Mbtallurgu, Gbolooia pRAcncA E Chimica Industrial. Eennen 

Jemungs. 
VIII. Saude Publica b Sciencias Mboicas. William C. Gorgas. 

IX. VtAS DE COMMUNICApIO, COMMERCIO, FlNAN^AS B ImPOSTOS. L. S. RoWC. 

Estas secgdes, por seu lado, eram subdivididas em 45 subeecyOes. 

Mais de 200 delegadoe das Republicas da America Latina frequentaram as seeeOes 
emquanto os Ebtados Unidos se achavam representados por mais de mil pessoas. As 
disciissdee e os relatorios do Congresso attrahiram a attend de todo o mundo e foi 
sem duvida a maior aasemblea scientifica que se realizou no Hemispherio Occidental 
e talvez em todo o mundo. Foi sem duvida um idoneo continuador do Primeiro Con- 
gresso Scientifico Pan-Americano, que se celebrou em Santiago, capital da Republica 
Chilena em 1908 e das anteriores assembleas que previamente se tinham realizado, 
apenas com delegados da America Latina e que se reuniram em annos anteriores no 
Rio de Janeiro, Montevideu e Buenos Aires. seu successo foi um resultado logico 
das reunites previas na America Latina e do cordial concurso dos Govemos da America 
latina e dos sens homens de sciencia. 

A aquelles que nSo quizerem limitar-se a consultar os volumes que cont^ as 
memorias e as discussOes e que desejarem conhecer alguma cousa mais dos trabalhos 
do Congresso e dos resultados por elle alcan^do se Dies recommenda a leitura da 
Acta Final — a expoeiy^o geral concemente & mesma— publicada sob a direcgSo do 
8r. Dr. James Brown Scott, Relator Geral do Congresso, e o relatorio do Secretario 
Geral, preparado pelo abaixo assignado e pelo Secretario Geral Adjuncto 8r. Dr. 
Glen Levin Swiggett. Nestes trabalhos encontrar-se-hSo nSo s6mente a acta final 
mas tambem um magnifico commentario, a llsta dos delegados dos Govemos que 
adheriram, sodedades, institui9des de ensino e outras corporayOes, seguidas de uma 
cuidadosa historia do Congresso. Estes volumes continuam d disposigfto dos que os 
pedirem ao Director Geral da Unifio Pan-Americana, Washington, D. C. 

Em conclusfto, eu desejo repetir, em duas palavras, como Secretario Geral do Con* 
gresBo, o meu apre^ e reconhedmento, que jd tive occasifio de exprimlr no men 
relatorio official, pela cordial coopera^ que por todos me foi prestada para levar 
a bom ezito este congresso, desde o Preeidente dos Estados Unidos, V. Exa., coma 
Secretario d'Estado, os Senhores Delegados da America Latina e dos Estados Unidos 
at^ OS diversos funccionarios do Congresso. grande intereese manifestado pela 
CommisB&o Permanente Executiva presidida pelo Sr. William Phillips, ao tempo 
terceiro Sub-secretario d'Estado, pelo Institute de Carnegie pan a Paz Intemacional 
na pessoa do Sr. Dr. James Brown Scott, assim como a coUaborag&o prestada pela Sr. Dr. 
Glen Levin Swiggett, como Secretario Geral Adjimcto, constituiram obras basilares 
para o successo desta reunifio. 

A UniSo Pto-Americana, instituiydo intemaclonal sustentada por todas as Repu- 
blicas Americanas e cujo Conselho de Administra^ 6 constituido pelos represen- 
tantes diplomaticos em Washington e pelo Secretario d'Estado dos Estados Unidos, 
conlribuiu com a sua poderosa influencia para o bom exito do Congresso e me aucto- 
lizou a servir de Secretario Geral do Congresso. 

Com a mai<»r con8iderac2o, subscrevo-me 

De V. Exa., 
Vor. Mto. Atto., 

John Barrett, 

Seeretatio OfTtU. 

Exmo. Snr. Sborbtario db Ebtapo, 

WoMhingUm, 2>. C. 



X LETTEES OF TRANSMITTAL. 

Washington, D. C, 31 de tnayo de 1917, 
Se^or: 

En cumplimiento de una recomendaci6n emanada de la Comisidn Ejecutiva del 
S^:undo Congreeo Ciendfico Fanamericano que se ieuni6 en Washington deede el 
27 de didembie de 1915 hasta el 8 de enero de 1916 y gracias a la cooperaci6n id efecto 
prestada por el Congreeo de Ice Estados Unidoe mediante su ley eobre rectificaci6n del 
presupuesto dictada el 8 de setiembie de 1916, h^oise recopilado y preparado pan 
sa publicaci6n, bajo la hibil direccidn del Sr. Dr. Glen Levin Swiggett, Subeecretaiio 
General, las memorias presentadas a dicho Congreso y los debates a que dieron lugar. 
£1 presente volumen contiene el informe relativo a la Secci6n VIII, de la cual fu6 
presidente el General W. C. Ckirgas, miembro de la Gomidi6n Ejecutiva. 

En el informe general que ya tuve el honor de presentarle, me fu^ dable considerar 
detenidamemte la importanda del S^:undo Congreso Cientffico Fanamericano, la 
numeroea concurrencia que al mismo asbti6 y el elevado m^to de las memorias 
presentadas y de los debates que en aquel se susdtaron. Por consiguiente, he de 
limitarme en la presente, destinada a servirle de mera introducci6n a cads imo de los 
voldmenes, a algunas consideraciones de car^ter general. 

En el Congreso estuvieron representadas por medio de delegaciones ofidalee las 
veinte y una repdblicas del Hemisferio Occidental. Tambi6n asistieron al mismo, 
tomando participaci6n en bus debates y presentando trabajos personales, delogados 
particulares de los prindpales cuerpos cientfficos y de los institutes docentes de esas 
mismas repdblicas. En tal virtud, las memorias y los debates mencionados deben ser 
considerados como la expresiiSn de un amplio esfuerso denttfico panamericano, 
encenando, por lo tanto, un valor inestimable. 

El Congreso estuvo dividido en nueve secciones prindpales que en seguida paso a 
enumerar junto con el nombre de sus presidentes. Fueron las siguientes: 

I. AMTEOPOiiOoiA. W. H. Holmes. 

II. AsTEONOidA, MsTBOROLOOiA T SisMooEAiiA. Robert S. Woodward. 

III. CONSKRVAadN DB IA8 FUSNTBS NaTUBALBS DB RiQUBSA, AoBIOULTUBA, 

iBBiGACiiN T Sblvicui/tuba. Geofgo M. Rommel. 

IV. iNSTBUOoidN. p. p. Clazton. 

V. iNOBNiBRiA. W. H. Bizby. 

yi. DbBBCHO iMTBBNAaONAL, DbBBCHO Ft^UOO T JURISPRUDBNCIA. JamOS 

Ikoini Scott. 

Vn. MnrBRiA, Mbtaluboia, GbolooIa EooNdmcA t QubnoA Afucada. Hen- 
nen Jeimings. 

YHI. Salubridad FtBUOA T CiBNCiA MioioA. William C. Gorgas. 

IX. Traspobtb, CoMBBao, FiNANZAS B Impubstos. L. S. Rowe. 

Estas secciones estuvieron dividas, a su vez, en cuarenta y dnco subsecdones. 

De las repdblicas latino-americanas asistieron m^ de doscientoe del^ados; en 
tanto que las sesiones del Congreso concurrieron m^ de mil personas de los Estados 
XJnidos. Los trabajos y debates del cuerpo despertaron ludversal inters, pues indu- 
dablemente fu6 aquel la asamblea dentffica m^ grande que registra la historia del 
Hemisferio Occidental y probablemente la del mundo. 1^ fu^, en consecuencia, digno 
continuador del Primer Congreso Cientifico Fanamericano que en 1910 se reuni6 en 
la capital de Chile y de los que previamente y con iina asistenda exdusivamente 
latino-americana se habfan congregado en Rfo de Janeiro, Montevideo y Buenos 
Aires. Su ^to fu^ consecuenda Idgica de las asambleas que anteriormente se habfan 
teunido en la Am6ncA latina y del cordial concurso que recibid de los gobi^nos y 
de los hombres de denda de esa misma parte de Am^ca. 

A cuantos no quisieren limitane a consultar los voMmenes que contienen las 
memorias y los debates y desearen conocer algo mis de las labores del Congreso y de 
ios resultados por 61 alcansados, se les recomienda la lectura del Acta Final y de la 
Kxpoaid6n General concremiente a la misma que escribio el Dr. James Brown Scott, 
Informante General del Congreso, asf como el Informe del Secretario General, prepa- 



LBTTBBS OF TRANSMITTAL. XI 

mdo por el suacrito y por el Dr. Glen Levin Swig^ett, Subsecretario Gena»l del 
mismo. En estoe documentos podr&n hallar no 86I0 el Acta Final 7 luminoeas consi- 
detadonee acerea de la mieana, sine tambi^n la n6mina de I08 delegados y de los 
gobiernofl, Bociedadee e institatoa docentee que tuvieron repreeentacidn en la Asamblea, 
juntamente con una relaci6n puntualizada de \bb labores de la miama. Loe que deseen 
obtener eatoe voldmenes pueden aollcitarloa del Director General de la Uni6n Pan- 
amerirana en W^bhington, D. C. 

Como Secretario General del Congreeo deeeo hacer constar una ves m^, antes de 
concluir, el agradecimiento que en mi inlurme general express por el cordial concurso 
que de todos redbf para aaegurar el 6xito del Gongreao, deede el Preaidente de loa 
Eatadoe Unidoa y usted miamo como Secretario de Eatado y deede loa delegadoa de 
la America Latina y de loa Eatadoa Unidoa haata loa diveraoa funcionarioa del Congreao. 
El gran inter^ deapl^gado por la Gomiai6n Permanente Ejecutiva, que preaidid el 
Sr. William Phillipe^ a la aasdn Tercor Subaocretaiio de Eatado; por la Fundaci6n 
Gamegie para la Paz Intemacional, por el drgano de au Secretario, Dr. Jamea Brown 
Scott; aai como la colaboraddn del Dr. Glen Levin Swiggett, Subaecretario General, 
contribuyeron poderoaamente a hacer memorable la aaamblea. Ja Uni6n Pan- 
amerirana, inadtucidn intemacional aoatenida por todaa laa reptiblicaa de America y 
cuyo Oonaejo Directive eatd formado por loa repreeentantea diplom&ticoa latino- 
americanoa reaidentea en Wdushington y por el Secretario de Eatado de loa Eatadoa 
Unidoa, contribuy6 con au poderoaa influenda al 6xito del Congreao y me autorizd 
para que deaempefiara laa funcionea de Secretario General de aqu^. 

Con aentimientoa de la m^ alta consideracidn me aubacribo 
De uated muy atento aervidor, 

John B^rbett, 
Secretario General. 

Al Honorable Skcrbtario db Estado, 

Wdshington, D. C. 



Washington, D. C, Le 31 max 1917, 

Monsibur: Conform^ment i la recommandation du Comity Ex6cutif du Second 
Congrte Scientifique Panam^cain qui a eu lieu i Waahii^ton du 27 d6cembre 1915 
au 8 Janvier 1916, et par la cooperation du Congrte dea Etats-Unia (loi du budget 
extraordinaire, 8 aeptembre 1916), lea m^moirea et diacuaaiona de cette grande rdunlon 
adentifique intemationale ont ^t^ recueillis et ^t^ pour dtre public aoua Thabile 
direction du docteur Glen Levin Swiggett aoua-aecr^taire g^n^ral . Ce volume contient 
le rappOTt de la aection VIII, dont M. le g^n^ral W. C. Gorgas du Comity Ex^cutif 
etait prMdent. 

Dana mon rapport offidel qui a ^t^ d^jli aoumis, je me suia ^tendu sur Timportance 
du Second Congr^ Sdentifique Panam^ricain, sur le grand nombre de personnea qui 
y etaient pr^aentea et sur Texcellence de sea m^moires et de ses discussions. C'est 
pourquoi, dans cette lettre qui, apr^ avoir subi quelques changementssans, impor- 
tance, sort d 'introduction i chaque volume, je n'en parlerai que d'une mani^ 
gtedrale. 

Toutea lea r^publiquea de rn^misph^re Ocddental au nombre de vingt-et-une 
^taient repr^sent^ au Congrte. De plus, dea d^l^gu^ ^ titre officieux envoy^ 
par lea associations sdentifiquea et lea institutions 6ducativea lea plus en vue de cea 
r6publiquea ont aoumis dea m^moirea et ont pris part aux d^b'b^rations. On pent 
done consider lea m^moires et lea discussions comme Texpression d'un grand effort 
sdentifique panam^ricain, poss^dant en consequence une valeur inestimable. 

Le Congr^ etait divisd en neuf sections principales que nous enum^rons d-dessous, 
eo donnant le nom de leura pr^aidenta. 

I. Antbopolooib. W. H. Holmes. 

n. AaTRONOMiB, MtrioBOLOOiB BT SisifOLOQiB. Robert S. Woodward. 



XI [ LETTEB8 OF XBANSMITTAL. 

III. Ck>N8BRyATI0N DBS RbSBOUROBS NaTURBLLBS, AORIOULTURB, iRRIGAnOK 

BT FoRftrs. George M. Rommel. 

IV. iNSTRUOnON PUBUQUB. P. P. ClftXtOIl. 

V. GiNiB Civil. W. H. Bixby. 

VI. DROir Intfrnatiokal, Droit Public ft Juivi8PRxn>BNCX. Jame^ Brown 
Scott. 

VII. MlNKA, M^ALLURQIE, GAOLOGIR PRATIQT7B, CT OhIMIB ApPLIQiriB* 

Hennen Jeiinings. 

VIII. Santb Pubuqub et Soibncb M^icalb. William G. Gorgas. 

IX. TRAN9POPT, COMMBROE, FiNANCM BT ImpOt. L. S. Rowe. 

A leur tour cca sections 6taieDt subdivis^ en quarante cinq eoup-sectione. 

On y comptait plus de deux cents d^^^ de<9 r^publiques latino-amdricaines, et 
plus de mille 64A6ga6a des EtatR-Unis ont assists aux reunions. Les discussioM et 
len proc^verbaux du Congr^ ont attir^ I'attention du monde entier, et Q a ^t6 sans 
le moindre doute la plus grande assemble scieniifique interna tionale de I'histoire 
de 'H^misph^re Occidental et peut-^tre mdme da monde entier, qui se soit r6unie jus- 
qu'ici. Venant apr^ le Premier Congr^ Scicntifique Panamdricain qui s'est r6uni k 
Santiago, capitale du Chili, en 1908, ev apr^ ceux qni ont eu lieu pr^cMemment, respec- 
tivement k Rio de Janeiro, k Montevideo et k Buenos-Ayres, ces demieis n'ayant que 
des repr^eentantB de P Am^que Latine, il e'est montr6 leur digne succeoseiur. Sa r^us- 
site a 6t4t un logique r^sultat de cee pr^o^dents conckuis dans PAm^que Latine et de 
la sinc^ et cordiaie cooptotion des gouvemements et des hommes de science de 
PAm^rique Latine. 

Pour ceux qui u'ont port6 leur attention que sur les volumes renfermant les m^moires 
et les discijstdons, et qui d^reraient connattre d*une mani^ plus approfondie lee 
actes et proc^-verbaux du Congr^, ainsi que les r^ltats qui s'en sent snivis, je leur 
conseillerai de lire "L'acte Final, Commentaire explicatif,'' r6dig^ bous la direction 
du docteur James Brown Scott, rapporteur g6n^ral du Congr^, et le rapport du Secre- 
taire Gen6ral r^ig^ par ce dernier et le docteur Glen Levin Swi^cgett. En les lisant 
on n'y tiouvera pas seulement TActe Final et le commentaire explicatif, mais encore 
les listes des d6l^^, dee gouvcmemento qui ont particip6 au Congr^, dea sod^t^ 
des institutions ^ducatives et autres, en m^mo temps qu*un compte rendu soign^ 
ainsi que I'histoire du Congr^. On pent se les procurer en faisant unu demande par 
4crit au Directeur G^n^ral de TUnion Panam^ricalDe k Washington, D C. 

En terminant, je vais en quality de Secretaire General du Congr^ exprimer de 
nouveau en peu de mots mee remerctments, ce que j'ai d^j^ fait dans mon rapport 
officiel pour la part que chacun a eue dans la reussite du Congr^ depuis le President 
dee £tat8-Unis, vous comme Secretaire d'etat, les dei^gu^s de PAmdrique Latine et 
ceux dee £tats-Unis jusqu'aux employes de biireau. Le haut inter^t manifeste par 
le Comite Ex^cutif permanent preside par M. William Phillips, qui etait alors troisi^me 
Sous-Secretaire d'Etat, par la Fondation Carnegie pour la Paix Internationale, par 
Pentremise de son secretaire le docteur James Brown Scott, et I'aide prdte dans Pexe- 
cution par le docteur Glen Levin Swiggett, comme sous-secretaire general, ont puissam- 
ment contribue k hire de ce Congr^ un evenement memorable. L'Union Panameri- 
caine, administration officielle intemationale de toutes les republiquee americaines, 
et dont le Comite d'Admimstration est compose des diplomates latino-americains k 
Washington et du Secretaire d'etat des £tat8-Unis, a use de sa favorable influence pour 
assurer le succ^ du Congr^ et m'a autorise, en qualite de Directeiur General de 
PUnion, k prendre en mains les responsabilites de Secretaire General du Congr^. 

Veuillez agreer, M. le Secretaire d'l^tat, en m^me temps que mes respectueux 
hommages Tassurance de mon entier devo(kment, 

John Barrett, 
Secretaire GSrUral. 

Monsieur le Segr^airb d'^at, 

Washington, 7). C. 



REGISTER OF WRITERS OF PAPERS. 



FIRST PAKT. j^^ 

Agramonte, Aristidee 100 

AndrewB , John B 280 

Audain, L UO 

Bauzi, Julio A 242 

Brazil, Vital 258 

Bronner, Augusta F 636 

CaldweU, Bert W 77 

Carter, H.R 41 

Chapin, Charlee V 403 

Dearholt, Hoyt E 633 

Devine, Edwaid T 187 

Doty, AlvahH 623 

Dublin, Louis 1 356 

Btchepare, Bernardo 651 

Etchepare, Julio 352 

Feinmann, Enrique 640 

Femtodez, Mauro 687 

Fiallo Cabral, Aristidee 261 

Flaher, Irving 529 

Forest, Bobert W. de 616 

Fulton, John S 464 

Gallegoe, Felipe 196 

Gatewood, James D 599 

Goddard, Henry H 628 

Gons^ez, Justo F 115 

Goigae, Gen. TVilliam G 7 

Gorriti, Fernando 696 

Guena, ArturoL * 264 

Guilfoy, William H 411 

Gmteras, Juan 9 

HayhuTBt, E. R 288 

Healy, William 636 

Hurty, J. N 398 

Johnstone, E. R 631 

Keyes, Edward L., ]r 477 

KleinSmid, R.B.von 181 

Enab , Frederick 107 

Lappin, Richard C 374 

Le-Roy y Cassi, Jorge 416 

L6pez de Mesa, Luis 166 

Lovejoy, Owen R 276 

Lyster, Major T. C 106 

Mathon, C 110 

McFarland, J. Horace 385 

xm 



XIV RE0I8TEB OF WBITEBS OF PAPEBS. 

Page. 

Meriam, Lewin 365 

Migone, Luis E 117 

Montev^de, Juan 322 

Moraga, PonrM, A 674,688,698 

Morales Villaz6n , N ^stor : 126 

Muhm, Teodoro 262 

Munson, Edward L 590 

Narancio, Atilio 196 

Nolen, John 387 

Oliva, Silvestre 518 

Oliveira Botelho, Joaquim de 305,613 

Olmsted, P. L 377 

P^raico, Alfredo 483 

Rankin, W.S 344 

Ravenel, Mazyck P 85 

Reeder, D. F 610 

Re}mold8, James Bronaon 496 

Ribas, Emilio 123 

Rivas, Ddmaso 95 

Rodrigues da Costa Dorla, Joe6 151,247 

Rossi, Santin Carlos 667 

Ruoda, P 233 

Salterain, Joaquin de 456 

Sarmiento Laspiur, Ricaido 162 

Schapiro, Louis 330,587 

Smith, Allen J 49 

Snow, William F 486 

Susini, JuanD 236 

Trask,JohnW 347 

Turenne, Augusto 283 

Varela, Tomis S 612 

Veiller, Lawrence 314 

White, William A...., \. 645 

White, William Charles 300 

Wilbur, Cressy L 400 

Wilcox, Walter F 336 

Wiley, Harvey W 146 

Woodward, William C 526 

Zanotti Cavazzoni, Luis 274 



FOREWORD. 



The work of the hygienic section has been most valuable. It has 
already produced excellent results in causing the Rockefeller Foun- 
dation to undertake the work of exteraiinating yellow fever. All 
the South American countries affected by this disease have agreed 
to cooperate, and if it had not been for the European war the work 
would have now been well under way. 

(Signed) W. C. Goegas, 

Chairmofln,. 

XT 



x^ 



SECOND PAN AMERICAN SCIENTD1C CONGBESS. 



KlfiCUTIVK COfiiMrnBB. 

WiLUAM Phillips, Aasistaiit Secretary €i State, Chairmaii ex officio. 

Jamxs Bbown Soott, Secretary, Carnegie Endowment for International Peace, Vice 

Chairman. 
William H. Wblch, President, National Academy of Sciences, Honorary Vice 

Chairman. 
John Babrbtt, Director General, Pan American Union. 
W. H. BiZBT, Brigadier General, U. S. A., retired. 
Philandbr p. Claxton, Commismoner of Education. 
WiLUAM C. GoBQAS, Suigoon General, U. 8. A. 
William H. Holmbs, Head Curator, Smithsonian Institution. 
Hbnnbn Jbnnikos, fonner President, London Institution Mining and Metalluigy. 
Gbobqb M. Rommbl, Chief, Animal Hushandry Division, Bureau of Animal Industry, 

Department of Agriculture. 
L. S. RowB, President, American Academy of Political and Social Science. 
Robbbt S. Woodwabd, President, Carnegie Institution ai Washington. 



ORGAraZATION OPnCBBB. 

John Babbbtt, Secretary General. 

Glbn Lbvin Swioonr, Assistant Secretary General. 

684»e— 17— VOL IX 2 



1 



SECTION Vin.— PUBLIC HEALTH AND MEDICAL SCIENCE. 

William G. Goroas, Surgeon General, United States Army, Chairman. 
John Van R. Hofp, colonel, United States Army, retired. Vice Chairman. 
Eugene R. WHrrMORS, major, Medical Corps, United States Army, Secretary. 

COMBOTTBES. 

SuBSBCTiON A.— Public Health. 
Rupert Blue, Surgeon General Public Health Service, Chairman. 

Subsection B.— Vital Statistics. 

Samuel L. Rogers, Director of the United States Census, Chairman. 

Subsection C. — Sociological Medicine. 

Gborob M. Kodkr, President National Aflsodation iar the Study and F^vention of 
Tuberculosis, Chairman. 

Subsection D. — Sanitalion. 

WnjJAM C. Braistbd, Surgeon General United States Navy, Chairman. 

Subsection E. — Laboratory Conferences. 

Eugene R. Whttmorb, majw, Medical Corps, United States Army, professor o£ 
pathology and tropical medicine, Army Medical School, Chairman. 



SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 



AIMS AND PURPOSES. 

The congress, in accordance with its high aims and purposes, 
namely, to increase the knowledge of things American, to dissem-^ 
inate and to make the culture of each American coxmtry the heritage 
of all American Republics, to further the advancement of science by 
disinterested cooperation, to promote industry, inter-American trade 
and commerce; and to devise the ways and means of mutual help- 
fulness in these and in other respects considered the following general 
program of subjects, divided into appropriate sections and subsec- 
tions. 

SECTION Vm.— PUBLIC HEALTH AND MEDICAL SCIENCE. 
PUBLIC HEALTH. 

Infectious diseases — the bearing of their modes of infection on 
methods of control; nutritional diseases — their pubUc health bearing, 
with special reference to beriberi and pellagra; reduction of infant 
mortality. 

VITAL STATISTICS. 

Sickness (morbidity) reports; birth and death registration. 

SOCIOLOGICAL MEDIOINE. 

Relation of the individual to the community; ways and means of 
bringing matters of public health to social usefulness; public health 
measures — ^industrial hygiene and sanitation; venereal prophylaxis, 
alcohol and drug prophylaxis; tuberculosis; mental hygiene. 

SANITATION. 

Town and city planning; buildings for human occupancy; food 
and water supply; ventilation; disposal of refuse. 

LABORATORY CONFERENCES. 

SympK>sia on anaphylaxis, Ufe histories of protozoa , and cancer 
research. 

5 



£ PBOGBBDINQS SECOND PAN AMBBICAN SOIEKTIFIO C0K0BB8S. 

RESOLUTIONS AND RECOMMENDATIONa 

The Second Pan American Scientific Congress considered and dis* 
cussed the subjects set forth in its program in the light of an inteU 
lectual Pan Americanism in a series of meetings from December 27, 
1915, to January 8, 1916, and adopted resolutions and recommenda- 
tions pertinent to the work of the nine main sections of the congress. 
The following recommendations refer to Section VIII: 

Article 39. 

The Second Pan American Scientific Congress, recognizing that the 
education of the pubUc in the elementary facts of malaria is of the 
utmost importance, requests that the American Republics inaugurate 
a well-considered plan of malaria eradication, based upon the recog- 
nition of the principle that the disease is preventable to a much 
larger degree than has thus far been achieved. 

Article 40. 

The Second Pan American Scientific Congress urges that the Amer- 
ican BepubUcB in which yellow fever prevails or is suspected of pre- 
vailing enact such laws for its eradication as will best accomplish that 
result; inasmuch as yellow fever exists in some of the European col- 
onies in America, they be invited to adopt measures for its elimina- 
tion. 

Article 41. 

The Second Pan American Scientific Congress recommends that 
such of the American Republics as have not already done so should 
justify the international conventions concerning the white-slave 
trade. 



GENERAL SESSION OF SECTION VIIL 

New Ebbitt Hotbl, 
Tuesday morning, December £8, 1916. 

Chairman, William C. Gorgas. 

The session was caUed to order at 9 o'clock by the chairman. 

YELLOW FEVER AND ITS ERADICATION. 

By WILLIAM C. GORGAS, 
Surgeon General^ United States Army. 

I should like to diacuss before you to-day yellow fever, and more particularly td 
discuss its sanitary side. Yellow fever is one of the diseases that America has inflicted 
upon the human race and I hope before many more years shall have passed that we 
shall be able to say that Americans have freed the human race from this fell destroyer. 
When the Europeans first came to America, in the latter part of the sixteenth century, 
they found yellow fever on the Mexican littoral of the Gulf of Mexico. Fevers at this 
time were not differentiated so that they did not recognize it as a distinct disease. 
The vastly increased travel caused by the coming of the whites gradually spread 
yellow fever far beyond its original bounds. About the beginning of the nineteenth 
century it bad spread through all the American tropics, the American Temperate 
Stoes, had ravaged Spain and had spread down the West Coast of Africa. At this 
time it looked very much as if yellow fever was about to become one of the great 
world-plagues, as had cholera and plague. It takes no very vivid imagination to pic- 
ture what tlie conditions would be when this disease had spread around the Mediter- 
ranean Sea, through India and into China. If the ravages in these regions were as 
great as had been the ravages in Spain, the gloom of the picture could hardly be over- 
drawn. In the year 1800 it looked as if yellow fever had entirely conquered America, 
was firmly established in Europe and Africa, and as if it were weU on its way to an 
equally firm footing in Asia. About this time steam navigation was introduced and 
sailing vessels began to be displaced as a means of sea travel. The sailing vessel was 
peculiarly adapted for carrying yellow fever from one port to another. The sailing 
vessel has to carry a large supply of fresh water for the use of its crew. This tank of 
fresh water was well adapted to breeding the st^gomyia mosquito, and the sailing ship 
in wann climates always had on board a plentiful supply of these mosquitos. The 
sailing ship upon coming into a port and tying up to a dock where st^gomyiaprevaUed 
at once had stegomyia come aboard, lay eggs in the water tank and from that time 
forward carried with her a plentiful supply of stegomyia. While in this condition 
whenever a human being came aboard in the early stage of yellow fever he was bitten 
by scnne of these mosquitos and the ship at once became infected . By means of these 
sailing ships yellow fever was transmitted and epidemics started far beyond the north- 
em habitat of the stegomyia mosquito. In Boston, for instance, the epidemic would 



8 PBOCEEDINGS SECOND PAN AMERICAN SCIENTIPIC C0N0BE8S. 

be started in this way: A ship supplied with stegcnnyia would come into the harbor 
and tie up to the dock early in the summer. The stegomyia would escape from 
the ship and begin to breed in the neighboring cisterns, wells, and other fresh- 
water deposits. Later in the summer an infected ship would come into the port. 
A man in the early stage of the disease would sleep ashore and infect the stegomyia 
ashore. This would start the epidemic which would continue imtil the cold weather 
came on and killed all the stegomyia. The introduction of steam vessels changed con- 
ditions so that they were very much less favorable to breeding stegomyia aboard 
ships. 

Steamships, when they carry fresh water, carry it in tanks located in parts of the 
ship not accessible to mosquitos, and gradually steam vessels have ceased to carry 
any considerable supply of fresh water, but distil it from time to time as needed . With 
the introduction of steam vessels the area affected by yeUow fever was slowly con- 
tracted till by 1900 the disease was confined to tropical and subtropical countries. In 
1901 Reed and his co-workers annoimced to the world their great discovery that yellow 
fever was conveyed from man to man by the bite of the female stegomyia mosquito 
and in nature in no other way. The sanitary authorities of Havana with the knowledge 
of this means of transmission wero enabled to entirely eradicate yellow fever from the 
city of Havana. For 150 years Havana had never been free from yellow fever and 
had been the endemic focus from which yellow fever had spread to all the Northern 
Hemisphere which had been infected by yellow fever. Within 10 years after the 
eradication of yellow fever from Havana the disease had practically disappeared from 
the Northern Hemisphere. The yellow fever sanitary measures worked out at Havana 
have since been adopted at Panama, Rio de Janeiro, and other places in the tropics. 

Yellow fever since 1901 has been driven from stronghold after stronghold till it is now 
endemic in only three or four communities, and there is no reason why these com- 
munities, in which yeUow fever is still endemic, if they adopted the sanitary meas- 
ures now well known as applicable to yellow fever, should not themselves become free. 
As we look back over the history of animal life as revealed to us by geology, for the 
past two or three million years we can see that thousands of different species of animals 
have been slowly brought to perfection through untold eons of time. For various 
causes many species have become extinct. Where the last animal of a species had 
died there is no possibility of again restoring this species. As far as we can tell from 
our geological record a species once extinct has never been redeveloped. The titano- 
saurus, for instance, which became extract many thousand years ago, we know has 
never been redeveloped from any remaining animal, and we all of us know that it is 
impossible for the titanosaurus to be redeveloped from any animal at present on the 
earth during any length of future time. Now the same is true of the yellow fever 
parasite. 

While we do not know the yellow fever germ from its analogy to malaria, we know 
that it must be a parasite very similar to malaria. If we can once get rid of yellow 
fever in the two or three places in the world where it is at present endemic the yellow 
fever parasite will be in exactly the same condition that the titanosaurus now ia. 
No environment or no length of time could ever redevelop this parasite, and man for 
the first time in his history would have completely conquered a disease. He will 
not only have conquered it, but he would have placed it in such condition that no 
faults or errors on his part would ever cause him to be again scourged by this fell 
destroyer. 

There is no doubt in anybody's mind that if the buffalo were a hurtful animal and 
the United States wished to deliver the world from the buffalo they could issue orders 
today which would cause the buffalo to become entirely extinct by the first of next 
February. Now, the yeUow-fever paiasite is in a much more precarious condition 
than the buffalo. There are many more herds of buffalo in the United States than 
there are endemic foci of yellow fev^ left in the world, and the countries in which 



PUBLIC HBALTH AND MEDICINE. 9 

theae foci exist could iamie sanitary orders which would cause the extinction of yellow 
fever by December 31, 1916, just as certainly as could the extinction of bu^o be 
brought about. 

The countries rejnresented in this congress are the ones principfdly concerned with 
yellow fever. This section of the congress is the section concerned with hygiene and 
sanitation. I therefcwe uige upon the section that they appoint a committee who 
shall draft resolutions urging the countries concerned to adopt the measures, in the 
two or three places where jrellow fever Ib still endemic, which have been so successful 
in driving yellow fever from the rest of the world. 

Dr. Juan Guiteras. Mr. Chairman, I would move you that a com- 
mittee be appointed by the chair to prepare a form of resolution to 
be presented to the general congress for action, tending to take up 
the question of the complete eradication of yellow fever from the 
Western Continent. 

The motion was seconded and unanimously approved. 

The Chaismak. I will appoint on the committee Dr. Vital Brazil, 
of Brazil, Dr. Juan Guiteras, of Cuba, and Dr. Henry Carter, of the 
United States, the committee to elect their own chairman. It would 
be desirable, if possible, for the committee to bring in this resolution 
for the afternoon meeting. The sooner it is adopted, the sooner we 
can get it to the general meeting of the executive conmiittee. 

I shall now call for the first paper on the program, ''Problems of 
insect-borne diseases in Pan America," by Dr. Juan Guiteras, of 
Habana, Cuba. 



ENFERMEDADES TRANSMITIDAS FOR INSBCTOS EN PAN-AMfiRICA. 

Pot JUAN GUITERAS, 
ProftiCT de Patologia Otmral y de Bnfermedadea Tropicales en la Univenidad de la 

Habana. 

El Presidente de la Secci6n m^ca del Gongreso ha tenido la bondad de sefialarme 
el tema de eete trabajo para su desarrollo y, dentro de los llmites de tiempo que se me 
ha concedido para la preparaci6n, me esforzar6 por llenar mi cometido de la mejor 
manera posible, atendiendo mis espedalmente a aquellos foctores del problema que 
puedan afectar o iuteresar las relaciones intemacionales de los palses que estin aqui 
representados. 

En la doctiina de las enfermedades transmitidas por insectos se revive de una 
manera singular y bajo los auepicios de la ciencia, el pensamiento sendllo y directo 
del pueblo desde tiempos muy remotos. La opini6n popular acogla f&cilmente la 
idea de la penetraci6n de las enfermedades por la superficie externa del cuerpo, 
s^tin se desprendd del concepto expresado por la palabra contagio. Asi vemos a 
Apolo en la leyenda hom6rica, lanzando a lo lejos sus dardos sobre los griegos para 
henries con terrible pestilencia, y asi tambi^n, mds tarde, en la Edad Media, encon- 
tramos la leyenda de los imtos como causa efectiva de la propagacidn de la Peste. 
Los recientes deecubrimientos de diversas infeccionea transmitidas por insectos, han 
confirmado estas opiniones, estableciendo un grupo notablHsimo de enfermedades 
introducidas "pot la niel: FilariasiH. Fiohre Amarilla, Paludismo, Peste, Tripanoso- 



10 PBOOEEDINOS SECOND PAN AMBBIOAN SCIENTIFIC CONOBESS. 

miaais, Espiioquetoaui, Undnariasis, LeLBhmaiuasu, y otras. Incluye el grupo 
algnnas de las inf ecciones de mim grave importanda para la rasa humana. 

En la mente popular, la piel, la parte m^ expuesta del cuerpo, se presenta como 
la m^ vulnerable, y acept&base naturalmente esta via como la m&B directa y sendlla 
para las infecdonee. Pero de tal modo estaba imbulda en los hombres de dencia la 
idea de medios de traniimiai6n mim rec6ndito8 y complicados, que, aun deepu^s de 
aeomar los primeros albores en estos campos de investigad6n, el gran inidador miono, 
el Dr. Patrick Manson no supo llegar a la vordad completa de la inoculad6n directa 
de la filaria por el n^osquito, sine que bubo de inventar la via tortuosa que suponfa la 
muerte del mosquito filari^lco en el agua, y la ingestidn del par&aito con aquel Ifquido 
por la via g^strica. Y mis redentemente aun, cuando bacfa ya ados que Finlay 
predicaba la transmiaibilidad de la Fiebre Amarilla de bombre a hombre por el 
mosquito, directamente a trav^ de la piel, Manson todavla indicaba la misma via 
torcida, por el mosquito y el agua al estdmago del bombre, para la propagad6n del 
Paludismo. 

Es de sentirse que drcunstancias, entre las cuales cuento el haber sido escogido yo 
como ponente, impidan el desarrollo de este tema en forma que mejor se ajuste con la 
ocaai6n preeente; porque en v^dad que nunca bubiera podido escogerse tema alguno 
que mds digno fuera de un Congreeo de esta indole. El tema es eminentemente un 
tema americano, del cual puede decirse, que ha derramado m^ gloria sobre la dencia 
americana que acaso los temas todos juntos que pudieran presentarse ante un Con- 
greso Pan-Americano. 

Americano fu6 el que, en el afio 1881, de una manera precisa y con acopio de dates 
Men fundamentados, declai6 por primera ves que se transmitla de bombre a bombre, 
por la picada de un Insecto, una inlecci6n de caiicter general. 

Que infecdones de esta naturaleza se relacionaban de algtin modo con las picadas 
de insectos, que parecfan inocular algtin veneno, producto de descomposidones de 
substancias animales o vege tales en el ambiente, la tierra, los pantanos, el aire; era 
una nod6n entrevista desde tiempos atr&s por pueblos salvajes, o poco menos, en 
diversas regiones y propuesta como solud6n dentifica por pensadores originales como 
Beaupertliuy (3), Nott (38), y, ya deerpu^ de la declarad6n terminante del Dr. Finlay, 
tambi^n por Eing (31). Extensas dtas de estos tiabajos, con observadones, se 
encontrar&n en la Bibliograffa que acompafia este escrito. 

Pero la declaraddn precisa de que el microbio de la fiebre amarilla se transmits 
de bombre a bombre por la picada de un insecto, y que este insecto no podfa ser otio 
que el mosquito que boy Uamamos Aedes calopuSf eea declaiad6n la bizo el ado 1881 
el Dr. Carlos J. Finlay, como consecuencia de genial razonamiento que se fundaba en 
una serie de profundas observadones y originales experiencias sobre la bionomfa de 
aquel dfptero. De esta manera se presenta el Dr. Finlay como fundador de la doctrina 
de enfermedades de tranamisidn insectil. No s61o fu4 el primero en mantener que se 
transmitfa una enfermedad del enfermo al sano por mediad6n de un insecto, sino 
que previ6 tambi^n que se bacfa mis virulenta la picada al transcurrir algtin tiempo 
deefpu6s de cbupada por el insecto la sangre del enfermo. 

Y fu4 tambi^ €1 el primero en aplicar un insecto bemat6fe^ a un enfermo y despu^ 
a un bombre sano con el objeto de tiansmitur un virus. Nos ensefi6 de esta manera el 
Dr. Finlay el m6todo de experimentad6n, con todos sus procedimientos de t6cnica, 
sobre el cual se fundan los grandes adelantos de la Medicina. Tropical. Invents 
tambl^n y public6, con todos los detaUes necesarios, el sistema que debfa seguirse 
para la extind6n de la Fiebre Amarilla. 

El Dr. Finlay falled6 el 20 de agoeto del ado en curso. Propongo a la Asamblea 
que se ponga en pi6 en reverenda a la memoria de aquel grande bombre. 

81 no fuesen sufidentee los anteriores triunfos para darle al Continente Americano 
la prioridad en este camix) de investigadones, podemos presentar la serie magistral de 



PUBLIO HEALTH AND MEDIOINE. 



11 



expeiimentoe que condujo a la comprobaddii por Smith y Kilbome de la tnui8mui6n 
de la fiebre tejana del guiado por la garrapata, el Margaropui annulatus, (50) 

Las inveBtigaciones de Smith y Kilbome y los resultados que obtavieron, consti- 
toyen la primera comprobaci6ii completa de la doctrina de Finlay, de la traiiflmiflidii 
de enfermedades por inaectos sanguisugos; y constLtuyen tambi^n la primera apli- 
cacidn can dxito de sa m^todo, ee a nber: la preparaci6ii de insectoe, con conodmiento 
completo de ea bionomk, para la vida de laboratorio y para obtenm*, a volnntad, picadas 
socesivas sobre animales enfermos y sanoe, en condiciones que se aproximasen lo 
m&s poable a las condiciones natorales.* 

Finalmente, si todo eeto no faese bastante a establecer sobre base finne la prioridad 
americana, podemos sefialar a la cdpula que corona el edificio, la obra de la GomisI6n 
del Ej^rcito de los Estados Unidos de Norte America, con la demostraci6n concluyente 
de la tnnfimisi6n por el mosquito de la Fiebre Amarilla, enfermedad epid^mica 
dotada de extraordinarias fuerzas de resistencia y de expanfli6n. (107), (108) 

Gomo resultado prictico del aistema de profilazis fundado en estas doctrinas, hemes 
eliminado del Gontiente, casi totalmente y en el transcurso de pocos afios, una de las 
pestilencias mis tembles que jam^ azotaron a la humanidad. 

y^ase Bibliograffa de (1) a (53). 

Pasarmnos a estudiar sucesivamente las enfermedades transmitidas por insectos 
que m&B impcvtanda tengan en Pan-Am6rica. 

Paludimo^—Entre estas enfermedades nos parece que el primer lugar le corres- 
ponde sin duda alguna al Paludismo. Es verdad que a primera vista la enfermedad 
no parece presentar ningtin grave problema intemacional, ni siquiera manifestaciones 
que pudi^ramos llamar de Inter^ general. Quiero dedr que el problema no se 
preeenta en forma alarmante a la opini6n pdblica. Podemos decir del Paludismo 
que es una enfermedad local y que, si su ^ea de distribuci6n es grande, est& com- 
iraesta de innumerables focos de cai^ter local. Son ^stos, sin embargo, tan numeroeos 
y ponstentes, que su caiicter fraccional no impide que, sumados los focos, constituyan 
la fuente m^ poderosa de destrucci6n de vidas y de eneiglas en la raza humana, 
exceptuando tan s61o la Tuberculosis. 

En ciertas regiones de los trdpicos, tan extensas algunas que llegan a formar nacionee 
de importancia, la mortalidad por el Paludismo puede superar a la de cualquiera 
otra enfermedad. Tal era la atuaci6n en Cuba en el ado 1900, que fu6 el primero en 
que contamos con dates del territorio todo de la Isla. Tal fu6 tambi6n la situacidn en 
Venezuela en el a£Lo 1910 y probablemente tambi^n en los afios anteriores, contando 
desde el 1905. (1) 

Nihruro de D^nciona por Paluditmo en Venezuela^ en lo$ afloe que $e espec^fican. 





Moertes 


Allot. 


por 




Paludinno. 


190B.... 


O.Olfi 


1906.-.. 


8,644 


1907.... 


7,006 


1908.... 


8,441 


1900.... 


10,268 


1910.... 


8,488 



El Annaiio de Venezuela que se cita, s61o da el ntbnero total de defuncionee por 
todas las catms paza el alio 1910. Pero las cifras del Paludismo se mantienen a tan 
elevado nivel, que no cabe dudar que en todos los alios mendonados la Malaria debe 
de ocupar el primer lugar, como ^n el afio 1910. Los infonnes de la India, de Italia, 

I Lm Ttrdadaros preo m aorea de Tinlay y Ifanaon se eoeoentnm entre lot iiiTettigtdoret del Ctibundo, 
Dvftim, O. Etodet tar Is oontagton da diarbon ehet let animtoz domettiiiaet. Balletin de TAotd. dt 
lfid.4aPafit,18T0. VoL XXXV, pi». 216 y 471. 



12 



PROCEEDINGS SECOND PAN AMEBICAN SCIENTIFIC CONGRESS. 



de Panami, del Braail, de la Isla Mauricio y otros, nos muestran iguales resultadoe 
para regiones determinadas, con exacerbaciones notables a vecee. Pueden ^etas 
alcanzar proporciones tales que Uegue a pioducirse un electo visible sobre la mor- 
talidad general. En estas condiciones decimos que existe un eetado de Paludismo 
epid6mico. 

En alios redentes nos vamos acostumbrando tambl^n a encontrar reducciones 
igualmente notables en la mortalidad por el Paludismo, como resultado de en^igicas 
medidas profiUcticas. 

Ejemplo muy notable de tales reducciones encontramos en las cifras demogr^cas 
de Cuba, segtin aparece en la gr&fica y cuadros adjuntos. 

Como antes dije, en el afio 1900, el Paludismo lleg6 a ocupar el primer puesto como 
mayor causante de las defunciones en Cuba. De entonces ac& ha descendido al 
vlg^sLmo lugar. Es este un resultado muy satisfactorio y Men vale la pena de estudiar 
las cifras en detalle. 

CuADRO I. — Ndmerode Defunciones por Falicdumo y Mortalidad por la misma causa por 
lOfOOO habitantes en los afios que se especijican. Repdblica de Cuba. 



Afios. 


Nrtmero 
de De- 
funciones. 


MortaU- 
dad. 


: Afios. 


NAmero 
de De- 
funciones. 


Mortali- 
dad. 

3.43 
3.38 
2.80 
2.25 
2.16 
1.87 
1.83 


1900 
1901 
1902 
1903 
1904 
1905 
1906 
1907 


4,107 
3,286 
1,546 
1,204 
1,079 
1,100 
1,147 
925 


25.16 
19.42 
8.79 
6.06 
5.79 
5.69 
5.77 
4.51 


1908 
1900 
1910 
1911 
1912 
1913 
1914 


730 
746 
622 
497 
493 
446 
453 



CuADRO II. — Defunciones por Paludismo y Mortalidad por la misma causa^ por 10,000 
habitantes en la Habcma en los afios que se especifican. 



Afios. 


Ntimero 
de De- 


Mortali- 
dad. 


' Afios. 


NtSmero 
deDe- 


Mortali- 
dad. 




funciones. 


1 


fondoDes. 


1871 


262 


13.01 


r 

1803 


246 


11.21 


1872 


316 


15.72 


1894 


201 


9.00 


1873 


829 


16.41 


1895 


206 


9.00 


1874 


288 


14.39 


1896 


450 


19.50 


1876 


284 


14.22 1 


1807 


811 


34.58 


1876 


334 


16.77 1 


1896 


1,907 


80.03 


1877 


422 


21.23 1 


1809 


'900 


37.35 


1878 


453 


22.77 t 


1900 


335 


13.02 


1879 


343 


17.23 


mi 


151 


6.87 


1880 


384 


19.27 


1902 


77 


2.90 


1881 


251 


12.59 


1903 


51 


1.87 


1882 


223 


11.77 


1904 


44 


1.50 


1883 


183 


0.16 


190S 


33 


1.11 


1884 


196 


0.80 


1906 


26 


a88 


1885 


101 ' 


5.05 


1907 


23 


a 76 


1886 


135 


6.71 


1906 


19 


0.60 


1887 


269 


12.43 


1900 


6 


0.18 


1888 


206 


10.37 


1910 


18 


0.46 


1880 


228 


11.16 


1911 


12 


0.30 


1890 


256 


13.30 


1912 


4 


0.12 


1891 


292 


13.78 


1918 


5 


a 16 


1802 


286 


13.26 


1914 


4 


0.11 



Como que el 6xito que exponen los anteriores cuadros se dehe principalmente a 
obra emprendida contra la Fiebra Amarilla, dejaremos para cuando se trate de dicha 
enfermedad el explicar c6mo se ha hecho esto y lo que ha costado. 

Dudoso es en \erdad que se pueda duplicar este ejemplo si tenemos en cuenta que 
la Hahana es una ciudad tropical de gran importancia comercial, centro de gran 
movimiento penonal y centro, por consiguiente, de grandes hospitales pdblicos y parti- 
culares; de loe cuales estos dltimos, por su organisaci6n especial, atraen un gran con- 




Ill-iSi^; 



srrr = :T = r« IS HIISI I S Mi 1 1 i 1 1 1 f H H • SH i ^ ; 2 









PUBLIC HEALTH AND MEDIOIKB. 13 

tiDgente del interior de la Reptiblica. Ck>n respecto a las eetadlsticas de esta dltima, 
conviene tambi^n recofdar que en todo el territorio no exiate lugar alguno donde las 
condiciones de temperatuza sean obst&culo a la e v oluci6n de las anofelinas. 

Refiri^ndome bievemente al quebranto econdmico que para una comunidad signi- 
fica el Paludiamo podemos decir, que el Director del Departamento de Entomologfa 
en Wasbington, L. O. Howard (24) eetima que las p^rdidas que el Paludismo le ocaai- 
ona a lod Estadoe Unidos pueden c&lcularse en 100 millones de pesos annates; y Angelo 
Oelli, deepu^ de entrar en detalles sobre el mismo asunto con respecto a Italia, y sin 
olvidar la influencia que sobre la emigraci6n sin duda ejerce el paludismo, concluye 
<*on estas palabres: ''Riassumendo, si pu6 dunque con certezza as8e\erare che la 
malaria casta annttalmenU aW Italia incalcoktlnli tesari,** (55) 

La campafia contra el Paludismo debe naturalmente de participar del miamo 
<:ardcter local que hemes sefialado con respecto a la distribuci6n y otras manifestaciones 
de la enfermedad. La obra, por consiguieDte, deberd subdividirse grandemente con 
el fin de cubrir las numerosas y desemejantes secciones del pals afectado. Las varias 
campafias que se proponen, y loe numerosos informes que se encuentran en la publi- 
caci6n que, bajo el titulo de ''Paludismo " edita el Comit^ para el estudio del Paludismo 
en la India, son muy caracterfsticos de esta clase de trabajos, s^n se descubre por 
la divisidn en comisiones y subcomisionee que con frecuencla dlfieren entre si en 
cuanto a oplniones y m^todoe. El Presidente del Comity Central se quejaba de estas 
divergencias y discusiones que no son sine resultados de la naturaleza misma del 
problema. (64) 

Ross (65) en su ezcelente monografla, reconoce la importancia de las opiniones 
locales y da mayor realce a su libro introduciendo en ^1 "contribuciones especiales" 
por autores que se ban labrado renombre intemacional por su labor en estoe proble- 
mas, en di'.ersas partes del mundo. 

Como era de suponer las campaiias antlpalddicas ban recibido mayor impulse, y 
han alcanzado sua mejores 6xitos en tomo de grandes centros de poblaci6n, o aquellos 
que por alguna causa especial se distinguen. Tales son las campafias de los ferro- 
carnles de Italia, de la Habana, de lamailia, de Panamd, de Mauricio, de Rio, Nueva 
Orleans, Bombay y otras. 

Encontiadas son las opiniones con respecto a los m^todos profil&cticos mia prove- 
choeoB en diversas localidades. Los campos contendientes pueden reducirse a doe 
grupoe, a saber: loe que ponen su esfuerzo principal en la campafta anticulicida, y 
los que se proponen Uegar a la inmunizaci6n del hombre por la administraci6n de la 
quinina en dosis profil&cticas. 

Tales discusiones me parece que pueden ser de inters en loe palsee donde no reina 
la Fiebre Amarilla; pero donde quiera que coexistan ambas infecciones, parece que 
debiera aceptaise como sistema fundamental de la profilaxis, la lucha contra el mos- 
quito que combate a la vez el Paludismo y la Fiebre Amaiilla. 

Los ^xitos que antes vimos patentizados en las eetadlsticas de Cuba, per obra anti- 
culicida ezcluaivamente se obtu\ieion. Con respecto a la quinina podr& dedrse que 
la droga se emplea hoy m&B eficazmente que antes; por lo menos no se gasta intitilmente 
en el tratamiento de estados que no son paltidicos; pero el uso profiUctico de la qui- 
nina no se ha empleado en Cuba, sino es individualmente. 

La inmunizacidn est4 muy claramente indicada en las enfermedades estrictamente 
humanas; pero, en aquellas infecciones que se mantienen en formas mis o menos 
larvadas en algtin animal intermediario, debemos sefialar los petigros de la seguridad 
falsa que se produce, de la creaci6n de razas de par&dtos resistentes a la quinina, y de 
favorecer formas peraistentes de la infeccidn himiana. 

No puede negarse, sin embargo, que en palses donde no exists la Fiebre Amarilla, 
el uso profiUictico de la quinina ha sido tan efectivo, y probablemente miB pr^tico y 
econ6mico, que cualquier otro m^todo. Vdanse, por ejemplo, las campafias anti- 
pal(idicas de Italia y de las colonias alemanas. 



14 PB00EEDIK08 BBGOKD PAK AlCBBICAN S OUmTUflO 00KGBE8GL 

En loe pttes de Fiebre Amarilla, nnestia seguridad depende de la eficada de nuesCxft 
labor anticaUcida. A este fin debemos siempre mantener escuela de prepaacidn 
para estas funciones que combinan a la vez las del entom^ogo, el ingeniero y el sani- 
tario. LaanadoiieBqaeiioest&npiepaiadasporeiiflefianzasiMictic^ 
debieian enviar hombres que se adieetreu en centros de rec<mocida expenencia como 
son, Nue . a Orleana, Habana, Flanam4 o Rfo de Janeiio. 

Pues no debemoe olvidar que hasta la existencia nacional entra en juego con la 
reflolucidn de estoe problemas. El vigor, la vida mimna de loe puebloe se gastan y 
rebijase el caricter a niveles inferiores bajo la influencia del Fbludismo, quedando la 
defenaa nacional reducida a la misma endemia inho^italaria que ahuyenta al extran- 
jero de las costas. Tal fu6 probablemente la decadencia de los imperios del Mediterri- 
neo que nos representa una de las eetrofas finales del Gbilde Harold: 

Thy shores are empires, changed in all save thee 

their decay 

Has dried up realms to deserts. 

He dicho que el Paludismo no presentaba ningtin problema intemacional grave, 
y, sin embargo, hay un aspecto de esta cuesti6n que no hemoe discutido adn, y que 
debe connderarse desde el mismo punto de vista que los problemas sanitarios inter- 
nacionales, ee decir, el de las cuarontenas. Desde luego que no voy a proponer que se 
incluya el Paludismo entre las enfeimedades cuarontenables. Como procedimiento 
intemacional no serla eso practicable. No debemos pasar por alto, sin embargo, el 
hecho de que nuestros medicos de puertos detienen, en la inspeccidn de barcos pro- 
cedentes de pafses sospechosos de peste o de fiebre amarilla, a muchos individuoe 
febriles que son enviadoe al Hospital cuarontenario. Resulta con frecuencia que 
se establece el diagn^tico de Paludismo, y estos individuos son debidamente tratadoe 
antes de entrar en el pais. 

Pero era mi objeto roferirme mis particularmente a lo que pudi6ramo6 llamar 
cuarontena interior de una parte de la poblaci6n contra otra; procedimiento que he 
recomendado en rolaci6n con las grandes industrias azucareras y otras empresas que 
atraen gran ndmero de jomaleros. 

Al hablar de cuarontena, en este case, me rofiero al examen de individuos que 
acuden a buscar trabajo en grandes centros industriales y que debieran ser en^rgi- 
camente tratados, si presentan infecciones paltidicas, hasta que dejen de ser una 
amenaza para la comunidad . 

Olvldase amenudo tener en cuenta la influencia de las congr^aciones humanas y 
de his corrientes migratorias sobre el Paludismo; influencia que se manifiesta tan 
claramente como en otras enfermedades transmisibles. Tal parece que todavfa tro- 
pezamos con diflcultades en la aplicaci6n prictica de la doctrina de la tranamisibilidad 
del Paludismo que fundaron Gerhardt, La^ eran, Ross y Grassi. 

Las notables recrudescencias del Paludismo, particulannente akededor de centroe 
de desmonte y otras empresas fezro^ iarias, hidr^ulicas o agricolas, no se explican gene- 
ralmente de manera satisfactona. Estos brotes, que pudi^ramos llamar de Paludismo 
epid^mico, obedecen principalmente a movimientos migratorios. Aquellas giandea 
empresas pagan buenos jomales y acuden a ellos hombres de todas clases, amenudo con 
8US tamilias . Suelen ser estos hombres predsamente de aquellos que no han prospe- 
rado en otras partes donde son conocidos por trabajadores indtiles, sujetos a los trastor- 
nos agudos y cr6nicos que ocasiona el Paludismo; individuos que acaso por esa misma 
causa buscan tierras mis salubree. Jomaleros de esta clase, y aun m&s probablemente 
sus familias, importan el Paludismo de la misma manera que pudiera importarse la 
Fiebre Amarilla. 

Resultarla econdmico para las referidas empresas el establecer laboratorios y pagar 
la direccidn de peritos para obras de saneamiento, y para descubrir y tratar debida- 
mente los casos de Paludismo que se presenten. Todo trabajador, antes de ingresar 



PUBLIC HEALTH AND MEDICINE. 16 

«n el campamento, debiera ser examinado para detenninar el aumento del bazo o la 
presenda de paiisitos en la sangre (60). 

Un eetadio cuidadoeo de los cuadros de la mortalidad en la Habana, que mia arriba 
insertamos, nos hari ver la influencia de los movimientos migratorioB sobre el Pa- 
ludiono. £1 incremento en IO0 afioe 1877-78 se debe a la terminaci6n de la guena de 
dies af&os, y la vuelta de las tiopas del campo a la Habana. En el atio 1895 empieza la 
aegunda gaena de independenda; iniciase en 1896 el ascenso de la mortalidad por Pa- 
ludiono, la que llega a la espantosa cifra de 80 por 10,000 habitantes cuando la recon- 
€entraci6n de la poblaci6n campesina en las ciudades por la orden tristemente memo- 
rable del General Weyler. 

Hace algunos afios que hlce un viaje de exploraci6n en la Gi^naga de Zapata que se 
extiende por la costa sur de las provincias de la Habana, Matanzas y Santa Clara. 
Es la Ci^naga un enorme dep<3sito de aguas dulces que no encuentran suficiente salida 
al marftel Sur, y que constituyen, como era de suponerse, un gran criadero de an6fele8 
y otroe moequitos. En la parte sur de la Ci^naga la poblaci6n consiBte principalmente 
de lefiadores y carbonoros. En la ocasL6n de mi visita la lormaban antiguos residentes, 
alguna gente de mar y reci^n Uegadoe de Espafia. No habfa Paludismo, y las condi. 
cionee de salubridad eran excelentes aunque se estaba trabajando en canalissaciones 
para el desagtte y el trilfico. 

En la orilla Norte de la Ci^naga se encuentran terrenos de grandee centrales para la 
plantaci6n de cafia. Uno de ellos, el central ''Constancia/' se proponia darie nuevo 
impulso a BUS operacionee y habfa importado de la provinda Occidental de la Ida, 
empobrecida par la decadenda del cultivo del tabaco, un ntbneio considerable de 
trabajadores con sus famllias. Se les habian construldo casas higi^nicas en un lugar 
Uamado ' ' la Horquita, ' ' junto a la Ci^naga. La r^6n de donde venlan estas famllias 
era de ligera endemiddad paltidica. Pronto deepu6s de su llegada eetall6 entre elloa 
un brote epid^mico de tal intensidad que amenasd seriamente el ^to de aquella 
cdonizaci6n, si no hubierasido por el en^rgico tratamiento qulnico estableddopor el 
Dr. J. M. P(»rtuondo que afortnnadamente estaba bien prei>arado para esta clase de 
emeigencia. 

£1 foco mayor de Paludismo en Cuba se encuentra hoy en la r^dn Oriental donde 
ae fomentan nuevos centrales de azticar y a donde acude la corriente migratoria del 
resto de la Reptiblica, de Espafia y de Jamaica. La mortalidad mis alta se preeenta 
en Guantinamo, con 19.62 por 10,000 habitantes, y le sigue Palma Soriano con 15.29. 
Por otra parte, en mudios t^rminos munidpalee ha deeapareddo el Pftludismo en 
estoe (Utimoe afios. 

Sigue una lista de las Anofelinas encontiadas en este Continente, y se marcan con 
bastardilla aquellas que han side sefialadas como transmlsoras del paludismo. 

Anaphela fnaeuUpenmt, Estados Unidos y Canad4; Anopheles emeiam, Estadoa 
Unidos y Cuba; Anophelee punctipmmis, Estados Unidos, Jamaica; Anophdee peeudo^ 
punetipennU, Panami, Antillas, Mexico; Anophelee punctimaculata, Panami; 
Anopheles apicmacula, Panamd; Anopheles malefactor, Panamd; Anopheles eisemi, 
Fuiain4; Anopheles annuUventris, Chile; Anopheles annulipalpii, Argentina; Anopho^ 
loBigoti, Chile; Anopheles Cruzeij Braeil, Panamd; Anopheles Lutsi, Braeil; Anoph0' 
les pseudonuicuHpes, Braeil; Anopheles franciscanus, Estados Unidos, Panami; 
Anopheles Gorgasi, Panami; Anopheles nigripee, Estados Unidos; Anopheles tarsima^ 
eukOaf Panami. 

Chagasia Fajardoi^ Brasil. 

ArnhdUagaia maeuUpes, Braeil; Arribalzagaia pseudomaculipes, Brasil. 

UangninhoiBa Lutzi, Braeil. 

Steihom^ niniba, Brasil, Guayana. 

Mysomyia Lutxi^ Braeil, Guayana. 

Cydolepteron Qrabhami, Jamaica, Cuba; Clyclolepteron mediopunetatum, Braail; 
Cydolepteron intermedium, Brasil. 

Myzonhynchella Lutzi, Braeil; Myzonhynchella nigrUttrsis, Braeil; Myzonhyn- 
chella parva, Brasil; Myzorrfaynchella dbiamactdata, Brasil; Myzorrhyndiella Oilesi^ 
BrasO. 



16 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

NyssoniiyncuB albimanus, BrasU, Venezuela, Guayana, AntiUas, Argentina. 

Cellia albimana, Antillae, Panamd, Guayana; Cellia argyrotarsis Estadoe Unidoe, 
Guayana, Braall, Argentina; Cellia Brazilensis, Braail. 

Kerteszia Boliviensis, Boli^'ia. 

V^ase Bibliografia de (45 a (67). 

Peste, — ^Le corresponde, sin duda, a la Peste el segundo lugar en el estudio que 
venimos haciendo. Es en la ^poca actual la enfennedad transmitida per insectos que 
mifl seriamente parece amenazamos; enfermedad nueva en nuestro Continente, donde 
fu6 introducida por primera vez en el (Utimo aflo del siglo pasado. 

Existen vaiios focos end6mico8 de Peste en el Viejo Continente. Con excepcidn 
del de Yunnan, todos los dem^ pennanecieron inactivos en el aflo 1893. En eete alia 
el mencionado f oco manife8t6 una gran ac tividad . Es el Yunnan una de las provincial 
meridionales de la China, limltrofe con la Birmania y el Tonkin. En el cursctodel a£Lo> 
1894 se extendi6 la epidemia por las vias de comunicaci6n, a trav^ de las provincias 
de Ewang-si y Kwang-tung hasta U^ar a la costa por Cant6n y Hong-kong. Este 
puerto fu6 el centre de distribucidn pura el mundo entero: Oporto en 1899, Brasil, la 
Argentina, Paraguay y Hawaii en el mismo afio; California y Glasgow en 1900; Cons 
tantinopla, Ndpoles, Liverpool en 1901; Odessa en 1902; Chile y Perti en 1903;. 
Panamd en 1905; la Isla de Trinidad en 1907; Venezuela en 1908; Nueva Orleans y 
la Habana en 1912. 

En nuestro continente se diagnosticaron los primeros cases humanos en Santos, en^ 
1899, y por el mismo tiempo, en la Asunci6n, Paraguay. Es muy posible que haya 
existido la Peste murina con anterioridad a esta fecha. Se presentan dudas con 
respecto al origen de la infecci6n en las costas del Brasil y del Plata, y se discute si 
fu6 importada de Mozambique o de Oporto. Sea cual fuere su punto de origen, la 
enfermedad nunca ha desaparecido de aquel litoral. 

La misma confusi6n existe con respecto a la importaci6n de la Peste en los Ekrtados 
Unidoe. La enfermedad apareci6 en Hawaii en diciembre de 1899. Prevaleci6 
de^graciadamente por aquel entonces la tendencia a la ocultaci6n. El caddver de un 
chino encontrado en San Francisco en marzo de 1900, y reconocido por las autoridadee 
f ederales como cad&ver de Peste, fu4 la primera intimaci6n de la presenda del mal en. 
los Estados del Paclfico. 

Extendidse la infecci6n por aquella costa, Uegando a MazatUox en M6jico por el Sur 
y a Seattle i>or el Norte, estableci6ndoee finalmente entre las marmotas (Citellua 
beecheyi) de California y entre las ratas de dLudades de importancia comercial, par- 
ticularmente en las que son centres de distribucidn de granos y de vfveres. En centres 
de esta clase parece que no e^posible, con los medios de que hoy* disponemos, lograi: 
la extinci6n de la Peste entre los roedores. Testigos son: Londres, Liverpool, Rfo de 
la Plata, Rio de Janeiro, California, y, mis recientemente, acaso tambi^n, la Habana 
y Nueva Orleans. 

Dije antes que la Peste era una enfennedad nueva en America, y esto es precise- 
mente lo que le da una potencialidad amenazadora para noeotros. En la India ha 
estado sujeta la enfermedad a flujos y reflujos tan inesperados como inexplicables. 
Cabe pensar que lo mismo pudiera suceder en este continente, aunque, por la expe- 
riencia hasta ahora adquirida, tenemos alguna base para la esperanza de que la actitud 
de los pueblos americanos ante la enfennedad ha de aseguramoe siempre el pronto 
dominio sobre ella. 7 

Por el contrario, se me figura que, entre los pueblos orientales, existe una actitud 
pasiva, algo semejante al fotaliemo que en la America Tropical predominaba con 
respecto a la Fiebre Amarilla. En eea misma actitud pudiera quiz^ encontrarse una 
explicaci6n de la mortalidad mia baja que en America parece presentar el mal . Quiero 
decir que en Oriente hay mis probabilidades de que pasen inadvertidos los casos ligeros 
y que la alta mortalidad represente una espede de selecci6n de casos graves. 

Loe foctores del ^xito en las campafias antipestosas son principalmente dos: d 
reconocimiento y pronta declaraci6n de la existencia de casos de Peste, ya sean hu- 



PITBUO HEALTH AND MEDICINE. 17 

manoB o muiinoe, y el mantenimiento de una bien organizada per8ecuci6n de latas, 
particulannente en Iob lugares donde liaya razones i>ara aospechar la existencia de 
ratas infectadas. 

Lo6 reeultadoe obtenidos en la Habana ban aido muy satisfactorios. Es esta dudad 
un impartante puerto de mar y nn gran centre de distribuci^ de vlveres. Las paredes 
de loe edificioe en la Habana vieja y barrio comerdal son mny gmeeas y eet&a cons- 
truf das de nn mortero que excavan f&cilmente los roedores, i^riendo cuevas y galerias 
que ascienden en complicada red hasta dos metros por endma del nivel del suelo. 
D^beee probablemente a estas condidones que hayamos tenido en la Habana predi- 
lecddn por el Bistema de fumigadones como uno de los medios para la defiratizad6n. 

En breve resumen los resultadoe obtenidos en la Habana son los siguientes: en el 
primer afio (1912) bubo tres caaos; en el segundo afio (1914) bubo 25 casos y 17 en el 
tercer afio (1915) . Durante el primer afio no bubo ningtin brote secundario. Durante 
el segundo afio tuvimos un caso en cada uno de dos pueblos del interior en iicil comu- 
nicacidn con la Habana por ferrocarril y carretera; una rata infectada en otro pueblo 
en las minmas condidones y 16 casos en Santiago de Cuba. En el tercer afio tuvimos 
dos casos en la capital de la Provinda Occidental que se comunica con la Habana por 
ferrocarril, y dos casos en un suburbio de la Habana al otro lado de la babfa. Un total 
de 57 casos en cuatro temporadas de Peste. Nuestra estaci6n de Peste ocurre en la 
primera mitad del afio. 

Nuestro ^to en la dominaddn de brotes de Peste es evidente; pero en la Habana 
lo mismo que en otras partes, existe la misma persistente tendenda a la reapaiid6n en 
afios sucesivos. Nos parece comparativamente f^Unl extinguir los brotes de Peste 
humana, o reducirlos a pequefias proporciones; pero es muy dificil extinguir por 
completo la Peste murina, por lo menos en grandes centres de distribud^n de granos 
y de vlveres. La causa se encuentra, sin duda, en las dificultades con que se tropieza 
pwa poner la poblad6n a prueba de ratas. 

En la Habana le damos mucba importancia al empleo del &ddo danbldrico en 
fumigadones extensas y en inyecdones parciales del mismo gas en las cuevas y ttineles 
de las ratas. Tiene la ventaja el gas danbldrico de ser r&pido en su acd6n, y de no 
ahuyentar las ratas por el olor picante. Destruye adem^ las pulgas al mismo tiempo 
que las ratas, e impide que se infecten nuevoe roedores que acudan a ocupar las ma- 
drigueras abandonadas. A las fumigadones muriddas se une una campafia activa de 
desratiaacidn por medio de trampas, la que se reconcentra en loe lugares donde se 
snpone que pueda baber ratas infectadas. 

Deseo aprovechar esta oportunidad i>ara insistir, como en otras ocasiones, en que se 
ciimpla estrictamente el Artlculo Primero de las Gonvendones Sanitarias Intemado* 
nales — la pronta declarad6n de casos de enfermedades cuarentenables. Losprimeros 
paaos de la Peste en este Oontinente se caracterizaron a vecee por deegradadas vadla- 
dones en la comprobacidn y declarad6n de los casos. Es bastante general la tendenda 
a condonar estas infracdones y aun se tiene a mal que de ellas se hable ptiblicamente. 
No me conformo con este sistema. Preferirfa que se sefialasen los infractores y se 
encontraae el modo de castigarloe. 

Debemos insistir, no s61o en la declarad6n inmedlata de los primoos casos de Peste 
humana o murina, sine en el envlo continuado de informes sobre las operaciones de la 
cami>afia antimurina. Si no se envlan informes de esta class, me permito sugerir que 
est& justificado el mantenimiento de medidas defensivas, aunque se declare que la. 
infe<xddn ha ceaado. 

Presento adjunto la forma en que se rinde en la Habana informe decenal de las 
operadonee del servido de desratizacidn. 

Deseo tambi^n recomendar insistentemente el uso del dddo danbldrico para la 
desratizacidn de naves que proredan de puertos infectados. lios gases que se 
ohtienen por la combustion del car))ono, al matar un ntimero de ratas sin destruir 



18 



FB00BBDIKG8 BEOOHD PAIT AMBBIOAN SOISJmFIO 00KGBB88. 



Uf pulgM]^qae ftlbeigan, dejan en libertad pulgM infectadiB que pueden atacar al 
hombre oja nuevas latas que lleguen a bordo. El monoxide de carbono parece ester 
tndicado para la deflratizaci^n de naves que no procedan de puertoe Infectedos. 
Estd per inventer nn apaiato genecador y propulsor de ^do cianhldrico para 




inyecter el gas, bajo presI6n y r&pidamente, en cloacas, cafios, cuevas de rates y 
eqMcios mayares. Acompafio la figura que represente el aparato generador, ideado 
por el Dr. Hugo Roberto, y que empleamos en la Habana para la inyecci6n del gas 
cianhfdrico en cuevas de rates. 



PtJBtIO HBALTH AND MEDIODnB. 



19 



No 86 ai hay en esta aaamblea algdn repreeentante de la "United Fruit Company'' 
que exponga el plan que ha ideado el Dr. Deeks, medico jefe del departamento de 
aanidad de dkha compafiia, para poner las navee a prueba de ratae. Di.ide el 
Dr. Deekfl bob barcoe en compartimientos o unidades, cada una de las cuales estd 
perfectamente alslada de las otras, de manera que se imposibilita el movimiento de 
una rata de una parte a otra. Conviene estudiar este plan por si fuese conveniente 
bacer obligatoria eeta construcci6n, o, por lo menos, elconcederprivilegiosBanitarioB 
a laB compafifas que la adopten. 

y^ase la BibUografia de (68) a (94). 

Fitbre amarUla. — No hace mucho que hubiera llamado la atencidn el ver postponer 
a un segundo tdrmina la endemia de tan tenribles manifeetadones epid^micas. Fiebro 
ameiicana, Pestilenda americana, Tifus americano, fueron tftulos con quie se indi* 
caba el origen americano de la infecci6n. Ya la enfeimedad habfa rendido sus 
bandens cuando se inidaron estas conferendas o acaso tambi^n hubiera recibido 
algdn tftulo pan-americano. 

KBPUBUCAD* CUBA 

SECRCTAUA DE SANIDAD T BENEFHXNOA 

JWATDSA lOCAt, im LA BABAWA 



DIREC CION PS SANIPAD 
PESTE BUBONICA 



SSKVKIO OS DHSRATBACIOXr 



Retumen de lo$ $ervieios pre$tado$ por egta Ofieina durante el transcuno de la deeena que 
termina eldiaSdel me$ de dieiembre de 1915, 



Tbabajos. 


Dfaa. 


TotaL 


34 


26 


26 


27 


28 


29 


30 


1» 


2 


3 


Batooowen aso diario 


600 


eoD 

1,613 


600 
1,612 


600 
1,612 




600 

1,612 


600 
1,612 


600 
1,612 


600 
1,612 


600 
1,612 


5,400 
1,613 




***** 


• .. 


* * 


* 


■ 












■ 




1 
157 


6 
158 


2 
126 


3 
179 




12 
212 


6 
145 


5 
146 


4 

125 


4 
169 


41 


Rates eoD tmnpM ... . 


1,^ 


Total deratas 


168 


16S 


128 


182 





224 


150 


150 


120 


168 


.1,447 


Dalas868nitMexaiiil- 
oadatenel Labora- 
torio de In^wttga- 
aioiiea, aa l&s ho^o la 

IfftiB A ^TATulrlnnfl 






















Mnt MrfOMiVf 


lis 


96 


81 


113 




155 


74 


101 


60 


75 


868 


























MnflC Poeii 
























Mas Alezandriniis. 
MnsDMumainis... 

MnsMuaculos 

MnsRattiis 

MnaaPoeU 

tiiiwiaitan.rnsiTiln, 
aslkMy easas da 

osis&jaajr:: 

Oueras obtonMlas.... 
iBspaeeido noetmna 

debaUaaadapisos. 

todas por Infrao* 
alooaa dadrdenes 
dal sarTido da 
dwraUsaolrtn 


Ninf 

1 

90 
90 
90 

35 
15 


una. 

'•"lis* 

115 
115 

42 
17 


1 
110 
110 
110 

23 
16 


1 

96 
96 
96 

22 
80 








1 

68 
63 
68 

41 
44 


3 
56 
55 
55 

62 
53 


1 

27 
27 
27 

37 
63 


7 




60 
60 
60 

S3 

37 

2 
70 


72 
73 
72 

32 
43 


609 
699 

609 

327 
318 




50 


50 


39 


1 
52 1 


75 


85 


115 


100 




drdewa 


6tf 



68486— 17— TOL EC- 



20 PB0CEEDIKG6 SECOND PAN AKEBICAK 8CISKTIFIG cbKOBBSS. 

Raiumen de lot $ervicio$ vre$iado9j>or e$ta Ofidna durante d troMcurso de la decena que 
termina udiaS dHmee de dteiembre de 19 IS — Contintia. 





DIM. 


TotaL 
























34 


25 


26 


27 


28 


29 


80 


f 


2 


8 




Beeord de A§enie9 


















» 






Btptehies tu Caia, 
























DUMt»^Raitt9 Bm- 
























tnfadtu. 




4 








1 
9 








4 
4 




trito. 


Nombnt. 




1 

2 


J. Roane 

A.Orfeg» 


80 
81 


8 


J. Lkxeft 




7 








9 




10 


10 


8 


TO 


4 


B.Cttitel 




e 








17 








19 


88 


6 


J.Herreim 


17 


IS 








14 








9 


71 


CBm. 


R-Tnero 




4 








1 








2 


80 


RegU. 


F.deV Otrate. 




3 








11 






10 


6 


U 



Agente qae ha tenido meior record, BmiUo Cantel, d«l Dtotitto No. 4. 










Lt^&ret enpufuenm 
hMia$latrM7ratM. 
























Diitrltondmerol 


10 


18 


4 


19 




19 


18 


8 


10 


8 


104 


Distritoodmero3 


81 


17 


9 


14 




10 


10 


16 


12 


16 


140 


DistritoodmeroS 


27 


24 


25 


88 




48 


22 


47 


20 


29 


881 


Distritoodmero4 


41 


48 


42 


58 




82 


54 


86 


24 


60 


425 


Dlstrito otkmero 5 


27 


88 


28 


87 




58 


20 


19 


86 


88 


800 


MneltodeCaballeffa... 


1 


2 


8 


1 




2 


1 




1 


2 


18 


Mnelto de San Fran- 


























1 


1 
1 


1 


8 

2 




1 
1 


4 
1 


8 


2 

1 


1 
2 


17 


Mnelle de Pania 


8 


MoeUef Hayana Cen- 






tral 


2 
8 






1 
2 






1 
4 


1 
5 






5 


MoeUeeSanJoatf 


2 


1 




2 


8 


2 


94 


MoeUeeTaUapledra.... 


4 


1 


8 


2 




1 


8 


8 


2 


1 


20 


DlstritodeCaMiBlanca. 


9 


4 





1 




1 


8 


2 


2 


2 


80 


DistritodeRegla 


2 


17 





9 




18 


6 


11 


10 


7 


80 


Total derates 


158 


103 


128 


182 




224 


150 


150 


129 


168 


1»447 



Record batido por el Distrlto No. 4 a cargo del Inspector Sr. Eogenlo OarraUo. 

Reetanen general de raUu habidoM dt9de el6 de marzo de 1914. 

I^timadeoena 90,617 

Esta decena 1,447 

Total general 92,064 

AivrrtenekLt,—^ oremaron 276 guayabitosL y de las mil ooatrodentoe ooarenta y aiete ratas captoiadas 
281 se atraparon en Km reglstros del alcantarluado. 

El tUtimo oaao de peste hnmana ooorrid el dla 4 de JnUo, y el tUtimo case de peete murina ooorrld el dfa 
12 de mayo del aflo actuaL 

Habana, 3 de dioiembre de 1915. 

Vto. bno.: 

Dr. F. RoDBlouss Aloitso, 
J^t del Negoelado de DesraHmeUm. 

ABMAMDO DSL VALLB, 

StgundoJ^e, 

Lleg6 la enfeimedad a adquirir a veces tal fuerza de expanai6ii que amenazaba 
tomar el car&cter de pandemia. Afortunadamente se le han cortado las alas y ya hoy 
muy remotas son las probabilidades de que se cumpla la profecfa de la inva8i6n de la 
India por la Fiebre Amarilla siguiendo la abreviada nita del Canal de Panamd. La 
Fiebre Amarilla ha desaparecido de Panami, de las Repdblicas de Centaro Am^iica, 
de las Antillas y de Vera Cruz. Casi puede decirse que est4 extinguida en las costas 
del Atldntico de Sur Arnica. Si el gran foco de endemiddad amarilla en el Africa 
Occidental no estuviese en vlas de recibir la atenci6n que reclama, (110), (111), (112), 



PXJBLIO HBALTH AND MEDIOIHB. 



21 



podiera suceder qne el amnento de las comunicadones tiaiiscontinentales y marf timas 
U^gaoe a ser mia amenazadora para la India que el Canal de Panamd. Es de recoidar 
que la Paste no lleg6 a nueetro Continente por la que parecfa la via mia directa, el 
Facifico, flino que anibd primero a las costas del Atlintico. Desde luego^que, eecep- 
toando acddentes, la rata serd aiempre la del mayor ti^co. 

£1 HJgniente cuadro expone el descenso de la Fiebre Amarilla en Cuba hasta su 
total extincldn: 

CuAOBO III. — MortaHdad por Fidnt AmarxUa en Cuba, par 10,000 habitanUs en Jot 

cttloB que ee eepeeifiectn. 



Afios. 


Mortatt- 
dad. 


1900 


3.35 


1901 


a3i 


1902 


0L006 


1903 





1904 





1905 


ail 


1906 


a 16 


1907 


a27 


1906 


ao7 


1900 





1910 





1911 





1912 





1913 





1914 






No tenemoB en forma utiUzable los dates anteri(»es a la Intervenci6n Americana, 
pero 68 pxobable que los que de la Habana poseemos, representenlbastante aproxi- 
Biadamente el movimiento de Fiebre Amarilla en toda la Reptiblica, puesto que la 
H^Vna. hM ado aiempre centre distributive, no solo de mercancias ytdejinmigiantea, 
amrt tambi^ de enfermedades. 

CuADBO jy^.—Fiebre Amarilla. Ciudad de la Habana. NUmaro de dduneionee u 
martalidad por lOfiOO habitanUe en loe afloe que ee etpec^iean. 



AfiOi. 


Ntawro 
de 


MortaU- 
dad. 


AiUw. 


NOmero 
d« 


^S2^ 




Obitoi. 




Obitoa. 


dad. 


1854 


1,043 


49.18 


1886 


166 


8.35 


1865 


660 


31.73 


1886 


167 


8.84 


1866 


1,808 


62.81 


1887 


683 


3a 66 


1867 


^'068 


96.88 


1888 


468 


38.84 


1868 


1,896 


67.01 


1889 


308 


14.88 


1860 


1,198 


67.61 


1890 


308 


14.80 


1860 


439 


31.35 


1891 


356 


ia80 


1861 


1,080 


49.60 


1893 


857 


ia66 


1801 


1,888 


67.58 


1808 


496 


33.61 


1863 


660 


36.86 


1804 


383 


17.11 


1864 


6,665 


37.15 


1896 


568 


34.86 


1866 


388 


11.67 


1896 


1,383 


55.56 


1866 


61 


3.50 


1807 


858 


8a60 


>2E 


601 


39.10 


1898 


186 


6.70 


1868 


390 


14.81 


1899 


108 


4.35 


1860 


1,000 


49.45 


1900 


810 


13.41 


1870 


573 


38.84 


1901 


18 


a 09 


18n 


991 


49.32 


1902 








1872 


616 


26.63 


1908 








1878 


1,344 


62.06 


1904 








1874 


1,426 


71.34 


1905 


33 


a76 


1876 


1,101 


5a 16 


1906 


13 


a40 


1870 


1,619 


81.30 


1907 


6 


a 16 


MSI 


1,374 


6a 14 


1908 


1 


ao8 


1878 


1,669 


78.38 


1900 








1870 


1,444 


73.65 


1910 








1880 


646 


83.38 


1911 








1881 


486 


34.33 


1913 








1888 


729 


36.54 


1918 








1888 


840 


43.63 


1914 








1884 


611 


35.67 









22 



PBOCBEDnrOB SEOOKD PAK AMBBIOAK SOIBinmO 00KQBB88. 



Al tratar del Paludiamo en otra parte de este trabajo hube de introdudr mi cuadro 
semejante a ^ste, y dije entonces que el descenflo de la mortalidad por el Paludlsmd 
en la Habana y Cuba era resultado de medidas tomadas especialmente contra la 
Fiebre Amarilla; y que dichas medidas conmwtfan, prindpalmente, en operadonee 
contra el mosquito. Ofrecf entonces que al llegar a esta parte del trabajo, por ser 
donde correefponde, presentarfa un resuznen de dichas operaciones, con relaci^ de los 
gastos. 

£mpezar6 dtando la f6rmula que debe servir de base en las campafias contra la 
Fiebre Amarilla. Las palabras fueron escritas por el PresLdente de esta Secddn, 
Dr. Gorgas, en el afio 1908: "Me inclino a creer que para la propagad^ de la Fiebre 
Amarilla es necesaria la presenda de derto n6mero de mosquitos y que, genoslmente^ 
en los pafses de Fiebre Amarilla existe dicho ndmero con gran exceso. La campafia 
contra el mosquito contin^ pues por algt&n tiempo redudendo el n6mero sin obtener 
resultados apredables sobre la enfermedad; pero que, llegado a derto punto se reduce 
el ntlmero por debajo del nivel neceeario, y la Hebre Amarilla cesa abruptsmente. 
Mant^ngase, pues, la poblaci6n de e8t^;oinias por debajo de 6se nivel que llamar^mos el 
nivel de Fiebre Amarilla y , por grande que sea el ntlmero de no inmunes o el de casos de 
Fiebre Amarrilla que se introduzcan, la enfermedad no puede piopagarse." Senci* 
llamente ezpuesto asf el problema es como un gran programa reduddo a una simple 
cartilla. 

Ezceptuando el uso de telas de alambre en los hoepitales y en lugares improvisados 
de aislamiento, nuestros esfuerzos se ban dirigido casi ezdusivamente contra las 
larvas de mosquitos. Me inclino a creer que los m^todos redentemente introduddos 
para atacar tambi^n la forma alada del insecto merecen tomarse en consideiacidiu 
Naturalmente que en presenda de un brote de Fiel^e Amarilla se impone la fond- 
gad6n culicida de los lugares donde ocurren casos. 

La campafia contra las larvas incluye el chapeo y limpieza de sanjas, drenaje, 
eliminad6n de dep6sitos de agua, introducci6n de peces larvlfogos y el uso de larvi- 
ddas (petrdleo, preparadones de fenol). Entre los peces larviddas debemos mencuH 
nar los que en Oul^ llamamos guajacones. Son camivoras y abundan m^ espedid- 
mente en nuestros rfos las espedes Oambusia punctata y O, puncHeulata, Poey. 

El siguiente cuadro presenta el resumen del trabajo de un afio en la persecudte 
de larvas. Para obtener el cuadro se ha sacado el promedio de varios afios de loa 
inf ormes decenales que envfan las Jefaturas de Sanidad de toda la Repfiblica. 

CuADBo y. — Ndmero de Inspeceiones por larvae y ndmero de eriaderoe que ee eneuentron^ 
con el tanto por ciento de eeioe. 



Mmm. 


Ndmero 
deinspee- 

dOOM. 


CrfaMlerat 
deltfTM. 


TMDtO 

dSto. 


iKoero 


246,846 
286,808 
260!804 
248,006 
261,701 
2a, 683 
268,646 
244,068 
287,484 
248,212 
244,828 
281,442 


282 
207 
268 
828 
880 
686 
678 
648 
028 
826 
878 
278 


0.11 


fahnro 


aot 


fiSSS?:..... I . . .. ; 


0.10 


AbriJ.:::::::;::::::::;::::::::::::::!::;:":;:::::::;!:::;:::.;::;;..".. 


0.U 


lltyO r.r-. 


0.1S 


jaiUo! 


0.28 


Julio 


0.28 


Afosto 


0.28 


86ptleiiibn • 


a28 


OotubrB ... .....••••.....•......••..•...••.•.•••...•«.••.••••.••«.•. 


0.21 


NovtombfB 


ais 


DifilAmbra 


0.1S 






Total 


2,842,462 


8,108 


0.17 







El presupuesto para este servicio en toda la Reptiblica, en el afio de 1914, ae com* 
pendia en la forma siguiente: 

Personal |82&,720 

Petedleo 44,732 



Total 270.452 



FUBUO HBALIH AND UXDlCimL 23 

Otios d^ftulos del Ptesapuesto Nacional de Sanidad que asdende a $2,616,770, y 
BO dedicadoe expreeamente a obras de petiolizaci6n y zanjeo, contribuyen tambi^, 
de manera indirecta a la campafia contia el mosquito. 

Ki colega el Dr. Agramonte ha de tratar del eetado actual del problema de la Fiebre 
jmarilla deede el punto de vista epidemioldgico y etiol6gico. Sigulendo el programa 
que me he trazado tzatar6 brevemente las cuestiones cuarentenarias que se reladonaa 
con Fiebre Amarilla. 

No ha de taidar mucho en reunirse en Montevideo la Conferencia Sanitaria de las 
Keptiblicas Americanas y parece el presente Congreso lugar indicado para presentar 
pnqpoeiciones de enmiendas a la Convenci6n Sanitana de Wdahlngton de 1905. 

Me prqpongo, pues, discutir dicha Convenci6n en lo que se relaciona con enferme- 
dades transmitidaB por insectos, y asuntos generales que con ellas se relacionan. 

£1 Artfculo I de la Convenci6n se refiere a la obligaci6n que contiae todo Gobiemo 
de notificar a los dem^ de la apaiici6n de un caso de Peste, C61era o Fiebre Amarilla 
en 0u territorio. 

En este Artlculo debiera ezigirse tambi^ la notificaci6n de la presenda de Peste 
inurina, y convendrla agregar un ptoaf o por el cual se facultase a los palses a mantener 
medidas especiales de defensa contra el que no cumplieee con el Articulo Primero. 

£1 Articulo VII dispone que la presenda de un solo caso de Peste, C61era o Fiebre 
Amarilla no impone necesariamente la aplicad6n contra un pais de las medidas 
indicadas en el Capftulo II de la Convenddn. 

Yo propondrla que se eliminase a la Fiebre Amarilla de esta exenci6n o piivil^o. 
£n la ^poca actual, con el aumento progresivo de la poblad6n no inmune en los que 
fueron focos end^micos, la presenda de un solo caso aut6ctono de Fiebre Amarilla, 
descubierto probablemente despu^s del tercer dla de la enfermedad, es asunto m^ 
grave, a mi juido, que la presenda de un caso de las otras dos enfermedades, particu- 
lannente si consideramos que pueden pasar 18 dias antes que obtengamos pruebas de 
que se hayan infectado mosquitos. 

Articulo VIII . Dispone que las medidas restric tlvas que contra un pais se impongan, 
debedm limitarse al distrito que estd actualmente infectado. 

En este articulo propondria yo que se agregase al primer pdirafo, lo siguiente: 

"Podri hacerse excepcidn, en el caso de paises donde han existido, o se supone que 
existen, focos end^micos de Fiebre Amarilla en medio de una poblad6n escasa y 
diseminada, y donde la existencia de habitantes inmunes puede ser causa de que no 
•e manifieste la presenda de mosquitos infectados." 

En el tercer p&rrafo de este articulo se expresan las condidones que deben cmnplirse 
para que las restricdones se limiten al distrito infectado. Aq\ii agregaria yo otra 
condid6n en esta forma: ''y con la condid6n, adem£s, de que el Gobiemo afectado 
dicte las medidas conducentes a obtener informes y hacer declarad6n de nuevos 
casos que en otros distritos se presenton. " 

Articulo IX. Expone las condidones que deberin cimiplirse antes que se declare 
on distrito libre de una infecci6n, y expresa el periodo de tiempo que deberd trans- 
cmrir sin que se presente caso alguno de la infecd6n. Con respecto a la Fiebre Ama- 
liUa el articulo autoriza a los Gobiemos para extender este periodo. Esta autorizacidn 
ha flido muy criticada, y, a mi juicio, debe mantenerse, por la misma raz6n que aduje 
al analif.ar el Articulo VIII, es dedr: por el cardcter larvado o latente que puede 
•■amir la Fiebre Amarilla en medio de una poblaci6n inmune. Los mejores esfuerzoe 
de las autoiidades sanitarias se estrellan ante la imposibilidad de s^uir las huellas 
de casos diseminados, de car^ter benigno, y que ocuiren prindpalmente entre nifios, 
pero que sirven de eslabones ignorados que unen un brote epid^mico con otro. 

£1 dltimo ptoafo de este Articulo, que indica las medidas que deben dictarse para 
impedir la propagaci6n de la enfermedad, debiera redactarse en la forma siguiente: 
"S^gundo, que todas las medidas preventivas de la propagad6n de la enfermedad 
han aido aplicadas, y han aide continuadas i>or un tiempo razonable, hasta que se 



24 PBOOBEDINQS SEOOND PAK AMEBIOAK BCIEKTIFIO COKGBBSS. 

eetablezca satisfactofriamente que no ha habido propagaddn fueia del distiito 
infectado." 

ArticuloXX. 01a«iflcaci6n de navea. Elsegundopfoafodice: ''SeconaLdeiacomo 
iospeekom la nave a boido de la cual ha habido caaoe de Peste o de O^eia «& el momento 
de la partida o durante la travesfa, pero en el cual no ae ha declarado ningdn case 
nuevo deede hace slete dias. Ser^ tambi^n Bospechoeoey tratAndose de Fiebre Anu^ 
rilla, Ice buquee que hayan pennaneddo en tal proximidad a las costas infectadai^ 
que haya hecho podble la entrada de mosquitoe en ellos." 

He de proponer que el pdrrafo quede redactado en la forma mguiente: 

"Se conaideraii como Bospechoso el buque a bordo del cual ha ocunido un case o 
casos de Peete o de Gdlera, en el momento de la partida o durante el viaje; pero en 
el cual no ha ocunido ningdn case en loe siete dlas anteriorea al de la arribada. Con 
reapecto a la Fiebre Amaiilla, el barco que, habiendo eatado expueato a la introduc- 
cidn del mosquito calopus de cualquier procedenda, embarca paaajeroa en puerto 
infectado y llega sin fiebre amarilla a boido. Con reapecto a la Peate, tambi^ el 
barco en que ha ocurrido una mortandad ins61ita de ratas." 

£1 tercer pdrrafo dice: "Se considera como ind^nne, aun cuando llegue de puerto 
contaminado, una nave que no ha tenido ni defundonea, ni caaoa de Peate, de O^era 
o de Fiebre Amarilla a bordo, aea antes de la partida, aea durante la traveala o en el 
momento de la llegada, y que, en el case de Fiebre Amarilla, no ae haya aproximado 
a la coata infestada a una distancia aufidento, a juido de las autrndadea sanitariaa^ 
para redbir mosquitos." 

Propondrfa que se modificase la ^tima parte del p^orafo que se refiere a Fiebre 
Amarilla, en la forma aiguiente: "con la condid6n, ai ae tiata de Fiebre Amarilla, 
de que la travesla haya durado m^ de seis dias, y que se pueda excluir la presenda 
de estegomias a bordo." 

ArticTilo XXI. En el pteafo 6, con referenda a la desratizadiki de baicos infectados 
de Peste, propongo que se introduzca una clausula que eapecifique que la operaddn 
debe hacerse con gas sulfuroso o icido cianhldrico, para obtener al mismo tiempo la 
destrucddn de las pulgas y evitar la infecd6n de nuevas ratas que puedan introdudrae, 
o de personas. 

Artfculo XXIY . Se refiere al barco clasificado como indemne, en que aparecen rata« 
infectadas, o en que se presenta una mortandad insdlita de roedores. Aqul tambi^n 
debe inaistirse en el uso de gas sulfuroso o cianhldrico para la desratizad6n. 

Los artfculos referentes a la Fiebre Amarilla que en la Convenci6n de Wddiington 
colocamos al final con el Ntim. XLVI, para conservar el mismo orden de artfciilos que 
tenia la Convend6n de Paris de 1903, deben colocarse en su lugar y recibir el Ntim. 
XXIX. 

El Artfculo XLVII de la Convend6n de W&ahington que, segthi lo que acabamos 
de decir, debe llevar el Ntlm. XXX dice: "Los barcos sospechosos de Fiebre Amarilla 
deber^ someterse a las medidas indicadas en los ntimeros 1, 3 y 5 del Artfculo anterior; 
y, 81 no se fumigan, se descargar&n segta dicfpone el sub-pdrrafo (a) 6 (b) del mismo 
AxtfcTilo. "Yo agregarfa, adenUb, "Con respecto al pdrrafo 3 del Artfciilo anterior, 
el perfodo de observad6n deber6 contarse desde el momento de la tiltima exposici6n 
al contagio." 

Otro asunto que habr& de discutirse desde el punto de vista intemacional, es la 
8ignificad6n de la palabra "inmune " en relad6n con la Fiebre Amarilla. Desde que 
empez6 a legislarse para impedir la propagad6n de eata enfermedad, hubo que tomar 
en conBideraci6n la existenda de un grupo considerable de personas que eran inmunes. 
Primero se consideraron como tales a los negros y a los natives de pa^ donde reinaba 
la Fiebre Amarilla. Despu^s se acept6 como base, que la inmunidad dependfa de 
un ataque previo de la enfermedad. En los reglamentos de cuarentenas s61o se con- 
aideraban como inmunes a aquelloa que preaentaban certificad6n aatiafactoria de 



PUBLIO HEALTH AND MSDICINE. 25 

haber pasado la Fiebre Amarilla, o de haber residido en un loco end^mico el tiemiK> 
necesario para juatificar la supoeicidn de que ya habfan adquirido la inmunidad. 

El ntfmero de mmunes a la Fiebre Amarilla disminuye progreaivamente y parece 
ya llegado el tiempo de que no ae tomen en conaideraci6n al redactar reglamentoe de 
cuarentenafly o, si se conaidera demaaiado radical eete acuerdo, definase, por lo menos, 
k) que, en lenguaje cuarentenario, debemos entender por ''inmune." 

Gomo que el ndmero de focos end^micoB viene diaminuyendo deade hace afioa, 
creo que debemoe aceptar actualmente como "inmunee" a^o a aquellaa peraonaa que 
ban residido en un loco reconocido como end^ico, durante diez afioe conaecutivoe 
anteriores al de 19Q2. 

y^aae la BibUograffa de (95) a (112). 

Las FUarioM, — ^Faaamoa ahora a la conflideraci6n de laa enfermedadea filari^caa. 
Fneron ^staa laa primeraa que acept^ definitivamente la cienda como enfermedadea 
tnmamitidaa pcnr insectoa. En la conBidefaci6n de eate aaunto encontramoa un nuevo 
i^Myo para la opinio antee expreeada en favor de la campafia contra el moaquito 
como principal factor en la profilaxia del Paludiamo; pueato que dicha campafia ea 
efectiva a la vez contra el Paludiamo, la Fiebre Amarilla y la Filariaaia. 

Mucbo fliento no poder preaentar datoa eatadfaticoa confirmatiyoa; pero ee general 
la opinidn entre loa m^dicoa de la Habana que laa manifeatacionee filarifaicaa ban 
diflminuido en eata capital con laa campafiaa anticulicidaa. 

Cuatro eapeciee defildridas ban aido reconocidaa en America como parasitariaa del 
hombre, a aaber: Filaria Bancro/H, FUaria Demarquayif AcarUhocheUonema pentOTis y 
Dirofilaria MagaJhaen. De 6ataa la MagaUiaesi, encontrada en Braail, ea muy poco 
conocidsi; la Demarquayi eat4 limitada a algunaa de las Antillaa Menorea y laa Guay« 
anaa, y la pentaru al Africa Tropical y la Guayana Ingleaa. La diatribucidn de eataa 
fiUridas en Am^ca ea, por conaiguiente, muy reatringida. No aaf la FUcaria Banr 
crofti que tiene una diatribuci6n mundial en laa tierraa bajaa y en laa cuencaa de loe 
rlba, en laa zonaa tropicalea y aubtropicalea. En el Continente Americano au ^ea de 
diatribxicidn abarca deade 31^ de latitud Norte baata 23^ de latitud Sur. 

Laa aiguientea eapeciea de moaqultoa ban aido aefialadaa como transmiaoraa de la 
Banearofti en America: en primer lugar y aobre todaa laa dem^ la CuUx /atigam, 
Mia dudoeamente la Aedes (Stegomyia) calopiu y CelUa aUnmana, Al Dr. Lebredo 
(117) debemoe una deecripci6n muy completa del mecanismo de la inoculaci6n de 
la filaria en el memento de picar el moaquito. 

Hay razonea para creer que la Bcmcrofti y la pentaru ban aido introducidaa en eete 
Continente en ^poca relativamente reciente. La importaci6n de eeclavoe de la coata 
Occidental de Africa debe de baber aido el medio de introducci6n de ambaa; aunque 
la BoTiero/H pudiera tambi^n baber aido importada de Asia por loa cidla. 

Ea intereeante obaervar que algunaa formaa de filiridaa y el Dracunculus, que deben 
haber sido importadoe frecuentemente con loa negroa de Africa (del Dractinculua ae 
aabe poeitivamente) nunca lograron naturalizarae en America, evldentemente porque 
no exiate el hu^ed intermediaiio. En Cuba a61o logr6 domiciliarae la Bancroft!, 
aunque eete pafa redbid, proporcionalmente a au poblaci6n, m^ negroa que ninguno 
olio, y continu6 recibi^ndoloe baata una fecba m^ reciente. 

y^ase la BibUograffa de (113) a (121). 

lyits eJkmtemdtico.'-EstBk enfermedad nunca ha llegado a tomar, en America, laa 
grandee propordonea que en el Viejo Continente. Exiaten aquf, ain embargo, focoa 
end^micoe, de loe cualea el m^ importante por au peniatencia, gravedad y extenaidn, 
ea el que deade bace mucboe afioe exiate en la meaeta central de M^jico donde ae le 
conoce con el nombre de ''tabardillo." Otro foco, deaconoddo baata ^poca muy 
reciente, exiate en laa dudadea importantea dd Nordeate de loe Eatadoa Unidoe 
donde ae preeenta la enfermedad en forma baatante atenuada y con poca tenden- 
da a la propagad6n. En eata forma hi6 deacrita como nueva entidad noaol6gica por 
Bxill, y ae llam6 BriU'a Diaeaae. (124.) 



26 PBOCEEDINGS SECOND PAN AMEBICAK 8CIENTIFI0 00NGBES8. 

No 86 presenta el Tifos Ezantem^tico en las Antillaa. La clase de poblaci6n que 
padece el Tifus, que ee la clase pobre, no emigra en America, por lo menos, en grandes 
grupos como en Europa. Deede el afio 1900 861o he viflto en Cuba un case de Tifus 
Exantemdtico, que fu^ importado de la capital de M^jico. Ni ee probable que esta 
infecci6n se naturalice en las taeiras calientes. El calor es poco favorable al desa- 
iToUo del Fedieulus vestimenU, ya por la acci6n directa de la temperatura, como 
perecen indicar los experimentoe de Anderson y Goldberger, o por la clase de ropa 
que el clima requiere. 

El descubrimiento de la transmisidn del Tifus Exantem&tico por el piojo de la ropa 
se hizo en 1909 por NicoUe, y en el mismo afio, independientemente, por Anderson 
y Goldberger (122) que estudiaban el Tifus en la meseta de M^jico. Todos estos 
observadores hideron sus experiencias en monos que resultaron ser muy susceptiblee. 
Nicolle experiment6 con el chinpancd y Anderson y (roldberger con el MacacuM 
rhesiu. 

La identidad de la enfermedad de Brill con el Tifus mejicano o Tabardillo, y con 
el Tifus europeo parece estar bien establecida. 

En mayo de 1914 Plotz (125) da cuenta de haber encontrado en la sangre de enfermos 
de Tifus un badlo pequefio que se obtiene en culdvoe aner6bicos. 

y^ase la Bibliografla de (122) a (126). 

Fiebre de Uu MontafUu Rocalloioa. — ^Es esta una enfermedad humana transmitida 
por garrapatas y que estd limitada a los Estados de la Uni6n Americana en la secci6n 
de los Rocallosos, partlcularmente los Estados de Idaho y Montana. El foco mi» 
intense se encuentra en el Valle de Bitter Root en este ^timo Estado. 

Los Doctoree Wilson y Chowning de la Univeraidad de Minnesota, el Dr. H. T. 
Bickets que muri6 martir de sus estudios de esta infecci6n, y oficiales medicos del 
Servicio de Salud Pdblica y del Ej^rcito, han contribuldo a la elucidaddn de este 
interesante problema. La Bibliografia se encuentra en un trabajo resumen de W. C. 
Bucker en "Public Health Reports" de septiembre 6 de 1912. 

Estos inveetigadores han demostrado que la Fiebre de los Rocallosos o Fiebre de 
manchas (spotted fever) es una infecci6n transmitida por la garrapata Dermacentor 
ventutus. Se han encontrado garrapatas de esta especie infectadas naturalmente y 
se sospecha que la cabra (Oreamnos montanos) y la marmota {CiUlltu columbianus) 
de los Rocallosos son los depositaries habituales de la infecci6n. El 4rea de distribu- 
ci6n de la cabra corresponde con la de la enfermedad en el valle de Bitter Root, y 
McClintic encontr6 ima garrapata infectada sobre uno de estos animales. Son suscep- 
tibles a la infecci6n los siguientes mamiferoe de aquel distrito: la marmota, el topo 
de aquella regi6n, la ardilla de rocas (Callospermophilus lateralis) ^ los chipmunks 
(EtUamias luteiventris y E. qtuidriviUatus) y la rata de montafias (Neotoma cinerea). 

No se ha descubierto el ageute inf eccioeo de esta enfermedad . Los primeros trabajos 
de laboratorio parecieron indicar la presencia de un piroplasma en la sangre, pero esta 
obser aci6Q no ha side confirmada por Stiles. Lo mismo puede decirse del bacilo 
deecrito por Rickets. 

V^ase la BihUografla de (127) a (131). 

Existe tambidn en los Andes una Fiebre de las Montaflas que se presenta en algunos 
valles de la Cordillera. Se ha descrito la enfermedad con los nombres de Verruga 
peruana f Fiebre de Oroya, Enfemudad de Carridn, El informe preliminar de la Comlsidn 
de la Escuela de Medicina Tropical de Han ard, bajo la direcci6n del Dr. Sfiong (140) 
mantiene que la Verruga y la Fiebre de Oroya son dos enfermedades distintas; una 
afecci6n local aquella, y una infecci6n general y gra^ e ^ta. En junio de 1913 el Dr. 
Townsend, entom61ogo del Gobiemo peruano, public6 (142) la relaci6n de im experi- 
mento de transmisidn de la Verruga a un perro chino, por inoculaci6n en la piel, de 
unoe insectos recogidos en la zona infectada. El intedo es un Phlebotomu$ y la especie 
ha side designada Verrucarum por Townsend. Segdn se informa en esta experienda 
la sangre del perro preeentaba los cuerpoe endoglobulares deecubiertos por Barton, y 



PUBUO HBALTH AND M8DIGIKB. 27 

que han recibido el nombre de Bartania baciUifarmit. La GomiaidD de Harvaid 
confinna la presencia de eetoe cuerpos en la Bangre de loe enfennos de Fiebre de Oroya. 

V^a^ la BibUogiafia de (132) a (143). 

La$ Espiroqtieto9e8. — De macho menos importancia que las eufermedades hasta ahora 
mencionadas tenemos en Arnica ^ureas de infecci6n por las espiroqu^tidas. El g^nero 
de esta familia que presenta especies paiasitariaa en el hombre, y causantes de fiebres 
del tipo recunente, es el g^nero Spiro9(Aaudinn%a, 

Mucho se ha diecutido sobre ai las espiroqu^tidas debeo claaificaree entre las bacterlas 
o entre loe protozoarioe, sin que, hasta ahora, se haya resuelto definitivamente el 
problema. 

Se han descrito varias especies de Spiroschaudinnia, cada una de las cuales produce 
una enfermedad especifica, distinta de las otras; pero todas bastante parecidas entre 
sf, aunque se presentan en regiones del globo muy apartadas unas de otras. 

Las especies son: Spiro9chaudinnia reewrrentUf descubierta por Obermeier en 1868, 
en casos de Fiebre Recunente europea. Fu6 ^ste el primer microorganiamo descu- 
bierto y comprobado como agente de una enfermedad en el hombre. Transmftese 
esta eq>ecie por la chinche, Clinoeorii leetulariui y por los piojos. 

8. DoUoni, es el microbio de la Fiebre Recurrente del Africa Occidental y de 
Colombia, infecci6n transmltida por especies de la ^unilia de las ArgdsidaM: el OmithO' 
doftu mouhata en el Africa Occidental y el Argaa Americanus en Colombia. Algunos 
autores no admiten la identidad de estas doe formas de Spiroschaudinnia. 

S. Novyi, agente infecti . o de la Fiebre Recurrente de Norte America; 8, Carteri de 
la Recurrente de la India y S, Berbere de la del Africa Septentrional. Estas dos 
dltimas son tiunsmitidas por piojos. 

V^ase Bibliografla de (144) a (149). 

La Tripanoiomiasu humana de Amhica, — Como era de esperarse, la gran ciudad 
tropical de Rio de Janeiro ha llegado a ser centio importante de investigaciones en 
lledicina Tropical. En tomo del '' Institute OswaJdo Cruz" y de la distinguida 
pecBonalidad cuyo nombre Ueva, se ha formado una escuela notable a la vez por los 
brillantes resultados practices obtenidos en la Medicina preventiva, y por las contri- 
buciones a las dencias m^dicas. 

La entomologfa, la helmintologia, la protozoolbgia de aquella regi6n son hoy objetos 
de investigaciones y publicaciones admirables; de manera que no es poaible hacer 
estudioe de caricter general sobre aquellas ramas de la ciencia sin referirse uno a la 
llteratuza braailefia. 

En la segunda parte del Vol. 1 de las **Memorias do Institute Oswaldo Cruz " aparece 
tin trabajo (160) en que el Dr. Carlos Chagas da cuenta de una nueva Tripanosomiasis 
por €i descubierta en la Proainda de Minas Geraes. Encargado de ima campafia 
antipalddica en la linea de construcci6n del Ferrocarril Central, llam6 su atend6n 
on hemfptero, de considerable tamafio, chupador de sangre que con el nombre de 
Barbeiro era conoddo en aquella comarca e infestaba las chozas de los pobres, donde 
se ocultaba de dla en grietas y rendijas de techos y paredes, para caer de noche sobre 
los habitantes dormidos. El insecto es igualmente vordz en los tres perfodos de su 
e\ olud6n, lar\ a, ninfa y adulto. 

Un estudio cuidadoso del hemfptero revel6 al Dr. Chagas la presencia de formas 
critideas en el intestine posterior. La inoculacidn de animales de laboratorio y de 
monos demostr6 que las critideas eran formas evolutivas de un tripanosoma de maml- 
leroe, para el cual el insecto era un hu^sped intermediario perfecto. Pudo seguir 
Chagas el dclo complete de la evoluci6n. El descubrimiento de peculiares procesos 
endoc^ulazes de esquizogonia di6 lugar a que se creyese necesaria la creaci6n de un 
nuevo g^iero de Trypanosomidas, al que se di6 el nombre de Schizotrypanum. Mis 
tarde, Chagas ysua colegas, al encontrar procesos esquizog6nicos semejantes en otras 
Tiipanosomidas, han propuesto que se abandone el nuevo g^nero. 

Desfgnase, pues, el pahbito, Trypano9(nna enui, y el insecto transmisor, Lamoi 
mtffitHuMf de la familia B^duviidMy aerie Oymnoeerata, suborden HeUrdptera^ ocden 



28 PB0GEEDING8 BEOOND PAN AMEBIOAK BCIEKTIFIO C0KGBE8S. 

Eemiptera, Ptoece que el ^ero Conorrhintu, pr6xiino al Lamut, y algunas Glino- 
c6ridas {Uchdarius) pueden tambi^n hacer el papel de hu^sped intermediaiio. 

Es evidente que el par^to se adapta f^ilmente a variadas condidones natumlea 
7 experimentales (ciiltivoa, etc.). Recieutemeute sugiere Chinas que el annadillo, 
Jkayput navemeinetui, puede aer el depositario natural del par&aito. 

Dada la adaptabilidad del oiganumo no debe mara illamos que la infecci6n ae haya 
generaliaado en la comarca y que constltuya un gra :iiiimo tdtctor de destruccidn y 
degeneiaci6n en las claaes pobres. En loe perfodoe de su desarrollo adiptase tambi^n 
el par&aito a variadas localizacionee endocelulaies que producen, en la esquizogonia, 
miUtiples lesiones de di ersos diganos, como el tiroidee, el aistema ner /ioeo y el muscu- 
lar, incluyendo el coras6n. La gametogonia se produce en las c^lulas endoteliales 
de los capilares del pulm6n. Tambi^n los eritrocitos albergan por algdn tiempo a 
los merossoitos en su crecimiento. Esta mdltiple exuberancia da lugar a la mia 
extraordinaria combinaci6n de sfntomas, desde ed case agudo de 10 a 30 dlas de dura- 
ci6n, hasta las variadas manifestaciones cr6nicas que constituyen diveraas formas de 
la enfeimedad: la peeudomixedematosa, la mixedematosa, la cardiaca, la nerviosa y 
la fonna cr6nica con exacerbacionee agudas. 

Las formas agudas ocurren generalmente en la primera infancia, de manera que las 
formas cr6nicas que se presentan en nifios que sobreviven al ataque agudo, tienen la 
duraci6n toda de la vida para extender su miserable carrera de infortunios. 

La enfennedad se caracteriza siempre por una hiperplasia del tiroides con dismlnu- 
cl6n de su acti idad funcional, por lo que se le ha dado el nombre de tyraiditU para" 
titaria. Presenta, miB o menos intensamente, los fen6meno6 del hipotiroidismo, as( 
como tambi^n los de la insuliclencia suprarenal. SI consideramos por un memento 
los efectos de estas insuficiencias glandulares y los que ban de producir mdltiples 
lesiones del sistema ner ioeo, formas difusas de meningo-ence&ilitis, lesiones mlocardf- 
ticas mds o menos extensas, no deber&n de aorprendemos las aiguieDtea palabraa del 
Dr. Ghagaa: ''Melhor fdra, no ponto de ^ ista social, viesse aempre a morte elimlnar 
da comunhSo himiana esses especimes de degenera^fto esqulzotripaaoaica, evitando 
asdm a continuag&o de uma vidaimproducente." Mejor fuera, dice, desde el punto 
de - ista social, que ^ iniese siempre la^ muerte a eliminar de la comuni6n himiana esas 
muestras de d^;eneraci6n esquizotripandsica, evitando de eate mode la continuaci6n 
de vidas improducti as. 

La naturaleza de este trabajo no me permite entrar en deacripciones m^ completas 
de tan singular enfermedad y debo ahora poner tannine a esta aerie de ligeros bosquejos. 
Permftaseme, sin embargo, que al concluir insista por un memento sobre el punto 
mds saliente de esta nue a doctrina de enfermedades transmitidas por insectos, punto 
que no * acilo en declarar, es el beneficio inmenso que le ha reportado a la humanidad. 

Podemos predecir con satis&u:ci6n los reaultadoe del deacubrimiento del Dr. Chagas 
sobre aquella poblaci6n degenerada, cretina, paralitica, de las comarcas del orte de 
Minas Geraes. Podemos predecir c6mo se eliminard allf otra de las r6moras que 
imped fan la marcha de los pueblos tropicales. La mayor parte de las enfermedades 
que hemes bosquejado en eate trabajo afectan eapecialmente al hombre de loa tr6picos, 
y algunas han despoblado extensas regiones de aquella zona. 

Desde el comienzo de estos estudios he crefdo, y asf ha pensado tambi^n nueatro 
Preddente, que la nueva luz aer& punto de atracci6n para loa fundadorea de imperios, 
y que un gran por\ enir le eapera a laa razaa que han venido luchando contra inniune- 
rables obstdculos para reno% ar las grandes civilizaciones del pasado en las tierras 
del Sol. 

Y pensar, Sefiores, que un hombre clamaba por largos afios en el desierto, clamaba 
en A ano para que el mundo \iese la nueva luz. A 61 dedicamos las palabras de Garlyle : 
"Cuintas -v eces hemes visto algtin explorador aventurero que, entre las censuras de la 
mdltitud, penetra por regi6n ohidada y distante, pero de importancla vital, cuyos 
teaoros escondidos bi6 61 el primero en descubrir y proclamar persistentemente, hasta 



PUBLIO HEALTH AKD MSDIOINB. 29 

<liie la fttenci^ii van enal y el etfaeno alH ae fijaion, y el triunfo tti6 complete. De 
ial mode, en aqoellM sua excuraioneB, al parecer ain nimbo, abre nuevas orientaciones 
y foada cobniaa habitablee en la vasta extenaidn ambiente de la Sombra y de la 
Nada." (Sartor Renrtus. Chapter I.) 

BIBUOO&AViA. 

1. Annario estadistico de Venesnela y docnmentoB de 1911 y 1912. Caracas, 1913. 

2. AiribUzaga, F^lix Lynch. Dipterologla Argentina. Revista del Mtueo de la 
Plata, 1891. 

8. Beanperthuy, Lonls-Daniel, Travaux scientifiquesde, docteur en m^ecine dee 
heukt6B de Paris et de Caracas. Naturaliste fran^ais et mirmgiaphe. Bordeaux, 
1891. 

En tfto afio pabUod kM mamiaoritof QD hennano del Doctor. ]fcste lUjeeKS en el tfio 1871. Be dice quo 
mnidtm etttfn ineorpondas eo oomnnieadoiwe dirlgidM a Is Academla de Parfs entre los alios de 1888 
J 18B. XI eaiiltalo aobn flebie amariUa del libro que antes ae dta, le publied en "La Oaceta Ofldal da 
Cnmaoi'' de mayo 38 de 1864. Dedlohocai^ttilohacolaBeltatqiieaoontintiaoidnapareoen. 

DaapuN de deeir que habla sido nombrado mMloo municipal de Comani durante la epidemia de flebre 
amarflla de 1868, contlnda: 

"Dans la mission que j'a-* ais k remplir, j'apportais le fruit de quatorze ann^ 
d'obser. ations tidtes au microscope sur les alterations du sang et des autres fluidee 
de r^conomie animale dans les fi^vres de tons les types." 

Despu^ de algiinas declaraciones may terminantes con respecto al tratamiento, 
abotda el tema de la etiologla en los aiguientes t^nninos: 

L'affectioa connue sous le nom de typhus amaril, de vomissement noir, etc., est 
produite par la mdme cause qui produit les fi^vree r^mittentes et intermittentes, 
C'est par suite d'une distraction bien grande qu'on a fait de la fi^ re jaune une maladie 
inflammatoire. L'examen microacopique dea mati^res noirea rejet^ea par les indi- 
vidua atteints de la fi^\ re jaune montre qu'elles sent de la m^me nature que cellea 
obaer 6ea dana lea fi^vrea irtermittentea, rdmittentea et pemicieuaea. L'analogie eat 
complete; c'eat la mdme aubatance, k la couleur pr^ qui eat jaune, verd&tre ou o1 acure 
dana lea autrea fl^vrea. II n'y a de diff^nce que dana le degr^ d'intenait^ de la 
maladie. Sana la preoccupation de vouloir faire de la fie\ re jaune une affection dia- 
tincte dea autrea fi^vrea, on eut tenu compte da antage que ce mal reconnatt pour 
cauae lea mdmes foyera de putr^factioo produite par la decompoaitlon dea aul atancea 
animalea et v^tal^a qui occaaionnent lea fid rea que Ton nomme miaamatiquea de 
toua lea types; et que cea fi^ rea coexiatent constamment a ec lea epid^miea de typhus 
amaril. Som ent, du reate, la lid re jaune re% ^t une forme normale qui n'eat pas 
one complication (comme on Ta donn^ k entendre) et pr^aente lea typea remittent et 
intermittent, et dana ce caa toua lea auteura aont d'accord aur Tefficacite dea anti- 
periodiquea pour enrayer la marche de cette affection. Noua ne pou ona partager 
Topi^on dea auteura qui attribuent lea aympt^knea obser ^a dana la premiere p^riode 
de la fi^re jaune k une gaatrite. L'autopeie ne confrme paa cette manidre de oir, 
puisque dana le plua grand nombre de caa la muqueuae inteatinale eat intacte, et lea 
ecchymoaea qu'on obaer . e quelquefoia k aa aurface ne doi ent paa 6tre plua attrit u^ea 
k un etat inflammatoire que lea peteduea et ecchymoaea de la p>eau ne procMent de 
rinflammation de cette membrane. Cea epanchementa aont dua k la grande lique- 
faction du aang qui auinte en quelque aorte k la surface dea muqueuaea, comme cela 
arri e dana le acorbut, la fidvre typh<Ade, dana lea caa de mort due k la moraure dea 
serpents ^ enimeux, etc. 

Le friaaon, la c^phalalgie, lea naua^ea, lea etourdiaaementa, la conrbature, etc., qni 
s'obeervent an debut du typhua amaril, aont lea mdmea aymptdmea qu'on obaerve, k 
on mcandre degre, il eat vrai, dana I'invaaion dea fievrea remittentea et intermittentea; 
et penonne ne a'eat aviae, dana cea demidrea maladiea, de lea attribuer k rinflammation 
de la membrane gaatro-inteatinale; et jamaia cea aymptdmea n'ont ete regardea comme 
one centre-indication k I'emploi dea antiperiodiquea. 



so PB00EEDING8 8B00ND PAN AMEBIOAN 8GIBHIIFI0 C0KGBE88. 

Le typhus amaril est une fi^vre de type axumnal, qu'on doit attaquer nns attendre 
la r^miflBion dee symptdmefl, et 11 hnt adminiatrer les neatralisuitB dee influenoea 
r^ut^ miaamatiquee, dans le fort mdme de la fi^vre, comme cela ae pratique dans lea 
premiers acc^ des fi^vree pemideusee: m^thode qui est constamment suivie dee plus 
heureux succ^. 

Qu'il me salt permis, en terminant ce court expos6, de dire quelques mots des 
traitements pr^conis^ dans le but de ranger la fi^vre jaune sous Tempire de certaines 
doctrines. 

La saign^e est constamment nuisible. Elle a deux graves inconv^nients: celui 
d'activer Tabsorption de la mati^ alt6r6e et qui constitue k un degr^ avanc6 la 
substance noire des dejections, et de preparer une convalescence tx^B longue. Lea 
saign^es locales sont ^galement nuisibles pour lee mdmes raisons, bien qu'k un moindre 
degr6. 

Lea vomitifs sont, pour le moins, inutiles. lis fatiguent les malades, et n'ont paa 
la puissance de d^truire Tagent morbide. 

Lea puigadfa ne aont indiqu^s que lorsque les antipModiques ont neutraUs^ Taction 
d^l^t^e de Tagent r^put^ miaematique. 

On ne pent conaid^er la fi^vre jaune comme une a£fection contagieuse. Les causes 
de cette maladie ae d^veloppent dana des conditiona climat^riquea leur permettant 
de a'^tendre k la foia ou aucceaaivement aur pluaieura locality. Gee conditiona aont: 
rei^vation de la temperature, I'humidite, le voiainage des cours d'eau, les lagunee, 
le peu d'ei6vation du sol au-dessus du niveau de la mer. Ges conditions sont cellee 
qui favorisent le d6veloppement des insectes tipulaires. 

La fi^vre jaune n'^tend jamais see ravages dana lea terraina mar^cageux de Tinterieur 
de la province de Cuman^. Elle eat inconnue dana lea belles et fertiles valines de 
Cumanacoa, de San Antonio, de San Francisco, Guanaguana et de Caripe, vall6es 
deatin^ea k devenir avec le tempa de granda centarea de population, et dont Taltitude 
varie de 200 2i 800 m^trea. 

La fi^vre jaune ne diff^ dee fi^vres putrides, remittentes et intermittentes, que 
par rintensite dea symptdmea. Comme cee maladiea, elle se d^veloppe apr^ une 
p^riode plus ou moina longue d'incubation, p^riode pendant laquelle lea fluidea 
lymphatiquea et sanguina aont alt^r^a profond^ment, avant m^me qu'aucun aymiH 
t6me faaae entendre son cri d'alarme. 

Lea tipulea introdulsent dana la peau leur su^oir, compost d'un aiguillon canalia6 
piquant et de deux acies lat^rales; ils instillent dana la plaie une liqueur venimeuae 
qui a dea propri^t^s identiquea k cellea du venin dea aerpenta k crocheta. II ramoUit 
lea globulea du aang, determine la rupture de leiira membranes tegumentairee, diaaout 
la partie parenchymateuae, facilite le melange de la mati^ colorante avec le a6rum. 
Cette action eat en quelque aorte inatantan^e, comme le d^montre Texamen microa- 
copique, puiaque le sang abaorb^ par cee inaectea, au moment mtoe de la succion, 
ne pr^aente paa de globulea. Cette action diaaolvante paratt faciliter le paaaage du 
fluide aanguin dana le conduit capillaire du su^oir. Si Tinsecte eat interrompu dans 
Poperation de la auccion, tout le venin reste dans la pMe et prodult une plus vlve 
d^mangeaiaon que loraqu'une grande partie du fluide venimeux est repomp^e avec 
le sang. On attribue sans motif le prurit k la rupture de TaiguiUon; cet aiguiUon est 
une substance cohi6e eiastique, dont je n'ai jamais observe la rupture dans mee 
nombreuaea observations. 

Lea agents de cette infection presentent un grand nombre de variet^s qui ne sont 
paa toutes nulaibles au m^me degr^. La variety zancudo bobo^ k pattes ray^es de blanc, 
est en quelque sorte Tesp^e domestique. Elle est la plus commune et sa piqilre est 
inoffensive comparativement k celle des autres eep^ces. Le pt^on est le plus grot 
et le plus venimeux; il produit une gale;^ son aiguillon est bifurque k son extremity; 
sa piqiire, dans les cas plus favorables, otTle venin n'eet pas absori>e dans reconomie, 
determine une irritation locale qui presente la forme d'un bouton prurigineux sem- 



PX7BLI0 HEALTH AND MEDICINE. 31 

blable an scabies pornlent, maia nullement contagieux. O'est Burtout lea enfonta 
qn'il attaqne. L'^tendue da foyer de sappuration rend diffidles lea recherchea qui 
tendent k d^couvrir Texiatence du aarcopte dana cea vMculea. 

L'adde carboniqne aaUor^ et lliydrog^ne phoephor^, gaz d6gag^ dana la d^compo- 
stum dea matidfee ammalea et v^talea en putrefaction, peuvent bien, k un certain 
degr^ de concentration, d^tarminer Paflphyxie; maia jamais produire un malaiae 
conpaimble aux cymptdmes des typhus ou des fi^vres d'acc^. 

Lee plagea des r^giona ^quatorialea et intertaropicales sent couvertes de d^biis de 
plantea marinea, de poiaBons, de crustac6s, de moUusques, etc., dont Taccumulation 
pfoduit une fennentation trte active, surtout k I'dpoque de lliivemage, quand lea 
pMea et lliumidit6 de la saison ferment de nouveaux elements ajout^ k la putrefac- 
tion. Lee radnee et lea tronca des paietuviers (rbizophora) et autres arbres p^lagiquea 
se couvrent k mar6e haute de couches de mati^res animalee, de mucosites et de myria- 
des de zooph3rtee geiatineux, dont lea vastes bancs, s'etendant pendant certainea 
auaona de I'annee k pluMeura millea de longueur sur la surface dea flots, sont generale- 
ment connua aoua le nom de agiui mala. A la mar^e basse, toutes ces substances 
ghitineuses appliqueee confxe r6corce dea arbrea se dess^chent et ferment un enduit 
qui ne taide paa k ae coirompre. Lea insectes tipulaires que frequentent les sombrea 
letraites formeee par lea mangliers, maintiennent leur existence en absorbant ces 
ihiidea d6c<NSipoeee. G'est acddentellement, on pent le dire, qu'ila font servir le sang 
de lliomme k leur nourriture, et dana ce caa, la puissance dissolvante des sues contenus 
dana le tube intestinal de cea inaectea eat telle, que les globules du sang sont ramollia 
€t hquefiee d'une mani^ preaque instantanee, comme j'ai eu occasion d'en faire I'ob- 
aervadon au moyen du microscope. Que sont ces mati^rea p^lagiquea dont lee tripu- 
lairea ae nounriaaait, ainon des substances animalee phosj^orescentes comme la chair 
dee poiasona? Qu'y a-t-il d'etrange que I'lnatillation dana le corps de lliomme de 
ces substances k I'^tat putride produiae des d^sordrea trte graves? M. Magendie 
n'l^t-il paa pionve que quelques gouttes d'eau de poisson pourri, introduites dans le 
Mag de0 animaux, determinaient en peu dlieures des symptdmes analogues k ceux 
du typhus et de la fi^vre jaune? N'est-ce pas, en effet, une instillation de poisson 
en putr^&Mstiim que versent ces insectes sous la peau et dans le tissu cellulaire de 
lliQmine 7 

n n'eat plus necessaire de chercher pourquoi le typhus icterode, si commun au 
voianage de la mer, est si rare dana Tinterieor des terres et sur les lieux peu fr^quentes 
par lea insectes tipulaires. On a observe k la Basse-Terre, capitale de Tune de nos 
Antilles, que les epidemies de fi^vre jaune n'etendent pas leur influence pemicieuse 
jusqu'au quartier du Matouba, localite aituee k une distance k peine d'une lieue de 
cette yille. n faut convoiir que cette diatance eat bien rapprochee pour preserver 
le Matouba des effluves pretendus nuiaibles exhales sur le littoral, et que les courants 
aeriens qui leur aervent de vehiciiles peuvent y transporter en peu de minutes quand 
le vent souffle dans la direction de Touest; tandis que cet eioignement du livage de 
la mer, c'est^rdire dee localitea habiteea par les insectes tipulaires, eet plus que 
sdBaaat pour preaerver de leur action et des gravee inconvenienta qu'elle produit. 
D'ailleura la diimie n'a-t-elle paa examine lee gaz des marecagea et dee mati^ea 
animales en putrefaction? Sea moyena parfoits d'analyae lui out permis de recon- 
nattre que les produits volatils de ces decompositions ne sont que des addes carb- 
ooique, hydrogteie sulfure et hydrog^e phosphore. II est parfadtement reconnu que 
ces gas peuvent k un certain degre de concentration determiner raaphyxie, mais 
jamais produire aucune maladie comparable aux sympt(knes des fi^vres d'acc^. 

Non aeulement le vima des insectes tipulaires varie aelon leura esp^cea et les localitea 
qn'ils habitent, mais auasi selon les saisons de Tannee. 

Cast aprte les gxandes inondationa et k repoque de Tabaissement des eaux qui les 
anoaent que lea aUuviona deposees sur les bonis des fleuves sont reputees malsaines. 
La retndte dea eaux abandonne lea mati^rea animalee et vegetales emp&tees dans ces 



32 PBOGEEDIKOS SECOND PAN AMEBIOAN 80IENTIFI0 C0NGBE8S. 

teirains ^uigeux aux aideora du soleil qui Active puinwunment leur putr^foction. G'est 
alors que les piqiires des insectee tipulaires qui s'alimentent de cee subfltances d^com- 
poshes cauBent plus d'irritation et Bont pluB dangereusee. C'est une vMt6 reconnue 
8ur lee bords de Urns lee grande fleuvee dee pays chaude, que lee fi^vree eeeentidles 
diminuent et eont plue b^nignee pendant la crae dee eaux. Cee faita e'appliqaeiit 
k TAmazone aued bien qu'au Magdalena. On eait que la peete dieparalt en Egsrpte 
k r^poque du d^boidement du Nil. 

On a dit que lee effluvee d^gag^e dee mar6cagee exeicent eur T^concnnie animale 
une influence plue nuieible pendant la nuit que pendant le jour. Pour quelle raieon 
en eerait-il ainai? Cee effluvee ne eont-ile pae au contraire beaucoup plue abondanta 
pendant le e^jour du eoleil our Thorizon? La chaleur n'eet pae I'agent le plue actil 
de la d6compoaition dee matinee v^talee et animalee, et de la f<»mation dee gas qui 
e'en 6chappent7 C'eet une explication peu eatiefaieante que la euppoeition de Tinno- 
cuit^ dee effluvee, pr6ciedment dane le m<Hnent de la joum^ oil ile eont plue abondante. 
On a admie que cee effluvee, apr^ avoir mont^ dane Tatmoii^^ durant le jour, 
retombaient pendant la nuit comme une roe6e malfaieante au voieinage dee mar^cagee. 
Pour que cette explication f dt exacte, il faudiait admettre Timmobilit^ de Pair au* 
deeeue dee endioitB mar^cageux. L'atmoq>h^ de cee locality n'eet-elle done pas 
aoumiee k cee giande courants a^ena qui bailaient avec une viteaee de pluaieura lieues 
par heure la euperficie de la terre? Que deviennent lee effluvee au milieu de cea 
giande mouvemente de ventilation? Dane lee i^one ^uatorialee et tropicalee, c'eet 
pr^de^ment pendant le jour que le eoleil, ce puieeant ventilateur, donne impuloon 
aux courante a^ene, et c'eet au contraire pendant la nuit que Tatznoflph^ reete en 
calme. 

AnimakuUs de laJUvre jaune; Vermiateaux lymphaiiques.—CeB animalcules se meu- 
vent dane toutee lee directione, remontant le courant, et eont dou6e d'un mouvement 
de giration de drdte k gauche et de gauche k droite. 

Une trte petite quantity de eulfate de quinine m^lang6e avec le liquide, paralyse 
inetantantoent Taction dee animalcules. lis eont entratn^ par le cours du liquide 
sane manifeeter aucun mouvement. 

Nota. — Cet article a 6t6 public dane la Gazette offidelle de Cumani, le 23 mai 1854, 
num. 57. 

Algonos han erefdo Ter en la dta anterior donde dJee: "uneudo hobo, a pattee ray^ea de blane" qua 
Beaaperthuy sefialaba eete moaquito de patas rayadas de bianco oomo el oaniante de la llebre amarina. 
La Terdad es que el mendonado aator dice piedsamente lo oontrario. 81 le lee ooidadoaamonte todo a| 
pasale en que ooorre la fraae antes oitada, le observaiA que Beanperthny eYldentemente conftinde doa 
clases oomunes de moeqnltos rayados, a saber, a AtdeM (Steffomfia) ealoput, y el Culex toUeitaut, Este 
dltimo merece ▼erdaderamente el nombre de bobo. Es muy Mdl matar este mosquito coando se posa 
sobialapleL Lo oontrario suoedeoon el colofwt que eeunodelosmosqaitos mis viyos, todo lo oontrario de 
bobo, £1 tolicUaut invade las habitadones hnmanas en grandee nt!meros y, sin la preeisldn de nnestroa 
oonocimientos actoales, se le tomaria por una eepede domdstioa. £1 hecbo de oonsiderar Beanperthny 
eete taneudo bobo como espede dom^stloa le Induce a sefialaro como el menos peligroso de los mosqultoa 
porque tiene, supone #1, menos oportonidad de aUmentarse de las sabstandas anlmales y vegetales en 
desoomposlddn, lasooaleSfSegto lacreendade Beauperthuy oontienen losanimAleolosde laflebie ftwiftHf^. 

4. Berkely, William E. Laboratory work with moequitoes. New York, 1902. 

5. Boyce, Robert W. Moequito or man? The conquest of the tropical world. 
London, 1909. 

6. British Museum. How to collect moequitoes, 1899. 

7. Carter, H. R. Notee on the sanitation of yellow fever and malaria from isthmian 
experience. Reprint from New York Med. Record, July 10, 1909. 

8. Castellani and Chalmers. Manual of Tropical Medicine, 1913. 

9. Chantemesse et Mosny. Traits d'Higi^ne, Vol. XVII, Etiologie et prophylaxie. 
Maladies transmissiblee par la p>eau, 1911. 

10. Clement, A. L. Deetruction dee insects et autree animaux nuieiblee. 

11. Doty, A. H. On the extermination of the moequito. Am. Journal of the Med. 
Sciences, February, 1906. 



FUBUO HBALTH AND MEDIOD^ 88 

12. Doty, A. H. The Mosquito: Its relation to disease and its extermination. 
New York State Journal of Med., May, 1908. 

13. Finlay, Carlos J. Trabajos selectoe. Selected papers. Publicaci6n del 
Gobiemo de Cuba, Habana, 1912. The first publications of Finlay on the trans- 
mission of disease by mosquitoes may be found also in ''Transactions of the Interna- 
tional Sanitary Conference of Washington." Protocol Ntim. 7» session of Feb., 1881, 
p. 34, and in the An. de la Real Acad, de Sciencias M6d. Fis. y Natur. de la Habana, 
Vol. XVIII, p. 147, session of Aug. 14, 1881. 

See also, ''Method of Stamping out Yellow Fever suggested since 1899 " in ''Selected 
Papers" above mentioned, or Transactions of the Conference of State and Provincial 
Boards of Health of North America, Oct., 1902, or New York Med. Record, May 27, 
1899. 

14. GaUi-Valerio, B., y Rochaz, J. Manuel pour la lutte contreles moustiques, 1906. 

15. Geriiardt, C. Ueber Intermittensimpfungen. 2Seitschr. f. klin. Med., VII, 
S. 373. 1884. 

16. Giles, G. M. A. Handbook of the gnats or mosquitoes. London, 1902. 

17. GMdi, Emil A. Die sanit&risch-pathologische Bedeutung der Insekten. 
Berlin, 1913. 

18. Goigas, W. 0. Sanitary Work on the Isthmus of Panama during the last three 
years: Reprint frcnn the New York Med. Rec., May 19, 1907. 

19. Goigas, W. C. Sanitation of the Tropics with special reference to malaria and 
yellow fever. Reprint from the Journal of the Am. Med. Asso., April 3, 1909. 

20. Goigas, W. 0. Sanitation of the Canal Zone. Address delivered at the Com« 
mencement Exercises of Johns Hopkins Univ., June 11, 1912. 

21. Grail, Ch, et Clarac, T. Traits de pathologie exotique. Vols. I and III, 1910 
and 1912. 

22. Grubbs, S. B. Vessels as carriers of mosquitoes. Yellow Fever Institute, 
U. S. Mar. Hosp. Serv., 1903. 

23. Grunbeig, Kari. Die blutsaugenden Dipteren. Jena, 1907. 

24. Howard, L. O. Economic loss to the people of the United States throu|^ 
insects that cany disease. U. S. Dept. of Agric., Bureau of Entomology, B\il. Nthn. 
78. 

25. Howard, L. O., Dyar, H. G., and Knab, F. The Mosquitoes of North and 
Central America and the West Indies, 3 vols., published 1912, 1915. 

26. Howard, L. O. Mosquitoes. How they live, etc.. New York, 1901. 

27. Howard, L. O., and Marlat, C. L. The principal household insects of the 
United States. U. S. Dept. of Agric, 1902. 

28. Howard, L. O. Remedies and preventives against mosquitoes. U. S. Dept. 
of Agric., Ftoners' Bui., 1911. _ 

29. Howard, L. O. The mosquitoes of the United States. Dept. of Agric, 1900. 

30. Kendall, A. I. Experiments in practical culicidal fumigation. Bui. Nthn. 2, 
Board of Health, Isthmian Canal Com. 

81. King, A. F. A. "Insects and disease, mosquitoes and malaria." Abstract of 
a paper on "The pre\'ention of malarial disease, illustrating, inter alia, the consen a- 
tive function of ague/' read before the Philosophical Society of Washington, Feb. 10, 
1882. Popular Science Monthly, New York, Sept., 1883, pp. 644-658. 

Aonqoe h«el« mtfs de on afto que Laveno luibla deeoublerto e] Plasmodiiim coando el Dr. King eeorlbld 
sa tnba^o, no ae refleie Me a aqoel detoabrlmiento. El Dr. King diee: " Bt mt prindpal objeto presentar 
eneitetrabi^Ioebediosqnepviedaeiidefeiisadel origen oollddodelasflebresmaUileas." Pareoepenaar 
el Dr. King, lo miono que el Dr. Nott oon respeeto a la ilebre amarlUa, que el moequito ee en oierto mode 
el agente morblfleo. Poreeoemplesasutrabajodelaiigulentenianera: "ElorlgenanlmaoularoiDseotll 
de lai enfermedadee no es una nuera idea." Como qniera que tea, el Dr. King, que eseribid un afio despu^ 
que el Dr. Finlay luil>la heoiio bob deelaradonee oon r eepec t o a la tranamisldn de la flebre amarilla por el 
BMaqofto, no ae refleie en manera alguna a la transmiatbilidad del paludismo de bombre a hombre, ni por 



84 PBOOEEDINOS SECOND PAK AMEfilOAN SCESKTOIO 00NGBE88. 

•I mosquito nl por nlngto otro medio. Oonttene, sfai embaiso, sa tnbi^ jxdm aerie de infenioeot argo* 
inentot qiw pniebcm que Is praeenoift del pahidismo ae lelaoioiia de algte 

toe. BreTemente ezpreaedoe los argomentoe eon: Cotocideiida de oondidonee teltiricae y cMm<ttcae que 
feToreoen a los moequitos y a la enfenneded; semejama de oondioioDee que protejen al hombie contra la 
flebreyoontrainseetos; la aciomeracidndeeasasseoponealdesanollodemoequitosyde la malaria. De 
la mlsma mauera estodia la aeddn de la Interposieite de boeques, del enlttro del toneno, de la fanrndacidtt 
de las tlerras, de la ezposiof^n duraate la noobe, del use de fuegos, de la Influenola de las ocnpadopea, da 
la eleyaddn sobre el nlrel del mar j, finatanente, la ooinddeDCia del pahidismo y de los moequitos. 

Es esto, sin duda, un Ingenloeo rasonamiento; pero no alcanxo a descubrlr que dlfleraeeencialmente del 
que, en Ibrma m48 omda, Herd a pueblos ignoranteo en difersos pafses a las miamas eonelustonee qua ez« 
ponen Beauperthuy, NoCt y King, es deeir, que los mosquitos tonlan algo que ver oon la pgodncddn del 
paludlsmo. 

32. Knab, Frederick. Unconsidered tacton in diaease tranflmiaaion by blood- 
sucking insects. Journal of Economic Entomology, Vol. V, No. 2, 1912. 

33. La eran, A. Note sur un nouveau parasite trou. 6 dans le sang de plusieurs 
maladee atteinto de fi^vre palustre. Acad, de M^., Paris, 23 Nov., 1880. 

34. Manson, Patrick. Tropical medicine. London, 1903. 

85. Mense, Karl. Handbuch der Tropenkrankheiten. Zweite Aufl., 1913. 

36. Bfitchell, Evelyn Q. Mosquito life. New York, 1907. 

87. Mosquitoes or Gulicidae of New York State. New York State Museum, 1914. 

88. lie propongo reproduolr fragmentos del trabalo del Dr. Nott, porque entiendo que no ae le ba com- 
prsndldo y basta ae olta endneamente el tftulo de su publloaddn, que es oomo slgue: 

Nott^ Joslab a, M. D., Mobile, Alabama. "Yellow Vtvti oootrMted wlfh BUious Few. Reaaoos 
tar beBertng It a disease wrfftiKfto. Its mode of propagation. Bemoleoanse. Probable inseet or anlmal- 
onlar origin, ete." New Orleans Medical and Burgieal Journal, VoL IV, No. 6, March, 1848. 

Rs el trabajo del Dr. Nott, oonalderando la 4poea en que ae eseribld, un hibU argumento en pro de la 
teoria microblana de las enfcrmedades. Lafreeuenoiaconqueemplealapalabra"inseoto"oomosindnimo 
da "animilonlo'' o germen o miorobio, oomo dMamos abora, y el nso que fkconenlemente haee de aecaa 
mis elerados en la esoala animal, verdaderos Inseotos, para sus ezpUcadones, ban eonduddo al esior da 
erser que 41 defendla la idea de la transmisldn de la flebre amarllla por el mosquito. 

Biguen los fragmentos del trabalo dtado: 

I now propose to give the results of mv observations on the peculiar habits, or what 
may be called the natural history of this disease, and my reasons for supposing its 
q>ecific cause to exist in some form of insect life. 

I propose now to show, from facts presented during the various epidemics in Mobile, 
that the morbific cause of yellow f e er is not amenable to any of the laws of gases, 
vapors, emanations, etc., but has an inherent power of propagatbn, independent of 
the motions of the atmosphere, and which accords in many respects with the peculiar 
habits and instincts of insects. 

Before entering on the "Insect Hypothesis" in detail, it may be well to give a 
familiar illustration of it, based on (acts well known to all classes in the cotton region. 
The perfect analogy between the habits of certain insects and yellow fever will thus 
be made apparent at once. 

It is a law of nature that eiery plant affords sustenance to several parasitic insects. 
The cotton plant, like others, is attacked by its parasites, ha- ing their peculiar habits 
and instincts. One or se.eral of these insects may appear the same season, and, true 
to their instincts, each attack, different parts or oigans of the plant, as the leaves, 
burk, woody fiber, roots, pods or bolls, flowers, etc. Some years there may be an 
entire exemption nom one of these insects, or, to use a medical phrase, there may be 
a few sporadic cases. At another time a wonn may appear at a single point, and 
from this focus will spread slowly o- er a portion of a field (as did the yellow fever in 
1842 and 43), leaving the other portbn almost untouched. In another year a worm 
comes like a great epidemic, apnearin^ at many points in rapid succession or simul- 
taneously, and ravaging not only a single pUmtation but laying waste the cotton 
region for several hundied miles. 

All the attempts heretofore made to account for the greater activity of the morbific 
cause of yellow lever at nig^t have fadled, and in my humble opinion the fact may be 
much better explained by a reference to habits of insect life. Many of the Infusoria, 
as wdl as insects prc^r, are rendered inactive by too much light, heat, or dryness. 
They remain quiet through the day^ and do their work at nif ht. 

It was not my plan to argue the insect origin of periodic tevers in this paper, but 
the morbific causes of fevers have been so long and so inseparably united in the 
minds of the profession that it is almost impossible to tear them asunder now. 



PUBUO HEALTH AKD MEDIdNB. 35 

All writefB aie a<p»ed on the foct that a very imperfect barrier will obstruct the 
progresB id marsh miasmata— row of houses or of trees, etc., will often effectually 
protect dwellings from the access of this faital poiaon. It is moreo>'er asserted that 
these miasma are not only impeded but attracted by trees. 

I ha e been a^ le in my researches, to disco ea no facts of this kind in ccmnection 
with yellow fe rer, and my personal obser atbn repudiates them in toto. We ne er 
find vellow fe er as the sportsmen say ''up a tree " but on the contrary, the materies 
morbi, whate er it may be, creeps along the ground, regardless of winds, passing 
under and throu^ houses, trees, etc., and knowing no impediment but a sheet dl 
water.' 

^ Contagion. If by this term we undontand that a morbid poison generated in one 
li ing body may by contact, either mediate or immediate, reproduce an identical 
disease in another, Uien are we justified in denying that jrellow te\ex is a contagious 
disease. But while without hesitation I take this position, I am equally strong in 
the con iction that there exists no concliud e e iaence that the germ or materies 
morbi may not be tran^Mrted from one locality to another. There are many curious 
fscts connected with this question which require a passing notice. 

The insect theory here again comes to our aid, and may explain difficulties which 
ha e much perplexed writers on contagion. The early history of ^rellow fe er 
Is in ol ed in great obscurity, and many of the highest European authorities belie e 
that this disease was imported originally into the Old World, and that it may still 
be transported from one country into another. There is no time here for discussing 
this point, and I will only say that the mass of authority in h or of this opinion is 
such as to challenge our full respect; no reasonable man, in the present state of facts, 
can assert positi ely that yellow fe. er may not, under peculiar circumstances, be 
transported. 

I have shown that yellow fever often commences in a point from which it gradually 
extends from house to house for several weeks. Now it is clear that in this case there 
must be a local, though in iaible. cause; it can not exist in the atmosphere, as it could 
not, if thus diffused, be confined to a point. Suppose the infected point and a few 
surrounding acres of ground were taken up in August and put down m the center of 
\ew York or Philadelphia, is it not probable that the disease would spread from that 
point as in Mo^ -He? If so, why may not the morbific cause 1)e carried and thrown out 
of a vessel with a caigo of damaged coffee, potatoes, grain, sugar, meat, etc.? The 
fferm might here 6nd a hiding place, though I ha e no idea that the gaseous emanations 
from these potable or animal substances could produce yellow fe er. We ha e 
no reason to belie e that such emanations, differing so widely in themsel es, can 
produce one specific disease. 

We ha e e idence around us almost constantlv that the germs of insects lie dormant 
for indefinite periods and are then suddenly called into acti ity and propagated with 
inconcei a^ le rapidity. By what physical causes these sleeping and waking states 
are go emed, human sagacity can not yet di ine. 

It Is proVaHe that yellow fe er is caused by an insect or animalcule bred on the 
ground, and in what manner it makes its impression on the system, is but surmise — 
unless the animalcule is, like that of psora, bred in the system, we could no more ex- 
pect it to be contagious than the bite of a serpent. We may therefore easily under- 
stand that it can at the same time be transportable in the form of germ ana yet not 
contagious. 

As according to the theory we are discussing, the natural history of yellow fe- er 
is closely allied to the natural history of insects, it is proper that I shomd say a few 
words more on the latter. The infusoria or microscopic animalcules particularly 
demand a passing notice, as few of our readers ha e access to original sources on this 
curious subject. It has, I think, been pretty clearly shown that the propagation of 
yellow fe er can not he explained by tne malarial theory, and it must remain with 
the reader to determine whether the chain of analogies offered render the insect theory 
more pro> able. 

The habits and instincts of larger Insects are obscured by numerous impediments, 
but how much more perplexing must be the natural history of those whicn can only 
be reached by powerful microsc<^Ms? We ha e learned much about the infusoria 
proper, but myriads of minute beings might inhabit the air and e . en congregate in 
sucn numbers as to dim the light of the sun without our being able to seize and obser . e 
them. Denying animalcules the power of flight, which would be absurd, there are 
•till ample pro isions of their transportation long distances, whether in the form of egg 
or perfect animal. 

I It if a oarkfOM tect tint from 1821^ to 1837 tbone wai no epktanio of yallow fever tn Mobile, tnd dartng 
tail time tbe iteaats wen beeutltally sheUed; slnoe ISrr we have had it Ove times, and the shelling was 
Bot co otlno ad. H the Imect theory be oorreot, could the lime be an impediment to their progrMs aoroet 
ttneta? 

684Se— 17— VOL IX— 4 



86 PBOOBEDIKQS SECOND PAK AMEBIOAK BCIENTIFIO C0KGBS8B. 

The narcotic poisons, for example, though deii^ ed from different plants and differing 
in their analysis, will often produce symptoms so alike as to render it impossible for 
us to decide under which a mitient is laboring. The same confusion will be found in 
the poisonous effects of different snakes, spiders, etc. In like manner fevers, if 
arising from insects of the same genus, might present some genial characteristics in 
common and yet preser e specific differences. 

The history of those great epidemics which sweep over the surface of the globe affords 
very strong support to the insect theory. 

" Whatever is true as to the habits of insects obvious to our senses is likely to be more 
especially so in those whose minuteness removes them further from observation. 
Their generation may be presumed to be more dependent on casualties of season and 
place* their movements determined by causes of which we have less cognizance; 
and their power of affecting the human body to be in some ratio to their multitude 
and minuteness." This last paragraph is quoted from Sir Henry Holland. 

39. Nuttall, George H. F. On the rdle of insects arachnids and myriapods, as 
carriers in the spread of bacterial and parasitic diseases of man and animids. Re- 
print from the Johns Hopkins Hospital reports, Vol. VIII, 1899. 

40. Osbom, Herbert. Insects affecting domestic animals. XT. S. Dept. of Agri- 
culture, 1896. 

41. Pasos, Jos6 H. Gontribuci6n al eetudio de los mosquitos de Cuba. Bdetin de 
Sanidad y beneficencia, julio-diciembre, 1909. 

42. PeryasB6, Antonio Gon^alves. Os culicideos do Brazil. Trabalho do Insti- 
tute de Manguinhos. Rio de Janeiro, 1908. 

43. Proceedings of the Medical Asso. of the Isthmian Oanal Zone. Half-yearly, 
1910-1913. 

44. Rosenau, M. J. Disinfectbn against mosquitos. Bulletin No. 6. Hygienic 
laboratory, U. 8. Marine Hosp. Service. 

45. Revista de Medicina Tropical, Vols. I-VII, 1900-1905. 

46. Rubner, Gruber u. Ficker. Handbuch der hygiene, Vol. Ill, 1913. 

47. Scheube, B. Die krankheiten der warmen l&nder. Jena, 1910. 

48. Sergent, Edmond. Determination des insects piqueurs et suceurs de sang. 
P&ris, 1909. 

49. Sergent, Ed. et Er. Moustiques et maladies infectieuses. 

50. Smith, Theobald, and Eilbome, F. L. Investigations into the nature, causa- 
tion, and prevention of Texas southern cattle fever. Bulletin No. 1, Bureau of Animal 
Industry, U. S. Department of Agriculture, Washington, 1893. 

51. Surcouf, J. M. R., et Gonzalez Rincones, R. Essai sur les dipt^res vuln^rants 
du Venezuela. Paris, 1911. 

52. Theobald, Fred. V. A. Monograph of the culicidae or mosquitos. 4 yds. snd 
Atlas, 1901-1907. 

53. Vermoret, V. Les pli^ges lumineux et la destruction des insects, 1902. 

Malaria, 

54. Bertrand et Ellynens. La malaria, 1903. 

55. Celli, Angelo. La malaria secondo le nuove ricerche. Roma, 1899. 

56. Darling, S. T. Transmiasion of malarial fe\ er in the Oanal Zone by anopheles 
mosquitos. Journal of the Am. Med. Asso., Dec. 18, 1909. 

57. Same. Factors in the transmiasion and prevention of malaria in the Pftnama 
Canal Zone. Annals of Tropical Med. and Parasitology, July, 1910. 

58. Gorgas, W. 0. The sanitary organization of the Isthmian Canal Zone as it bears 
upon antimalarial work. 

59. Grassi, Battista. Studi di uno zoologo sulla malaria. lUmia, 1900. 

60. Guiteras, Juan. Malaria, in Manual de PWbctica Sanitaria. Issued by the 
Health Department of Cuba, 1905. 

61. Laveran, A. Du paludisme et de son hdmatozoaire. Ptaris, 1891. 

62. Mannabeig, J. Die malaria-krankheiten in NothnagePs Specialle Fathologie 
u. Therapie. Vol. II, 1899. 



PUBUO HEALTH AND MBDICnnS. 37 

(S3. Orenstein, A. J. Moequlto catching in dwellings In the prophylaxis of malaria. 
Amoican Jour, of Pub. Health, February, 1913. 

64. " Palludiflm " being the Transactions of the Committee for the Study of Malaria 
in India. Simla, Noe. 1-5, 1910-12. Also Proceedings of the Third Meeting of the 
General Malaria Committee, 1913. 

65. Rofls, Ronald. The pre^ ention of malaria. London, 1910. 

66. Stephens and Christophers. The practical study of malaria, 1908. 

67. Sternberg, G. M. Malaria and malarial diseases, 1884. 

Plague. 

68. Agramonte, A. The late outbreak of plague in Havana. Reprint from Amer- 
ican Journal of Trop. Diseases, July, 1914. 

69. Agramonte, A. Plan de campafla sanitaria contra la peste bub^nica. Secre- 
larfa de Sanidad y Beneficencla, 1915. 

70. Agramonte, L6pez del Valle, Guiteras. Discusi<Sn sobre peste bub6nica. 
Acad, de Ciencias Med. Fisicas Natur, febrero 26, 1915. 

71. Baker, Carl F. The classification of American Siphonaptera. U. S. National 
Museum, 1905. 

72. Bamet, E. B. La peste bub^nica. Junta Sup. de Sanidad, Cuba, 1903. 

73. Boelter, W. R. The rat problem. London, 1909. 

74. demow, A. G. Plague in Siberia and Mongolia and the Tarbagan. The Jour- 
nal of Tropical Med., Feb., 1900. 

75. The same. Hie endemic centers of plague. Journal of Tropical Med., March, 
April, May, 1900. 

76. Creel, R. H. Epidemiology of plague in New Orleans. Am. Journal of Trop. 
Die. and Prev. Med., Sept., 1915. 

77. Chrux, Oswaldo Gongalvez. Peste. Instituto de Mangguinhos, 1906. 

78. Eager, J. M. Hie present xMtndemic of plague. U. S. Pub. Health and Mar. 
Hosp. Service, 1906. 

79. Giemsa, G. Ueber die vemichtung von ratten, etc. durch kohlenozid. 
Arch. f. Schififs-u. Tropen-Hygiene. Band XV, 1911. 

80. Guiteras, Juan. La pulez cheopis, transmlsora de la peste bub6nica entre las 
nUas de la India e& la pulga corriente en las ratas de la Habana. Comunicaci6n v erbal 
COQ presentaci6n de specimens. Anales de la Acad, de Ciencias Med. Fis. y Nat. , 1908. 

81. Guiteras, Juan. Three cases of bubonic plague in Habana. Journal of the 
Am. Med. Asso., Nov. 16, 1912. 

82. Guiteras, Juan, and Recio, A. Bubonic plague in Cuba. Reprint from Boletfn 
de Sanidad y Beneficencia, 1915. 

83. Hart, Merriam C. California ground squirrels. U. S. Ptih. Health Reports, 
Dec. 25, 1908. 

84. Journal of Hygiene. Plague numbers and papers. Vol. VI, No. 4, Sept., 1906 
VoL VII, No. 3, July, 1907; Vol. VII, No. 6, Dec., 1907; Vol. VIII, No. 2, May, 1908 
Yok, X, No. 2, Aug., 1910; Vol. X. No. 3, Nov., 1910; Vol. XII, No. 1, May, 1912 
Voi. XII, No. 3, Oct., 1913; Vol. XIV, No. 3, Nov., 1914; Plague supplements I and 
n, 1912; III, 1914; IV, 1913. 

85. KoUe, W., u. Wassermann, A. Handbuch der pathogenen Mikroorganismen. 
Pest. IV, Bd., p. 165, 1912. 

86. Lebredo, Mario G. Plan de campafia contra la peste bubdnica. Secretarla de 
Sanidad y Beneficencla, 1915. 

87. Liston, W. Gl^i. The cause and prevention of the cfpread of plague in India. 
Dec. 11, 1907. 

88. The rat and its relation to public health. Publication of the U. S. Pub. Health 
and Mar. Hoap. Service, 1910. 



88 PBOCEEDIKGS SBOOKD PAK AMBBIOAK 8CIBNTIFI0 OOKOBE88. 

89. Boflenau, M. J. An investigation of a pathogenic microbe applied to die 
destruction of rats. Hygienic Laborat<»ry Report No. 5, U. S. Mar. Hosp. Servicf^ 
1901. 

90. Arehivf. SMffB- u. TropenrHygiene, The first volumes from 1897 follow very 
closely the march of the plague pandemic. See also the Weekly Reports at th« 
U. S. Public Health Service. 

91. Simpson, W. J. Recrudescence of plague in die East and its relations to 
Europe. The Journal of Tropical Med., Sept., 1899. 

92. Simpson, W. J. The Groonian lectures on plague. Journal of Trop. Med. and 
Eyg., July-Sept., 1907. 

93. SweUengrebel, N. H., u. Otten, L. Ueber "mitiglerte'' Pest Infektionbei 
Ratten, etc. Arch,/, Sekiffe- u. TfoppenrHyg., Bd. XVIII, No. 6, 1914. 

94. Wyman, Walter. The bubonic plague. Publication of the U. S. Mar. Hoip. 
Service, 1900. 

Yellow/ever, 

95. Agustin, Geoige. History of yellow fever. New Orleans, 1909. 

96. Boyce, Rubert. Yellow fever and its prevention, 1911. 

97. Garter, H. R. The period of incubation of yellow fever. New York Med. Ba^ 
March 9, 1901. 

98. Same. The methods of the conveyance of yellow fever infection. Yellow 
Fever Institute, Bui. No. 10, U. S. Pub. Health and Mar. Hosp. Service, July, 1902. 

99. Same. A note on the spread of yellow fever in houses. 

100. Finlay, Carlos J. Trabajos selectos. Selected papers. Publicaci6n del 
Gobiemo de Cuba. Habana, 1912. The first publications of Dr. Finlay on the 
transmission of disease by mosquitoes may be found also in ''Transactions of the 
International Sanitary Conference of Washington,'' Protocol No. 7, Session of Febru- 
ary 18, 1881, p. 34, and in the Anales de la Real Academia de Ciencias M^cas, 
Flsicas y Naturales de la Habana, Vol. XVIII, p. 147, Session of August 14, 1881. 

See iJso Method of Stamping out Yellow Fever suggested since 1899, in Selected 
Papers above mentioned, or Transactions of the Conference of State and Provincial 
Boards of Health of North America, October, 1902, ot New York Medical Record, May 
27, 1899. 

101. Quiteras, Juan. Experimental yellow fever at the inoculation station, with 
a view to producing immunization. Amer. Medicine, Phila., Nov. 23, 1901. Pub- 
lished in Spanish in Revista de Medicina Tropical, Habana, Oct., 1901. 

102. Guiteras, Juan. The natural history of epidemics of yellow fever. Annual 
Report of the Supervising Suigeon General of the U. S. Mar. Hosp. Service, 1888. 
Republished with notes on endemicity and infantile yellow fever, in BoMn d$ 
Sanxdad y Bencficeneia, Dec., 1912. 

103. The same. La fiebre amarrilla infantil. Revieta de Med, Trop,^ Habana, 
abril, 1902. 

104. Marchoux, Salimbeni et Simond. Raport de la Mission Fran^aise. Arm, 
de VlmUtut Paeteur, Nov., 1903, p. 665. 

105. Otto, M., Neumann, E. 0. Studien tkber das Gelbe Fieber in Braailiem. 
Leipzig, 1906. 

106. Parker, H. B., Beyer, G. E., Pothier, 0. L. A study of the etiology of yeUow 
fever. Yellow Fever Institute Bui. No. 13, March, 1903. 

107. Reed, Walter, Carrol, James, Agramonte, A., Lazear, J. W. The etiology of 
yellow fever. A preliminary note. Read at the meeting of the American Pul^ 
Health Asso., held in Indianapolis, Ind., Oct. 22-26, 1900. Rq[Mint from the PkHa. 
Med. Journal, Oct. 27, 1900. 

106. Reed, Walter, Carrol, James, Agramonte, A. The etiology of yellow fever. 
An additional note. Read at the Pan Am. Med. Cong, held in Habana, Feb. 4r-7» 
1901. Published in Spanish in Revista de Medicina Tropical, Habana, Feb., 1901. 



PXJBUO HEALTH AND MEDIGINB. 39 

109. Ribas, Emilio, Lntz, A., Pereiia, Baireto, Barroe, A., Silva, Rodrlgaes. Ex- 
pcrienciM lealizadas no Hospital de Isolamento de S. Paolo por inidativa da Direc- 
toria do Servido Samtario do Estado. Feb., 1903. 

110. West Africa, Disciission on the distribution and prevalence of yellow fever 
in W. A. at the Society of Tropical Med. and Hygiene. Journal qf Trip, Med, and 
H^., Jan. 2, Jan. 16, Feb. 1, March 1, 1911. 

111. West Africa^ Report of certain outbreaks of yellow fever. 

112. West Africa, Reports of the YeUow Fever Conunission in 1912 and 1918. 

FUaria, 

lis. finlay, Carlos J. Consideraciones sobre algonos casos de Filaria observados 
enlaHabana. An.deUiR. Aead.de (Xentia» MSd. Fi»,y Natdel^ntLhBSiSk.lSSZ'^ 

114. FOllebom, Uebertiagung von Filarienkrankheiten durch MQcken. Anh, /. 
8th. u Trap. Byg., Band 11, No. 20, 1907. 

115. FOlleb<m, Beihefte. Vol. XII, 1908. 

116. Guiterss, John. The Filaria sanguinis hominis in the United States. Chy- 
hffia. Medkal News, Apr. 10, 1S86, p. 399. 

117. Lebredo, Mario G. Metamdrfosb de la filaria sanguinis hcnninis noctuma en 
•I mosquito y causas que acceleran o retaidan su evolucidn. Punto por donde seJen. 
Modo experimental de hacerlas salir bajo el microscopio. Revieta de Medieina Tropical^ 
Julio^agosto, 1905. 

118. Manson, Patrick. The filaria sanguinis hominis. London, 1883. 

119. Mastin, W. M. History of filaria sanguinis hominis, 1888. 

120. Ndfies, Enrique. La drugla de las manifestaciones filarii^sicas. Premio de 
la Academia, 1905. 

121. Wucherer. OauUa Med, da Bahia, Dec., 1868. 

Tjfphutfi 



122. Anderson, John F., and Gddbeiger, Joseph. A note on the etiology of "Tabar- 
dillo," the typhus fever of Mexico. Public Health Reports, Dec. 24, 1909. 

123. Andcmn, J. F. Tyjdius fever, its etiology and methods of its prevention. 
U. 8. Pvbl. Health Reports, Apr. 30, 1915. 

124. Brill, Nathan £. An acute infections disease of unknown origin. A clinical 
■tody based on 221 cases. Am, Journal of the Med. Sdmiices, Apr., 1910. 

125. Plots, Henry. The etiology of typhus fever (and of Brill's disease). PreHm- 
luaiy communication. Journal of the Am, Med. Asso., May 18, 1914. 

126. NiccoUe, Gh. Beptoduction exp^rimentale de typhus exanthdmathique dies 
le rioge. Compt. Rend. Acad, de SeUnaes, juillet 12, 1909. 

Rocky Mountain fever. 

127. Andsfson, J. F. Spotted fever (tick fever) of the Rocky Mountains. A new- 
disease. Hygienic Lab. Bulletin No. 14, U. 8. Pub. Health and Mar. Hosp. Service, 
1903. 

128. Aihbum, P. M., and Craig, Ghas. F. A comparative study <^ tsutsugamushi 
disease and spotted fever or tick fever of Montana. Manila, 1908. 

129. McOlintic, T. B. Rocky Mountain spotted fever, being the last season's notes 
(1912) before he died of the disease he was studying. Public Health Reports, Apr. 
24,1914. 

130. Reed, R. Harvey. A contribution to the study <^ mountain fever. Journal 
Am, Mad. Asso,, April 20, 1908. 

131. Stiles, Ch. Wardell. A zoological investigation into the cause, tzansnussbn, 
and source of Rocky Mountain "spotted fever." Hygienic Laboratory Bulletin* No 
20, 1915. Public Health and Mar. Hosp. Service. 



40 PBOGEEDINGS SECOND PAN AKBBIOAK 80IBNTIFI0 OOKOBB88. 

Oroiyajtver. 

132. BaasetrSmith, P. W. The pathology ctf the blood in Verruga. Brit, Med. 
Jaum., 1909, Sept. 16, p. 783. 

133. Biffi, Ugo. Sobre las h^noaglutinas de la aangre humana y hematologfa de 
la ''enfermedad de Oarridn." Bol de la Aead. NaeUm. de med. de Lima, III, 1903, 
No. 2. 

134. Biffi y Carbajal, G. Sobre un caso de "enfermedad de CtmGia" con vernico- 
mas 8upurado6. Cr6niea midica, XXI, 15 de Oct. de 1914. 

135. Hiisch. Handb. d. hist.-geogr. Path.- 2. Anfl. II, 1883, p. 78. 

136. Odiiosola, Ernesto. Estado actual de nuestroe conodmientos acerca de.Ia 
enfermedad de Ganidn o verruga peruana. lima-Perd, 1908. 

137. Odiiozola. Gac, med. de Lima, 1858, abril; Med, Tim. and Oaz., 1858, Sept., 
p. 280. 

138. Ruge, R. Zur geographischen Pathologie der WestikOste Siklamerikas. Beri. 
tlin, Woeh,, 1897, No. 46, p. 1005. 

139. Salasar. Oae, med, de Lima, 1860. 

140. Strong, Richard P., Tyzs^, £. E., Brues, Charles T., Sellards, A. W., Gasti*- 
bum, J. C. Verruga Peruviana, Oroya Fever and Uta. Preliminary report of tlie 
first expedition to South America hem. the department of tropical medicine of 
Harvard University. Jour, of the Am, Med, Aseo,, Nov. 8, 1913, Vol. LXI, p. 1718. 

141. Tamayo, M. 0. Apuntee sobre la bacteriologia de la enfermedad de Carridn. 
Cr6n. Mid, Lima, jtmio, 1913. 

142. Townsend, C. H. T. La Zitira es traamisora de la Verruga Peruana. Cr&mea 
Med,, junio, 1913. 

143. Townsend, Charles H. T. The Transmission of Verruga by PhlebotomiiB. 
Jour, of the Am. Med. Auo., Nov. 8, 1913, Vol. LXI, p. 1717. 

Spiro€haetoiii, 

144. Balfour, Andrew. The q[>irochaetae of Egyptian reli^MUig fever. Fourth 
Report of the WeUcome Tropical Reeeanh Laboratoriee, 1911. 

145. Breinl, A., Kingdom, A. Observations on the animal reactions of the spiro- 
chaetae of the African tick fever. Lancet, March, 1906. 

146. Same. Studies on q[>irillum Obermeieri and related organisms. Jour, qf 
In/, Die,, Chicago, May, 1906. 

147. MtUilens, P. Ruckfallfieber. Spiroch&ten. Handbudi der path, mikroofg. 
Eolle u. Wassermann, Bd. VII, p. 864, 1913. 

148. Novy, F. G., Enapp, R. £. Spirochaetae Obermeieri. Jour. Am. Med. 
Am$o., Jan. 13, 1906. 

149. Sergent, Edm., Foley, H. Recherches sur la fi^vre recurrente. Ann, d$ 
rinetitut Poiteur, May, 1910. 

TrypanoeomiUmt. 

150. Chagas, Carlos. Nova tripanozomiaze humana. Estudios sobre a morfoloji* 
e o ciclo evolutive do Schizotrypanum cnud n. gen. n. ep. ajente etiolojico de novm 
entidade morbida do homem. Memoriae do Inetituto Otwaldo Cruz, agosto, 1909. 

151. Chagas, Carlos. Nova entidade morbida do homem (Resume geral de estudos 
etiolojicos e clinicos). Memoriae do InetUuto Otwaldo Cruz, Tomo III, Fadculo 
II, 1911. 

152. Diaz, Ezequiel. Molestia de Carlos Chagas. Estudios hematologicos. Memo- 
riae do Inetituto Oewaldo Cruz, Tomo IV, Facfculo 1, 1912. 

153. Guerreiro, Cezar. Observa^oee urolojicas na molestia de Carlos Chagas. 
Memoriae do Inetiiuto Oewaldo Cruz, Tomo IV, Facfculo 1, 1912. 

154. Hartmann. Notiz liber eine weitere AH der Schizogonie von Schizotrypanum 
cruzi. Arch,/, Protietenkunde, 1910, Vol. 10, p. 361. 



PUBLIO HEALTH AND MBDIOINB. 41 

155. Mayer, Martin, a. da Bocha-Iimai H. Zum Vedialten von Schizotrypanum 
cniii in WarmblHtem und AiQacfpoden, ArMvf. Sehift u. Trop.-Eyg., Beihefte, 
VoL XVIII, 1914. 

156. Viann% Gaqiar. Gontiibu9ao para o eatado de anatomia patolojica de "Mo- 
leetia de Oarloa Ghagas " (Eaquizotiipanoae humana ou tireoidite parazitaria). Menuh 
fiat do ImtUuto Otwaldo Cna, Tomo III, Fadcolo II, 1911. 

Dr. AfifsTiDES Agbamonte. Before begiiming the discussion of 
this interesting paper of Dr. Guiteras, I b^ to move you, sir, that 
the suggestions which Dr. Guiteras has made toward modifying the 
articles adopted by the last Pan American conference be referred to 
a committee for action, report, and recommendation; and, further^ 
more, that the chairman be authorized to appoint this committee. 

The motion was seconded and unanimously approved. 

The Chairman. Since this subject is somewhat aUied, I will refer 
it to the committee just appointed, consisting of Dr. Guiteras, Dr. 
Carter, and Dr. Vital Brasil. 

CoL John Van R. Hoff. It has been suggested that Section VHI 
of this congress consider most praiseworthy the work done in Cuba by 
the various organizers of the health organization there, and pass a 
resolution of thanks and applause to said organizers. I wish to 
make this motion. 

The motion was seconded and unanimously approved. 

The CH/vraMAN, As Dr. Carter's paper wlQ be upon much the same 
subject as that of Dr. Guiteras, the chair will rule that further dis- 
cussion be postponed until the conclusion of Dr. Carter's paper. 

Hereupon, Dr. Agramonte, of Habana, Cuba, took the chair. 



IMMUNITT TO YELLOW FEVER. 

By H. R. carter, 
AtsisUmi Surgeon Oeneralf United States Public Health Service, 

Whether the Immunity pvoduced by an attack of yellow fever ia permanent or 
tttnpofary ia a disputed point among modem epidemiologista. NaturaUy, a diaeaae 
pfodoced by rnkfoorganiama and which recovers apontaneonaly mnat produce im« 
mnnity, local or general, tonpoiary or pennanent, else one would not recover. That 
U ia permanent haa been, and ia now, the opinion of American epidemiologistB and 
of the older generation of the French and English writers, who added so much to our 
knowledge of thia disease by their observations in the West Indies and in Africa. 

There was, however, a very common belief among the laity of localities in which 
yellow fever was endemic that leaving such focus of endemidty for a sufficient time 
would reetare the susceptibility to the disease. This belief is alluded to by many 
writers. It was, I think, universally r^arded as erroneous by those not living in 
endemic arttm, bat given more consideration and sometimes, I think not generally, 
affirmed by writefs who live in such endemic areas. 

On the other hand, a commission of the Pasteur Institute (Marchoux, Salimbeni, 
and Simimd), working at Rio Janeiro in 1903 to 1905 state categorically that the im* 



42 PB00EEDIKG8 8B00KD PAK AMEBICAK BGIBKTIFIO COKOBESS. 

immunity i»oduced by an attack of yellow fev^ gives temporary immunity only 
and that the inf ecti<m is kept up in endemic centers by recurrent attacks among 
the indigines. This view is reiterated by other recent French observers and, so 
far as recurrent attacks being common, is accepted by Seidelin, Bubert Boyce, and 
others. Indeed, it is fair to say that this view, that recurrent attacks of yellow fever 
are common, is held by nearly all of the writers recently engaged in investigating 
the epidemiology of yellow fever. Seidelin seems to base his belief mainly on the 
occurrence of sickness in men who have had yellow fever before, which attacks he 
pronounces to be also yellow fever on account of finding in the blood of these patients 
the organism, Paraplasma flavigenum, he believes to be the cause of yellow fever. 

When the statement above quoted was first made by Mardioux and Simond no 
evidence therefor was, I think, given. A large amount is given, however, by Simond 
and his collaborators in the report on the epidemic at Martinique in 1908 and 1909. 
This report is far stronger in its implication of recurrent attacks than it is in assa- 
tions of definite recurrences in individual cases and it is a strong report. Without 
cnticiaing it— this would require a greats knowledge ol the nosology and epidemi- 
ology of Martinique than I possess— it is so at variance with what I have seen in the 
United States, in Cuba, and in Panama that it seems advisable to give such reasons 
as I have for the opposite view. Especially as one would suppose that in the United 
States where greats intervals occur between epidemics of yellow fever, which have 
also been apparently both more extensive and more severe than those in Martinique, 
one would be more apt to find recurrent attacks than in that island. 

In speaking of the immunity given by an attack of yellow fever being permanent — 
generally permanent only is meant. Absolute immunity given by one attack is 
not predicated of any disease. 

Obviously, the natural method of testing this question is by observation of the 
exposure of men who have had yellow fever to the infection of that disease and deter- 
mining if they contract it again. The existence of the infection and degree of ex- 
posure would be judged of by the proportion of cases contracted by those who had not 
had yellow fever similarly exposed to infection as contrds. If a negative result is 
reported the observation would be convincing in proportion to the number of sup- 
posedly immune men thus exposed, the intervals from their last attacks, the degree 
of exposure, and the certainty that secondary attacks did not occur among them. 

Such observations are not rare. For instance, at the end of 1879, there must have 
been a very small proportion of the population of New Orleans, Mobile, and the coast 
towns between them who had not suffered an attack of yellow fever in that or in 
previous years. They were free from yellow fever until 1897. In that year and 1898 
there were widespread epidemics. Yet recurrent attacks were reported in extremely 
few cases in these towns in 1897 and 1898, 18 years lat^. Certainly no considerable 
number of well-marked cases could have occurred in those years. The same is true 
of many other epidemics and many other towns in the United States. We can readily 
present then a large number of people having had one attack of yellow fever exposed 
alter sufficiently long intervals to infections very prevalent among those who had 
not had yellow fever with report of no, or extremely few, cases of yellow fever among 
them. 

Ou^t not this to be convincing of the permanency—the general permanency— of 
the immunity? Put yourself on the other side. The first three factors in the evi- 
dence: The number of people exposed, the lengths of the intervals and the prev- 
alence of the infection— you will readily grant us; but I fear that a question will be 
raised on the last condition— the certainty that secondary cases did not occur. The 
question will be asked: Is it certain that yellow fever did not occur, and quite gen- 
erally, among these people? It would be held that on account of b^eving that <me 
attadc gives permanent protection we would not recognize yellow tevet occurring 
among them. 



^PXTBIIO HEALTH AND MEDICINE. 43 

There is truth in thifl contention. We of my generation have accepted previous 
opinion on this matter and, not having found it contradicted by obvious facts, have 
not examined into the matter critically. We assumed that one attack gave perma- 
nent protection. We would then have been little apt to consider an attack of sick- 
ness occurring in one who had previously had yellow fever as yellow fever unless it 
was either (1) well marked or (2) gave rise to yellow fever in others. The first might 
not be the case with lig^t — certainly not wit^ ephemeral — attacks, the kind which 
woidd naturally occur as second attacks. The second we will consider presently. 

Even if a second attack were clearly yellow fever one with our belief would, in the 
absence of good evidence to the contrary, question the diagnosis of the previously 
reported attack. This it is natural to do because we know how many cases of other 
diseases are diagnosticated as yellow fever during an epidemic. I did this in the 
case of an officer in my service, who died of yellow fever under my care at Chande- 
leur in 1890. He was reported to have had yellow fever in 1878. For the acceptance 
of a second attack then it might require that a well marked case of yellow fever 
occur twice in the same person. Now, even under the doctrine of temporary immu- 
nity, this would be rare, as those who hold it also hold that there would be a lowered 
susceptibility from the first attack and that if the attacks were not very far apart 
the second one would be mild— or very mild — and that is reasonable. You can see 
then that we have not been in a proper state of mind to examine this part of the ques* 
tion critically, and indeed I at least have not done so. Even allowing for this, the 
number of second attacks reported in places in which yellow fever occurs only in 
epidemics — the places in which we would be most apt to expect them — are exceed- 
ingly rare. They are reputed, however, and the recognition of such cases is proof 
that our eyes are not so blinded by our belief that we can not recognize second attacks 
of yellow fever, if they be plain enough. I have seen three cases of yellow fever in 
people who were said to have had a previous attack. In two of them the evidence 
for the first attack seemed to me to be slight; the third I could not inquire into. 

When we come to individual cases, the men we knew who had yellow fever at one 
epidemic and were exposed to it a second time after a considerable interval — and I 
have seen many such— the most I can say is that in my acquaintance I have not 
known a second attack to be reported. Drs. P. and W. had yellow fever in Memphis, 
Tenn., in 1878 and 1870, respectively, and were not exposed again until 1897 at Ed- 
wards, Miss., after intervals of 18 and 19 yean. P. was not reported to have yellow 
fever at Edwards, but he woi sick there with a diagnosis of malarial fever, which was 
also prevalent and to which he was subject. W. was not sick at all. Lieut. G. had 
yellow fever in Brownsville, Tex., in 1882. No exposure untO 1898 at Siboney, 16 
years later. He was sick at, or after leaving, Siboney with a diagnosis of malarial 
fever, which was extremely prevalent. He did have malaria; plasmodia demon- 
strated and recurrent attacks for about a year; but that by no means excludes the pos- 
sibility of yellow fever. Dr. P., of my service, had yellow fever at Chattanooga, Tenn. , 
in 1878. Next exposure was at Panama in 1903 — ^26 years interval. He was, after 
nearly a year's residence in good health at Panama City, sick at Ancon Hospital in 
October, 1904, with what I myself thought was going to develop into a severe attack 
of yellow fever until the second day, when the case showed itself to be clearly dengue^ 
I am satisfied that this case was dengue— although it was before we knew the diag- 
nostic value of the blood-picture— for it was a severe case, and such are well marked. 
The terminal eruption, too, was typical. Yet you see that one believing that secondary 
cases are common might find fault with the diagnoses of all of the above. Icouldadd 
ol my own knowledge I think from 25 to 50 cases to the above, but they would be 
more or less similar. Some did not get sick on the second or subsequent exposure» 
yet that is not convincing. Some people who have never had yellow fever go through 
an eiademie unscathed. Also, light attacks might well escape any notice. 



44 PBOOEEDIKGS 8B00KD PAK AKBBIOAK SOIBNTIFIO 00K0BE88. 

The difltodty is that we recognize no sign %a pathognomonic for all caaes of yellow 
fever, the mild and ephemeral as well as the severe. It is true that Seidelin claims 
to have such a sign in his Paraplasma flavigenum, and also to have demonstrated it 
in a secondary (ephemeral) case of yeUow fever in himself and in others, some of 
whom showed no signs of illness— i. e. were "carriers.'' Without in any way pro- 
nouncing on the validity of his claims, yet until his primary contention is con- 
firmed—the transferrence to guinea pigs is certainly discredited— we can not accept 
the existence of his bodies as pathognomonic of yellow fever and hence as proving 
a second attack. 

The second test, that yellow fever was communicated to others from cases of sick- 
ness of men who had previously had yellow fever, Ib again hard for us to apply. 

When you consider how freely men '* protected by a previous attack of yellow 
fever" have been allowed to move from places virulently affected with that disease 
into susceptible communities in the United States, and how many hundreds of times 
this has occurred during epidemics, you would think we should have satisfactory 
data on this subject, positive or negative. If not immune to yellow fever, some of 
these men should have contracted it and developed it in an infectable but not 
infected place, and even if not diagnosticated it should have infected mosquitoes 
and spread to others in whom the diagnosis would be easy. An epidemic can not 
be hidden. 

I know of no evidence that this has occurred, yet the evidence to the contrary 
has not been scrutinized critically. Since we did not believe that secondary cases 
of yellow fever occurred— or occurred very rarely— if an outbreak occurred we would 
be little apt to impute conveyance of yellow fever to any sickness of indeterminate 
nature occurring among people who were "protected by a previous attack of yellow 
fever.'' Almost any other hypothesis would be accepted to explain it, or it would 
be left unexplained. Indeed, in times of epidemics there are so many ways in which 
infection can be introduced that an outbreak of which we are not able to explain 
the introduction is not to be wondered at. 

To use this test, then, we must depend upon the scrutiny of exposures of susceptible 
communities to cases of sickness of such "protected" men who had themselves been 
exposed to yellow fever and under such conditions that other sources of exposure of 
the community are excluded. Opportunity for tlus would rarely occur during an 
epidemic. 

As evidence that attacks of yellow fever do not recur among such "protected" 
people, these observations to be convincing must be on a laige scale; there must be 
many failures of susceptible communities thus to receive infection. Tlus would 
be negative testimony and convincing only in proportion to its mass. I know of 
no positive observations on this subject. It seems useless to relate the twenty-five 
or thirty-^naybe fifty— negative observations I could give you. They are not 
enou^ to be convindng. 

Possibly, however, we have in the passenger traffic of the Plant Steamship line 
data of sufficient mass to be worth considering. From 1889 to 1800, inclusive (9 years) 
there was no bar to the transit on these vessels from Habana to Key West and Tampa 
of passengers "protected against yellow fever by a ptewioua attack or 10' years resi- 
dence in an endemic focus," and a great many of them came— Cubans on their 10 
years' residence and Americans on certificates of a previous attack. There were 
dgar Victories in Key West, Tampa, and Jacksonville, all manned by Cuban em- 
ployees. There were generally two vessels per week; part of the time three vessels. 
Habana was about 6 hours from Key West and 24 frc»n Tampa. I am unable to get 
the exact numbers of these passengers on account of the destruction of the records 
of the State Board of Health of Florida by fire. Such reports of this board as are 
available to me give the number of such passengers as follows: 



PUBUO HEALTH AND MBDIOIKB. 45 

Tampa Bay quarantiiie — 

1891, May 1 to October 31 2,620 

1892, May 1 to October 31 2,684 

1893, May 1 to October 31 2,449 

1894, May 1 to October 31 3,681 

PoupyeM* 11,434 

Key West— 

1893, Aogiist, September, and October 3,134 

1894, May 1 to October 31 7,656 

One and a half years 10, 690 

In addition we have a Habana record showing that about 3,420 passengers were 
co-tified fen- Tampa in 1895 (2,850 from May to October 1). At the above rate the 
entries at Tampa would, for 9 years, be 25,726. Call them 20,000, to be conserva- 
tive. For the short time of which we have record, Key West had^ double as many 
entries as Tampa, and this is in accord with my observation at the time in 1899. It 
will be very conservative, then, to put the number of these so-called ''immune pas- 
■eaigera" at 30,000 for the 9 years-^it was more likely 50,000 or 60,000. Many entries 
naturally were of the same people going backward and forward between Habana and 
Florida ports. Now, remember that this very considerable number of people— and I 
have given you minimal figures — came from a city where yellow fever was epidemic; 
that they came in hot weather; to towns where Aides calopus (Stegomyia) were abun- 
dant and active and where people susceptible to yellow fever were also abundant. 
If, then, any considerable propc^on of them after arrival had been infective to 
Aides eaiopue (Stegomyia) I can not but think that there would have been at least 
one outbreak of yellow fever in Florida during these 9 years. There was none. 

Were these people so exposed in Habana that any considerable number of them 
would certainly hare contracted yellow fever if they were susceptible to that disease? 
Let us see. That those who had not had yellow fever were liable, and very liable, to 
oontzact that disease from exposure in Habana at this time was evidenced by the his- 
tory d vessels from that pert whose personnel had not had yellow fever. They fre- 
quently brou^ cases of yellow fever to our quarantine stations. In 1895 at the Dry 
Toftugas I had 13 cases of yellow fever on Habana vessels out of a crew list of less than 
450 men. Indeed the crew list of men exposed to infection in Habana was not over 
hall of 450 as the steamers lay in a safe part of the harbor— Triscofia— and allowed only 
a Tery few men ashore and were practically free from fever. It occurred (with one 
exception) on vessels which had lain on the Habana side of the harbor. Unqueetion- 
My then, those susceptible to yellow fever could contract it in Habana during this 
time. 

Compare these observations: 

(1) Four-hundred and fifty people who had not had yellow fever, from Habana, 
gave 13 cases of yellow fever, every one of which should have been infective to Aidee 
ealajme (Stegomifia). 

(2) Thirty thousand people from the same place during a period covering the same 
time give no evidence of infecting .£det calopus (Stegomyia): certainly gave rise to no 
outbreak in the susceptible communities to which they moved. 

You may not consider this proof* There may not be enough of it to satisfy you; 
bat the mass of this evidence, negative as it is, is sufficient, until the contrary is proven, 
to omfirm me in my belief that for sanitary purposes the immunity conferred by one 
attack of yellow fever is permanent: that recurrent attacks, infective to Aides ccdopus 
(Stegomyia), do not occur and that we are justified in basing our sanitary measures 
thereon. It alioald at least prevent your acceptance of the doctrine that the immunity 
ooof erred by an attack of yellow fever is quite temporary and that subsequent attacks 



46 PBOCBBDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

infeddve to Aides ealoptu {SUgomyis) are common and that sanitary measures based 
on the contrary opinion are not justifiable and unsafe. This observation— the passen- 
ger traffic of the Plant line— is also inconsistent with the existence of ''Carriers'' as a 
common phenomenon capable of infecting JBtfet calopus (Stegamifia) with yellow 
fever. 

I said " until the contrary is proven," because if it be ever shown that an organism 
causative of yellow fever occurs in men who have had previous attacks of this disease, 
and is conveyable from them by 2Ede$ ealopui (SUgom^) mosquitoes to other men, 
producing yellow fever in them, I will count the contrary proven. I well know how 
much more determinative are the results of experimental than of epidemiologicai 
investigations. Yet in this disease it was, I believe, the latter that gave the^key to 
the problem; which determined the direction of the experimental investigation which 
demonstrated the method of conveyance. I do not mean that this is the only mean» 
of demonstration. Even if the causative microorganism is not demonstrated, the 
frequent recurrence of clinical yellow fever in those who have had one attack, 9m 
indicated in the Martinique epidemic sufficiently verified, would be proof. 

There are other epidemiological investigations which are at least consistent with a 
doctrine of permanent immunity such as the spontaneous disappearance of yellow fe vet 
from small and moderately sized towns in the Tropics which received few susceptible 
immigrants. I do not mean that this alwa>s occurs, but it is by no means rare in 
America. The great decrease of infection in Habana in 1899, due to the falling off of 
immigration in the previous years, is also consistent with it. This was shown in the 
small number of cases of yellow fever in the spring and summer of that year as com- 
pared with normal years, although the town was full of Americans who went everywhere 
and of Mdes ecdofms (Stegomffia). 

SUHMABT. 

Is the immunity conferred by an attack of yellow fever permanent, or are subsequent 
attacks common? The first is the view held by observers in countries where yellow 
fever prevails epidemically. The second has been the belief of many, especially of 
the laity, in endemic foci. It is now held by many eminent investigators who have 
worked in endemic foci of yellow fever; by the majority of recent writers, I think. 

The evidence for the permanence of this immunity oug^t to be most abundant in 
places where yellow fever occurs in epidemics and much is brought fcnward, negative 
from the nature of the case. This evidence would rarely be satisfactory to those hold- 
ing a contrary view, because the belief of the physicians in such places that this 
immtmity is permanent would render them little apt to recognise secondary attack* 
unless they were well marked, and they would rarely be well marked. 

There are, however, some epidemiological data which, as far as they go, are evidence 
against the occurrence of secondary cases infective to AlkUi ealopuM (Stegamyia), 

Thus: Between the years 1888 and 1898 there entered Florida ports over 30,0(M> 
people certified as ''protected from yellow fever by previous attack, or 10 years' 
residence in an infected focus. " They came during the summer, May 1 to October 
31 from Habana, where yellow fever prevailed during this time — ^to Key West and 
Tampa — towns full of Aides ealopus (Stegamyia) and of people susceptible to yellow 
fever. The time of passage was about 8 hours to Key West and 24 to Tampa. As no 
yellow fever developed ia Florida during this period there should have been no con* 
siderable number of secondary attacks infective to Aides ealopus (Stegamyia) among 
these people. 

That yellow fever could be readily contracted from Habana by people susceptible 
to it is shown by the fact that during this time 450 people from Habana not certified 
as immune to yellow fever yielded 13 cases of yellow fevor at a quarantine station. 

As 13 cases of yellow fever, any one of which should have been infective to Mlts 
ealopus (Stegamyia), occurred among 450 men who had not suffered from one attack 



FUBUO HBALTH AND HBDIGIKB. 47 

it would seem that, if recurrmt attacks were common, enough cases should have 
occurred among the 30,000 to have produced an outbreak in Florida. There was 
none. 

The abore is also evidence tiiat yellow fever carriers are not as common as allied 
by soma modem obeerven. 

BIBUOORAFHT. 

Marchoox et Simond. Annales de Tlnstitute, 1905 

Ifarchoux et Simond. Etudes sur la Fi^vre Jaune. Ann. de Tlnstitute Pasteur. 

1906. 
Simond, Aubert et Noc. Epidemieologue Amarile. Ann. de Tlnstitute Pasteur. 

1909 
<9axac et Simond. La Fidvre Jaune. Pathologie Exotique. Vol. 111. 
Sddelin Harald. Report of yellow fever expedition to Yucatan. 1911-12. 
Seidelin Harald. Nature and Control of Yellow Fever. 1912. 
Seidelin Harald. On the Existence of "Pseudo-Carriers" of the Infection of Yellow 

Fever. 1914. 
Britidi Yellow Fever Commission. Reports 1913 and 1914. 
BepcHts State Board of Health of Florida. 1891 to 1896. 

The chairman called for a discussion of the papers of Dr. Guiteras 
and Dr. Carter. The discussions in Portuguese and Spanish of Dr. 
"^tal Brazil of Brazil, Dr. Elias Sag&maga of Bolivia, and Dr. Luis 
Ifigone of Paraguay were unfortimately not reported. 

Dr. Daicaso Ritas. This subject of tropical diseases is of great 
interest, and it has been so wonderfully illuminated by our teacher, 
Dr. Guiteras, that there is really nothing to add. Still, there are 
some other observations from the standpoint of my own experience 
that I would like to speak of. 

Emetin, since the subject has been mentioned, is not in my judg- 
ment a specific. I have treated cases of ameba dysenterise with 
emetin, and I have been able to remove the ameba from the intestines 
if I searched long enough, but I never was able to find the occult blood. 
I refer to that, because the occidt blood is a test more deUcate than 
the microscopical finding of the ameba. The ameba may not be 
found in sufficient nimibers so as to be seen imder the microscope, 
but the occult blood test I have found more reUable. Emetin has 
also been used a great deal in pyorrhea alveolaris. So far as my 
experience is concerned, it has no especial value. Of course, I would 
not say that emetin in dysentery has no tonic value. 

The discussion by Dr. Rafael Gonzalez-Rincones, of Venezuela, in 
Spanish was not reported. 

Dr. GurrsBAS. Dr. Carter did not use, I think, an argument which 
certainly should have some weight, though it is of negative charac- 
ter also: It does not seem to me that it would have been possible to 
eradicate yellow fever from Habana, the neighboring cities and the 
country in Cuba in general, if the recurrence of yellow fever were the 
rule as these gentlemen seem to imply. To me that appeals very 
strongly. I do not see how yellow fever could have disappeared imder 
these circumstances; for instance, if it was being kept up in the interior 



48 PB00EEDING8 SECOND PAN AMEBIGAN 8CIBKTIFIC C0KGBB88. 

by repeated attacks among the Cuban population. We never should 
have seen the end of it, it seems to me. 

Dr. Cabteb. When I spoke of the immunity from yellow fever as 
being permanent, I meant that it was generally permanent, as per- 
manent as that of smallpox, of measles, and of the other zymotic 
diseases. Secondary attacks imquestionably occur, but the teaching 
at present of certain schools is that secondary attacks are common, 
that immunity is not only transitory but very transitory, that it 
lasts but a short while. I was led to write this paper because recently 
I have been investigating the nature of a disease, trying to determine 
whether it was yellow fever or not. I found that it occurred habitu- 
ally among people who had been long resident in endemic centers; 
and in one case at least had occurred in one who certainly had had 
yellow fever. Tlu-ee gentlemen whom I know, one who had worked 
with SeideUn in Africa, one who had worked with Simond in Mar- 
tinique, and a third, firmly believe that there was no immunity beyond 
six months or a year or two years, that secondary attacks of yellow 
fever were not only common but the rule. Therefore the conclusion 
that I tried to draw from the occurrence of this disease among those 
who had had yellow fever fell to the ground. I saw at once that 
they were properly unwilling to accept my statement of not having 
seen secondary attacks, of not knowing of secondary attacks, at a less 
value than I placed on it. It was perfectly true, as they stated, that I 
had not been in the proper mental state to fairly evaluate the symp- 
toms of obscure diseases or httle ailments, ephemeral diseases occur- 
ring in those who had had yellow fever; that I did not expect them to 
be yellow fever and therefore might overlook them. Therefore I made 
my argument and rested my case upon the broad epidemiological 
fact of the immune traffic from Habana to Florida, 30,000 (there 
are really about 50,000) people who had had yellow fever coming 
from Habana in the summer time into a coimtry where yellow fever 
was not prevalent, where stegomyia were present, and that was 
full of people who had never had yellow fever. The time of passage 
was from 6 to 24 hours. If they had been subject to secondary 
attacks or if carriers had been at all common among them, it seemed 
to me that they would unquestionably have infected stegomyia in 
Florida. Out of this number of people, from 30,000 to 50,000, 
some of them would have infected stegomyia and would have pro- 
duced an epidemic. Now an epidemic can not be hid. It is upon 
that broad epidemiological fact that I rest my thesis that secondary 
attacks in yellow fever are rare and from the sanitary standpoint 
need not be regarded. 

The Chairman. If there is no further discussion I shall announce 
that the next paper will be read by title, as the author, Dr. Allen J. 
Smith, has just sent a telegram, stating that it will be impossible for 
him to be present this morning and read his paper in person. 



PUBUO HEALTH AND HBDIOimL 49 

FBLARIASIS IN THE AMERICAS. 

By ALLEN J. SMITH. 
MeManes Laboratofiet of Pathology of the School of Medicme, University of Penn- 

sylvania. 

In broad wignificance the tenns filariaais, filariosis, and filarial disease have an 
inclusive application necessarily beyond the scope of an article intended for current 
piesentation; although the writer in the course of literature consultation required 
for the preparation of the present pi^>er has been fully persuaded of the desirability 
of an inclusive monograph upon the major title, embracing the filarial parasites both 
ol man and of the lower animals, with appropriate presentation of their morphology, 
life histories, modes of acquirement, and of the pathological consequences of para- 
sitism by them, as well as their geographical distribution and histories. 

The full subject being of unwieldy proportions the present discussion will be 
limited to the geographical distribution and history in the Americas of those species 
ol the filarid» which parasitize man, with further restriction, too, to those particular 
qpedee alone whose larval or microfilarial stages ^ are met in the blood (for conven- 
ience, therefore, to the exclusion of DraeuneuluM medinermi (linn., 1768), the ques- 
tionable species FHaria oris hominis Leidy, 1860, and Agamofilaria georgiana Stiles, 
1906), and to a few points of particular interest to the writer in the clinical study of 
filariaais. Recently Padilla' published his discovery of the presence of a small 
aperiodic, actively motUe microfilaria in the blood of persons presenting no symptoms 
referable to the parawtes, in the Province of Tucuman in Argentina (in over 25 per 
cent of individuals examined in the Galera district, in over 16 per cent of those exam- 
ined in Arcadia). This he regards as a new species (F, tvcwnani), in which view he 
is not, however, sustained by Neiva, of the Cruz Institute of Rio de Janeiro. The 
writer believes he would be acting prematurely in at once accepting the verity ol 
Padilla's new species, as in a number of respects (exclusive of its ensheathment, which 
Padilla asserts, but which might be a mistake when we remember that Manson himself 
at first thought the microfilariae of po'ttoru were ensheathed) it closely resembles the 
larval Filana demarquayi. He may perhaps therefore at the present time be pardoned 
if no systematic discussion of the proposed species is included in the current paper. 
Unquestionably fuller knowledge with confirmation or with correction will shortly 
follow. 

American Filabiasis. 

1. FILARIA BANOROPn (OOBBOLD, Wl), 

Synonyms: F. sanguinis hominis Lewis, 1872; F. sanguinis i^gyptioa Sonsino« 1875; 
F. damathemiea da Silva Araujo, 1875; F. toUchereri da Silva Lima, 1877; F. noctuma 
Hanson, 1891. 

Historical. — ^This, the pathologically most important and the most widely distrib- 
uted of the restricted group of filarial worms here under consideration, was discovered 



> TiMb nme microlUariA, suggested by Le Danteo in 1904 (Malad. des Pays Chaads, Paris, 1010, p. 1000) 
M a oonveolent tonn lor th$ vennioular brood met in the blood of the definitive host of whatever species, is 
▼arioosly employed as synonymous with the words embryo and larva. The writer believes that a difler- 
an t tatlon of terms to be applied to the different early stages of tiie parasite is desirable; and he would sog- 
gist that the term filarial embryo be applied only to the vermioule within the egg membrane within the 
iit«us of the mother; that the term microfilaria or filarial larva be restricted to tiie vsrmicule, whether 
shsathed or free, alter its birth and during its presence in the blood or other fiuids of tiie definitive host and 
betev tta a oee es to the intermediate insect host; that for tiie stage represented by the further developed 
▼wnieale in the mosquito or other intermediate host Uie term prefilaria be employed; and that these 
taam be understood as gensral to aU speoMs, to be employed in connection with the spedflo name of the 
tdnlt fliaila wbsB refvenee to particular stages of the early lif^ of the parasites is desirable. 

■ SaaniM msdioa, BiMOOt AJrss, 1915, Sept S, anno 23, p. 871. 



50 PBOOEBDIKGS SEOONP PAIST AMEBICAK SdEKTIFIO C0KGBB88. 

in its larval or microfilarial form in 1863 by Demarquay, in Paris, in the fluid with- 
drawn from a hydrocele of a patient from Habana.' Demarquay's part in the history 
of the parasite attracted little attention and was practically overlooked untU recalled 
in 1881 by Dr. Bemhaus de lima.' Three years alter Demarquay's discovery, the 
parasite was independently found, again in its microfilarial stage, in the Uoody and 
chylous urine of a number of individuals in Bahia, Brazil, by 0. Wtlcherer,* the hosts 
being for the most part natives of Brazil. By these first two demonstrations of this, 
the first known human hematic microfilaria, America became definitely fixed in the 
histcny of our knowledge of this parasite. 

,In 1870, Timothy R. Lewis* met the same larval filari« in Galcutta, in the chylous 
urine and later in the blood * both of chylurics and of persons apparently in health. 
Lewis gave the first descriptbn of the microfilarial sheath, and applied tA these 
hematozoa the name Fiiaria mmgxdnis hominis (dropped by rule along with others in 
favor of the name first assigned to the later described adult worm of the species). 

In 1876, Bancroft, at Brisbane, Australia, after having encountered the larval form 
in chylous urine and in the blood, first met with an adult female parasite in a lym- 
phatic abscess; and the following year Cobbold, to whom the specimen was sent for 
study, described it and gave it the specific name Fiiaria hancrofti* Shortly after 
Lewis ' and Garter*, in India, also obtained adult specimens, the former contributing 
the first description of the male. Da Silva Araujo* in October, 1877, in Bahia, autf 
about a month later dos Santos,** in Rio de Janeiro, first met with the adult parasite 
in the Western Hemisphere. 

From the time ot their first recognition until 1891 all microfilarise fbund in humaa 
blood were r^arded in casual manner as identical and as belonging to the species 
here under consideration. Manson," to whom we owe so much of our knowledge of 
filariasis in general, in this latter year called attention to the fact that more than one 
species, represented by hematic microfilariae, infest man; and separated primarily 
those with microfilariae in the peripheral blood stream at night from those whose 
larvae are present in the peripheral circulation during the day, and those, the micro- 
filariae of which may be found in the peripheral blood both day and night. His 
names for these species, Fiiaria noetwma, Fiiaria diuma, and Fiiaria perstans are of 
commendable descriptive value; but in accordance with the rules of zoological nomen- 
clature the first and second are properly but synonyms for Fiiaria hancrofti Cobbold, 
1877, and Loa loa Guyot, 1807. 

The rdle of mosquitoes as intermediate hosts of Fiiaria bancrofti was first urged by 
Manson,*' his study being taken up from purely theoretical reasouing as to the need 
of some bloodsucking agent to free the microfilariae from the original host. The 
experimental work was prosecuted in 1877, Manson feeding a number of bloodsucking 

1 Oas. mM. de Ptrit, Oct. 11, 1883, p. 686. 

• Th«86 inaug., Rio de Janeiro, 1881. 

• Oas. med. da Bahia, Dec. 16, 1868, p. 97; fl>id., Sept. 30, 1800, p. 39; of. Unuperger, Zeitsofar. f. Fara- 
•Itenk, 1860, t. 1. p. 376; Lenckart, Parasiteii, 1878, Lelpxig and Heidelberg, v. 2, p. 640, et ante. 

« Sixth Aon. Rep. Sanit. Comm., Qoyt. India, Appendix A ,p. 196-178, 1870; Brit. Med. Jour., Nov. 19^ 
1870. 

• Rigbth Ann. Rep. Sanit. Oomm., Ooyt. India, Appendix B, p. 9(1, 1879; eee abo Qoain's Diet, of Med.» 
arte., Chyloria, Fiiaria saitguinia komhHt. 

•London Lancet, July 14, 1877, ▼. 2, p. 70; iWd., Oct. 6, 1877, ▼. 9, p. 496. 
f London Lancet, Sept. 99, 1877, t. 9, p. 453. 

• Carter undoubtedly early propoeed explanation Ibr the ohylurio fymptoma; but the writer haa tilled 
to find reference to the pr co e n t connection of his name except In Bancroft, and Indudes hie name here 
because of the authority of Brumpt, Precis de Parasltologle, 9d ed., 1918, p. 504. 

• Oat. mM. da Bahia, Not. 1877; abet. In Arch, de mM. nav., Paris, lUrch, 1878. 
■* Pr ogresso mM., Rio de Janeiro, Deo. 15, 1877. 

u London Lancet, 1801, t. 1, p. 4; Brtt. Med. Jour. 1897, ▼. 9, p. 1837. 

u Cobbold, London Lancet, 1878, ▼. 49, p. 60; Manson In Davidson's Hygiene and Diseases of Warm 
Climates, 1803, Edinburgh and London, p. 771; Jour. Lbm. 8oc. London, Aug. 1878, ▼. 14, Zoology, p. 804; 
Trans. Linn. Soo., London, 1884, sec ser., t. 9^ Zoology, p. 367. 



PUBLIC HEALTH AND MEDIOINB. 51 

iBsects upon a filariated individual and examining them at intervalB therealter. In 
moflt of the insects the larval filarue were digested or else at least failed to develop; 
bnt in a certain mosquito they grew in size and underwent a developmental difiPeren- 
tiation. His observations were early and fully corroborated by Lewis,' Sonsino,' 
Silva Araujo,* Bancroft,^ and others. At first, while it was appreciated that the 
prefilarise underwent a probably necessary development in the mosquito, it was be- 
lieved that the latter, dying when ovipositing on water, was responsible in the greatest 
sense only for affording access of the parasites to water ; that they became free for a time 
in water; and were transferred to the definitive himian host when water containing the 
vermicules was swallowed. The real part taken by the mosquito as the direct trans- 
mitter as well as an intermediate host came to be accepted only after the studies of 
Grassi and No^, and subsequently of Ftkllebom, proving the direct transmission of 
Dtrofilaria immxHi Leidy, of the dog, by mosquitoes, and after further studies of Man- 
Bdn and Bancroft, and of Low,' James, and 'others, about 1900; but for a considerably 
later period the idea of water convection continued to attract adherents (as Audain 
and Ricot, in Haiti). ^ 

From the earliest observations the association of filarial parasitism with hematuria 
and chyluria was recognized, although not explained. An influence on the x>art of 
FtUma banerofti in the etiology of lymphvarices and elephantiasis was likewise sug- 
gested at an early date, as in the experience of Lewis ' and others; but perhaps to 
Hanson's studies more than to any preceding influence should be credited our pre- 
vailing views aB te the explanation of the relation between the parasite and these 
filarial manifestations, with the addendum of the further influence of bacteria (the 
dermococcus of Le Dantec) in inducing the recurrent and eventually chronic in- 
flamations which lead to the great fibrous overgrowth in the skin in elephantiasis. 

OtograpMcal distribtuion in America. — Precise information of the existence of this 
type of filariasis is best afforded by examination of blood withdrawn at nighttime by 
puncture of the peripheral circulation of the individual under suspicion; and from a 
reasonable number of such investigations of different life-residents of a given locality 
an acceptable idea of the endemic presence or absence of the affection and of its rate 
of incidence in the locality is attained. (It is true that if one will withdraw a larger 
amount of blood, hemol3rse it and centrifugate, microfilariae of the species may be 
found at almost any time in the 24 hours; but during the day there is a chance that 
even by this method the parasites will be missed.) Data based upon such ideal 
methods of study are unfortunately obtainable in published form for only a com- 
paratively small part of the general American distribution. Hematochyluria, lym- 
phedema and elephantiasis are, it is true, comparatively common clinical complica- 
tions of filariasis of this type; but it must be kept in mind that other causes of 
lymph obstruction than filarial parasites are possible. The endemic prevalence of 
such conditions, however, is not likely to be due to such other influences; and in the 
absence of better evidence these complications are very commonly accepted as 
indicating the presence of this parasite in an area concerned. 

Based upon evidence of varying exactness, but in the main quite credible, it is safe 
to say, as most writers declare, that Bancroft's filaria is known to-day to be the most 
widely distributed species of filaria parasitizing human beings, extending unevenly 
throughout the whole tropical belt, and north and south in diminishing rate beyond 
the thirtieth degree of latitude. 

1 Proc. Asiatlo Soc, B«Dgal, March, 1878, p. 80. 
>lCed. Ttmetand Gas., May 37, 1883, p. 654. 

* R«f erred to by MiiCft^>**^ in Revlata dos Corios tlMorioaa a prat, da Facnlt. da MM. da Rio de Janairo, 
1885, ami. 3, no. 8. 
«8dentlflo Lactorae, Brlabane, 1879. 
> Brit. Mad. Jour., 1900, v. 1, p. 1466. 
« BtH. Mad. Joor., ▼. 3, p. 663. 

' Flarraa faitartropicalae, Aodaln, 1909, Porto an Princa, pp. 790-803. 
Eighth Aim. Rep. Sanit. Comm., Govt. India, App. B, p. 341, 1873. 

e843e— 17— VOL rr 6 



52 PBOCEEDINOS SECOND PAN AMEBICAN SCIENTIFIC CONGRESS. 

As far at America is concerned, it is very improbable that the worm is indigenous, 
although no less acute and erudite clinical reasoner than Carlos Finlay * has raised the 
question of its pre-Columbian existence in the Western Hemisphere; suggesting that 
possibly the idol Tetzahuitl (meaning ''a horror") may have been intended to repre- 
sent filarial disease, being made in the image of a man with a necklace of 10 human 
hearts and with a great serp>ent about his body intertwined among a variety of animal 
figures. On the contrary, there is a prevalent belief, expressed as early as 1750 for 
elephantiasis by Hillary ' and repeated by many others, as in recent years by 
Daniels, ' that the species was introduced into America from Africa with the importa- 
tion of negro slaves. 

There are reasons, suggestive if no more, partly based on the history of human com- 
merce and travel in comparison with the grades of infestment of known districts and 
the history of ancient prevalence of such manifestations of filariasis as elephantiasis 
and chyluria, that would support the conjecture that the original location of the species 
was along the southern coast of Asia, and that the parasite spread thence east and west 
into Indo-China and Oceania on the one hand and into Africa on the other. In the 
latter continent it would appear to have taken a hold first in lower Egypt and the 
nearer shores, and to have followed thence along the east coast and to Madagascar, to 
have penetrated Africa along the Nile, and to have proceeded along the Mediterranean 
coast to and along the west coast of Africa, penetrating thence into the interior along 
the Kongo Basin. 

The known severity of infestment of some of the Antilles, the fact noted both by 
Hillary * and by Hendy ' that elephantiasis is said to have been rare at the beginning 
of the eighteenth century in Barbados (although later become so common as to have 
acquired the name '* Barbados leg"), and the absence of notice of such a striking 
phenomenon as elephantiasis in the detailed records of the discoverers and the con. 
querors (as the "Decades" of Peter Martyr, Eden's Translation, 1555) give food for 
belief that with the transportation of negroes from the west coast of Africa the parasite 
found its first fixed hold in the Western World in the West Indian Islands. From the 
frequent infestment of and high grade of prevalence in the Leeward and Windward 
Islands one may at least tentatively believe that the parasite found early lodgment 
here; although the relative importance of Cuba, Haiti, and Porto Rico make it im- 
probable that these large islands failed to be invaded as weU. 

The widespread occurrence of filariasis in the West Indies was doubtless largely a 
sequence of interinsular communication, with perhaps repeated renewal from Africa. 
That the parasite spread from the island foci to the mainland is probable and is 
somewhat supported by the popular belief in Dutch Guiana* that elephantiasiB 
was brought into that coimtry in 1799 by negro slaves from Barbados. The marked 
grade of infestment in Brazil about Bahia and Rio de Janeiro, and the early employ- 
ment of negroes in the development of these districts, make it probable that here, 
too, direct importation from AMca determined special foci of parasites. The com- 
parative freedom of the Pacific coast, even in tropical America, in contrast with the 
long range of Atlantic coastal infestment, gives further weight to the general view here 
expressed of the origin of American filariasis of the Bancroft type from trans- Atlantic 
(presumably African) importation. 

As known to-day in America the species has been met in cases indigenous to the 
districts for which they were reported as far north as Philadelphia and in South 
America as far south as Buenos Aires. 

1 Aim. de la real. Acad, de Ciencia8,eto.,de la Habana, 1882, v. 19, p. 40; also Trabs^os select., 1912, p. 611. 
> Diseases, acute and ohronio, peculiar to the island of Barbados, I/ondon, 1750; referred to by Castellani 
and Chalmers, lianual of Tropical Medicine, 2 ed., 1913, p. 112S. 

• Brit. Med. Jour., Sept. 24, 1808, v. 2, p. 879. 
« Sup. dt. 

• Glandular Disease in Barbadoes, London, 1784; referred to by Castellani and Chalmors, Man. Trop. 
Diseases. 2 ed., 1013, p. 1125. 

• DaTidsoo's Qeosraphioal Pathology, New Yofk, 1803, r. % p. 9S7. 



PUBLIC HEALTH AND MEDIOIKE. 53 

United StaUM. — In 1897 Duim ^ published the occurrence of Bancroft's ^ariasis in 
a young woman 19 years of age, a native of Philadelphia and resident of this city con- 
tinuously, with the exception of a visit in Altoona, Pa. ; somewhat earlier Wyim ' 
had published a case occurring in a woman of Indiana who, while having visited in 
"the West" and in New York City, ''had never resided in nor visited tropical or 
subtropical r^ons"; and still earlier Weiss ' had reported a case on about the same 
level of latitude in a child who had never been outside of the State of Illinois, John- 
stone in 1903 reporting a second case from the same Stated In 1891 Slaughter ^ 
announced his discovery of two indigenous cases of hematochyluria with micro- 
filariss in the urine from the northern part of Virginia, one of his patients residing 
within 6 miles of Washington, D. C. 

In 1913 Barnes reported a third case of Bancroft's filariasis from the same district 
in a Washington negro bom in Maryland and never farther south than Culpeper, Va.* 
Nofthingham ^ reports a case of elephantiasis of questionable type, which he regards 
as of filarial origin, in a mulatto native of North Carolina, living near Wilmin^n. 
Microfilariae were not demonstrated in the case. He quotes Dr. Eoyster, of the same 
State, to the effect that filariasis is rare in North Carolina, and Dr. E. J. Wood as 
regarding it comparatively common. The first demonstrated cases of indigenous 
filariasiB of this type in the United States were reported by John Guit^ras " from Charles- 
ton, S. C, along with four other cases from Key West, Fla. These Florida subjects 
were natives of Cuba and had probably brought their parasites from their home island; 
but Guit^ras expressly stated his belief that the worm existed at the time of his obser- 
vations either as '*a permanent resident or a successful colonist in the island of Key 
West." His belief has since been confirmed for the State of Florida;* and in South 
Carolina, in addition to sporadic cases in the general littoral, Charleston has proved 
to be by far the most severely infested focus of filariasis in the United States if not in 
the whole world,'^ Johnson " reporting 19.25 per cent of positive findings in 400 hospital 
inmates within the past year. A case studied in Philadelphia by F. P. Henry >' is 
referable either to South Carolina or Fl<»ida, the subject having lived from birth in 
Columbia, S. C, and in Palatka, Fla., imtil shorUy before coming under observation 
in Philadelphia, and the writer recalls two South Carolina nergoes infested by FUaria 
banarofti, studied in Philadelphia by William Pepper, jr., but not published. 

If one may infer from the scattered instances of chyluria and elephantiasis along 
the South Atlantic and Gulf coast regions, the affection prevails in sporadic grade 
throughout this general district. Mastin " in a comprehensive and analytical article 
upon filariasis reported an indigenous case from Mobile, Ala., and in a lecture by 
Matas,'^ based upon an imported case of filarial chylocele of the tunica vaginalis, rec- 
ognition was expressed of the sporadic occurrence of such filarial manifestations as 
chylocele, chyluria, and eleplumtiasis in the Louisiana district. The writer, while 
stationed at Galveston, on several occasions met with what he believed to be clinical 

1 Tr. CoO. PhyslGteiis, PHila., 18B6» V. ao, 3 aer., p. 80. 
a lodkuDs Mad. Jour., 1806^, r. 14, p. 400. 

• North AnMriciin Fraot., Oct., ISOO. 

« CliiOi«o Med. Beeofder, 1908, T. 35, pp. H 83; Wonien's Med. Joor., lOM, T. 14, pp. 1, 95. 
» Med. NewB, Sept. 5, 1801. 

• Monthly Cyek^ediA and Med. Ban., Jan., 1013. 
' Qiarlotte Med. Jour., 1014, r. 70,p. MO. 

> Med. Newa, Apr. 10, 1886. 

• CL Smith, Aim. UnlT. Med. SoL, 1803, t. 1, p. L 131; Andnde, Amer. Jour. Med. SoL« 1006, v. 180^ 
p. 198; Knox, lOttt. Smgeoo, 1011, T. 38, p. 060. 

u De SMMore, Med. Newi, Jane 38, 180O; Thompaon, Tnns. So. CaroUna Med« Afl800.» 1888, p. 141; 
Andnde, Oa. Praetitiooer, ▼. 8, p. 10. 
u Sooth. Med. Jour., July, 1015, t. 8, p. 830. 
KMed. News, May 3, 1808. 
X Aim. ol 0iix«ery, 1888, T. 8, p. 830. 
MKeir OrleaiM Med. and Sng. Jour., June, 1801, t. 18, p. 501. 



54 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC C0NQBES8. 

expressions of filariasis, a case of chronic lymph fistula and a case of elephantiasis; 
but in these, as well as in several series of night-blood preparations from medical 
students and hospital inmates, failed to find microfilariss. More systematic studies 
would undoubtedly reveal scattered cases through a large part of the southeastern 
section of the United States, as suggested by instances of similar clinical manifesta- 
tions of filariaais reported from time to time for more than a generation past (as Brigg's 
case of elephantiasis at NashviUe, Tenn.*), and corroborated by the occasional demon- 
strated cases above mentioned (as those of Weiss and Johnstone in Illinois, and <d 
Wynn in Indiana). 

Cases of imported filariasis have been recorded from different parts of the United 
States, mainly from the West Indian Islands,' and recently on the Pacific coast, from 
the Philippine Islands, the Pacific Islands, or from Asia. But as far as the writer is 
able to learn at this time, no indigenous cases have been recorded from the Pacific 
coast of the United States. Wellman and v. Adelimg ' state that filariasis is con- 
stantly present in the cities upon San Francisco Bay, but believe there is no danger 
of distribution among the citizens because of the lack of suitable mosquito carriers. 
They have studied Culex conaobrinus and Culex tar$ali8t the two most important 
mosquitoes of the locality, from this point, and have determined their incapacity to 
serve as transmitting agents. 

West Indian Islands. — Collectively the West Indian Islands are all open to suspicion 
as infested localities. The parasite has been actually demonstrated in most of the 
larger islands and in many of the smaller ones; and various clinical featiu^ of filaii* 
asis have been recorded for others, lending support to the belief in their infestment as 
well. 

Discovered first in a Habanese, the parasite to-day constitutes one of the persistent, 
if not serious, pathogenic agencies in Cuba, apparently beginning to yield in frequency 
of occurrence in response to the vigorous antimosquito campaigns of the past decade 
and a half;* and doubtless if one may judge from the early records of filarial clinical 
manifestations, the island has been infested in at least a moderate degree for a long 
time.' 

In reference to the prevalence of the disease the data compiled by Nuilez are of 
significance. Out of a total hospital population of Hospital Mercedes, from the estab- 
lishment of the institution in March, 1886, to January, 1906, of 62,548 patients, 356 
were recorded as proved filarial cases or as exhibiting one or another form of the clini- 
cal expressions of filariasis; and in Hospital No. 1, founded in 1900, up to July, 1904. 
there had been received 19,586 patients, among whom similar evidences of filariawiB 
were recorded in 70 — somewhat less than 0.5 per cent incidence in each institution. 

1 Noted in Gross's System of Surgery, 1882, v. 1, 607. 

s Otdt^ras, sup. dt.; others mentioned below in asslfnment to plaoes of origin; add here the case of Dela- 
field in New York, said to have come "from the West Indies," Med. Oas., 1883, v. 10, p. 210, and case of 
Kalisld, Amer. Jour, of Urology, 1911, y. 7, p. 429, in a negro " from the West Indies." KahsU states that 
he has met five cases of Bancroft's fllariasjs in New York City in the last five years. 

» Jour. Amer. Med. Assoc., July 11, 1910, v. 55, p. 217. 

4 Ouit^ras, Insect Borne Diseases, Tr. of II Pan American Congress, Washington, D.C., 1915-16, Scien- 
tific section. 

» Literature upon Cuban Infestment: Finlay, Ann. real. Acad, dendas med.etc, de la Habana, y. 19, 
pp. 40-51, June 15, 1882, and Trabajos Select., 1912, p. 611; Ooit^^fas, Med. News, Apr. 10, 1886, referring 
from Key West 4 cases to Cuba; Matas, New Orleans Med. and Surg. Jour., Jan. 1801, v. 18, p. 501, a case of 
ohylocele imported into New Orleans from Cuba; Lebredo, Key. de MM. tr(^. Habana, 1904, y. 5, p. 171 ; 
Ibid., 1905, V. 6, pp. 117, 141; Jour, of Infect. Dis., 1905, y. 1, supp. 1, p. 3S2, deaUng with mosquito transmis- 
tlon; Garcia Rijo, Crdn. m<d.-qutr. de la Habana, 1904, y. 80, p. 119; Garcia Mon y Carballo, Reyista de 
mM. y drurg. de la Habana, 1904, v. 9, p. 622; Nuflez, Escuela de Medldna, Mexico, 1906, y. 21, p. 120, and 
oontinuationy, dealing with filariasis and its surgical complications; L. Gutierres Lee, Crdn. m6d.-qulr. de 
la Habana, 1911, y. 37, p. 550, and Rey. de mM. y churg. de la Habana, 1911, y. 16, p. 406; reference to cases 
of elephantiasis in Med. Report of United Fruit Co., New York, 1918, p. 85; Brault, Gas. des Hopit, 1907, 
y. 80, p. 155, general artide on geographical distribution of filariasis; etc. 



PUBUC HEALTH AND MEDICINE. 55 

The Island of Haiti, where the work of Leon Audain and his aseociatee,* has been 
notable, is known to be infested and has probably been infested for many years, per- 
haps in no higher ratio than Cuba. 

Porto Rico at the present time is heavily infested. Ashford ^ after examining a 
aeries of civilian and enlisted Porto Ricans, states that in his belief about 10 per cent 
of the general population of the island harbor filariae, about 12 per cent of the soldiers 
examined and nearly the same proportion of civilians having been found parasitized. 
Of somewhat more than a dozen students from Porto Rico examined in the pathological 
laboratories of the University of Pennsylvania within the last few years 4 were found 
to be hosts of Filaria banerofli* Punk * has reported a similar finding in Philadelphia, 
and Marden * in Baltimore, in Porto Ricans. Recently Martinez,* writing from San 
Juan, P. R., has discussed a case of filarial lymphangitis simulating bubonic plague. 

Young in 1897 ' reported a case from Jamaica; and more recently WanhiU • after 
meeting with but a single case in several troops of native soldters«and after inquiring 
among local medical officers of experience, states that while occasionally encountered 
in Jamaica, filariasLs is almost unknown on that island. He mentions the fact that 
Mott failed to find any microfilariae in a series of 400 slides of blood collected by Dr. 
Grabham from natives of Jamaica. 

Among the Danish West Indies, the islands of St. Thomas • and St. Croix *° are 
recorded as infested localities. 

It is improbable that the Bahamas are entirely free, but that these islands can have 
no more than rare sporadic instances of filariasis is surely indicated by the fact that in 
the long list of publications consulted by the writer he has failed to encounter any 
record of the affection in these more norUiem islands. 

Of the lesser Antilles, in the groups of the Leeward and Windward Islands, stretching 
out below Porto Rico toward the South American coast, there is reason to believe 
there has been an early and heavy implantation of the parasite, and there is evidence 
that it persiBts in some of these islands in high grade up to the present. >> 

> Aodain, FoniMs ohir. <to k fllarkne genlt., 1894; Rioot In Audain, Flevns Intertropicales, 1910, p. 777; 
cC also Moooarro» in OnndMr and Comby, Traits de UaL de I'Enfuioe, Paris, 1904, y. 2, p. 802. 

• Mad. Beoord, Nov. 7, 1908, y. 64, p. 734; Report of Surgeon Oen. U. 8. Army, 1903-04, p. 92. 

• Smith and Rivas, Amer. Jour. Trop. Med., Dec, 1914, v. 3, p. 861; 3 cases; 1 unreported. 
« Proe. PhUa. Path. Soe., 1914, v. 16, n. s., p. 63. 

• Hosp. BolL, Univ. of Maryland, 1913-14, t. 9, p. 60. 

• Jour. Amcr. Med. Ajsoe., May 38, 1914, y. 63, p. 1632. 
▼ Brit. Med. Jour., 1897, v. 1, p. 1037. 

• Jour. Roy. Army Med. Corps, London, 1906, p. 561. 

• PoBtopidan, quoted by Blandiard, Traits de ZooioKie MM., Paris 1890, y. 3, p. 637; Opie, Amer. Jour, 
of Med. fioL, September, 1901, v. 132, p. 351; and probable case of filariasis, intermittent ohyluria> SoUs- 
Ooban, Times and Ragteter, May 18, 1889, Jour. Amer. Med. Assoc., July 3, 1803. 

w Abbe, N. Y. Med. Jour., February, 1880; y. 31, p. 139; Lambert, N. Y. Med. Jour., Apr. 30, 1892. 

n Literature upon Leeward and Windward Islands: Braolt, sup. dt.; Creyaux, I/Ematmie chylense oa 
gy a l i w is i i des Pays chauds, 1873, ra y l ewed in I/Unkm med. , 1^78, y. 13, p. 795; Leookart, Panwiten, Leipsig 
aadHeldeIbiirs,1876,y.3,p.e28; PUnt, N. Y. Med. Jour., June 15, 1895, p. 787, a case in New York from 
Barbados; Mansoo, Brit. Med. Jour., 1897, y. 3, p. 1837; Lothrop and Pratt, Amer. Jour. Med. ScL, 1900, 
T. 130, p. 535, 3 cases in Boston from Barbados; Qalgey, Select. Colon. Med. Rep. , London, 1004, p. 190, St. 
Laeia; Moneonro, in Oruicfaer and Comby, Traits les Mai. de PEnfance, Paris, 1004, y. 3, p. 802; Low, 
Jear. Trop. Med. and Hygiene, Feb. 15, 1908, y. 11, p. 59; Orindon, Missouri Med. Jour., 1908-09, y. 5, p. 
m^ ease from Ouadaloope; Slmond, Noc and Aubert, BuU. Soo. Path. Ezotique, Paris, 1909, v. 2, p. 319; 
CIvac, Leboeuf and Rigollet, Traits de Path. Exotique par OraU et Clarao, y. 6; Mai. Parasit., Peste, 
Ftois, 1913, p. 313; HiQary, Diseases peculiar to the Island d Barbados, 1750 and Hendy, Glandular Dis- 
mm in Barbados, 1784, both quoted by Castellanl and Chalmers, Man. of Trop. Med., 2 Ed., 1913, p. 1135; 
Ljls, Ann. of Sorsery, 1913, y. 56, p. 943, case in New York from St. Kitts; O'Nell, Best. Med. and Surg. 
Jbor., 1908, y. 158, p. 117, a ease in Boston from Barbados; Armstrong and Mullally, Surgery, Qyneool. 
sad Obstat., 1914, y. 10, p. 699, a case in Montreal from Antigua; Leger et Le Gallen, Bull. Soc Path. Ezo- 
tique, Parte, 1914, T. 7, p. 135, Ouadaloupe; Steyenel, ibid., 1913, y. 6, p. 357, Ouadaloupe; Noc et Stevenel, 
ML, 1913, T. 6, p. M8, Martinique; for old unedited references see Honllier, De la fllarlose, etc, des Pay 
, TbmifUoatpOkt, 1913. 



56 PB00EEDIKQ8 SECOND PAN AMEBICAK SGIEKTIFIG C0K6BE88 



In Low*8 admirable travel study, he found evidence of heavy infestment (47 < 
out of 143 examinations at night) in St. Kitts. Manson found microfilaria in 6 
films of blood out of 2B sent him from St. Kitts and Montserrat. In Dominica, Low 
examined 144 individuals at night and found that 11 harbored microfilari« in their 
blood. In Guadaloupe Leger and Le Gallen, in an examination of 150 Guadaloupiaa 
enlisted men in 1914, found 23 infested (15.33 per cent); in 1913 Stevenel found 4 
out of 12 individuals examined to harb^ FUaria bancrofti in Guadaloupe. That 
Antigua is at least in some measure infested may be inferred from a case reported 
from Montreal, Canada, by Armstrong and Mullally in 1914, as originating in Antigua. 
Guadaloupe is said by Clarac, Leboeuf , and Rigollet to be seriously involved by filari- 
asis,' and Martinique is likewise characterized by these authors. Simond, Noc, 
and Aubert state that clinical manifestations of filariasis are common in Martinique; 
and Noc and Stevenel in 1913 published data showing that of 4,000 individuals com- 
ing to the dispensary of the hygienic institute in Martinique between 1909 and 1913. 
88 showed different forms of lymphatic affections (77 endemic lymphangitis, 15 
elephantiasis, 25 without microfilarifie). 

In St. Lucia, Low examined the blood of 356 persons at night, finding microfilarise 
in 27.' In St. Vincent he examined the blood of 100 individuals at night, 6 of these 
showing the presence of microfilariae; and Manson found the same number, out of 
152 blood preparations sent him from this island, to contain microfilaria. In Bar- 
bados, the manifestations of filariasis (as the '* Barbados leg") have been known from 
the early part of the eighteenth century; and a serious endemic focus is centered in 
this island. Of 600 individuals examined at night by Low, microfilaria were found 
in the blood of 76 (12.66 per cent), a proportion comparable to that indicated for 
Porto Rico by Aahford. The ishind is particularly named by most writers in sys- 
tematic treatises upon parasites and tropical diseases; and a number of Barbadian cases 
have been recognized and published from other parts of the world to which they have 
gone (as the cases of Lothrop and Pratt, in Boston). 

In Grenada, Low found no examples of infestment among 174 individuals examined 
at night; and in Oarriacon, a small island of the Grenadine group, out of 28 individuals 
he found 1 case of filariasis nt>ut this individual had been bom and lived in St. Kitts 
until within a year of the time of Low's examination, and should under the circum- 
stances be regarded as belonging rather to the more northern island ). 

Trinidad was found by Low to be a decidedly infested Island, 43 individuals out 
of 400 examined at night by him showing microfilariae in their blood; Vincent * in 
examining 500 individuals in hospital, asylum and private practice found 25 in- 
fested (5 per cent) and 33 showing elephantoid complications (6.6 per cent). 

While in this hasty review of the West Indian Infestment, the writer has doubt' 
less missed nuiny important items, the serious grade of involvement of certain islands 
and the widespread diffusion of the parasite is surely shown sufSdently to substan- 
tiate the statement that collectively these islands are all to be regarded as open to 
the suspicion of being infested . And yet the Bahamas, Jamaica, and Low's experience 
in the Grenadines are evidence that such a sweeping statement must not be too seri- 
ously accepted for any individual location. There are places in the West Indies 
(perhaps, too, limited localities on infested islands), where known and unknown 
circumstances have operated to prevent the invasion or the permanent fixation of 
the parasite; but whether such circumstances are to be regarded as constant for these 
places is quite another matter. 

Mexico and Central ^Immoa.— Returning to the mainland of the American Conti- 
nent, in Mexico definite records of the discovery of the parasite are singularly lacking 
in the literature which the writer has had opportunity to examine, although general 
statements of the occurrence of filariasis are now and again to be met in systematie 

I See also Leockart, OrerMz, Orindon, Ifonoorro • BilU Med. Jour., 190a; r. 1, p. m. 

t Cf, also Galgej. 



PUBUO HEALTH AND MEDIOINE. 67 

artides upon the affection. Claiac, Leboeuf , and Rigollet ^ state that elephantiasis 
18 "comparatively frequent on the coasts of Mexico, becoming more rare as one 
proceeds to the north." Newman and Mayer,^ in their cursory statement as to the 
distribution of JUaria bancroftif also include Mexico as infested. The writer recalls 
to have i>er8onally observed several cases ef elephantiasis in Mexico in the course 
of visits in the Republic some years ago. 

Nor is the recorded evidence of the prevalence of the parasite in the Central Ameri- 
can Republics more satisfactory in the literature available to the writer. Creneral 
references to its occurrence in Central America,' in Nicaragua,* and a few specific 
records of its clinical manifestations ^ in Costa Rica in the medical reports of the 
United Fruit Co. constitute the only items met. The writer's colleague. Dr. Damaso 
Rivas, a native of Nicaragua, has personally informed the writer that cases of ele- 
phantiasis are not very uncommon in Nicaragua. 

In Panama, elephantiasis is noted as "relatively common'' by Clarac, Leboeuf, 
and Rigollet,* and examination of the reports of the department of sanitation of the 
Isthmian Canal Commission may be regarded as verifjdng this statement. Occasional 
cases of elephantiasis, lymphscrotum, and chyluria occur in these monthly reports, 
and there are a number of demonstrated cases of filariasis distributed in the various 
faoepital records. It is to be recalled that these reports do not deal directly with 
the fixed population of the Republic of Panama, but rather with the heterogeneous 
group of canal employees who congregated In the Canal Zone during the period of 
active canal construction, and that among them many of the laborers came from 
known localities of infestment, as from various West Indian islands. Some of these 
people, however, doubtless have remained on the Isthmus, and one can not dis- 
regard them as having been and even now in some degree being i>otential factors of 
maintenance and dissemination of the affection in the district. 

The figures collected by the writer from the reports of the department of sanitation 
are undoubtedly too low, as they are based upon the hospital records of blood exam- 
inations, and for the most part these examinations were made for other diseases than 
Bancroft's filariasis, the vast bulk of the blood specimens having been unquestionably 
prepared in the daytime. Uncomplicated cases of filariasis, too, are not likely to 
have been included in the hospital population; and the tediousness of blood exami- 
nations with high objectives, as for malaria, is probably reason to suppose that in 
most instances as little as possible of any given blood film would be actually scruti- 
nized. The reports for nine years, from 1905 to 1913, inclusive, are best adapted for 
analysia, because of the uniformity of the plan of reports of blood examinations and 
of report of positive findings of microfilariae. In this period they aggregate a total 
of 144,423 microscopic blood examinations in the various hospitals of the Canal Zone; 
among which 111 positive instances of demonstration of microfilariae are recorded, 
considerably less than 0.1 per cent. By years the distribution of recorded instances is 
asfoUows: 1905, 2; 1906. 1; 1907, 3; 1908,3; 1909, 9; 1910, 29; 1911,44; 1912, 13; 1913, 
7. The annual report for 1914, which is not included, states that two cases of filariasis 
were admitted to the hospitals of the Zone, but does not give the number of blood 
examinations made in the hospital laboratories. The cases were distributed over the 
entire length of the Zone, being recorded at Ancon, Colon, Miraflores, and Santo 
Tomas, indicating, therefore, infestment on the Pacific as well as on the Atlantic 
aide. Specific differentiation is not indicated in the reports; but there is one case 
(1900, at Colon) reported as "filaria diuma."^ 

I Sop. dt., L«ewftrd and Wladward Islands, p. 374. 

* Atlas and L«hrb. idchtiger tierlseh. Parasit. u. Ihrer Uebertrftg., Mflnchen, 1914, p. 365. 
> Castallani and Chalmers, sup. dt. Leeward and Windward Island Literatnre. 

« Newman and Mayer, sup. dt. 

* As of diyhiria and elephantiasis; Med. ReporU United Fruit Co., New York, 1912, p. 67; 1913, p. 87. 

* Sop. dt. I.,eeward and Windward Inlands, p. 374. 

' For above dats d. reports of department of sanitation of Isthmian Canal Commission, Waahlnfton, 
D. C, tot yean tndleated, condensed in the Annnal Report of the Director, or embodied In the monthly 
laboratory reports of the Tarioos hospitals tat the different months of eadi year. 



58 PBOCEEDINGS SECOND PAN AMERICAN SCIENTiriC CONGRESS. 

South America. — In Colombia Marquez > refers to cases of elephantiasis and chyluria 
occurring not infrequently in the Santa Marta district (on the Atlantic side). A case 
originating in Colombia, apparentiy near Cartagena, is reported by Cimningham ' 
in Boston, whither he had come for surgical treatment; and casual mention of Colombia 
as infested may be noted in the works of Moncorvo ^ and of Castellani and Chalmers *. 
Moncorvo alone, of the writers consulted, lists Ecuador among the coim tries infested; 
although it is unlikely to be any more exempt than its neighbors Colombia and Peru, 
the latter being incriminated by a number of writers.* Crevaux and Moncorvo place 
Chile also among the countries infested by Filaria bancrofli. 

The parasite is undoubtedly more common and has been better traced in the Atlan- 
tic coastal countries of South America. J. Surcouf and R. Gonzales Rincones, in 
their paper on the bloodsucking diptera of Venezuela,* state that chyluria and ele- 
phantiasis, evincing the presence of Bancroft's filariasis, are very common in Venez- 
uela about its important western harbor, Porto Cabello; and the proximity of the 
island of Trinidad ^ is strong suggestive evidence that the eastern coasts of Venez- 
uela have not failed of infestment. Important texts such as Castellani and Chalmers, 
Clarac, Leboeuf, and Kigollet, and Moncorvo,® and Newman and Mayer • mention 
Venezuela in their lists of infested countries. 

The three Guianas are probably equally and seriously invaded. Speaking of 
British Guiana, Daniels ^^ calls attention to the coastal coincidence of Filaria ban- 
crofti and elephantiasis in contrast to the absence of elephantiasis in the interior and 
to the replacement in the latter district of Filaria bancrofti by another species, F. 
demarquayi. Low " found over 16 per cent (25 out of 150) of a series of blood films 
collected at night to contain microfilariae in studying the incidence in British Gui- 
ana.'' 

In Brazil, Otto Wticherer,*' at Bahia, was the first in America to observe the larval 
stage of the parasite, in 1886, in the prevalent hematochyluria of this district; but 
this, as well as other filarial manifestations had been a matter of Interest and anxiety 
for years earlier in Brazil. As early as 1835, a conference was held upon the subject 
of hematochyluria at Rio de Janeiro, following and probably stimulated by the paper 
of Salese upon this condition.'^ Rego '' in 1843 recorded elephantiasis as being com- 
mon in Rio de Janeiro, and quoted Souts-Ammarel, of the latter dty, as having dealt 
surgically with certain examples of huge elephantiasic growths of the male and female 
genitals. Wtlcherer's discovery, not published for several years, was followed in 

1 Geograpbia M6dica y Patologfa de Colombia, Bogota y Nueva York, 1916, pp. 140, 219. 

• Ann. of Surgery, 1906, y. 44, p. 481. 

> Sop. dt., Leeward and Windward Islands, p. 808. 
« Sup. dt. Leeward and Windward Islands, p. 1126. 

» Castellani and Chalmers, sap. dt.; Creyaux, sup. dt.; Newman and Mayer, sup. dt.; Moocoryo, tup. 
dt.;etal. 

• Arch, de Parasltologie, 1911-12, y. 16, p. 248. 

' Vide supra, Leeward and Windward Islands, Low. 

> Sup dt., Leeward and Windward Islands. 

• Sup. dt. 

M Brit. Med. Jour., Sept. 24, 1898, y. 2, p. 878. 

u Sup. dt.. Leeward and Windward Islands. 

a Consult also Lodnyood, Maryland Med. Jour., Oct., 1907, y. 46, p. 367, case in Baltimore; Lefeyre, 
Tr. N. Y. Path. Soc., 1893 (Noy. 23, 1892), p. 114, case hi New York; Pildier and Pildier, New York Med. 
Record, 1911, y. 79, p. 434, a case hi New York; all from British Ouiana. Armstrong and Mullally, Sur- 
gery, Qynecol. and Obstet., 1914, y. 19, p. 699, a case in Montreal from British Ouiana; Kingsbury, Jour. 
Cut. Med., 1911, y. 29, p. 867, case bom In Venesuela, living from age of 6 to 22 hi British Guiana, one year 
later obeenred hi New York; HiUis, London Lancet, 1882, y. 2, p. 669; Manson, Brit. Med. Jour., 1897, 
y. 2, p. 1838; Guard, Brit. Guiana Med. Ann., 1897, y. 9, p. 24; Winckel, Arch. f. kUn. Med., Feb. 26, 1876, 
y. 17, p. 303; and as noted under Leeward and Windward Islands, Castellani, and Chalmers, Qarac, Leboeof 
and RigoUet, Monconro, Creyaux. 

u Sup. dt., note 6. 

14 Dissertation sur lliomaturie ou pissement du sang. These, Paris, 1834. 

» Gas. des Hopltaux, Aug. 31, 1843, p. 412, from Beyista mM. flumenense. 



PUBUC HEALTH AND MEDICINE. 59 

Brazil by a group of investigators, including at Bahia, J. F. da Silva Lima,' who is 
credited with applying the name Filaria wuchereri to the parasite, A. J. da Silva 
lima,' da Silva Araujo,' who, in 1S75, met microfilariae in the exudate from lesions 
of craw-craw and in this connection applied the name Filaria dermathemica, and who, 
in October, 1877, encountered the adult worm in elephantiasis of the scrotum, Pe- 
reira,* d*Almeida Couto,' and Paterson,^ and, at Bio de Janeiro, F. dos Santos,^ 
who was one of the early observers of the microfilariae in the blood in elephantiasis 
tnd who obtained the adult worm in a lymphatic abscess only about a month after 
de Silva Araujo in Bahia, de Moura,' who obtained the microfilariae in the exudate 
from craw-craw lesions, and de Magalhaes.* 

As some indication of the incidence of the parasite Paterson at Bahia in 1878 foimd 
26 cases of filariasis among 309 individuals examined at random. Moncorvo '° in 1904 
stated that the affection was less frequent in Brazil at that date than it once had been. 
Oliveira " in 1909 in his thesis presented to the medical faculty of Bahia indicated an 
endemic index of 10.5 per cent of filariasis in Brazil." 

In 1882 Wernicke " published a case observed by him in Buenos Aires, the most 
southern recorded case on the American continent, the solitary case, as far as the 
writer knows, referred to in various systematic articles which list Argentine as an 
infested district (save the recently reported cases of Padilla in Tucuman). 

2. FILARIA DKMABQUATI (HANSON, 1897). 

Synonyms: Filaria ozzardi Manson, 1897, pro parte; F. juncea Railliet, 1908. 

In 1893 and in 1895, in blood films sent him from St. Vincent by Dr. Newsam, Man- 
son " met with a microfilaria which he had not previously encountered, smaller than 
the larval Filaria hancrofti, without a sheath, with a finely effilate tail end, and aperi* 
odic. Tentatively, at Blanchard's suggestion, he named the parasite in honor of De- 
marquay, the original observer of the larva of FUaria bancrofti. And in 1896 and 
1897, in a series of blood slides sent him by Dr. Ozzard from Indians of the interior of 
British Guiana, Manson again met with a microfilaria of the same morphology (which 
he believed might be identical with the St. Vincent specimens) but in association 
with it another small aperiodic, nonsheathed microfilaria with a bluntly pointed tail 
(which he believed identical with the African perstans). Uncertain of his ground, he 
lor a time hesitated to distinguish between the two, giving them jointly the name 
Filana oztardi. Ozzard and Daniels >^ shortly after^uds confirmed Manson's discov- 
ery, but at the time made no distinction between the two confused larvae. 

t Oftt. mM. da Bahia, Sept., 1877, v. 3, 2 aer., p. 387, translated In Arch, de mM. nay., Paris, Dec., 1877, 
T. 38, p. 490. 

• B«v. iii6d. Rio de Janeiro, July Ifi, 1870, ▼. 1, p. 107. 

• llem. Bohre a fiUarose on a molestia por uma nova espede de parasita catanea, Bahia, 1875; Oas. m6d. 
de Bahia, Nov.. 1877, t. 2,3 aer., p. 403, translated in Ardi.de mM. nav., Paris, March, 1878, v. 20, pp. 200^ 
470; Qaz. m6d. da Bahia, 1878, v. 8, 3 ser., p. 40; Oac. mM. da Bahia, Oct., 1870, v. 4, 3 ser., p. 455. 

• Hal. parvit. lea plus freqnentes dans les cttmatea intertropioaleB, 1870, Dissert., Bahia. 

• Hematuria endemica dos paiaes quMites, Bahia. 1873. 

• Has. m6A. da Bahia, Dec., 1878, v. 3, 3 ser., p. 530; translated io London Veterinarian, Jnne 30, 1870, 
and to aatveston Med. Jour., Jan., 1880, t. 1, p. 14. 

« Gas. ni6d. da Bahia, Marob, 1877, ▼. 3, 3 ser., p. 187; Progresso mM., Rio de Janeiro, 1877-78, t. 3^ 
p. 95, 100. 

• Revista mM. de Rio de Janeiro, Aog. 31, 1875, ▼. 3, p. 315 and continoations; Da Chyluria, These, 
Rio de Janeiro, 1877. 

• Gas. mt6d. da Bahia, Dec., 1877, t. 3, 3 ser., p. 588; Progresso inM. Rio de Janeiro, Norv. 15, 1877, v. 
3, p. SO. ihid., May 15, 1878. 

>• Sup. cit.. Leeward and Windward Islands. 

u Inaug. Thesis, BahJEft, 1000; quoted by Padilla, Semana mM., Buenos Aires, 1015, anno 23, p. 371. 

X For more reoent studies in Brazil cf. Froes, Brazil mM., Rk> de Janeiro, 1000, v. 30, p. 03, 75; Mootolro, 
Tribona mM., Rio de Janeiro, 1008, v. 14, p. 00; Ferrari, ibid., y. 14, p. 07. 

M Consideraeioose a propodto de un oasode quilnria observado en lapolidtaiioa del oircnlo mM., Argen- 
tine, Boenos Aires, 1S83. 

■« Brit. MM. Jour., 1807, v. 3, p. 1837. 

» QuoCM by Manson, ibid.; see also Ouard, Br. Quiana MM. Ann., 1807, v. 0, p. 24: and Daniels, Br. 
GniaiM MM. Ann., 1807, ▼. 0, p. 28; ibid., 1806, v. 10, p. 1; Jour. Trop. MM. and HyK., 1808, v. 1, p. 13; and 
Brtt. MM. Jour., 1808, v. 2, p. 878. 



60 PBOCEEDINOS SECOND PAN AMERICAN SCIENTIFIC C0N0BE88. 

In the same year Daniek ' at a post-m(vtem examination of two Indians, who doff- 
ing life had shown both fine-tailed and blunt-tailed larvae in their blood, met with a 
number of adult filarise which were identified later with adults of AcanthodieUonema 
persUms ' by Manson. As the blunt-tailed larvae were from the first suspected of 
being identical with the African perstans lanne, and as such larvae were obtained by 
Daniels from the adult females, the one group confused under the name PUcaria oz- 
zardi was thus definitely eliminated. Meanwhile Galgey in St. Luda ' had recog- 
nized the presence of the Microfilaria demarquayi in St. Luda and in 1899 had ob- 
tained a number of adult females from the upper part of the mesentery at autopsy. 
One of these he sent to Ozzard for determination and description, but, owing to its 
poor state of preservation, little definite could be made out. * In the same year, how- 
ever, Daniels * had opportunity to perform a post-mortem section of the body of a 
third Indian from the interior of British Guiana and found beneath the peritoneum 
of the anterior abdominal wall an entire adult female filaria and the broken caudal 
«nd of a male. The Indian in life had shown both fine-tailed and blunt-tailed larvae 
in his blood, the former predominating toward the end of life. These adult filarise 
differing from the previously separated perstans adults, Daniels published them as 
the probable parental forms of the fine-tailed larvae. In form they resembled Filaria 
bancro/H rather than AcanthocheiUmema perstans^ were characterized by a smaller head 
said thicker body than the latter, and lacked the caudal cuticular processes of the 
latter, the tail of the male being more tightly enrolled, terminating abruptly, and 
showing no protruded spicules (there are, however, two spicules which were not at 
the time recognized). The fine-tailed larvte from St. Vincent, St. Lucia, and from 
British Guiana having been identified, these worms (the adult females agreeing with 
Gralgey's specimens from St. Luda) have been accepted as Ptlaria demarquayi (the 
tentative spedes PiUxria ozzardi thus falling out entirely). 

As far as its distribution in America is concerned the study by Low * is the most 
complete thus far at hand. In St. Lucia, in an examination of 472 individuals, he 
met with the larval demarquayi in 23, and notes the fact that it tends to segregate 
itself in special fod, the heaviest infestment of St. Lucia being met in the part known 
as Gros Islet. In Dominica he examined 160 persons and found Microfilaria demar- 
quayi in but 2. In Barbados he found no instances of the parasite in question in 
600 individuals examined (in contrast to the heavy infestment of Barbados by Filaria 
hancrofti). In St. Vincent he met it in scattered fod in the country districts, as in 
the village of Calliaqua, where 8 out of 30 persons were found to be hosts of the 
parasite. 

In British Guiana Low examined 163 full-blooded Indians from various parts of the 
interior, finding 49 to be hosts of Filaria demarquayi (alone in 11; in association with 
Acanthocheilonema perstans in 38). 

Vincent,^ in his study oi filariawis among the asylum and hospital populations in 
Trinidad, notes the finding of a single instance of panuritism by deTnarquayi, 

It ia quite possible that the geographical distribution in America is more extensive 
than is here indicated and that Low's suq>idon is correct that it and perstans are 
probably scattered all throu^ the deeper forests of not only British Guiana, bat of 
the other Guianas as well, and perhaps of Venezuela. One may not improperly 
think of it in connection with the diurnal microfilaria reccnded in t^e Colon Hospital 
Report for 1906 in the Reports of the Isthmian Canal Conmiission. And the writer 

I Drit. Med. Jour., 1898, v. 1, p. 1011; Br. Guiana Med. Ann., 1806. v. 10, p. 1. 
s See note to Daniels's paper in Brit. Med. Jour., 1808, t. 1, p. 1011. 

* St. Luda, Colon. Reports, 1800; Brit. Med. Jour., 1800, v. 1, p. 146; see also Low, Brit. Med. Jour., 1008, 
V. 1, p. 196. 

* See Ossard, Jour. Trop. Med. and Hyg., 1902, ▼. 5, p. 250. 

• Brit. Med. Jour., 1800, v. 1, p. 1450. 

• Brit. Med. Jour., 1002, t. 1, p. lOA. 
» Brit. Med. Jour., 1002, v. 1, p. 180. 



PUBLIC HEALTH AND MEDICINE. 61 

€tn not but ndae the qaestkm whether FUaria tucumani, recently reported from the 
district of Tucuman in Argentina, will not be found to be FUaria demarquayi. This 
last ii a onall and active microfilaria, without periodicity (but with predilection for 
ni^^t as shown by the fact that night blood is apt to contain upward of double the 
proportion of microfilarifle seen in day specimens), showing marked variation in size 
(but with an average of .0.17 mm. long and 0.005 mm. thick and some as long as 0.252 
mm., some not more than 0.087 mm. in length), and provided with a sheath. Varia- 
bility in size is well known in case oi the microfilaria of demarquayi.^ If Padilla's 
specimens are really ensheathed he is correct in differentiating them from demarquayi, 
but the determinaticm of tlus point is not always easy. For example, Manson ' at 
first believed that the demarquayi larva was ensheathed, but recognized later that the 
^ypearance was due to artefact from the shrinkage of the microfilariae in stained blood 
films. Should this surmise be onrect the American limits of distribution will be 
materially widened; and there should then be expected more or less infestment in 
the deeper Brazilian forests to link up the Guianas with Argentina. 

The general impression at first was that FUaria demarquayi is native to America^ 
the very isolation of its foci of endemicity suggesting this. But the certainty of 
such belief is disturbed by the fact that Manson some years ago found a microfilaria 
of apparent identity in the blood ol a native of New Guinea, according to Seligman,* 
who likewise has met the same microfilaria in the same distant locality. 

The importance of the worm is doubtful from a positive standpoint; its presence 
being without recognized pathological effects upon the host. But in a negative way 
it is of importance that medical men distinguish it and its microfilaria from FUaria 
banerofli, lest from omfusion we fail to appreciate in full the serious pathogenic effects 
fllth0 latter worm. 

Iti intermediate host is unknown. Low, from this standpoint, tested CulexfadganSf 
BUgomyia fudata, Culex taeniatua, Anophele$ albipe$, Pulex penetran$f and Pulex 
initani witiiout meeting with development of the microfilarise into prefilarial forms.* 

8. ACANTHOOHKIIiONBMA P£B8TANS (mANSON, 1891). 

Synonyms: FUaria sanguinis hominis var. minor Manson 1891; F. sanguinis hominis 
Persians Manson 1891; F. perstans Manson 1891; F. ozmrdi var. truncata Manson 1897. 

Hanson, in 1891,^ from the study of blood from negroes from Western and Central 
Africa, distinguished microfilarise of essential difference from those of FUaria 6an- 
erqfti, which previously were the only known filarial hematozoa of man. Two new 
types were met, one of a size comparable to the Bancroft type, ensheathed, but 
occurring in the pmpheral blood in day rather than at night, this being subsequently 
identified as the larval form of Loa loa (named at this time by Manson FUaria sanguinis 
Aofittnu var. major); and a second, smaller, not sheathed, with active progressive 
movement, and without either diurnal or nocturnal periodicity in the peripheral blood 
but found therein at all hours, to which he gave the name FUaria sanguinis hominis 
var. minor (subsequently changing the name to FUaria perstans). In an article pub- 
lished in 1897,* inter alia he announced that in blood preparations collected and for- 
warded to him by Dr. Ozzard from aborigines living in the interior of British Guiana 
he had hiled to find microfilariae of the type of FUaria hancrofti, but had encountered, 
sometimes in the same perparation together, sometimes separately, two small non- 
sheathed microfilariae, one with a finely drawn point of the tail, resembling the micro- 

> CI. Galgey, Brit. Med. Jour., 1399, v. 1, p. I4s! 

• Brit. Mad. Jour., 1807, y. 2, p. 1837. 

« Joor. of PathoL ftnd Bact., 1901, y. 7, p. 306. 
< Brit. Med. Jour., 1902, y. 1, p. 196. 

• Loud. LMoet, 1891, y. 1, p. 4, abstncted In C«ntnlbL f. allg. Pathol., 1891, y. 2, p. 298; Trans. Beveotb 
Intamat. Congren Hyg. and Demography, 1891, y. 1, aeot. 1, p. 79. 

• Brtt. M«l. Jour., 1897, y. 2, p. 1887. 



62 PROCEEDINGS SECOND PAN AMERICAN SCIENTIPIO CONGRESS. 

filaria of Filaria demarquayi (which he announced in the same paper from the island 
of St. Vincent), and the other with a blunter tail, which resembled the African per- 
sistent microfilaria. In spite of the recognized morphological differences he for the 
time applied to both the name Filaria ozzardi. This finding was shortly afterwards 
corroborated by Ozzard and Daniels. * 

In December, 1897,^ the latter investigator announced that he had met adult 
filarise in the retroperitoneal tissue at the base of the mesentery, about the pancreas 
and beneath the pericardium in two autopsies upon Indians from the interior of 
British Guiana, who in lifetime had shown in their blood both forms of the so-called 
Filaria ozzardi. The females ranged from 70 to 80 mm. in length; the males were 46 
mm. long; and in both sexes a small triangular cutiodar process was noted on each 
side of the caudal tip. The male tail was curved, and there was noted a single spicide. 
Larvae obtained from these adult females corresponded with the blunt-tailed type of 
Microfilaria ozzardi. From subsequent comparison with adidts obtained from African 
hosts of Microfilaria perstans, come to autox)sy in London, Manson ' identified Daniels's 
specimens with the African adult parasites; and subsequently, based upon the cuti- 
cular processes at the caudal end they were referred to the genus Acar^thocheilonema 
Cobbold by Railliet and Henry.* 

In its American distribution AcanthocheUonema perstans (Manson), it is to be noted, 
as in Africa, occurs in the hot, heavy and moist climate of tropical forests, rather than 
in open districts. In the coast districts of British Guiana neither this nor Filara 
demarquayi (the two originally confused under the name Filaria ozzardi) were met in 
blood examinations by Daniels and by Ozzard at Georgetown and New Amsterdam. 
Filaria bancrofti had been found in 52 out of 348 individuals of the settlements (whites, 
negroes, and civilized Indians) by Daniels; and Ozzard had in a like population met 
with 24 cases of Bancroft's parasite out of 83 individuals examined. Manson in blood 
specimens from 61 natives of Demerara had found 9 instances of Filaria bancrofti^ but 
none of the small unsheathed larval worms. But among the aborigines of the interior 
Daniels ' found 134 individuals out of 231 examined to harbor the small forms (both 
perstans and demarquayi^ confused) which he was at first disposed to accept as varia- 
tions of a single species. Low ^ examined 163 full-blooded Indians of different parts 
of the interior of British Guiana and found 105 of them to be hosts of the small un- 
sheathed microfilariae, with double infestment by Filaria demarquayi and Acantho- 
cheUonema perstans in 38, perstans alone in 56 and demarquayi in 11 alone (a total of 94 
of the 163 infested with Acanthocheilonema perstans). Apparently this is the only 
focus of American endemic occurrence of this parsite, but one which is firmly fixed 
among the Indians of the deeper forests of British Guiana, extending, if Low's sus- 
picions be correct, into similar parts of both French and Dutch Gulanas and into the 
confines of Venezuela. In the upper part of the British Guiana coast it is known to 
approach the sea. 

The carrier is unknown, investigations thus far made being without positive results; 
but it is usually believed to be a bloodsucker of habits requiring the protection of 
shade and a constant tropical heat, with moisture. Various mosquitoes have failed 
to show development of the larvse ingested from a filariated subject; or at best have 
shown only uncertain and partially developed prefilarise. In Africa Brumpt noted 
the fact that in spite of high incidence in communities the naked n^joee were by 
no means selected; rather those who wore some amount of clothing (but fleas and lice 

> Brit. Quiana Med. Ann., 1897, y. 9, pp. 21-28. 
» Brit. Med. Jour., 1898, v. 1, p. 1011. 

* rroplcal Diseases, ed. 1910, p. M8; see also aonototlon to Daniels, Brit. Med. Jour., 1809, v. 1, p. 1450: 
and Low, Brit. Med. Jour., 1902, y. 1, p. 100. 

« Ball, de la Soo. PathoL Exotiqu^ 1012, r. 5, p. 895. 

> Brit. Med. Jour., 1898, y. 1, p. 1011. 

• Brit. Med. Joor.; Jan., 1902, y. 1, p. 196; iUd. 1008, y. 1, p. 722. 



PUBUC HEALTH AND MEDICINE. 63 

were not found capable transmitters). The writer would reserve until later comments 
upon this problem, the solution of which need not necessarily follow absolutely the 
proved methods of insect transmission obtaining in case of Filaria bancro/ti and Loa 
loa. 

The pathogenic influences of the parasite are equally unknown, and apparently 
of no great moment. There are apt to be heavy infestments in a single host, the adult 
worms ranging from a small number to many. Brumpt,^ in an African subject, met 
at autopsy with several hundreds of these parasites. 

The species is undoubtedly African, the widespread distribution in western and 
central Africa assuring us upon this point. Its American appearance can best be 
accounted for by convection through the African slave trade, its definite and limited 
distribution here being determined by the conditions of life for its unknown trans- 
mitter, clearly favored in districts of little civilization, and therefore determiuing 
its marked restriction to the Carib Indians of the dense forests of upper South America, 
to whom the improvements of civilization have not yet reached. It seems not impos- 
sible that when fuller medical knowledge of the deeper Amazonian forests is attained 
the parasite will be encountered in this area as well. The writer would urge for this 
parasite not only the chance of an as yet unknown pathogenicity but also the negative 
importance, mentioned above in connection with FUcaria demcarquayiy of avoiding 
confusion with the microfilaria of Bancroft's parasite. 

4. DIROFILARIA MAOALHJBSI (BLANCH ARD, 1896). 

SyrwnyfM: F. bancro/H Magalh^es 1892, nee Cobbold 1877; F. magalhassi Blanchard 
1895. 

The intracwporeal habitat of the microfilariae of this species is unknown, and the 
writer is justified in including the parasite in the present article only because of the 
probability that, when opportunity is afforded for their observation, they will be 
found in the circulating blood (in analogy not only with the other filarise here described, 
but more particularly with its closer relative, Dirofilaria immitis Leidy, of the dog). 
The parasite has been encountered but a single time. In 1886, J. P. Figueira de 
Saboia, at Rio de Janeiro, found at autopsy of a child, in the left ventricle of the heart, 
a male and a female adult filaria, which he referred to P. S. de Magalhses for study 
and description.' No statement as to the nature of the fatal illness of the child is 
given; and the blood is not known to have been examined for larv». The path- 
ological role of the parasite is therefore unknown; and this solitary occurrence in a 
human being is often held as accidental, with expression that probably it will be found 
in more fixed parasitic occurrence in some lower animal. Occasional suspicions of 
the possibility of aberrant occurrence of Filaria bancro/H Cobbold in the blood cir- 
culatory system in adult stage have been suggested; but even were this true the ana- 
tomical characters serve to distinguish these two species and also to distinguish the 
specimens of Magalhfies from Dirofilaria immitis Leidy, of the dog (the latter having its 
proper habitat in the rightcardiac ventricle) . Magalhaes, at the time of his description, 
r^arded his specimens as the adults of Filaria ^7icro/(t Cobbold; and this was accepted 
uAtil 1894, when Manson pointed out the mistake and in 1895 Blanchard gave it the 
name of its discoverer.* It is distinguished by its size (the female measuring 155 mm. 
in length and 0.715 mm. in thickness, the male 83 mm. long and 0.407 nmi. thick); the 
female cephalic end is club-shaped, that of the male not swollen; the cuticle is finely 
striated circularly; the mouth simple, circular, unarmed, terminal; the tail of the male 
has four pairs of preanal and four pairs of post anal papillse of slender shape and villous 
surface, two equal spicules, and is slightly incurved. The embryos as obtained from 
the adult female measured 0.300 to 0.350 mm. long and 0.006 mm. in thickness. 

>C. B. Soc hUA., 1904, v. 51, p. 758. 

sMi«alhS3, Oftf. Mad. da Bahla, 1887-88, 3 sw., y. 49, pp. 100, 152, 200; ibid., 1891-93, 4 stf. v. 3, p. 
4M; Caotnlbl. t Bakt. a. Parasitenk., 1892, y. 12, p. All. 
• Lavtno and Blandiard, Jab hematotoaircs de lliomme et des animaux, Paris, 1895. 



64 PBOCEEDINGS SECOND PAN AMEBICAN 8CIENTIFI0 C0NQBB8S. 

The desirability of recognition of further instances of this parasite, whether in 
man or a lower animal, especially in the Brazilian district where it has been found 
in the solitary known case, is of course obvious. 

5. LOA LOA (OUTOT, 1806). 

SynonyvM: FUaria loa (Guyot, 1805); F, oculi GervaiB and Van Beneden, 1859; 
Dracunculvs oculi Diesing, 1860; D. loa Gobbold, 1864; F, tubconjunctivalit Guyon, 
1864; F. diuma Manson, 1891; F, sangumit hominit var. major Manson, 1891. 

In tracing the American relations connected with this parasite the writer must 
primarily express his indebtedness to Ward,' who in his admirable indusive and 
analytical study of 1906 has followed the history of this parasite and has, in addition 
to a clear discussion of its morphology and life history, arranged a full list of its pub- 
lished occurrences with bibliography. From this the writer has cidled the cases 
assigned to the Western Henusphere, adding thereto the instances which are recorded 
in literature since 1906 for America. 

It La to be recalled that Loa loa is within very strict limits a habitant of west Africa, 
where doubtless it has existed from time immemorial. Its specific name loa was 
the name applied to it by the negroes of Angola, where Guyot, a French naval surgeon, 
observed it in 1777, his accotmt not being published until 1805.' Yet before Guyot's 
observation of loa reference appeared to certain wanna of the human eye encountered 
in the West Indies, which to all appearances must be referred to the parasite here 
considered. Thus as early as 1770 Mongin * recorded the extraction of a worm from 
beneath the conjunctiva of a negress at Maribarou in the island of Santo Domingo. 
Two cases in negroes at Cayenne in French Guiana were reported in 1777 by Bajon,* 
in the one case the worm being removed in 1768 from beneath the conjunctiva ci a 
negro girl of eight years of age, in the second the worm not extracted but seen to 
move across the eye between the conjunctiva and cornea of an older negress (in 1771). 
Arrachart published two cases on the authority of Mercier, who in 1771 extracted a 
worm from beneath the conjunctiva of a negress in the island of Santo Domingo, and 
in 1774 extracted the second from the eye of a negro above the cornea. 

Arrachart also states that in 1795 a Creole woman, Mile. Fraise, bom in Santo Domin- 
go, assured him that her brother when from three to five years old had had several 
worms extracted from his eyes and that young negroes of the island were often attacked. 
In Arrachart's publication, appearing in 1805, the accounts of Guyot's observation of 
these worms on the coast of Angola and his reasons for differentiation of them from 
Dracunculus medinensisy with which doubtless the earlier American cases were con- 
fused, were given. Thereafter the American list, following Ward, includes a case in 
which De Lassus, an army ofiftcer in Santo Domingo, removed a worm from the eye 
of a negro; ^ a case of a worm observed by Clot-Bey * crossing the cornea of an African 
slave girl at Monpox, Colombia, in 1828; the removal of two filariee in 1837 from the 
eye of a young Guinea negress in Martinique by Blot.^ Two instances of eye filarise 
follow from Brazil, in each of which the question of Guinea worm arises, one a case 
of extraction of a worm from the eye of a negro in Rio de Janeiro by Lallemont,* the 

I Jour, of Infect. Dis., 1900, v. 3, p. 37. 

• In Amobart, M^moires, dissertations et obaervations de cblrargie, Ptrls, 1806: M^moire sur 1m vacs det; 
yanx, read before the Academy of Surgery in 1778, p. 317. 

s Jour, da MM., Paris, 1770, y. 82, p. 888. 

« M^miira pour servir a lliistoire da Cayenne et de la Guyana franooise, 2 vols., Paris, 1777, toL 1, p. 826 
abitrMtad in Jour de MM., 1778, v. 49, pp. 880, 481; quoted in Arracbart, sup. cit. 

• Recorded by Larrey, M^moires de cfairurgie mllitaire et camp., Paris, 1812, 4 vob., toI. I, p. 228. 

• Bar. gte. Acad. roy. dee sdeocee, stance dn Dec. 10, 1832. Ardi. gen. da MM., Paris, 1(^ annte., vol. 
80, p. 678: tbis by tome aotbors referred rather to BooUn. 

' Bsoarded by Ouyon, C. R. Acad. 8cL, Paris, 1838, t. 7, p. 766. 

• Caapar's Wocbenschr. f. d. ges. HeUlnmde, 1844, p. 842. 



PUBLIC HEALTH AKD MBDICIKB. 65 

other the report of a caae obeerved by Siguad ^ of the removal by C. J. doe Santos 
oi a worm from the orbit of a negress of the Mina tribe in Brazil, at Rio de Janeiro, in 
1833. In 1845 Mitchell ' saw a worm, estimated at about 2 inches in length, in the 
sabconjunctiva of a negress in Trinidad who had come from the west coast of Africa 
in 1S34. The worm was first noted in 1837, again in 1841 and 1845, and was said to 
have grown in the eleven years. (Ward properly questions whether each time the 
same parasite was seen.) By Mitchell's account there was a tradition that a similar 
worm had been seen in a family in Antigua 60 years before (1799). 

With these the published American cases close until the latter end of the past cen- 
tury, the usual and probably the correct interpretation of the cessation being that 
with the end of slave importation from Africa the source of the parasite was diverted 
from the Western Hemisphere. It is to be presumed that the parasite failed of find- 
ing a proper insect conveyer in America and that each case therefore died out without 
dissemination. The only strong suggestion of endemic fixation concerns Santo 
Domingo, where if the statement of Mile Fraise to Arrachart was correct, the worm may 
have been locally propagated for a time. It is not stated, but is to be presumed, that 
her brother, a child of between three and five years, was born on the island, as she 
was, and that he there acquired the infestment she related. The further statement of 
the common affection of young negroes on the island and the several recurrences of 
case reports from this island bear as evidence in the same line. Whether there was 
also some local dissemination in Brazil is also a matter of some possibility, the Mina 
negress from whom Dos Santos removed a specimen being presumably a native. It 
is to be remembered, however, that there is some uncertainty as to the identification 
of all these early American cases; that they were regarded at the time as Guinea 
worms (which it is well known acquired at least partial endemic fixation in South 
America and the Lower Antilles). 

Since the date of Mitchell's observation (1845), alter a lapse of half a century, occa- 
sional cases have reappeared in America, but with a change of location to the north, 
in the United States and in Canada, and with a change from the uniform infestment 
of negroes (except the Creole child related by Mile. Fraise to Arrachart) to infestment 
of whites who invariably present the history of sojourn in west Africa (for the most 
part in missionaries returned from the latter district). 

Ward lists, of the modem American cases, the following: (1) Mrs. M., a missionary 
living prior to 1897 for several years at Batanga, 70 miles inland on the Gaboon River, 
in west Africa. In 1898, at Toronto, Canada, Dr. Frederick Fenton removed two 
q>ecimens from her lids, and in 1899 f otmd a third , but failed in extraction.* (2) About 
1896, Dr. F. N. G. Starr, of Toronto, Canada, removed a filarla from the skin of the 
chest of a woman who had been a missionary on the west coast of Africa, but had 
returned on account of ill health; and demonstrated it before the Toronto Patho- 
logical Society.^ (3) In 1902, Milroy, of Omaha, Nebr., removed a loa specimen 
from the upper right eyelid of Mr. K., an American who had been living in 
Batanga, in German West Africa.' (4) Ward also records a series of cases detailed 
to him by Dr. B. C. Loveland, of Clifton Springs, N. Y., later of Syracuse, N. Y. 
In 1890, Loveland removed a loa from the skin of the left scapular region of Mrs. 
R, who had been a missionary stationed near Batanga; and in 1898 he extracted 
a loa from the eye of Mrs. J., also a missionary invalided home from Batanga. Love- 
land stated that Mrs. J. informed him that her husband and children have all had 

1 Bjgiod, Da CUmat et dfls nnUK) . da BrMl oa itetistique m4d. de cet Empire, Paris, 1844, p. 135. 

* Loodon Lancet, 1859, ▼. 3, p. 583. 

* Case detaUed in Ward's paper, sap. clt. 

* Detailed in Ward's article, sup. dt.; and both this and the previous case recorded by Primrose, Brit. 
Mod. Jour., IffB, T. 3, p. 1382. 

* Detailed In Ward's paper, sup. dt. 



66 PEOCEEDINGS SECOND PAN AMEBICAN SCIENTIFIO CONGRESS. 

these parasites. (5) Dr. C. F. Friend, of Chicago, is also quoted by Ward in relation 
to a previously unreported case, Mrs. X., formerly a missionary in west Africa, from 
whose eye he removed a specimen about four years after her return to America. (6) 
Vail, of Cincinnati * presented before the American Academy of Ophthalmology and 
Oto-Laryngology in 1905 several specimens of loa he had removed from the eyes of 
Mrs. L., the returned wife of a medical missionary at Flat, Ebolowa in central Africa. 
To these cases, all from Ward's paper, may be added : (1) McDonald in 1908 ' reported 
a case of extraction of a specimen of loa from the eye of an American who for nine 
years previously had resided in the Old Calabar reg:ion of west Africa. (2) In 1911 , 
Huffman and Wherry • reported a second case from Cincinnati, Ohio, with description 
of the parasites removed from the eyes of Mrs. B., after return from missionary service 
at Batanga in the Kameroon district in West Africa. 

Smith and Rivas ^ in 1911 presented before the Philadelphia Pathological Society 
specimens from two white American missionaries invalided home from the same dis- 
trict in west Africa. One of the specimens, from Mr. K., of Philadelphia, was imper- 
fect, only the caudal half of the worm, a male, having been obtained. The anatomical 
features presented by this led the writers to the query whether it does not represent a 
new species of the genus loa. No other species of loa or of other genera of filaridae with 
habits like those of Zoa is known; but the question of a possible American species is 
raised by Ward to account for the suggestion of endemicity in South America and in 
Haiti, as an alternative to acceptance in these localities of a fit insect transmitter. 
And such a possibility is by no means to be lightly brushed aside. Can this be the 
meaning of the case reported in the Canal Zone at Colon Hospital in 1906. as JUaria 
divmaf Or if that case be hunted down, will it turn out to have been an imported 
case of Loa loa from Africa (which does not seem probable) or a mistaken diagnoali 
of an aberrant day specimen of Bancroft's microfilaria, or the microfilaria of pentans 
or demarquayit * 

There is no occasion in this article for narration of the identification of loa with 
Microfilaria diuma by Manson and others, or of the development of our present views 
as to its morphological peculiarities or its pathogenic effects, nor yet to more than 
mention that the suspicion held in Africa that the parasite is carried by "mangrove 
flies" (Chrysops and tabanv^ species) has been sustained by the success of Leiper * 
in obtaining development of the microfilariae into prefilariae in Chrysops dimidiatui 
and Chrysops sUacea. Fliee of the same genus and with the same unpleasant habit of 
energetically sweeping about the heads of human beings and trying to alight to draw 
blood are known in America, as Chrysops vittatia Wiedemann and Chrysops niger 
Macquart. Leiper failed to obtain prefilarial development in stomoxys, in various 
mosquitoes, and in fleas and bedbugs. It is questionable whether in actual truth the 
parasite will be found consistently non transmissible in America; and there may welj 
be a suspicion as to whether the uncertain endemicity temporarily apparent in Haiti, 
and possibly In South America, was not real, and whether firm fixation was not escai>ed 
more by chance than by necessity. 

Comments. 

Of the main purpose of the current article, that of presentation of the history and 
geographical distribution of the group of filarial parasites above considered, the pro- 
ceeding pages doubtless cover the principal features; but the writer realizes that much 

» See Llppert and also Vafl, Cincinnati Lancot-Clinic, 1905, v. 65, p. 733. 

> So. California Practitioner, 1908, v. 23, p. 325. 

s Parasitoloi^y, 1911-12, v. 4, p. 7; see also Huffman on the loa larva, ibid., p. 75. 

< Proc. Phlla. Path. Sec. 1911, n. s., v. 14, p. 2; and Amer. Jour. Trop. Diseases and Prevent. M*vi., 
1914, V. 2, p. 361. 

» See Report of "Dept. of Sanitaticm, Isthmian Canal Commission, laboratory report of Colon Hospital for 
June, 1906. 

• Proc. Zoolog. Boo. London, 1910. 



PUBLIC HEALTH AND MSDIdKB. 67 

bfts probably heexk miawd which ahoold have found place therein. SyBtematlcally 
ccnnplete knowledge of the geography of the different fiUxndm \b very desirable as a 
baaiB for any sound plan for prophylaxis, and for dealing with the larger problems of 
eradication of these pests. When we consider that surely three of these five parasites 
have been brou^t into the Western Henusph^e, and that of the other two, only one, 
the single occurrence of Dtro/Uaria magdUuuif is surely indigenous, and when we recall 
how restricted in distribution are AeanthocheUonema perstani and JUaria demarquayif 
how Loa loa after seeming to take hold in Haiti and Brazil promptly disappeared when 
its importation ceased, and how apparently the mosquito campaign in Cuba gives some 
promise of the abatement of JUaria bancrofliy it seems well worth while that we should 
look iarwnid to the possibility of eradicating all these parasites from among us. The 
problem is surely not greats than that of dealing with the hookworm; for some of the 
group probably no more than that of handling yellow fever. 

But to establish the fundamental knowledge to be utilized for so laudable a purpose, 
we require more definite information as to the precise geographical location and area 
of infested districts for each species of filaria. This means concerted work, a combina- 
tion of individual and central effort. Where health statistics are maintained by local 
or general governments, filariawB (with differentiation of the species for obvious 
easons) should be made reportable. Where such plan is impracticable, local medical 
organizations should act instead, and ask for voluntary reports from members and other 
phyaidans of the district concerned. A central agency for reception, coordination 
and publication of such reports could undoubtedly be found in the health department 
of some one or other of the American countries, or in such an oiganization as Uie Inter- 
national Health Commission, which is doing such admirable work toward reducing 
the ravages of the hookwcvm. With the field well mapped out, not only will the 
extent of the problem be before us, but at the same time there are sure to be sugges- 
tions from that knowledge as to advantageous mode of dealing with the question in its 
q>ecific stages. 

The pioneer work of Low and others who have been mapping out the infested 
areas d the West Indies and of British Guiana is even in its incomplete form suggestive. 
The peculiar limitation of demarqiuiyi to country districts and unorganized villages 
in St. Vincent, and the restriction of demmquayi and pentans to the forest depths of 
inland Guiana, with tendency toward heavy infeetment in these areas, will unques- 
tionably be found significant in the matter of the mode of their transmission. And 
the promise of effectiveness of mass handling of these affections b to-day in closest 
line with prevention of transmission. 

1. Problems o/JUarial transmission. — It is probably a general law that transmission 
of filarial worms must include opportunity for development of the larval filaria, or 
microfilaria, in some intermediate host into an infesting or prefilarial stage. We 
know, thanks to the studies of Manson, Bancroft, Lewis, Dutton, Low, James, Lebredo, 
Daniels, Leiper, and others that Culexfatigans in the West Indies, Myzomyia rossH in 
India, Ppretophorus costaHs in Nigeria, Myzorhynchus sinensis and harHrostris in 
India and China, Mansonia uni/ormis in Africa, India, the Philippines, and Australia, 
Stsgojn^ pseudoseuUUaris in Fiji (7), and other mosquitoes serve as intermediate 
hosts adapted to such development for the larval Filaria banaro/H; that for Loa loa 
development of the microfilaria takes place in certain mangrove files, Chrysops dimi- 
dialus and silaeea, and that these are i^parently efficient transmitters of the prefilaria; 
that Aeanihocheilonema perstans seems to reach at most only partial development in 
several types of mosquitoes and possibly, too, in the African tick, Omithodorus mou- 
bata, which are therefore only tentatively held as transmitters; and that Filaria 
demarquayi may likewise undergo at best only partial development in certain mos- 
quitoes, and that these can not be held certainly as transmitting agents. On the 
negative side, too, for each of these parasites a liat of bloodsucking arthropods have 
been tested and found for the individual species incapable of acting as efficient hosts 
and transmitting agents. 

68486—17— VOL ix 6 



68 PBOOEEDINGS SECOND PAN AMERICAN SCIENTIFIC C0NQBE88. 

In the early views of mosqiiito transmission, it was not contemplated that the infested 
mosquito directly transmitted the prefilaria along the sheath of the proboscis of the 
insect to the wound made by the mosquito stilette in the skin of its \dctim. Rather 
it was thought that the insect merely provided accommodation for development into a 
phase capable of independent life ; that after oviposition on the surface of the water, with 
the death of the mosquito, the prefilaria escaped into the water and later gained access to 
the human host by being swallowed with the water. The proof of direct transmissdon 
of Dirofilaria immitis by Anopheles maculipennis by Grasei and N6e was applied at 
once to the conception of the part played by mosquitoes in transmission of human 
filariasis; and Manson's theory of partial water convection was abandoned byManson 
himself in favor of the theory of direct insect convection. The experience of time 
and study have confirmed this latter belief for the mosquito and FUmia hawrofti. 
But, on the one hand, does this necessarily disprove the older idea or some possible 
adaptation thereof for all species, and on the other hand is the list of insect conveyors 
for this one species complete? Are mangrove flies the only transmitters of Loa Uwf 
Are we to accept for perstans and for demarqtiayi the imcertain sausage-shaped forms 
which have developed in the thoracic muscles of certain mosquitoes as sufficient proof 
that these insects are efficient intermediate hosts and capable transmitters of these 
parasites in nature? 

The relative infrequence with which FUaria bancro/H and Loa loa occur in associa- 
tion with other filari^e (more marked for the first than the second) is in consonance 
with the mode of transmission by bloodsucking insects specific for each; the frequent 
coincidence of Filaria demarquayi and Acanthocheilonenia perstans in British Guiana 
is suggestive of a conmion mode of transmission (which may be by some totally differ- 
ent type of transmitter, or which may differ itself intrinsically in method). Whatever 
the agent or the modo it seems rather fixed in limited areas, not apt to persist in organ- 
ized communities, and to he of such a nature as to favor heavy infestments in the local- 
ity where it exists. It is qmV« conceivable that such characters may apply to some 
bloodsucking insect; but the writer ^'^an not easily rid himself of the thought that the 
modus operandi may be quite dififereitb^ and perhaps follow the lines of Manson's 
original conception with certain modifications:^ 

For these latter species may there not be some miStAp of transmission possible which 
will not necessitate the supposition of peculiar bloodsucSMC&living only in restricted 
and undeveloped districts and in the depths of forests? IBi^B^{t Pp^^*^^® ^ ^^ 
lack of ensheathment in the blood of the host endows these smal^ltg^®^^*"* * 
mode of e cape other than through abstraction by a hematophagoiis inSfi^^^ ^^^ 
in early comments upon lack of microfilarial sheaths in these blood wornllf^^^te 
that perhaps, because of their freedom of movement, these might be able tojE^lTey 
through the walls of the blood vessels and escape into the tissue spaces. m5L\i^ 
not, if they possess such abiUty, succeed by their own efforts in escaping fro3-ni 
body of the host to a temporary free existence? Would it be impossible for th%e 
without inducing notable symptoms, to escape via the kidneys, the intestine, or ^ 
lungs to such freedom? > The writer would suggest especially the desirabi ity \ 
examining the expectoration and the mouth moisture for microfilaria, recalling he>, 
the fact that escape through the walls of the pulmonary capillaries is not an unknow) 
rtep in the life cycle of certain worms (as in case of larval hookworms and larva- 
strongyloides). And as by accident, the larger ensheathed larva of Filaria bancrofi 
IS sometimes expectorated with a bit of blood. Dutcher » reports a case of Bancroft'^ 
filariasis in a Porto Rican soldier, who in a paroxysm of coughing in whooping cougl^ 
expectorated a sm all amount of blood between the hours of 9 and 10 in the mornin^,r 

« Low (Brit lied. Jour., 1908, v. l, p. 723; Jour, of Trop. Mod., 1808, v. «, p. 130) In Uganda notes \ 
frequence of large numbers of perttaru mlcroflJariiB in the hincs. 
» Joor. Trop. lied, and Hyg., Jane 1, 1M4, v. 17, p. 1«. 



PUBLIC HEALTH AND MEDICINE. 69 

A number of microfilariae being afterwards found therein. Beukiima, * at Nagasaki; 
likewise found microfilariae in the hemoptysis of a case of Bancroft filariasis; a third 
case is reported by Yamane,' and Garcia Mon and N. Carballo,' in Habana, met with 
a case of repeated hemoptysis at night with microfilariae in the expectorated blood . 
(In this last case, because of the time of finding the larvee in the pulmonary area, and 
because the blood taken from skin puncture at 9 p. m. failed to exhibit microfilarise, 
the query naturally must arise whether possibly there existed here an infestment with 
a diurnal filaria.) 

We are well aware that the embryonal forms of a related genus, Dracunculus medi- 
ntnriSf escape, as the mother worm perforates the skin of the host, from the maternal 
body into the water; live independently therein for a number of days, and then 
devebp into an infesting prefilarial form in some species of eyclops; and that when 
swallowed with the water drunk by a human being they escape into the stomach and 
infest the man by penetrating from the alimentary canal into the tissues. This last 
is brought out by Leiper's experimental infestment of monkeys by giving them to 
drink water containing infested eyclops, and by the fact that in water acidulated with 
hydrochloric acid the body of the cyclope is disintegrated, and the contained pre 
filarial parasites are set free, apparently not only unharmed by the acid but stimulated 
by it into activity of movement. 

May it not be possible that some such route of escape is also followed by the small 
nnensheathed microfilarise of the perstans and demarquayi species (perhaps to find 
their intermediate host in eyclops or an analogous water animalcule)? And is it not 
possible that the restriction of locality characterizing these parasites in America (away 
from the centers of population, in country villages and in forests), and the high ratio 
of incidence in the inhabitants of such places, may be as well explicable on the basis of 
contaminated drinking water as upon the local occurrence of a very particular type of 
moBquito or other bloodsuckers? 

One wiio ia laa from districts where actual investigation is possible on such lines 
naturally hesitates to annoy the field worker with such queries; but the points of 
analogy seem sufficient to make the thought possible that truth may be near (especially 
while we are not assured of success in the mosquito trials thus far made for either 
perstons or for demarqvjoyi). 

2, Problems of microfilarial peruxiicity. — Clinical diagnosis of filariasis should not 
be absolute save after detection of microfilariae in the blood or other fluids of the sub- 
ject. Differentiation of the type of fiiariasLs, while possible from gross manifestations 
in case of Filaria bancrofU and Loa loa, should rest mainly upon differentiation of 
the microfilarial species. This depends principally upon morphological features of 
the larval worms; but it is desirable to know whether the subject manifests periodicity 
or iqpeiiodicity of microfilarial presence in his peripheral blood, and whether an 
Actual periodicity is diurnal or nocturnal, before coming to final conclusion as to the 
Bpedes with which he is dealing. 

The nocturnal periodicity of the Bancroft type of microfilaria was early a matter 
of much speculation and theorization, becoming only the more attractive when a 
diwni^l and a persistent species came to be known. Of the older theories in explan- 
Mtioa of this phenomenon in case of Filaria hancro/ti that of v. Linstow ^ rests upon 
a mechanical basis. Linstow believed that during the active working daylight 
houiB of the host the peripheral capillaries are narrowed, or in a state of tonicity, 
and that at such times the larvse of Filaria hancro/ti are too large to enter these con- 
stricted circulating passages, but that in the relaxation of sleep the peripheral capil- 
laries widen sufficiently to allow the vermicules to enter and traverse their lumina 

1 Mederl. TtKlaebrin t. geoeesk., Amsterdam, 1884, v. 30, p. 561. 

> Csnferalbl. f. UJn. Med., ICar. 24, 1888, p. 221, oondeiMed from article by Kentaro Mnrata in Hit. aos d. 
Ifad. Fttcnlt. d. kaiser!. Japanlsoh. Universitftt, Bd. 1, no. 1, Toklo, 1887. 
• BoivlrtB med. y. oinuR. da la Habtna, 1004, ▼. 9, p. 088. 
4 Oantrttlbl. f. Bakt. u. Parasitenk., 1992, v. 12, p. 90. 



70 PBOCEEDINGS SECOND PAN AMEBIOAN SOIENTinO C0NQBE88. 

and that therefore at nighttime alone (ordinarily, for Mackenzie ' had shown that 
the phenomenon was connected with sleep rather than with darkness, and could be 
reversed by reversal of the sleeping habit of the subject) these parasites are demon- 
strable in the blood withdrawn by skin puncture. While attaining for a time wide 
credence, this explanation rapidly declined in popularity when its inconsistency 
for the diurnal periodicity of Loa loa became appreciated. The suggestion of Myers * 
that each periodic appearance of the microfilarise represents a fresh quotidian brood, 
and that each interval is due to the death of the last brood, never attained any wide 
acceptance; and was thoroughly discredited by the proof that these filarial larve are 
possessed of much greater duration of life than a single day, and that in reality the 
phenomenon of periodicity is rather bound up intimately with cyclic change of 
location of the vermicules in the blood circulatory area. Manson, who first established 
the last fact, conceived that theae changes of position of the microfilaria en maose 
from the peripheral to the pulmonary area, and thence to the periphery again, can be 
explained as a chemotropic phenomenon.' No chemotropic agent, whether positive or 
negative in its influence upon the microfilarise, has ever been demonstrated (although 
theoretically demonstrable); and we may seriously question the verity of the con- 
ception in that it has been shown that periodicity is not absolute for any periodic 
species, but that for any nocturnal or diurnal type it is possible at any and all hours 
to demonstrate microfilariae of the species in question in at least small numbers in 
the blood of the periphery. If chemotactically influenced, all microfilariae in every 
part of the circulation should be influenced equally and at the same time. It can not 
but appear singular, too, that if there be chemotactic influences regulatory in case of 
PUaria bancrofti and Loa loa some evidence of like phenomena can not be wit nes s ed 
in case of all hematic microfilariae. The adaptation theory of Bahr * may likewise 
be held in question. This conception would presuppose some unformulated natural 
law of adaptation of the habits of parasites to the habits of their necessary transmitting 
hosts (that, applied to Pilaria bancrofti^ its microfilariae appear noctumally in the 
peripheral blood of man to insure their acquirement by a night feeding mosquito; 
that, in case of Loa loa^ its larvae are diurnal in order to facilitate their withdrawal 
by some day biting bloodsucker, as chrysops). Why should adaptation demand an 
ingenious arrangement when mere persistence of the species in the peripheral blood 
for the whole 24 hours could not fail to accomplish the same end? Can it be 
consistently supposed that Bancroft's microfilaria would change its habit of peri- 
odicity to become a persistent parasite in the peripheral blood in order to adi^t 
itself to the day-feeding Stegomyia pBeudoBcutellaris in the Pacific islands when, 
among others, the efficient intermediary, Culex fatxgans^ prevails in the same lands 
as a dusk and night attacking pest? The writer would prefer to accept the indi- 
viduality of Filaria philippinerm$ Ashbum and Craig, rather than be compeUed to 
the idea that it is a Filaria bancrofti changing its habits to accommodate itself to an 
unnecessary intermediate host. 

In a recent article the writer, with Dr. Rivas,* detailed a scries of studies made upon 
several cases of loa and of bancrofti infestment, in which we felt that we found evidence 
against phototropic and thermotropic influences in relation to the phenomenon of 
periodicity, and, on the other hand, suggestions that mechanical factors (such as 
increase of the circulatory flow from exercise and from alcoholic stimulation, and 
variation of compression of the tissues) are operative in determining the number of 
microfilaria to be found at a given* time in measured specimens of the peripheral 

i Londan Lancet. 1881, v. 1, p. 707. 

s Med. Report China Imp. Customs, Shanghai, 1886; abst. in Brit. Med. Jour., 1887, v. 1, p. 783, and edi- 
torial, ibid., p. 1394. 
a Brit. Med. Jour., 1899, Sept. 9, ▼. 2, p. 044. 
4 Jour.'of London School of Trop. Med., 1912, Supplement 1. 
* Smith and Rivas, Amer. Jour. Inf. Dis. and Rov. Med., 1914, ▼. 2, p. 361. 



FUBUO HEALTH AND MSDIOINB. 71 

blood.^ Comparatiye counts of the number of microfilarue (in a Bancroft case) in 
measured amounts of blood from the peripheral capillaries (skin prick) and from a 
Tcin (by syringe directly from vein) at time of maximum showed a marked excess 
of midofilarisd in the former; which was taken to mean that the microfilarue are 
accumulated in the perii>heral capillaries at time of presence of the period, probably 
because they aro too large to pass through at that time (not merely because they are 
too large to get into the capillaries in the interval, as Linstow supposed). We believe 
that the maximftl presence thus represents a concentration of the parasite by, as it 
were, the sievelike function which the capillary networks serve, a sieve fine enou^ 
to retard the progress of the vermicules, but not to completely prevent their passage. 
This alone can not, of course, explain the clinical peculiarities of periodicity,. but we 
bebeve it to be basic. Oonsidering in illustration the microfilaria of FiUxria ban- 
cro/H and of Loa loa, this would not explain why the first are nocturnal and the second 
diurnal; the two species would present practical identity and probably aperiodicity 
were it otherwise. The writers would believe, with v. linstow, that there does 
occur a diurnal tonus or constriction of the peripheral capillaries and at night (from 
the fatigue of the day and the relaxation of sleep) a slight widening. The proof is 
perii^M not complete, but {physiologists believe that such variations of caliber of the 
pedi^ieral capillaries is compensated for in the splanchnic area, dilatation of the skin 
capillariee bdng accompanied by contraction of the splanchnic capillaries, and vice 
versa. However, a second capillary barrier to the free circulation of the microfilaria 
in the blood stream, that of the pulmonary capillaries, must be kept in mind, a series 
d capillariee the lumen of which is believed to be fairly constant and independent 
d at least ordinary variations of the perii>heral circulation. 

From histologic studies one may be fairly assured that the caliber of the fine pul- 
monary capillary network is much the same as the average caliber of the fine peripheral 
capillaiiee, permitting a free progress of the red-blood cells '4n Indian file,'' but not 
hufge enough to allow progression of more than a single cell side by side. This should 
mean no inconsiderable difficulty for an object of the size and shape of either ban- 
etofli or loa microfilaria to pass through the pulmonary area (probably hours, if one 
may compare the time of presence of the parasites in the cutaneous capillariee). 
The intervention of these two capillary barriers in the circle, one at the cutaneous 
periphery of the general circulation (with an appreciated diurnal contraction and 
nocturnal dilatation) and one in the lesser circulatory area (this one relatively fixed at 
a caliber just permitting single red cells to move easily), may be believed to complete 
conditions making for an intermittent retardation of convection of any passive objects 
near the size of red cells and not quite as adaptable as are red cells, because of greater 
long measurements and unfovorable curves. Caught in the skin capillary network 
in the period of diurnal constriction, even those somewhat lees than 0.007 nuUimeter 
in diameter would be enmeshed, only to escape in large number as the tonicity of day 
gives way to the widening of night (those which pass the pulmonary area at night 
and are swept to the skin would at once pass through and back to the lungs); 
passed to the lungs, they are again held until the force of the stream washes them 
through. Those which more closely approximate the red-cell measurements are 
held even better in the relatively unvarying lung plexus of capillaries and are there 
enmerfied even when the skin capillariee are dilated in sleep (this probably accounting 
for the perfect periodicity of l^eroJUoKna banero/H in comparison with the greater 
tendency in case of MieroJUaria 2oa to be found occasionally in the peripheral blood 
in the interval). Those that are materially sQudler than red cells are retarded in 
neidier set of cafHllaries and are persistently to be found in the peripheral blood as 
weQ as in the pulmonary blood. From the standpoint of size the microfilaria of 
Bancroft's species is the largest, measuring usually nearly or quite 0.300 millimeter 

> Compare GnnvUle^ old theory of the influence of modification of rate of blood flow and blood pressure 
bj ileep in explanation of mlgretloB of microfilaria to surface at night, London Lancet, 1S83, Feb. SO. 



72 PBOCEEDINQS SECOND PAN AMEBICAN SCIENTIFIC CONGBESS. 

in length and 0.0075 to 0.008 millimeterB in thickness; the larval Loa loa is' from 0.200 
to 0.250 millimeter long and from 0.006 to 0.007 millimeter in thickness; the larval 
form found in the blood of the type described from Japan by Taniguchi is described 
as 0.164 millimeter in length and 0.008 millimeter in thickness; the larval demar- 
gtutpTineaauiea 0.200 millimeter long and 0.005 millimeter thick; the perstans larva 
is nearly of the same size, possibly a shade thinner. 

The bancrofti and Umiguckii larvse are both periodic at night in the peripheral 
blood, and they are the Uiickest; loa microfilaria ranks less in thickness and is peri- 
odic in the diumally constricted skin capillaries; perstans and demarquayi both have 
materially smaller diameters and are not restricted at all, that is, are aperiodic. 
From the standpoint of size, therefore, there is a basis for belief that the two barriers 
of capillary network to be passed determine the fact of periodicity for microfilariae of 
approximately the thickness of the diameter of a red blood cell, and offer explana- 
tion of the aperiodidty of those of materially smaller diameter. In the diurnal con- 
traction and nocturnal dilatation of the skin capillaries (with the relative fixation of 
the pulmonary capillary mesh) there is basis for explaining the nocturnal entangle- 
ment of the laiger forms at night, and of Loa loa by day. 

But size can not be the sole factor to be appealed to. In some sense any ensheathed 
microfilaria may be thought of as a relatively passive object, swept by the current of 
the blood and unable to accomplish much active progression of its own initiative; 
but unsheathed microfilarise can readily dart at will in the fluid in which they live. 
To observe the ineffectual wriggling of a larval bancrofti in the field of the microscope, 
and to note the swift darting movement of the same larva if in some way it escapes 
from its sheath, is to recognize at once the difference referred to. The writer is confi- 
dent that even were perstans and demarquayi larvse ensheathed, their small size would 
insure their passage through the capillary barriers and their aperiodidty; but their 
freedom of movement in the blood, because they lack the embryonic sheath, in addi- 
tion assures them ability to force their way along (and probably would, even were 
they laiger than they are). With the ensheathed types this advantage does not ob- 
tain. The writer knows of no unsheathed periodic microfilarise. Only one aperiodic 
sheathed hematic microfilaria of man has been described, the contested Filaria pkUip- 
pinensis of Ashbum and Craig, of the Pacific islands. Its microfilaria! measurements 
are identical with those of the larva Filaria bancrofti, with which many would identify 
it. Its sheath is described as closely fitting, in contrast with the loose saccular en- 
sheathment one notes in case of Filaria bancrofti and Loa loa. This surely means as 
much in the matter of the effectiveness of its motor efforts, as to a human being it 
matters for his ability to run whether he be ensheathed in a closely fitting garment 
adapted to his Umbs, or completely enveloped within a loose sac. The writer is dis- 
posed to regard the aperiodidty of this exceptional type as due to its ability to move 
in free progression in spite of its relative size, because its sheath does not hamper its 
movements. 

To carry this idea still further, one may well believe that between ha and bancrofti 
forms of larvse the more twisted appearance of the former in permanent microscopic 
preparations means that in life loa is the more vigorous. Some progression is possible 
for each, in spite of the sheath, little though it be for either; but it should be greater 
in case of loa, other things bdng equal, and this should mean for loa more fadlity in 
passing capillary networks (that is, avoiding concentration of numbers, save in the 
fullness of diurnal tonidty). 

One can readily apply the explanation to the fact of reversibility of bancrofti peri- 
odicity by changing the period of sleep from night to day, and to the loss of periodi- 
dty in general disturbances of the circulation from fever, anesthesia, etc. (de Saus- 
sure reports a case at Charleston in which during labor a negross lost the periodidty 
of her microfilariae, although later the periodicity was regained).* The writer must 

1 Med. News, 1890, June 28, v. 56, p. 704. 



PUBUO HEALTH Ain> MEDICVSTR. 73 

oonf esB that he can not see its applicability to the reported failure to cauBe change 
of penodicity in loa infestments by changing the hours of sleep to day, unless the 
observers tailed to recognize that there reaUy occurs apeiiodidty (as mig^t be ex- 
pected) rather than reversal of periodicity to night. Loa loa is naturally less definitely 
' penodic than banerofti (that is in the inteiVal one is surer of finding a few microfilariae 
in the peripheral blood) ; in reversal of sleep to-day a failure to get full capillary tonus 
would merely cause loss of the required accumulation, that is, would only make the 
p^ods less distinct. 

In capitulation of tiiis attempt to explain the phenomenon of filarial periodicity, 
the writer would hold in theory: (a) That no microfilaria which is without a sheath 
in the circulating blood or is closely sheathed and which in size is materially less 
than the diameter of a red blood corpuscle or at least not distinctly thicker ,'^ can accu- 
mulate under ordinary conditions of circulation in any part of the circulatory cycle, 
and can not for that reason present the phenomenon of pmodicity; (b) but that any 
microfilaria which, because of size or looseness of ensheathment, along with no great 
vigor of motor activity, is likely to be caught in the mediwork of the peripheral and 
pnfanonary S3r8tem8, is sure to exhibit this phenomenon; (e) that of this latter group, 
the larger the parasite, the looser the sheath and the less vigorous the motor activity, 
the more likely is the periodicity to be nocturnal, and conversely the smaller and 
more active are likely to be diurnal in their peripheral periodic presences; (d) changes 
of marked d^ree in the vascular tone of the host, whether iiom. disease, drugs, or 
habit, may induce loss of periodicity. 

If Filaria phUippinensis really is Filaria bancro/ti, the writer suspects its aperiodi- 
city is rather due to climatic influences upon the vascular tone of the host than to 
any change of habit of the parasite itself (aside from the peculiarity of its closely 
adapted sheath). Such an explanation should be open to verification or to disproof 
experimentally as weU as clinically. In fact Rivas and the writer have sought in a 
dog infested by the aperiodic Dirofilaria immitU, kindly sent us from New Orleans 
by Dr. C. G. Bass, to induce in mimicry of periodicity an accumulation of microfi- 
huw in skin areas by constriction of capillaries in the areas in question from cold 
and by compression. Our results have been irregular, variations both in excess and 
in deficiency and sometimes no variations at all being recorded in comparison with 
the numbers taken from uninfluenced surfaces. That a disturbing influence was 
exerted can be said definitely; that the results were not uniform can only be attrib- 
uted to failure of imiformity of adjustment of conditions. The writer for the present 
can cmly exj^ress hope that fiurther experimentation will lead to more uniform results 
80 that reliable statements may be made pro and con in relation to the explanation 
we have proposed. 

3. Problem a» to the longevity of filarial paratitei, — No less to the general public 
than to the infested individual does the problem of prognosis of filariasis appeal. We 
have no reliable remedy for the destruction of the parasites; and we can not, save by 
extraction of the parent w(»ms (as in loa and in occasional cases of Bancroft 's filariasis) , 
put a stop to the infestment and to the chance of dissemination, or to the danger of 
untoward complications to the individual himself. In such a position, what do w# 
know of the length of time during which adult filaris remain alive, and for what 
period of the lifetime oi the female does she give birth to microfilaria? How long 
after entrance into man before they reach maturity? If fertilized, how long will that 
state of fertilization continue without renewal? Is infestment in any way preventive 
of reinfeetment, or may hyperfilariasis occur if chance permit? How long are the 
microfilaria visible in the blood and what comes of the millions which must surely 
escape abstraction by mosquitoes? If there be a free stage in any of these species, as 
suggested above, what is its length? How long may the prefilaria continue to live in 
the intermediate host? It is far more easy to propoimd such problems than to even 
suggest the mode of their solution; and yet there is need of exact information in this 
genera] connection on mwe points than here brought forward. 



74 PBOGEEDIKGS SBOOKD PAN AMEBIOAK SCIENTIFIC COKGBESS. 

Adult filaiise sometimes die within the lifetime of the human host, and of neceesity 
die at least shortly after the death of the human being who harbors them. They have 
been foimd calcified and encapsulated in the tissues. But why they die, whether 
from filarial senility or special and unknown cause, we are igncnrant. 

To the clinical article by Matas,^ of New Orleans, McShane adds a section dealing 
with biological questions concerning FUaria bancro/tif wherein he refers to observa- 
tions by da Silva Araujo of individuals who had suffered with chyluria for 14 and 22 
years, in whose chylous urine he found microfilaria; of a like observation by Sonsino 
of a woman similarly affected for over 20 years, with microfilaria in her urine; and 
of a statement by Lanceraux of an old Creole woman of over 80 years of age who had 
had chyluria for more than 60 years, in whose urine he found microfilariae. These are 
ominous data, but there is no assurance that the last instance (or any of them for that 
matter) does not include reinfestment. The duration of complications such as ele- 
phantiasis (Mr chyluria without the demonstration of coincidence of microfilaiise in the 
blood or urine is not significant of the length of life of the original parasites, obeenra- 
tions of cases of such condition without microfilariasis being regarded rather as evi- 
dence that the parent worms have died, leaving the complication as a sequel. The 
certain knowledge we possess of the life of FUaria baneri/ti within the body is meager; 
but from the time of infestment to maturity surely several months must elapse and 
possibly more; and the duration of life in maturity probably ranges from 1 or 2 to 15 
or 20 years. Longer periods of microfilariasis are probably explicable on the baais ol 
reinfestment. The small number of adult parasites usually found and the lack of 
clear evidence of reinfestment have opened the question whether an immunity is 
gained against ready reinfestment or whether, on the other hand, a condition of 
hyperfilariasis is possible. 

In case of Loa loa^ the frequent finding of immature worms and the failure to find 
microfilaria in children, and the more common finding of mature specimens in adults 
have led some to believe the develc^mental period of the parasite in the host is a pro- 
longed one, although,' judging from the appearance of its ' ' Calabar swellings, ' ' clinical 
effects may appear within one or two months. Its adult life is surely capable of 
extending over a number of years (one of the cases reported by Smith and Rivas * 
was of at least 10 to 11 years and possibly 18 years in duration); and in this species 
the large number of parasites which may be found in one individual (34 found by 
Penel in one individual)^ is probably significant of more frequent reinfestment than 
in case of FUaria bancrofii, 

Kdlz,^ who was himself parasited by AoanthocheiUmema perstoM, first found larval 
filari® in his blood four years after the supposed time of infestment. Others reduce 
this period of development in the host to within one and a half years; its full life 
period doubtless may range up to a number of years, although Uttle is definitely 
known of this point. There may be large numbers found in one individual. 

The period of development and duration of life of FUaria demarquayi are probably 
flindlar to those of the already mentioned parasites, but certain information is lacking. 
The number infesting one individual is not apt to be large, but commonly more than 
a single pair. 

Known instances in Africa of the coincident infestment of one host by Loa loa and 
AcanthocheUonema perstarUy and in British Guiana of the coincidence of the latter and 
FUaria demarquayi are by no means infreqiient. But thus far it is rare to find coinci- 
dence of FUcffia banercfH with other filarial parasites; whether from the special pecu- 
liarity of the transmitting agents, peculiarity of conditions of infestment, or any par- 
ticular resistance offered by FUaria bancro/H to secondary infestments, is unknown. 

1 New Orknns Med. and Snrg. Jour., 1891, ▼. 18, p. 501. 

• Leber and Prowasek, Betbeft s. Arch. f. Schiffs- u. Tropenhyg., 1902, v. 16, p. 441. 

• Sap.dt. 

« Aitdi. de Pansttol., 1906, ▼. 9, p. IM. 

• Arch. f. Sohilb- a. Tropenbys., 19U; ▼. 16, p. SU. 



PUBUC HEALTH AND MEDIOIKB. 75 

Infonnatioii upon the normal periods of development, duration of the period of 
sexual reproduction during maturity, the time of senescence, and the full limit of life 
of each of these parasites would be of decided interest, and useful from a standpoint 
of prognosis, if not for other points as well. 

How long is the life of the microfiliaria in the blood of the definitive host? Cer- 
tainly more than 24 hours, as Myen once suggested in attempting to explain the 
periodicity of FUaria banero/H. The writer has seen one out of a number of larval 
FUarim hanero/H living in a thick blood film, isolated on a glass slide, after eight days 
bad lapsed; other writers have maintained th^n extracorporeaily even longer. In 
cases where fortunate removal of parent filarift by operations has been accomplished 
(wh«i chyloceles and similar surgical complications have been treated) the microfi- 
laria disappeared from the blood in the course of a few weeks. But this need not 
of necessity follow in so short a time, if one may appeal to the analogy of experi- 
ments with other filariee. Gruby and Delafond injected microfilariae <d Dirofilaria 
immUU into other dogs than the host from which they obtained them, and could find 
them for as long a period as three yean thereafter in the blood of the redpients; 
and in a rabbit they lived at least 89 days. 

We have little knowledge of the fote of the larvae which faH to be taken out of the 
drcnlation by the intermediate host. Of course, where such condition as chyluria 
exists, many pass to the exterior of the body in the urine. Whether there Ib another 
easy path of loss has not'been sufficiently studied. As above indicated, the writer 
feels that time and effort should be applied to determine whether they are not fre- 
quently to be found in sputum and in the moisture of the mouth and respiratory 
passages. Occasional remnants, at times encapsulated and calcified, have been 
observed in the capillary areas of the lungs, liver, spleen, and kidneys; but no suffi- 
cient trace of the great numbers which presumably die in the host has ever been 
realized. 

4. Problem of dieTnotherapy offilariagis, — ^The therapy of filariasis, aside from that of 
its complications and the surgical indications, involves two possible purposes, the 
destruction of the parent filaria (with the consequent destruction of their microfilariae 
as well) and the destruction of the microfilarise sdone. Of these the former is of course 
the more desirable; but success in the second line may at least prevent serious com- 
plications for the individual host and will for the time set aside x>06sibility of dis- 
semination of the parasites to new hosts. Neither empirically nor from exx>erimental 
studies are we in possession of an agent which can be relied upon to accomplish the 
destruction of either the parent worms or their broods of microfilaria; nor is it to be 
surely expected that the precise remedy in the same dosage will, if ever discovered, 
necessarily be equally lethal for all species of filarise. Numerous drugs which might 
be found lethal to microfilariae can not with certainty be expected even in higher 
dosage or more persistent administration to kill the fully developed parental forms. 
It seems not improbable, too, that the ensheathed microfijariae would manifest a 
better protection against destructive agencies than the free microfilariae because of 
the ensheathment itself. 

But one who has access to fresh blood preparations from filariated human beings 
or for that matter anyone who can command similar material from cases of animal 
filariasis, as that of the dog, will do well to systematically study in such preparations 
(with and without citration of the blood) the possibility of destroying the microfilariae 
with certainty and promptness by such drugs and in such dosage as might be permis- 
sible in human medication. Accomplishment of even thia limited purpose will mark 
a long step in advance; and possibly may suggest further method of eradication of 
the parent worms and thus definitely curing the affection. Perhaps adjustment of 
dosage or chemical variation of the basic remedy might succeed with the adults 
when once a reliable microfilaria! lethal agent or method is realized. The writer is 
disposed to believe that investigations prosecuted along one or other of these theo- 
retical lines in careful systematic fashion with view of destroying microfilariae will 



76 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

eventually be found successful, in each case founding the crucial experiments in 
man upon preliminary observations upon living microfilaria on the microecopic 
slide and then upon those in circulation in some filariated animal, as a dog. The three 
lines of study in mind include the employment of (a) exogenous agents likely to be 
immediately toxic to the microfilariae, (6) of means of cutting down or off the food 
supply of microfilarise, and (c) of generating within the host of substances toxic to 
microfilariae (in each case within range of toleration of the host). Of these of course 
the first must appeal the most strongly. Four remedies, administered empirically, 
have seemed to have influence in case of Microfilaria hancrofii: thymol, methylene 
blue, quinine, and arsenic. Each, urged as curative at first by its advocates, has fallen 
into disrepute because of failures in the hands of most of those employing it. Occa- 
sional experimental study of such agents ^ may be met with, but little has been done 
toward a consistent and systematic trial in vitro and in vivo of the filariacidal influ- 
ences of all of the suggested remedies and others which might appropriately be 
considered. When one remembers the thorough and long-c<mtinued studies of 
E3irlich in ferreting out salvarsan for the destruction or the syphilitic treponema, 
the insignificance of our searches for filariacides is obvious. 

As far as the second measure is concerned there is of course little actual fundamental 
knowledge. There is a slight increase in size of the microfilariae from the measure- 
ments of those in the maternal uterus and those of the microfilariae in the circulating 
blood (thought by some to be due merely to inhibition of fluid), but the variability 
noted in the size of Microfilaria denwrquayi as seen in any blood preparation bespeaks 
some degree of growth in the microfilaria! stage of the parasite. It seems unlikely 
that the nutrient material basic to such growth was derived solely from the maternal 
worm before the birth of the microfilaria. Much of the substance of these as of other 
parasitic worms is of carbohydrate nature, largely glycogen; and it is at least worth 
consideriog whether by restricting in the diet of the host elements which make readily 
for the formation of glucose and glycogen in metabolism (the application of Allen's 
diabetic regime, for example) may not influence both the parent and the microfilaria! 
parasites in harmful fashion without injury to the host. Suggestions bearing on the 
linQ of the third idea, that of inducing harmful changes in the host with the purpose 
of interfering with the well being of the filariae naturally first are offered by the 
well-known fact that in acute infectious diseases the hosts of intestinal parasites are 
often spontaneously relieved of their parasites. The writer knows of no instance of 
the cure of filariasis by an intercurrent infectious fever, and has no data that the num- 
ber of microfilariae in the blood is influenced under the same circumstances. But 
there can be little doubt of the reality of the principle that the toxemias of acute 
infections are apt to work harmfully upon coinciding animal parasites. Bahr' 
studied the effect of a staphylococcus vaccine upon one of his filariasis subjects, 
with negative results. There may naturally be considered in this same connection 
the factor of increased body temperature of the host; and undoubtedly the possi- 
bility of thermotherapy^presents a field open to research (as by the induction of 
febrile temperature by some such definite chemical as /S-tetrahydronaphthylamine). 
Reasoning by analogy it is possible, too, that exaggeration of substances identical 
or similar to excretory or waste material from the parasites within the host may 
be of harmful influence to the parasites. Most of these low animal parasites pro- 
duce among their waste products fatty acids, thought to include in important propor- 
tion valerianic acid. Is it possible in vitro to find that substances of such a type, 
valerianic acid, butyric, oleic, acetic, or lactic acid, in proportions tolerable to the 
host, can have lethal effect? 

The field is almost entirely unworked, and the writer has said more than enough 
to suggest lines of work, which are open at every point in fact. 

Hereupon the session adjourned at 12.15 o'clock. 

I Bahr, Filariasis in Fiji, Jour, of London School of Trop. Med., snpplement 1, 1913, p. 78. 
«Ibld.,p.70. 



SESSION OF SECTION Vm. 

New Ebbitt Hotel, 
Tuesday afternoon, December 28, 1916. 

Chairman, Col. John Van R. Hoff. 

The session was called to order at 2 o'clock by the chairman. 
The Chairman. The first paper on our program is by Dr. B. W. 
CaldwcD, of the American Red Cross. 

THE EProBMIC OF TYPHUS EXANTHEMATICUS IN THE BALKANS AND 
IN THE PRISON CAMPS OP EUROPE. 

By BERT W. CALDWELL, 
Superintendent Allegheny General Hospital ^ Pittsbxirgh, Pa. 

The epidemic of typhus exanthematicus which spread over Serbia from December, 
1914, to the end of July of tlie present year, was in proportion to the territory involved 
and the population affected, the most severe that Europe has ever experienced. The 
spread of this epidemic from the Danube to the Grecian boimdary, involving every 
hospital, prison camp, soldiers' barracks, and almost every home, was due entirely 
to preventable causes, to inexcusable indifference on the part of the Serbian civil 
and military authorities, and to carelessness which amounted to crime. 

It is impossible to tell how many were afflicted with this disease, as there are no 
reliable statistics available. The military reports do not include the civil popula- 
tion and those who were ill and died of this disease unattended by physicians, where 
no diagnoses were made. Conservatively, one out of every five of the two and a 
half million population was attacked by typhus, and 135,000, including 30,000 Austrian 
prisoners, died of typhus during this epidemic. The hospital mortality ranged from 
19 per cent to 65 per cent. No part of the country escaped, and every city, town, 
and village in Serbia contributed to the morbidity and to the consequent mortality. 

The unreliability of the estimates in this epidemic is further increased by the fact 
that the Serbian physicians classified typhoid fever as typhus abdominalis, relapsing 
fever as typhus recurrens, and typhus fever as typhus exanthematicus, and they used 
the term ''typhus*' vicariously to indicate any one of these three diseases. Lack 
of physicians in hospitals and among the civil population caused the diagnosis of 
tjrphns to be made in almost any case running a temperature, and was given as the 
cause of death in many cases where it did not exist. 

The word "typhus" covered a multitude of sins in diagnoses, as well as a world of 
ignorance and carelessness. This does not apply, however, to the better hospitals 
under Serbian control, or to those managed by the American Red Cross units, or 
to Red Cross missions sent from other countries. 

Typhus is transmitted by the louse. The body louse is completely incriminated; 
the bead lo^^ probably so, and the crab louse not at all. While no human experi- 
ments were made in Serbia, still the observations made in those cases of typhus oociu>- 

77 



78 PBOCEEDIKOS SECOND PAN AMEBIOAK 80IBKTIVI0 OOKQBB80. 

ring in hospitals and private homes, gave no evidence that the disease is transmitted 
in any other manner than through the hite of the infected louse. Measures looking 
to the eradication of lice from people and in their habitations, the improvement of 
personal and community cleanliness and hygiene, the isolation of people afflicted 
with the disease, within a short time placed the epidemic under complete control. 
Like cholera, typhus is one of the easiest infections to prevent, and should it creep 
in, it is one of the easiest to eradicate when conditions favor, and when our present 
knowledge of the control of the disease is scientifically applied. It is essentially a 
disease of winter months, and no sanitary measures at present known are better or 
more efficacious than warm weather and sunshine, when the poor can leave their 
crowded quarters for the open air, and when bathing can be accomplished frequently, 
when clothing can be waited and changed frequently, and when lice leave because 
of the heat which they can not endure. As the colder months, with their congested 
conditions, immediate want and squalor, are ideal conditions favoring a typhus 
epidemic, so warm weather, accompanied by the sunshine, which permits the popu- 
lation of homes and communities to seek more hjrgienic living conditions, to take 
better care of their clothes and persons, and to destroy the lice with which they 
have been infested, are the conditions which favor the control and eradication of 
this disease. Want and the overcrowding of people, soldiers, and prisoners, where 
the facilities for bodily cleanliness and personal hygiene are denied, where filth 
and squalor exist, and is added to by each incoming guest, when the climate is so 
severe that heavy clothing with infrequent changing is imperative, afford conditions 
for the breeding of lice and the propagation of this dangerous infection which are 
ideal. 

Typhus has an incubation period of about 14 days; probably a little under 14 days 
than a longer period. Eruption follows the onset closely and reaches its maximum 
intensity on the fifth day. It is during this five-day eruptive period that the presence 
of the infected louse becomes dangerous to the non-immune; after this period of the 
disease and during the convalescence, there is little or no danger of the louse becoming^ 
infected after feeding upon the patient. The disease reaches its climax and if death 
does not ensue a long and difficult convalescence is experienced. The mental dis- 
tress and disturbance, often serious in character, invariably follows. Gangrene of 
the extremities at times necessitating amputation complicates convalescence. Severe 
emaciation attends the convalescent stage and a general neuritis is often noticed . The 
disease seems to be a general septicemia, but nothing has been discovered at autopsy 
to throw any light upon the pathology of this disease, with the exception of the recovery 
from cultures taken from the spleen of an organism resembling the Plotz oiganism. 

Sex influences the incidence of typhus. Adult males are particularly susceptible; 
adult females form a very small percentage of those infected and a still smaller per- 
centage of those who die of the disease. Usually the disease when attacking females 
is mild in type and the severe sequelae which follow the disease in males is not noticed 
among the females who have suffered from this infection. Children of both sexes 
are seldom attacked. The greater opportunity which women and children have 
and which they exercise for the cleanliness of their clothes and persons and which 
men, especiaUy soldiers on campaign and prisoners in barracks are usually deprived 
of, undoubtedly affords protection to the weaker sex; so also those who live in sanitary 
eurroundings and who have an opportunity to Uve in comparatively good hygiencic 
conditions are equally protected. 

With proper precautions laige numbers of nonimmimee can Uve in the midst of a 
typhus epidemic and escape the disease. In Monastir during the period of the epi- 
demic our American missionaries maintained a school and orphanage having an 
attendance of 140 pupils. Their school is located in the center of the city and within 
a stone's throw of four of the laigest hospitals, accommodating at one time 3,000 typhus 
patients. In addition typhus was incident in the homes of many of the immediate 



PUBUO HBALTH AND MEDIOINE. 79 

ncighbon and the teachers in this school and the senior pupils visited the hospitals 
regularly two or three times a week to minister to the sick and yet there was not a 
single case of typhus among the pupils or faculty of this school. In Belgrade a found- 
lings' home, containing 40 children, is located just across the street from the civil 
hospitals and Dr. Ryan's Red Cross Hospital, where thousands of cases were treated 
in the course of the epidemic and no case of typhus occurred in this orphanage. The 
insane asylum in Belgrade, containing 180 males and 160 females, is located adjacent 
to the civil hospital and is separated from it only by a high stone wall. The inmates 
of the asylum p^formed manual labor in and about the hospital grounds, yet during 
the entire epidemic only four cases of typhus occurred in the asylum and the progress 
of the epidemic was immediately checked. 

But only where the conditions for hygienic living were provided did the Serbian 
peqple escape. All classes and professions were affected. The medical profession 
in Serbia suffered more from the disease and consequent mortality than any other 
pnrfession in proportion to its number. Overworked and exhausted by the endless 
labor of caring for their sick, these civil heroes lost 160 of their number out of a total 
of 340 at the beginning of the war. To these self-sacrificing men and women a glory as 
great as any gained on the battle field or in fire-shelled trench is due. They spsied 
not themselves, they spared no effort and no labor, but worked until exhausted and 
the disease attacked them. Among our own American physicians who went to the 
aid oi the strickoi people of Serbia five died, two of whom, Drs. Donnelly and Mac- 
Grudor, were members of the American Red Cross imits. The nurses did not escape; 
they too performed heroic deeds, and in one of our Red Cross imits 11 out of 14 were 
strickoi with typhus; happily none of them died. The physicians and nurses which 
other countries sent to Serbia suffered as heavily. 

The conditions for the spread of the epidemic in Serbia were ideal. During the 
Balkan War typhus had invaded Serbia and had never been completely eradicated. 
Here and there scattered through the country, especially in the northern districts, 
were sporadic cases and from these loci of infection the epidemic had its origin. The 
people were exhausted from previous wars; they had been invaded by a large army 
and the civil population had retreated as the army fell back. Belgrade in normal 
times has 100,000 people— during the war only 30,000 remained. The smaller cities 
and villages in central and southern Serbia soon became congested and overcrowded. 
The lack of bathing fadlitiee in the homes of the better class of Serbians, their entire 
absence in the homes of the middle and poorer classes, the crowded conditions in 
which they were forced to live, the cold months of the winter, all favored the intense 
spread of the epidemic which had started. Then came their military success. The 
Austrian army was thrown back through the invaded territory and across the Save 
River and 70,000 Austrian prisoners were taken captive. These prisoners, starved, 
exhausted, and vermin infested, were distributed in the little cities and villages oif 
central and southern Serbia, thus further increasing the already overcrowded con- 
ditions. 

In December, 1914, a sick soldier was sent to his home in Belgrade and was confined 
to his bed for three days before a physician was called and a diagnosis of his case made. 
His home was in one of the thickly populated quarters of Belgrade and many of the 
members of his family and his curious but well-meaning neighbors visited him during 
this period of illness. When a physician was called the patient was found to be in 
the fourth or fifth day of the eruptive period of typhus. No effort was made to isolate 
or quarantine this case and people were permitted to visit the patient as before until 
he died. Within two weeks in this particular section of the city dozens of cases of 
typhus developed and the epidemic spread through all quarters of the city. In 
six months it was estimated 7,000 cases of typhus occurred in the city of Belgrade 
abme, the civil hospital caring for 1,850 of them, with a mortality of 19 per cent, which 
was the lowest hospital mortality of which the writer knows in any hospital in Serbia. 



^80 PROCEEDINGS SECOND PAN AMBBIOAN SCIENTIFIC CONGRESS. 

At the same time in other cities of Serbia, among soldiers, prisoners, and civil popula- 
tion, the epidemic was increising at a fearful rate, and by the middle of January 
practically the whole of Serbia was involved. 

The overcrowded conditions in the hospitals in northern Serbia led the Serbian 
authorities to distribute the surplus sick suffering from t3rphus among the hospitals 
in the cities and villages of central Serbia and Macedonia, in many instances infecting 
cities wh^e the disease had not existed up to that time. Due to lack of room in ho^ 
pitals, soldiers and others connected with the army, becoming infected with typhus, 
were sent to their homes in whatever part of Serbia they mig^t live, in this manner 
carrying the disease broadcast with them. From this time there was no possibility of 
controlling the epidemic with such means as the Serbian authorities had at their com- 
mand. Such efforts as were made by the medical authorities were feeble and unavail- 
ing; indeed , the epidemic had grown to such proportions that the entire time and labor 
of the few physicians in Belgrade and throughout Serbia were devoted to waiting upon 
those abready infected with the disease. The Serbian authorities lacked oiganization^ 
capacity, and direction, and the most inexcusable and unexplainable things were per- 
mitted to be done by them. Trainloads of typhus patients were sent from northern 
Serbia to all parts of the country, even to the extreme southern boundary, in this man- 
ner invading many localities with the infection which were comparatively free from 
the disease. The cities in which the few cases of typhus had abready made their 
appearance might have been protected by prompt isolation, disinfection, and efficient 
quarantine. All these measures were entirely neglected. Their hospitalization was 
miserable. The regular hospital establishments were too few in niunber and of too 
small capacity to accommodate those who had been wounded or taken ill during the 
military campaign; and schools, colleges, and public buildings of all kinds were hur- 
riedly converted into emergency hospitals to accommodate those who were becoming 
infected with typhus. Two beds were placed side by side together and a single mat- 
tress placed over them, in this manner affording accommodation for three patients 
where only two could have been acconmiodated before. No wards were segregated 
for the especial use of treating typhus patients, but the incoming patients were scat- 
tered indiscriminately throughout the hospitals in whatever section or ward an empty 
place could be found. Often a patient suffering from typhus in the active stage oi 
the disease was placed between two patients on the same bed who were not suffering 
from the disease, and in the due course of time all became infected. Every hospital 
became a hotbed of infection. Few of them had anything like sanitary arrangements^ 
and in them only military patients were accommodated. The dvil population was 
almost entirely neglected; only such attention in a professional way was given to 
patients in their homes as could be given by physicians already overworked by their 
duties in the military hospitals. In one section of Macedonia, containing a popula- 
tion of 250,000 people, there were only 8 physicians, all of whom were attadied to the 
military service, and not a single one was left to give any attention to the civil popula- 
tion. Hundreds of new cases were reported daily, and the deaths reached an alarming 
total. The people, long inured to hardship and misfortune, became disheartened 
and discouraged at the fearful danger that was threatening them with extermination. 
Starvation and squalor added their terrors to the frightful picture, and the people were 
without hope. It was amidst such surroundings and at such a time that the American 
Red Cross Sanitary Commission and the commissions sent by the Grovemments of 
England, France, and Russia, arrived in Serbia, during the month of April, and began 
their energetic campaign to combat and control the disease. There were never more 
favorable conditions for the spread of an epidemic than those eaisting in Serbia at this 
time. With these commissions came what was far more valuable to the suffering 
people and far more effective in the control of the disease — the warmer weather and 
the sunshine. With every warm day the disease lessened. The people left their 
crowded homes, the prisoners were permitted to leave their congested barracks, and 



PUBLIC HEALTH AND MEDICINE. 81 

the aoldiera had greater and more opportumties and time for the promotion of personal 
and community cleanlinesB. These new conditions, aided effectively by the activi- 
ties of the American Red Cross Sanitary Commission, under the energetic, experi- 
enced and versatile director, Dr. R. P. Strong, soon placed the infection in that por- 
tion of Serbia which was assigned to the American Red Cross Sanitary Com mission 
for the field of its labors under good control, and a few weeks later the disease was com- 
]detely eradicated. Serbia, for the purposes of controlling the epidemic, was divided 
into four sections; the northern and eastern sections, respectively, were assigned to 
the Frendi and Russians, the central section was assigned to the English, and the 
southern, comprising practically one-half the area of Serbia and many of its laiger and 
more important cities, was assigned to the American Red Cross Sanitary Commission. 
Immediately after arrival the Americans began their campaign in Uskub, Veles, 
Priaien, Pristina, and Monastar, and, while on the 1st day of May there were 3,000 
cases in Uskub, 1,500 in Veles, 1,000 in Prizien, 1,000 in Pristina, and 2,000 in Mon- 
astir, three months later, on August 1, there were not a dozen active cases in all of 
these cities, or in the remaining parts of Macedonia. 

The measures taken by the American conmussion consisted in fumigating all hos- 
pitals, barracks, schools, and other loci of infection. The patients in the hospitals 
were bathed with soap and water and kerosene, and their clothes were disinfected 
by steam at a temperature of 115° Cel. for 30 minutes. After this process the patient 
was returned to a clean and vermin-free ward. This process was repeated as necessary. 
Soldiers and prisoners in barracks were bathed and their clothing disinfected in a like 
manner. Houses in which typhus was present were fumigated, and the patients were 
quarantined and isolated, or removed to the typhus lazarettos connected with local 
hospitals. A general sanitation of towns and cities was instituted, bathhouses were 
built, sewers were constructed, and proper disposal of sewage and garbage was insisted 
upon. Elmeigency hospitals were abandoned as rapidly as possible, and patients 
suffering from typhus were segregated and sent to hospitals or wards especially dedi- 
cated to the treatment of these cases. General sanitation and hygiene was insisted 
upon throughout the territory, and conditions rapidly improved. With the coming 
of the warm months of summer the disease disappeared, and it is worthy of note that 
it diflfl^ypeared coordinately in all parts of Serbia, in those districts in which the mis- 
sions from other countries were laboring, to the same gratifying degree as in the district 
to which the American Sanitary Commission was assigned. Only in the thickly 
populated districts of northern Serbia was an isolated case here and there reported, and 
it does not seem to have been completely eradicated in this territory. In the event 
that conditions such as existed during the past winter repeat themselves during the 
coming winter, Serbia will again experience, or at least this northern part of Serbia, 
an epidemic of typhus. 

Aa magnificent as were the results which attended the labors of the American Red 
Cross Sanitary Commission, not less worthy of credit, and certainly more marvelous, 
were the accomplishments of the countries bordering on Serbia, in keeping the disease 
from getting a foothold within their borders. A nimiber of cases, probably a thousand 
or two, w^e reported in those parts of Austria-Hungary adjacent to Serbia, but the 
epidemic was not permitted to spread, and after a time was eliminated entirely in 
many localities in which it had made its appearance. In Roimiania, which is the 
highway of travel between Serbia and the southern part of Europe and Russia, the 
energetic measures taken in the quarantine station at the Roimiania-Serbo border 
completely prevented the entrance of the disease into this coimtry. 

Bulgaria, with its highly developed corps of physicians and sanitarians, which 
bounds Serbia for almost its entire lengtii on the east, and which is another hi^way of 
oommunicatbn between southern and western Europe, succeeded in preventing any 
typhus from crossing its boundary line. But the most creditable of all was that of the 



82 PBOGEEDINOS 8BG0KD PAN AMERICAN SCIENTIFIO C0N0BB88. 

Greek phymdanB and quarantine officers and sanitarians. (Greece bounds Serbia on 
the south, and since the beginning oi the war the only communication which Serbia 
had with the rest of western Europe and America, was through the port of Saloniki, a 
dty of 200,000 people, with an additional 40,000 refugees of all classes, located within 
buildings and barracks within and about the city. Saloniki is connected with Serbia 
by two lines of railroads, and the old Via Romana highway affords another means of 
conununication between Monaatir and Saloniki. Hundreds of thousands of people 
traveled in and out of Serbia through this port, and were exposed constantly to the 
disease while in Serbia during the lifetime of this epidemic, yet such were Uie care- 
fully executed measures established by the Greek quarantine officers and sanitarians 
that lees than 200 cases were reported in Saloniki and in the remaining cities of Greece 
while the epidemic in Serbia existed. At each point of entrance into Greece, the 
Greek authorities had instituted quarantine stations equipped with disinfecting plants 
and isolation wards, and every passenger on every train, and everyone crossing th^ 
boundary line on foot or by conveyance of any kind, was stopped at these stations, 
examined by competent quarantine physicians, their clothing and baggage disin- 
fected, and all suspicious cases running a temperature of any Borty or due to any cause, 
were held for an incubation period of 14 days before being permitted to continue their 
journey into Greece. Upon arrival of any passenger from Serbia to Saloniki, or any 
other city in Greece, the traveler was again examined by a physician, who issued him 
a card upon which were blanks for the recording of temperature for the five succeeding 
days, and under heavy penalty for failure to carry out the instructions, the traveler 
was ordered to report daily to the local physicians for the recording of his temperatures 

In the city of Saloniki, where a majority of the cases reported made their appear- 
ance, the authorities handled the situation in a correct and scientific manner. Every 
case which ran a temperature from any cause, in the city, was reported to the health 
officer, who held the attending physician to a strict account for the foithful reporting 
of progress and diagnosb in the case. In any case of doubtful diagnosis, expert pro- 
fessional advice from the health office was tendered without charge to the patient, 
and in case a diagnosis of typhus was made, the patient was called for by an ambulance, 
taken to a central disinfecting plant, where his clothes were taken from him and disin- 
fected in an autoclave, the patient given a hot-water, soap, and kerosene bath, his 
hair cut, and new hospital clothes given to him, and in a different ambulance from 
that which conveyed him to the disinfecting station, he was removed to a typhus laza- 
rett located at the edge of the city, and there remained until his recovery. He was 
not permitted to receive any visitor or any article sent from the outside, and was 
waited upon during his illness by a competent force of physicians and hospital attend- 
ants. The feat which these efficient sanitarians accomplished in preventing the 
epidemic from gaining a foothold in their city, which was at that time the greatest and 
busiest port in the Levant, is a wonderful demonstration of what proper hygiene and 
sanitation will do. 

The problems which confront all the countries engaged in this war are the care, 
treatment, and preservation of the health of the prisoners which they take captive. 
These men, brou^t together from all parts of the world and suffering all the hardships 
of long and arduous campaigns, under the most unfavorable living conditions, espe- 
cially when engaged in trench wartime, are, when they are taken prisoners, usually in 
a state bordering on starvation, exhausted in mind and body, and almost without 
exception vermin infested. To the country which takes these men captive comes the 
great problem of preventing the bringing in of contagious and infectious diseases, 
which not only threaten the health and lives of other prisoners, but their own soldiers 
and civil population as well. So far as typhus is concerned, these countries handled 
the situation with wonderful success. 

In <me of the countries having upward of 2,000,000 prisoners, and in which prison 
camps accommodating f<vty <v fifty thousand prisoners are not unusual, with the 



FUBUO HBALTH AND UXDiaOTK. 88 

exoeptioD of one or two cunps, they hare succeeded in keeping t3rphn8 from coming 
in. In these camps in whidi the epidemic has occurred it has been controlled with 
t minimnm degree of sickness and loss of life. Their methods for controlling this 
disease are simple, but very effective when consistently carried out. Upon the 
entmnce of a number of new prisoners into any prison camp they are immediately 
isolated in a section of the camp separate from the remaining barracks for a period of 
14 days. Upcm admission to these isolation barracks each prisoner has his hair cut, 
is taken to a central bathhouse, disinfecting plant, and laundry, located in the center 
of the isolation compound, where he is bathed with cresolized aoap and water and 
afterwards with kerosene, during which process his clothes are disinfected with live 
steam at a temperature of 135^ Cel. for 20 minutes. After his bath his clothes are 
retained to him and he departs from the building through an exit in the rear of the 
bathhouse. This process is repeated during the 14-day period every 4 or 5 days. 
At the end of that time the prisoners are mustered for personal inspection by the 
prison physicians, and if they are in condition they are sent to their permanent bar- 
neks in the other compounds. In the event that any case of infectious disease occurs 
in any part of the prison camp, the case is at once removed to a well-equipped hospital 
attached to the prison and is there isolated and quarantined until he is free trom 
dangOT to the other prisoners. The American Red Cross Commission, sent to Ger< 
many for sanitary work in the prison camps in that country, personally inspected 
camps 1b which there were 125,000 prisoners. They mustered for personal inspection 
of clothing and persons, hundreds of prisoners of different nationalities in the different 
camps: they persoBally inspected hundreds of barracks in which prisoners were 
quartered, and thousands of beds and bunks on which the prisoners slept, and not a 
single loiaas or bedbug was discovered. This demonstrates the wonderful care and 
application whidi the authorities of this Government use in preventing the incidence 
of contagions diseases of any sort among its prisoners and illustrates most forcibly 
what eneiy<etic and correct measures will accomplish wh^i scientifically applied in 
the preventiMi of infectioa. 

The greatest hotbed of tjrphus and other infections existing in Europe before the 
outbreak of the epidsBaic in Serbia was in Galicia and Poland, along the Russian 
battle £ront. With the overrunning of these two immense Provinces by the con- 
teadins armies the danger from the spread of the disease to the remaining parts of 
Europe became greater and more apparent each day. ^lien finally the Russians 
were driven back beyond the borders of Galicia and Polwid, and tiie current of travel 
between important points of these two Provinces a$;ain began to flow, it became 
aecossary for the German and Austrian Governments to make great preparations 
and take the most effective measures to prevent the ingress of infection. On this 
front ia built what the Germans call a louserin, which was completed at a cost of 
6,000,000 marks, and was paid for out of the private fortune of the German Emperor. 
To this great establirimient all persons, of wliatever age, nationality, or rank in life, 
going from Germany into Poland or Galicia and from those Provinces returning into 
Germany or Austria, arc sent and are detained for 5 days, during which period they 
are bathed daily and their clothes disinfected in their large autoclaves with each 
bath . A t the end of the five-day period each traveler is given a personal examination, 
ami upon being found to be free from disease or vermin is given a certificate which 
permits him to continue his journey across the frontier. No exception is made in 
the case of any traveler, no matter what his rank or station in life may be, the imperial 
family being just as amenable to the rules of this great establishment as the poorest 
sttl^ject of Poland or Germany. 

In Serbia, in addition to typhus, relapsing fever, which is transmitted by the bed- 
bug, was prevalent in large numbers. The sanitary methods applied by the American 
Red Cross Sanitary Commission in combating the typhus epidemic went very far 
toward the elimination of relapsing fever, especially the fumiitation and disinfection 
684a&-17— VOL IX 7 



84 PBOGBEDIKGB SBCOHD PAN AMBBIOAK 80IBVTIFI0 O0KOBB8S. 

of bansckB, hospitali, beds, and clothing. It did not disappear with the approadi oi 
■ummer, but decreased to a very great degree. Typhoid fever was constantly pre s en t, 
not in epidemic form but in sufficient numbers and covering a sufficioitly wide range 
of territory to become a serious problem. The cities and viUages of Seibia, without 
exception, are built on rapid-running streams, usually on both banks of the river, 
which serves the common purpose of sewer and bath, laundry and drinking-water 
supply. Only the fact that the water which supplies these streams comes from the 
mountains and that generally the streams are rapidly running over gravelly beds, 
and the water has a tendoicy to purify itself quickly, is a greater incidence of water- 
borne diseases prevented. 

The fly problem is always serious, and the natural habits of the peasants and their 
living conditions all tend to the increase of fly breeding. Manure of all scurts is care- 
fully saved for the fertilisation of the fields and other purposes. Human and animal 
feces is carefully conserved, mixed with straw enough to hold it together, made into 
large circular cakes, and pasted against the outside walls of the habitations of the 
people, there to remain until dry and hard, and in tlus condition to be carefully saved 
for fuel purposes during the succeeding winter. Every house, every alley, every 
street, every place, was a breeding place for flies, and typhoid fever has probably 
be^ one of the current diseases in Serbia and Macedonia for generations. 

The country is farmed by irrigation. Every valley has its mains and laterals run- 
ning through it, all the ditdies grass-grown and shaded to prevent evapcvation, afford- 
ing ideal places for the breeding of mosquitoes. Malaria, during the months of July, 
August, September, and October, is prevalent to an unusual degree. It is peculiarly 
pernicious in its forms, and the writer knows of more deaths resulting from malaria 
infection in Serbia during the six months he was present there than occurred in 
Panama during any one of the nine yean of the American occupation. 

In addition to all these dinases, Uskub and other cities of Serbia experieoieed epi- 
demics of papatacci fever— a three or four day fever, not bital in character, communi- 
cated by the papatacci gnat, which is prevalent along the Adriatic shores and in 
this section of the Balkans. The patient suffers severely from headaches, back and 
body pains, congestion of the conjunctiva, throat and nasal passages, and runs a tem- 
perature of 104® F. for two or three days, which then subsides and a rapid c<mvalescence 
ensues. The treatment for this fever is purely symptomatic; no measures have been 
discovered other than general sanitation and hygiene to combat this disease. 

The treatment of typhus fever is unsatisfactory. It is supportive and S3rmptomatic 
in character. The use of the serum prepared by Nicolle, or that prepared from the 
Plots <»ganism seems to have a tendency to abort the disease, and seems to have 
value in its thenqmtics. Plenty of water should be given to the patient, and a 
saline infusion should be constantly at hand for use at any period succeeding the 
eruptive stage and the climax of the disease. The severe emaciation which attends 
all these cases should be carefully managed. The diet should be carefully selected 
and carefully administered, and every precaution to support and stimulate the patient 
judiciously should be takm . The nervous and mental systems, which are very much 
disturbed, should be carefuUy cared for, and this disturbance, often continuing lor 
six months following convalescence, should never be neglected. 

The prophylactic measures which were employed in Serbia by the American Red 
OosB Sanitary OommissioQ, and those idiich are used in the prison camps in Europe 
and in the quarantine stations of the countries bordering on S^bia, afford an effective 
prophylaxis in this disease. The value of the Plots serum in immuniiing against 
tjrphus infection is problmnatical. It probably has a value which will be fully dem- 
onstrated before typhus is eliminated from the Balkans. It was very interesting to 

ote that out of some two or three hundred people nonimmune to typhus, who found 
it necessary to go to this part of Europe during the epidemic, all of whom were inocu- 
lated with the Plots vaccine, among whidi numbor were all of the members of the 



PUBUO HEALTH AND MEDIOIKB. 86 

American Red Gtosb Sanitary Commiasion, with bat one exception, and the memben 
ol the mianon which Columbia University aent to Serbia, and many others who were 
exposed at some time or another to a greater or less degree to the infection, not one 
case developed. 

The lesson which this epidemic teaches is particularly valuable to the sanitary 
worid, especially to those localities which are from time to time subject to an epi- 
demic of typhus fever. It demonstrates beyond any question of a doubt that the 
I can be kept out of a country by instituting im>per quarantine and sanitary 
s, and by the proper observance of personal and community cleanliness and 
hygiene. It has demonstrated with equal certainty that if it should at any time 
secure a foothold in any locality, it can be easily limited and eradicated in a short 
time. With our present knowledge of the measures which control this disease, we 
can take a very optimistic view of the future, and assert with coi^fdence that the 
epidemic of typhus which Serbia has so recently experienced is probably the last 
eDe which will occur in Europe, unless conditions favoring epidemic are worse than 
ever before existed in the history of the continent. 

Hie Chaibiian. We shall now listen to a paper on ''Present views 
in respect to modes and periods of infection in tuberculosis/' by 
Dr. M. P. Ravenel, of the University of Missouri. 



ntESENT VIEWS IN RESPECT TO MODES AND PERIODS OF INFECTION 

IN TUBERCULOSIS. 

By MAZYOK P. RAVENEL, 

iVo/ettor i^J Prtventive Medicine and BaeUriology, Dvtetior of PuftKe ITsaUJk Lohor^ 
torjf, Univenity of Mietourif Columbia, Mo, 

In considering the various modes in which infection with the tubercle bacillus can 
occur, we may, for the purposes of this paper, leave out of discussion all except inha- 
lation and ingestion, because there is practically no difference of opinion concerning 
the others. They play a small part in the epidemiology of the disease, and the total 
number of cases due to them is insignificant compared to those in which infection 
takes place throug}i the respiratory and the digestive tracts. Both routes of infec- 
lioo are now universally recognized, and there remains to be determined now only 
their relative importance as portals of entry. 

Tuberculosis is a disease, the lesions of which are found so preeminently in the lung, 
that it is easy to understand how the older physidane considered the respiratory 
tmct the route of invasion. The classic work of Arnold gave scientific standing to 
tills ?dea, since it proved that the lung could be invaded even by particles of inert 
matter, such as lamp-black, introduced by the respiratory tract, and the experiment 
of Comet, who exposed guinea pi(pi to the dust produced by breaking up dned tuber- 
culous sputum with a broom, resulting in the infecticm of most of the animals, seemed 
to settle the question in favor of this method from a practical point of view. 

The older 6beervati<ms were apparently lost sig^t of, and did not receive due con- 
iideration until after the memorable British Congress on Tuberculosis in 1901, when 
the attitude of Koch in regard to the danger of bovine tuberculosis and the all^;ed 
larity of primary intestinal tuberculosis brou^t tiiem to the front once more. 

RESrUUlTOBT INFaCTION. 

Hie work of Arnold and the experiments of Comet have been mentioned as fur- 
nishing the basis for the belief that tuberculous infection took place mainly throng 



86 PBOGEBDIKOS 8BC01!n> PAN AMEBICAN BCIENTIFIO 00N0BE8S. 

the respiratory tract. Further evidence seemed to be at hand in the greater number 
of casus in \i hich the supposedly primary lesion was found in the limg and bronchial 
l>anph nodes as compared with the intestine and mesenteric glands. The value of 
this evidence has been weakened during recent years by the discovery of the fact 
(hat in children particularly the bronchial lymph nodes are often tuberculous when 
no change can be found in the lung, and the belief is growing that the bronchial 
gland:) and nmall lymph nodes are first infected, and the limg tissue becomes in- 
volved later. Schroeder and Cotton have demonstrated that infection of the lung 
and bronchial glands can result from inoculation into the most distant parts of the 
body. A calf inoculated under the skin at the end of the tail died affected with 
tuberculosis M the lungs. The bronchial, mediastinal and mesenteric glands were 
edematous and contained tubercle bacilli, though not having the histological changes 
of tuberculosis. ' 

Three hogs inoculated in the same way developed progressive tuberculoeis of the 
lungs, liver, and inguinal glands, and in one the gastrohepatic and bronchial glands 
were involved. 

It IS evident that infection of the lung is not the simple process of inhaling bacilli 
directly into the alveoli, as was formerly believed, but involves a more complicated 
mechanism. 

The fixing of the portal of entry by the so-called oldest lesion is also open to serious 
question. I have produced fatal pulmonary tuberculosis in monkeys by feeding, 
with very insit^iificant intestinal lesions. All the oldest lesions were located in the 
lungs and bronchial glands, yet the method of feeding laiT^ly precluded the possi- 
bility of the tubercle bacilli reaching the limg except through the digestive tract. 
Practically all observers agree that in children there is a marked tendency to rapid 
and geneml dissemination of the disease, and many note that it is frequently im- 
possible to determine the oldest lesion. As our conclusions have been drawn largely 
from post-mortem observations on children these facts are significant. 

DUflT AND SPRAT. 

In regard to the form in which tubercle bacilli are inhaled, all are agreed that dust 
from dried and pulverized sputum, and mouth spray produced in coughing, talking, 
needng, etc., both play their part. The relati^e danger of the two methods has not 
been determined, some belie\dng that dust is the chief menace, while others follow 
Flflgge in holding that the mouth spray produces infection more readily. The bacilli 
in the spray are certainly more apt to be alive and virulent. Both must be recog- 
nized as capable of producing infection, and droplet infection is probably the more 
dangerous. 

INFECTION TRBOnOR THB DIOEfrriYB TRACT. 

Tbtt fiiit recorded cases of infection through the digestive tract are those of Klenke, 
who in 1846 gave the histories of 16 children ^ho have been fed on cow's milk, and 
all of whom showed tuberculosis of the intestines, glands, skin, or bones. 

Previous to this, however, (^armichael, in 1810, recorded as his observation that 
he had frequently seen the mesentmc glands strumous without involvement of the 
external glands, and this led him to believe that in scrofula the mesenteric glands 
were first involved. He referred to the frequency of a disease similar to scrofula 
•een in pigs fed on sour milk, and called attention to the common occurrence of 
bowel trouble in children at the time of weaning '*too often followed by di^iease of 
mesenteric and lymphatic glands." 

Casper. 1882, refers to the extent of tuberculosis ("nodular consumption*') among 
the milch cows of Paris, and says: "It is possible that there is a connection between 
this phenomenon and the many tuberculous diseases among the children of Paris.'* 

Experimental evidence of tuberculous infection in cattle by feeding was given as 
early as 1868 by Chauveau, who extended his work with corroborative results in 1872 



PUBUO HEALTH AND MEDICINE. 87 

and « 1873, and Villemin in 1869 obtained positive results by feeding in rabbits and 
guinea pigs. He was the first to employ a tube for the introduction of tuberculous 
material into the stomach. Experiments by scientists of every nation have given 
positive support to the work of these early observers. It is also a well-known and 
widely observed fact that in the spread of tuberculosis of cattle and swine the digestive 
tract plays a most important rdle. Swine particularly are infected through the diges- 
tive tract in the great majority of cases, and the ingestion of milk from tuberculous 
cattle is universally recognized as one of the chief factors in the spread of the disease 
amcHig these animals. The first examinaticm made by the officers of the Federal meat 
inspection service is based on this fact. In 93.3 per cent of cases tuberculous hogs 
show infection of the cervical glands. 

As the disease is essentially produced by ingestion the glands and tissues associated 
with the digestive tract are the most frequent seats of infection. Indeed, the superior 
cervical glands (in almost all cases the submaxillary gland) are nearly always affected, 
as at the post-mortem examinations held by bureau inspectors over a consecutive 
period on 120,000 tuberculous hog carcasses, 93.3 per cent were found to contain lesions 
m these glands. The laige tonsils and the laige number of lymph sinuses in the lymph 
glands probably account for this great frequency. 

From some records relative to the locations of tuberculous lesions in cattle that were 
made at the same time that the figures pertaining to hogs were collected, it appears 
that in tuberculous cattle the lesions of tuberculosis were located in the cervical glands 
in 66} per cent of the animals, in the bronchial glands in 54^ per cent, and in the medi- 
astinal glands in 63.6 per cent. 

In 1901, in his London address, while discussing the relation of bovine tuberculosis 
to human health, Koch took the ground that infection through food could be assumed 
to have taken place with certainty only when the primary tuberculous lesion was 
located in the intestines. He claimed that this was rarely found to be the case, and 
aigued that the danger of infection through food was slight. The stand taken by Koch 
aasomed that the tubercle bacillus was unable to gain entrance to the system through 
the intestinal wall without the production of a lesion at the point of entrance. 

The question raised by Koch has been thoroughly investigated, and it can be said 
with certainty that the tubercle bacillus can penetrate the mucous membrane of the 
upper digestive tract as well as that of the intestine readily and quickly, without 
producing a tuberculous lesion at the point of entry. It is, however, held by Baum- 
gartwi that there is always a focus of infection at the point of entrance sooner or later, 
even though it may be microscopic. Against this is the demonstraticm by von Behr- 
ing and Roemer of the ready permeability of the intestinal mucosa of young animals 
by various bacteria, even the laige anthrax bacillus. In 1 ,000 swine, infected through 
food, Ostertag found the glands of the throat, neck, and mesentery tuberculous, while 
the mucous membrane of the intestine was always free from disease. Orth, in 1879, 
and Comet, in 1880, observed bacilli pass step by step through the fully developed 
mucous membrane of the uninjured intestine and reach the lymph channels and mes- 
enteric glands, leaving no recognizable trace behind (Furst). Dobroklonski, in 1890, 
working under Comil, showed that the tubercle bacdllus would quickly penetrate 
the healthy wall of the intestine in guinea pigs. Desoubry and Porcher, students 
of Nocard, shofwed in dogs that during the digestion of fats large numbers of bacteria 
w«re earned throu^ the intestinal wall and could be detected in the chyle within a 
lew hours after the meal was given. If food free from fat was given few or even no 
bacteria could be found. Nicolas and Descos, in 1902, found that tubercle badlli 
given to dogs in fatty food reached the chyle within three hours. During feeding 
experiments conducted at the laboratory of the State Live Stock Sanitary Board of 
Pennsylvania, we frequentiy observed extensive tuberculosis of the lungs and thoracic 
glands in animals which showed slight or even no involvement of the intestine. In 
1902-3 I introduced into the stomachs of a number of dogs tubercle bacilli suspended 
in an emulsion of melted butter and warm water, using a tube in order to prevent poe- 
•ble inlectioo through the trachea. The dogs were killed alter three and one-hall to 



88 PBOCEBDINQE 8EC01!n> PAK AMSBIOAK SCIBNTIFIO 00NOBB8& 

four hours, during active digestion, as much chyle as possible was collected, and the 
mesenteric glands were removed. Guinea pigs were inoculated with this materiaL 
Tubercle bacilli were demonstrated in abundance in 8 of 10 experiments. The dogs 
were kept on soft food for some days before the experiments, and were purged with 
castor oil, in order to rid the intestine of all foreign matter which might injure the 
mucous membrane. Numerous sections of the gut were examined also, but no injury 
could be detected. 

It b possible here only to mention the work of Oalmette and his students, as a result 
of which he reached the conclusion that pulmonary tuberculosis acquired at any age 
may be due to recent intestinal infection. 

The rapidity with which tubercle bacilli penetrate the intestine and reach the lung 
through the thoracic duct is remarkable. Besanti and Panisset found that when fed 
to dogs in soup they reached the heart blood within four to five hours. Bartel found 
that after a single dose they penetrated the iminjured intestine and reached the 
mesenteric glands during the following digestive period. Schlossman and Engel, by 
inoculating tubercle bacilli suspended in cream into the stomachs of young guinea 
pigs through an incision in the abdominal wall, demonstrated that they reached the 
lung within six hours. Their work has been confirmed by Ravenel and Reichel. 
Rabinowitsch and Oberwarth established nourishment throu^ a gastric fistula in 
swine, and then resected the aesophagus, after which tubercle badUi were introduced 
into the stomach. Within 24 hours they were shown to have penetrated to many 
organs of the body. 

INFECTION BY THE BOVINB TUBERCLE BACILLUS. 

The statement of Koch in 1901 that bovine tuberculosis was not a menace to public 
health has also led to a vast amount of study which throws light on the portal of entry 
of the tubercle bacillus. It is conceded by everyone that bovine tuberculosis is 
found almost exclusively in children under the age oi 16 years, and that the suscefH 
tibility to this type of infection is greater during the first five years of life than it is 
afterwurds. It is perfectly evident that the only exposure that children of this age 
can have to the bovine germ is through the food which they eat, and infection there- 
fore is invariably through the digestive tract. 

The results of the English Royal Commission, the German Imperial Commission, 
and numerous private workers have been frequently quoted, and I give here a sum- 
mary of cases collected by Dr. Park which indicates fairiy the amount of infection 
due to the bovine tubercle bacillus, especially in fatal cases. 

Adults, 16 years and over, 955 cases, 940 human, 15 bovine. Children, 5 to 16 
years, 177 cases, 131 human, 46 bovine. Children up to 5 years, 368 cases, 292 humaa, 
76 bovine. 

Many nonfatal cases of tuberculosis are also caused by the bovine germ. These 
are found almost exclusively in children and the infection is through the digestive 
tract. 

Fraser, in 67 cases of bone and joint tuberculosis in children under 12 years of age, 
found the bovine germ 41 times, the human 26 times, and both 3 times. 

Mitchell examined 72 children under 12 years of age with cervical adenitis and 
found the bovine g^m in 65, the human in only 7. 

It should be remembered that the human tubercle bacillus is capable also of pto- 
dudng infection through the digestive tract and the mistake must not be made ol 
considering only those cases in which the bovine genn is found as due to ingestion. 

INFECTION THROUGH THI TONSILS. 

The frequency of infection through the tonsils has been reoentiy called in question 
by von Pirquet, who quotes Albrecht and Ghon to support lus view. The fonner in 
1,060 cases found only three instances of primary tonsillar infection and the latter 



PUBUO HBALTH AND MBDIOIKB. S9 

ill 188 CMM found only one . It is hard to reconcile these findings with those of otiiera 
cr with experimentftl work. 

Wood has collected from the literature 1 ,671 cases, 88 (5^ per cent) of which showed 
primary tuherculosis. These examinations were made by various methods and 
probably fall short of the truth. Lartigau and Qoodale have shown that systematic 
inoculation of animals gives a higher percentage of tuberculosis. In 75 cases Lartigau 
found 12 (or 16 per cent) tuberculous. Dieulafoy by the inoculati<Hi of guinea pigs 
found tuberculosis of the tonsils in 15 of 96 cases. His work has been criticized on 
the ground that he made no histological examinations and was not careful to exclude 
crypts, which may lodge tubercle bacilli. However, Latham, who avoided these 
sources of error, in 25 consecutive autopsies on children from 3 months to 13 yean 
of age, found seven which were tuberculous— results practically identical with thorn 
of Dieulafoy. (Confirmatory reports have been made by a laige number of observenii 
many of which are included in the figures quoted from Wood. The susceptibility 
of the tonsils to tuberculous infection is shown by the examination of person dead of 
phthisis. 

Experimentally the tonsils are readily infected by direct application as well as 
by feeding tuberculous material. In a series of experiments which I carried out 
at the laboratory of the State live Stock Sanitary Board of Pennsylvania swine fed 
with tubercle bacilli from man and from cattle developed gviendized tuberculosis 
with marked involvement of the tonsils, apparently primary, with necrosis and ulcer- 



The experiments on these lines are too numerous to review here. Practically all 
experimental observers have noted the susceptibility of the tonsils to tuberculoua 
Infection. Wood, of Philadelphia, has carried out a most instructive series of experi- 
ments on swine. He found that the application of tubercle bacilli to the back of the 
mouth rapidly produced primary tuberculosis of the tonsils, soon followed by involve- 
ment of the submaxillary and cervical glands and extensive disease of the lungp. 
The mesenteric and bronchial glands were always diseased in about an equal degree. 

I have referred above to experiments carried out on monkeys by feeding, in which 
the lungs showed extensive and destructive tuberculosiB. In these animals, while 
no lesion of the tonsil could be found, caseous lymphatic glands were found in the 
neck in the region draining from the throat and there could be no doubt that a part 
of the inf ectioQ at least occurred by penetration of the mucous membrane in this 
wgioo. 

Grober believes that infection through the tonsil is the most frequent origin of 
apical tuberculosiB. His experiments have demonstrated that from the cervical 
^ands there is a direct route to the pleune and lun^s, and that this leads especially 
to that portion of the lung most frequmtly the primary seat of tuberculosia— the apex. 

The evidence that the tonsils are frequ^tly the portal of ^try for the tubercle 
iMMdllus appears to me very conclusive and it seems equally certain that food is the 
bearer of the infection in a laige im>portion of cases. 

PERIOD OF INPacnON IN TUBBKOULOSIS. 

Few problems offer more inherent difficulties in their solution than the determina- 
lioo of the age at which tuberculous Infection cccurs. It is easy to construct tables 
showing the age at which the disease becomes manifest clinically, but, except in the 
early years of life, these give little clue to the exact time of infection. 

There is no doubt of the existence of a widespread opinion that infection takes 
place chiefly in inhmcy and childhood and this opinion appears to be growing. It 
ssems to have a legitimate basil even if not whdly true. In 1900 Nageli showed by 
aalopsiee in Zuridi that by the age of 30, 98 per cent of persons showed tuberculous 
Isnoos or scars, results which have been in a measure confirmed in other cities, but 
which can not be accepted as correct for the general population. 



90 



PB0CBEDIKQ8 SBOOHD PAN AMBBIOAN 8CIENTIFI0 C0KQBE88. 



The use of tuberculin by the method of Vod Pirquet or some of its modificatiooB is 
even more directly responsible for the belief in early infection. Yom Pirquet himself 
obtained positive reactions among children of the poorer class in Vi^ma in a surpris- 
ing number of cases— 70 per cent if clinical cases of tuberculosis are excluded and 
80 per coit if included, as shown by the following table: 



A««(j«w). 


Indudlng cases of tubercu- 
losis. 


~ losls. 


Total 
number. 


Positive 
reactions. 


Percent 
positive. 


Total 
number. 


Positive 
reactions. 


Percent 
positive. 


Under 1 


410 
116 
306 
264 
316 
183 


21 
34 
74 
127 
188 
165 


6 
30 
35 
48 
64 
80 


888 

80 
163 
180 
154 
147 






lto2 






2 to 4 


22 
63 
74 
105 


11 


4 to 7 


80 


7 to 10... 


48 


10 to 14 


70 







More surprising even are the results of Hamburger and Monti, also on children of 
the poorer daas in Vienna: 



A«e (years). 


Number 
obildien. 


Positi^e 
reaction. 


Percent 
positive. 


rnderl 


28 
46 
56 
75 
50 
68 
46 
80 
85 
26 
20 
19 
17 
17 






lto2 


4 
11 
24 
26 
82 
28 
23 
25 
23 
27 
18 
16 
16 





2 to 3 


90 


8 to 4 


88 


4to5 


58 


6 to 6 


61 


6 to 7 


61 


7to8 


78 


8 too 


71 


9 to 10 


86 


10 to 11 


S 


11U>12 


Oi 


12 to 13 


91 


18 to 14 


91 







Based on such findings the belief is widriy hM that over 90 ptf cent of children 
are infected with tuberculosis by the 14th year, and statements have been made 
that tuberculosis in adult life is only the recrudescence of infection acquired in 
early life. 

A further study of reports from different parts of the world reveals marked varia- 
tions in the percentage of positive reactions, but all show that tuberculous infectloii 
in childhood is extremely common, as seen by the following table: 



Name. 



Overland, Bergen. 

Amenta. Palermo 

MOIler, Vienna 

Caimette, Orvsex and LetuUe, lille. 
Stawsky, Odessa 



Number 
tested. 



848 
800 
949 



Age. 



12-14 
8-13 

10-14 
5-13 

13-16 



Positive. 



PsresHf. 
50.0 
88.0 
54.0 
81.4 
60.0 



Post-mortem reports by von Pirquet, MQUer, and othem show that the positiva 
reactions fall short of diowing the full number of those infected. 

Turning to recent work in the United States, we find a somewhat different picture. 
Yeeder and Johnston tested 1^1 hospital children in 8t Louis, and obtained a maxi- 
mum of positive reactions at the 10 to 14 age peiiod of 48 per cent, including cases ol 
clinical tuberculosis, and 38 per cent exduaive of these. 



POBUO HBALTH MKD MCDIOIMB. 



91 



Tdftd iwMtfonfy ineluiing coMt o/eHmal titherculo9ii. 



J^iymmy. 


Number 

of 
ehndren 
tested. 


positive 
reacttoos. 


Percent 
posltiye. 


Under 1 


234 
187 
188 
SM 
183 
157 
115 
113 


35 
S4 
57 
08 
74 
09 
45 
54 


11 


lto2 


S4 


Sto4 


ao 


4to6 


33 


• to8 


40 


8 to 10 


44 


10 to IS 


40 


IS to 14 


48 








1,831 


430 









ReaetUmB in thildren without dinieal mantfettatUmt of tuhercidoHs. 



Age(yett«). 


Number 

oC 
children 
teeted. 


Positive 
reactions. 


Percent 
positive. 


Under 1 


302 
100 
163 
172 
153 
136 
107 
94 


3 

83 
40 
44 
88 
87 
30 


1.5 


ItoS 


5.5 


Sto4 


19.0 


4 too 


23.0 


0to8 


39.0 


ttolO 


30.0 


10 to IS 


84.0 


IS to 14 


38.0 








1,135 


• 











Oattermole, of Colorado, in a seriee of 66 cases from 1 to 14 years of age, found 25 
or 38 per cent of positive reactions. Taking the 10 to 14 year age period his positive 
reactbns reached 63 per cent. 

Cattermole qnotes Manning, of Seattle, as having obtained 58.1 per cent of positive 
teactions, at the 10 to 15 age period, in a series of 228 children. 

He also quotes Fishberg, of New York, who among 692 children living with tuber* 
culous parents in the tenements obtained 67.25 of positive reactions, while among 
688 of Uie same dasB, but living with nontuberculous parents, 52.72 per cent gave 
positive reactions. 

It is impossible to escape the conviction that childhood is preeminently the time 
of life when the tubercle bacillus gains a foothold in the body. 

These findings are corroborated by post-mortem examinations done on children who 
have died from various diseases. 

The studies of Harbits throw much light on this question. I give his results, as 
well as those of others, most of which are quoted from his monograph. 

HarbitE, in 275 autopsies on children under 15 years of age, found 117 (42.5 per 
eent) of tuberculosis. 

Babes, in 902 autopsies on children under 16, found tuberculosis in 288 (81.9 per 
eent). 

In 1887, in 93 autopsies, tuberculosis of the branchial and mesenteric glands was 
found 66 times. In only 13 was death caused by tuberculosis. 

Geilly in 902 autopsies on children under 15, found tuberculosis in 288 (31.9 per 
eent). The maximum was reached at the 6 to 9 year pmod, 46.9 per cent. 

Mflller, in 500 autopsies on children, found 150 (30 per cent) cases in whidi death 
was due to tuberculosis, and 59 (11.8 per cent) of latent tuberculosis. 

Hecker, in 700 autopsies on children, found active or latent tuberculosis in 147 
(21 per cent). 

l^nrad, in 654 autopsies on children, found tuberculosis in 157 (24 p^ cent). 



92 PBOOEEDINQS SECOND PAN AMBBIOAN 801ENTIFI0 00N0BE88. 

At the Pathological Institate of Kiel, in 2,572 aatopmes on duldien under 15, tu- 
berculosis was found in 16.7 per cent 

Bolts, in 2,601 autopsies on children under 15, found tuberculosu in 428 (16.1 per 
cent). Exclusive of those under 1 year of age, we have 1,171 autopsies witi& tuber- 
culosis in 364 (31 per cent). 

Heller found latent tuberculosis in 140 (19.6 per cent) among 714 children dead 
of diphtheria. 

Councilman, Mallory and Pearce, in 220 autopsies on children dead of diphtheria, 
found latent tuberculosis in 35 (16 per cent). 

Hand, in 332 autopsies on children, found tuberculosis in 115 (34.6 per cent). 

Still, in 769 autopsies on children under 12, found tuberculosis in 269 (35 per cent). 
In 43 it was latent, and in 117 (43.4 per cent) before the second year. 

Many other similar reports could be given, but these have been selected as covering 
a laige part of the world, and representing fairly the occurrenqe <^ tuberculosis as 
found post-mortem in children. 

The difficulty, especially marked in adult life, of connecting the clinical manifes- 
tations of tuberculosis with the date of infection, has already been mentioned, but 
fairly accurate information on aduk infection can be obtained by the careful study of 
groups of individuals of good family history especially exposed to infection for con- 
siderable periods, such as physicians and attendants at hospitals and sanatoria for 
tuberculosis, and those who marry consumptives. A number of collective investiga- 
tions are q^uoted by Cbmet and other writers. Many of these, owing to incomplete 
data and other defects, are of little or no value. From the material at hand I have tried 
to select those which seem to throw some light on the question. 

Saugman states that of 174 sanatorium physicians, whose average term of service 
was three years and whose subsequent history was followed for three and one-half 
years, only two became tuberculous. Among 64 laryngologists from 8 different 
clinics, none contracted tuberculosiB. 

Williams has, in two papers, given most interesting facts concerning infection <d 
physicians and attendants at Brompton Hospital, founded before the discovery ol 
the tubercle bacillus, and before the contagiousness of tuborculosiB was recognised. 
His first paper gave the statistics of the hospital staff from its foundation in 1846 to 
1882, 36 years. Among four resident medical officers, one of whom held office 25 
years, no case of consumption hos developed. Among 150 house physicians, none of 
whom held office f<v less than six months, and many much longer, only eight cases 
of consumption occurred. 

The second paper gives the results from 1882 to 1909. It includes resident and assist- 
ant resident medical officers, house physicians, resident and nonresident porters, 
pathological assistants and dispensers, in all 369 persons, of whom 12, or 3.2 per cent, 
developed phthisis later, two of them through inoculation wounds. 

The comments ci (Soring on this report are most interesting. He compares these 
results with those obtained by himself in a study of 3,090 individuals of nontub«!CU- 
lous parentage, assuming that a person coming of taioted stock would not be likely to 
take service in a consumption hospital. Among his 3,090 persons 79, or 2.6 per c^t, 
developed tuberculosis. Thus two groups, (me exposed to special risks and <me not, 
showed an amount of infection varying only 0.6 per cent. If the two hospital cases 
associated with inoculation wounds are left out of consideration, we have fvactically 
the same percentage of infection, 2.6 per cent and 2.7 per cent. 

At the Adirondack Cottage Sanitarium there has been no case of infection since its 
foundation more than 28 years ago among the employees, including waitresses, cham- 
bermaids, and laundresses. 

Infection through marriage may give some clue to the susceptibility of adults. 
Comet says: "The numbor of cases of marriage infection, often of classical simplicity, 
runs up into the hundreds." His own study of 594 couples showed that in 23 per 



FUBUO HEALTH AND MEDIOIKE. 93 

cent both partnen were tub«!cuk>u8. He admits that the findings do not necessadly 
imply an etiological relation between the cases. Ck>met believes the actual cases 
nin hi^er than the figures given indicate. Other observers place marital infection 
at tram 3 to 12 per cent. Recent studies made acc<»nding to modem statistical methods 
tend to throw doubt on the earlier work. 

The late E. 6. Pope's study of this question failed to show definite proof of infection 
between married persons. His work has been reviewed by Karl Pearson, who says: 

I may conclude in the slightly modified words of Mr. Pope: 

It would seem probable, then, (1) that there is some sensible but slight infection 
between married couples, (2) that this is lareely obscured or forestalled by the fact of 
infection from outside sources, (3) that the liability to the infection depends on the 
presence of the necessary diathesis, (4) that assortative mating lurobably accounts for 
at least two-thirds and infective action for not more than one-third of tne whole cor- 
felatkm observed in these cases. But the demonstration of this result depends on 
the accei>tance of the inherited diathesis to be effective, and the existence of assorta- 
tive mating of equal intensitv in the case of want of mental balance must prevent 
doamadsm. In all future collection of statistics with regard both to marital uifection 
and parental infection, it is most important that the age of husband and wife at mar- 
riage and the age at onset and death in both should be recorded. Age at onset and 
death of the parent, age of parent at birth of child and age at onset and death of child 
ahould also be recorded . It is only by such complete records that we shall ultimately 
be able to accurately app(Mtion the action of infection, assortative mating, uid 
inheritance. 

For real light on the problem of assortative mating of the tuberculous, we must wait 
till we have definite knowledge in each case of the family history of botn husband and 
wife. If we find (i) that the marriage of two ultimately tuberculous persons took 
place before either were suspected of the disease, and (ii) that there is in such cases 
a larger percentage of family histories of tuberculosis than in the case of nonmarried 
tuberculous individuals, we should have definite evidence of the assortative mating 
which seems probable. If, on the other hand, the percentage were smaller, we should 
have definite evidence for the infection theory. 

The difficulty of determining the date of infection by the appearance of clinical 
symptoms has already been mentioned. As our ideas have been in the past largely 
drawn from clinical data it is evident that there is need of some revision. How such 
data may midead is evidenced by the statement of Goring (Studies in National Dete- 
rioration, Y): "The mean age of onset for both sexes taken together is about 27 — ^the 
standard deviation is about 9 years. It follows from this that between the ages of 14 
and 45 may be looked upon roughly as a danger zone for tuberculous infection. The 
modal value of age of onset is about 23, and this is the age when danger of infection 
18 most intense; the danger diminishing fairly rapidly to the age of 14, and more grad* 
aally to the age of 45." 

It aeems certain that the early years of life are those in which tubwculous infec- 
tion takes place in the great majority of cases, and primary infection of adults is much 
less frequent than formerly believed. Clinical histories can not be relied upon to 
determine period of infection. It seems equally certain that infection of adults does 
occur, and that no age is exempt. 

CONCLUSIONS. 

1. The evidence at hand indicates that in the majority of cases the req;>irat(»7 tract 
Is the route of infectbn. 

2* The alimentary tract is a frequent portal of entry for the tubercle bacillus. 

$• The tubercle bacillus is able to pass through the intact mucous membrane of 
the alunentary tract without producing a lesion at the point of entrance. This takes 
place most retidily during the digestion of fats. 

4. The bacilli pass with the chyle through the lacteals and thoracic duct into the 
blood, which conveys them to the lungs, where they are retained laigely by the fil- 
tering action of the tissues. 

5. Infection through the alimentary tract is especially frequent in children* 



94 PBOGEEDIKGS 8B00ND PAK AMESIOAN 80IEKTIFI0 C0N0BE88. 

6. Infancy and childhood are preeminently the periods of life when the individ* 
ual is susceptihle to tuberculous infection, and the majority of cases of infectioD 
occur during these early years. 

7. Any campaign against tubercnlosb which leaves out of consideration the proteo> 
tion of children against infection will fail of success. 

8. Tuberculous infection in adult life occurs, but not so frequently or readily a» 
genially believed. 

9. Tuberculous infection may occur at any age. 

Dp. Carter. I am reminded of some data that Dr. Ravenel may 
not have seen. I left Habana after the influence of the reconstruc- 
tion period had passed. I foimd that the death rate for four or five 
years from tuberculosis was four and one-half times that of the aver- 
age large American city. I took, for comparison, New York, Chi- 
cago, and Philadelphia. It is difficult to state that there should 
bo as much infant infection from food in Habana as there should 
be in American cities. In the first place, the Cuban mothers in the 
beginning nurse their own children; it is rare that the child starts 
there bottle fed. 

Milk is always boiled before being sold. The people are accus- 
tomed only to boiled milk and won't drink raw milk. Their raw 
milk will not keep, and so it is boiled from a commercial stand- 
point. When I say *'raw milk," I mean raw cow's milk. They do 
drink the raw milk from the goat or ass. The little troop of goats 
or asses is driven around from door to door and the animal is milked 
into the cup or bowl that is brought out from the house. Now, I 
think neither goats nor asses are especially liable to tuberculosis, 
so one would think that there was little infection from milk in child- 
hood in Habana. The foods they got later, it seemed to me, would 
be singularly free from conveying tuberculosis. The principal source 
of meat was the dried beef from the Argentine cattle, which in 
their half-wild state then should have been meas\u*ably free from 
tuberculosis; the next was probably codfish; and the third were Amer- 
ican hog products. Such beef as they had been getting had come 
mainly from the Province of Porto Principe, where the cattle were 
wild cattle on the plains. It would seem that the Cuban either in 
childhood or in adult life should have been singularly free from in- 
gested tubercle bacilli as compared with those in America; and yet, 
for the four years I took — ^I forget what they were now, but it was 
well after the reconstruction period — ^there were about four and one- 
half times as many deaths reported in Habana as from the three 
cities I took — Chicago, Philadelphia, and New York. I mention 
that not as opposing your view, but because I believe it will give 
additional data. 

Dr. Ravenel. Not as a reply, but in explanation, I will say that 
that same line of argument has been brought up in regard to Japan 
and a number of other places. Now, I do not pretend to be able 



POBUO HEALTH AND HEDICIKB. 95 

to explain eyerything about tuberculosis, but the actual incidence 
<rf tuberculosis does not prove the mode of infection one way or the 
other. I can only answer by simply saying how much worse it 
would have been if exposure through food had been added to expK>sure 
through the respiratory tract, how many cases may have been 
saved in Habana in spite of there being four times as much as in 
diis country, and how much worse it would have been if in addi- 
tion to that infection there had been added bovine infection also and 
ingestive infection. 

The Chairman. The next paper on the program, ''Parasitic dis- 
eases in the American tropical countries/' is by Dr. D4maso Rivas, 
formerly of Nicaragua, and now of the University of Pennsylvania. 
Dr. Guiteras, will you be kind enough to take the chair ? 

Thereupon Dr. Juan Guiteras, of Habana, Cuba, took the chair. 



THE PARASmC DISEASES IN THE AMERICAN TROPICAL COUNTRIES 
AND THEIR EFFECT UPON THE PROGRESS OF CIYIUZATION AMONG 
THE LATIN-AMERICAN PEOPLE. 

By DAMASO RIVAS, 

ProfiM90T Univertity of Penntylvania Mtdieal Sdu)oh 

I. iNTRODUCnON. 

The term "disease" (dis-ease) implies lack ix absence of ease, uneasiness, pain, 
etc. Pathology defines the word "disease" as a morbid !>tate of the body; a deviation 
from the health or ncMinal condition of any of the functions of the organism or 
tissue of the body, due either to physical, chemical, or biological agencies. By 
"biological agencies" is commonly understood that collective ^roup of phenomena 
produced by the metabolic activity of certain lower forms of life, either plants or 
animals, on the tissues or organs of a higher organsim upon which they live. Since 
theee lower forms of life depend for their existence upon the food derived from 
the organinn, the name of parasites is given t-hem in contradistinction to the other 
organism upon which they live commonly known as ho^t. Biologically, therefore, 
disease is a symbiotic phenomenon between the parasite and the host on which the 
action of the former is detrimental to the latter. 

That these lower fonns of life were the cause of diseases in man was suspected since 
the time of the Egyptian and Greek civilization. Not one can fail to recornize the 
Importance of the hygienic regulations in the Mosaic period. The writing of Hippo> 
cratee, Celsus (25 B. C), AreUeus (3^-00 A. D.), and Galen (131-210 A. D.) are full 
of suggestions, and Paulus in 1700 gave an accurate description of the diseases due to 
flat and round worms. 

Modem medicine began after the Crusades when western Europe was confronted 
with new diseases imported from the Orient, and when Fracastori (1483-1553) formu- 
lated the theory of contagious and disemination of diseases during his study of syphilis, 
but the foundation of parasitology and tropical medicine dates from 1547 when Brie 
discovered the liver^uke. and Dubini in 1838 found the hookworm. Demarquay 
in- 1863 discovered the microfilaria; Bancroft the adult worm; and Manson demon- 
ftrated the lile cycle ol the parasite in the mosquito. 



96 PBOOBBDIKOS 8E00KD PAN AMBBICAK BCIENTIFIO C0NOBE8S. 

Protoxon were recognised by Lewenhoak siiice 167.5. Obermeyer diecovered the 
pararate of relapsing fever, and Loesh the amoeba djrse.iteriae. (H great importance 
has been the discovery of the malaiia parasites by Lavaian in 1880, and those of Rosa 
and Grassi upon the life cycle of this protosoa in the mosquito. Dutton in 1902 dis- 
covered the organism of the sleeping sickness; Schauddinn that of syphilis, and Ghagas 
in the last ye^rs the parasite of American trypano^miasis. 

A great factor in the develop of tropical medicine and parasitt^ogy in general ha» 
been the wonderful progress made in bacteridogy and the name of Pasteur, Koch, 
Hansen, Eberth, Nicolaier, Yerson, Kitasato, and others stand preoninently a» 
pioneers in this modem science. 

II. PAEASmO DI8BA8B8. 

Among the parasites in general are included bacteria, protosoa, and metasoa and 
they produce bacteria, protoaoan, and metaaoan diseases, respectively, but by common 
consent the name of parasitic diseases is commonly implied to those diseases known 
to be produced by protosoa and metaaoa parasites in man. Bacterial diseases, as a 
rule, are acute, of short duration, and end either m death or complete recovery. 
The protosoan and metasoan diseases on the other hand are commonly chronic, of long 
duration and of uncertain termination. They are seldom pet h the cause of death, 
but they produce in the host a constant impairment of health and a predisposition 
to permanent organic disturbances and secondary complications. The parasitic 
diseases of man known at the present are numerous and their number are constantly 
increasing as the biological cause of these diseases are discovered, but of those only 
those due to protosoa and metasoa of a special importance to the tropical countries, 
will be here considered. 

III. D18BA8B8 DUB TO PARAsmc Protosoa: Malaria, Dtsbntbrt, Trtpano* 

SOMIABIS AmBRIOANA. 

Of the several protosoan diseases of the Tropics, three particularly deserve q;>edal 
consideration, namely malaria, dysentery, and American Trypanosomiasis. 

MALARIA. 

This disease is especially common on the west coast of Africa from the Senegal ta 
Congo, and the whole of Africa except Giqpe Colony. It is also common in India» 
Asia, Southern Europe, and all the tropical and subtropical r^ons of America. Of 
all the diseases of man, malaria may be said to be the most cosmopolitan disease. 
In America it is especially found in the tropical regions along the Atlantic coast of 
Mexico, Central, and South America. 

The disease is produced by malaria parasite. This protosoon lives in the red 
blood cells of man and feeds on the homogjobin of the cell. In a marked infection 
the destruction of red-blood cells may be such that a rapid manifestation of anemia 
may follow. The parasite is also the source of irritation to such internal organs as 
the spleen and liver, which in time gives rise to passive congestion, fibrosis, pigmen* 
tation, and other disturbances. The parasite is transmitted by the mosquito — 
anopheUi maeuUpene^—yrhich lives in swampy places and bites especially at ni^t. 
The malaria parasite on entering the body of the mosquito undergoes sexual devel- 
opment and metamorphosis leading to the production of several hundred of minute^ 
sporelike bodies called $porzoide$ from a single pair of the malaria parasites. The* 
mosquito infects man by introducing these qxwsoides during the bite of the insect. 

The disease produced by the parasite is known as malarial fever and is manifested 
by intermittent attacks of fever, accompanied with chills and sweating. At the* 
beginning the disease is characterised by having an acute course lasting from some- 
weeks to one or two months, which, if untreated or inq»<^>erly treated, becomes chronic 
and incurable. During the chronic stage the malarial parasites may have disappeared 



PXJBUO HBALTH AHD MIDIOIHB. 97 

from the blood, but it haa left in man a permanent lesion in the intenial organs^ 
opedally the liver and qpleen, characterixed by torper of these organs, permanent 
lesknis in the blood and bloodnnaking organs, manifested by a certain degree of 
tecondary anemia, more or less intense. The impairment of function of internal 
orgviSy together with this anemia, is the source of general physical and mental lethargy 
commonly seen among the people of the tropical countries. 

DTSBNTBBT. 

By the term ''dysentery" is generally understood a disturbance of the intestines 
manifested by dianhea and accompanied with bloody stools. Several may be the 
cau s e s for this morbid condition, such as bacterial infection, protosoan, metagoan 
infestation, etc. We know at present more than 12 biological agencies as the cause 
of dysentory, among which one, BfUamoebakutolytieat is of special interest to the 
Amoican tropical countries. These protozoa belong to the ThUapode$. It lives in 
the large intestine of man, imbedded in the ulcers of the mucosa and submucosa. As 
the organism is the cause of the ulceration, one of the characteristic symptoms of this 
disease is hemorrhage from the bowels and the presence of blood in the passage, whidi 
in time may gradually give rise to a pernicious type of secondary anemia. In pros- 
trated cases the parasite is apt to be carried either by the lymph channels or the 
blood stream to the liver, where it produces amoebic abcesses of the liver, commonly 
seen in the Tropics. The involvement of the liver is accompanied with torpor <rf this 
organ, which is the cause of icterus, gastrointestinal disturbances, and a general 
impairment of health. The patient at this stage of the disease commonly presents 
a greenish tint of the skin and conjunctiva, his mental and physical power are inw 
paired, a general lethargy is common, and a constant desire to sleep prevails. This 
condition may be aggravated by a secondary bacterial infection, which not uncom- 
monly may cause death. 

The parasite is transmitted by ccmtaminated water, food, etc., and probably also 
an unhygienic condition of the mouth and teeth are important {H-edisposing factors. 
It has been shown lately by Barrett and Smith that in cases ol pyorrhea alveolaris 
amoebae are joesent in acortain percentage of the cases in the pus collected from the 
teeth. Whether these organisms are the same as those of dysentery has not been 
determined as yet, but it is not improbable that the same predisposing fncicn of 
pyonhea are those of dysentery. Six cases of dysentery which have come under the 
writer's observation, all have shown to bo accompanied with pyorrtiea alveolaris or 
to have had the disease for some time previously. Of course pyorrhea alveolaris is a 
very conunon disease in man and the above observations may merely be a coincidence, 
but thesaprosoitic habit of the amoebesof the mouth leaving, as it does, in the pockets 
ol the gums, and that of B. hutoljfttcaf leaving similar pockets in the submucosa of 
the intestine, may possibly point to the fact that both organisms, if they are not the 
same, at least require the same environments for their existence and that the pre- 
dktpooMig causes in both instances are the same, and that pyorrhea alveolaris, if it does 
not represent the primary manifestation of dysentery, at least may be regarded as a 
prediiposing condition. 

TBTPANOeOMIASIS iLMSRICANA. 

In 1910 Chagas, in Brazil, discovered a flagellate in the blood of children suffering 
with remittent and intermittent fever accompanied with a cortain degree of anemia, 
edema, enlargement of the lymphatic glands of the neck, axilla, and the spleen. 
This flagellate is known as the trypano$oma crud and is transmitted by eonorkinui ' 
msgittui, commonly known as ''kining bug.*' This form of disease is of special 
in^MTtaiice to the American tropical countries in general, because though it has been 
found only in South America, it is not improbable that in the future the dinase will 



98 PB0CEEDIKG8 SEOOVD PAN AMEBIOAN 80IBKTIFI0 C0KQBE8S. 

be found to be also prevalent in Central America and in the south of Mexico. The 
studies made up to the present time on this disease may be said to be incomplete. 
They show, however, the interesting fact that the affection is more common among 
children; that it produces certain morbid changes dironic in nature which are apt 
to leave a permanent impairment of the body, and that, like other chronic parasitic 
diseases, it predisposes to secondary infection and complications which not uncom- 
monly are fatal, thus bearing an important relation to the infant mortality in the 
American tropical countries. In some respects this disease may be compared to the 
sleeping sickness of Africa, and {Mrobably it represents a mild character of that disease. 

IV. Diseases dub to Parasitic Metazoa: Filabiasis, Anctlostomiasis, 

ASCARIASIS. 
META20A. 

Among the metazoa parasites are included trematodes, cestodes, and nematodes. 
The trematodes as a rule are unimportant parasites of man here in America, and with 
the exception of schiBtosoma and a few other trematodes common in Asia and Africa^ 
this group of parasites has only a few parasitic species of man. Among the cestodes, 
txnia Bolium, tsenia saginata^ txnia eehinococcus, and dibothrocephaltis latiu are the most 
common parasites of man, and though they are indeed of great importance in human 
parasitology, they per se are not restricted to tropical countries. 

The group of nematodes, however, comprise numerous parasitic species of man, 
among which three especially, uBmely JUarix, anqfloitomun, and ascaris are of special 
interest to the American tropical countries. 

FILARIASIS. 

This disease is caused here in America by filaria bancrofti, commonly known at 
F, noctuma. The adult parasite lives in the lymphatic of the pelvis and abdomen of 
man, where it deposits its embryos or microfilaria, which, carried by the lymphatic 
channels and thoracic duct, reach the heart, the blood stream, and are found in the 
peripheral blood. The parasite is transmitted to man by several species of mosquito, 
and probably by bedbugs and ticks. The microfilaiis enter the body of thes^ 
insects with the blood. It undergoes development, and after a certain time, about 
12 days, it becomes a larva, in which stage it passes to the probosis of the mosquito 
and is introduced into man during the bite of the insect. 

The presence of the parasite in man may not be accompanied with any appreciable 
S3rmptoms, but not uncommonly it mi^ht give rise to a moderate degree of anemia, a 
certain degree of eosinophilia and other constitutional disturbances. In marked infec- 
tion of long standing, the disease not uncommonly may give rise to a chronic derma- 
titis and cellulitis in the dependent parts of the body such as the legs, anna, etc., 
character!/^ by fiborosis of the sucutaneous tissue, hyperplasia of the akin, and 
edema of the parts commonly known as elephantiasis. 

The fact that ancient Indian writers were acquainted with elephantiasia, whila 
Gelsus does not appear to have known the disease, and according to the writing of 
nillary and Hendy that this disease was rare in Barbadoes at the beginning of the lOtb 
century, and furthermore Hillary's view that elephantiasis was introduced by the 
Ne^ro slaves from Afrira, gives rise to the belief that the endemic home of filariasisis 
Asia and that it so spread from hence to Africa and from Africa to America. In 
America, filariasis is especially common in the West Indies and it is believed that in 
Porto Rico, in certain districts, about 20 to 30 per cent of the population is affected 
with the disease. Filiarasis is also common along the Gulf of Mexico and all alomc 
the Atlantic coast in the tropical regions of Central and South America. 



FUBUO HBALTH AND MIDIOINB. 99 

▲NCTIfOSTOMLlSIS. 

The AncylostomlMw or hook wwm dieoaio is produced by a peradtic nematodes 
which inhabit the small intestine of man. The parasite lives attached to the mucus- 
BMmbrane of the intestines by means of special oigans of attachment in the form of 
hooks or plates, which produce laceration and ulceration at the point of attachment. 
The parasite in general is the source of gastro intestinal and constitutional disturb* 
ances. It has been diown by Smith and Loeb that the parasite is provided with a 
pair of glands at the cephalic end which empty into the mouth and that the secretioii 
of this gland has an anticosgulating action on the blood which prediqMse to aconstant 
ooeing of blood from the ulcerations at the point of attachment of the parasite. Occult 
blood in the stools is a constant symptom of the disease and this slow but constant loss 
of blood in the patient gradually gives rise to a secondary anemia pernicious in type. 
The abdomen is usually distended, and the internal organs such as the spleen, Uver 
and kidney are the seat of organic lesions. The physical and mental faculties gen- 
erally diminish and it is not uncommon to see among these unfortunate patients such 
a deppsnerated stage of the mind which almost reaches imbecility. The parasite is 
transmitted by the mouth with infected food or polluted water or through the skin 
in the larva stage of the parasite. The ^ggs of the worm are discharged with the feces, 
and in soil there hatches a larva which infects man. 

A8CARIA8I8. 

By Ascariasis is meant that group of morbid conditions produced by the presence 
of oseorat Iwnbrieoidei in the intestine of man. This parasite is commonly found in 
children and only occasionally in adults. The disease is of importance in the Ameri- 
can tropical couiitiies in so far as it is responsible for a variety of morbid changes in 
children in those regions which not uncommonly cause death. The presence of the 
parasite also is the source of gastro intestinal disturbances, distension of the abdomen, 
emaciation and a certain degree of anemia. If the infection is persistent it may lead 
to a retardation of growth in the child and is apt to leave permanent organic lesions. 
The parasite is transmitted in the larva stage by contaminated water, food, etc., or 
directly introduced with the fingers. It is a common habit among the poor and the 
lower class in the Ammcan troiHcal countries to lay the child on the ground, when 
naturally he soib his fingers and introduces the larva into his mouth with the dirt. 
The eggs are discharged with the feces, then undergo development in the soil and 
water into larvas which are transmitted directly as above staled, by the contaminated 
food or water. 

y. GbNBRAL CONSmSRATION AND CONCLUSIONS. 

The above brief description of the most common parasitic diseases in the American 
tropical countries clearly shows that these diseases per se are not as a rule the causes 
of death, but they predispose to secondary complications and more especially give 
rise to permanent organic disturbance in man, leading to a physical and mental 
impairment. These diseases, as may be seen, are especially common in those places 
where the hygiene have been neglected, thus countries like Cuba, Panama, and 
Costa Rico, in which special stress has been placed by their respective govemmenls 
lor the eradication of these diseases, clearty diow the beneficial result of these prophy- 
Uctic measures, and also may be taken as an example that if such a regulation was in 
force in other trof^cal countries in America, equally as good results would be obtained. 

The importance of sanitation of American tropical countries can not be too highly 
emphaaizad. It is almost superfluous to say that for the normal per f ormance of our 
mental faculties a normal ccmdltion of the body is essential. The human race, of 
course, is constituted by the aggregation of those units of which man is the representa- 
tive, and it is only when those units work in harmony and with sound body that they 
664»^17— Tocix 8 



100 PB0CEEDIKQ8 SECOND PAH AMBBICAK SOIBKTmO OOITQ] 



can produce sound and efficient results. It is almost useless to expect that a man 
afflicted with these chronic diseases can perfonn his duty in the same way as a normal 
man will do it. In vain will be all the effort toward the p rogress of civilization among 
the Latin-American people, if the most essential part, the hygiene of these countries 
and the health of the community, is neglected. How can it be expected that a man, 
with an enlarged liver or enlarged spleen and in which other organs at the same time 
are not performing their ncmnal function in the elimination of the poison from the 
system, would perfonn the same tasks as another person with a n<»mal body? The 
blood we know is our vital liquid and supplies us with food, and it is easy to under- 
stand that our physical and mental faculties will be greatly impaired by any degree 
of disturbance in the circulatory system. We know that ideeping sickness in Africa 
IMxxiuceB a complete lethargy in the patient who usually dies in the comatose .omdi- 
tion. We know that similar symptoms are common, though in a mild degree, in 
chronic malaria, ancylostomiasis and other parasitic diseases, the lethargy character- 
istic of the people of the tropical countries and the well known "mafiana*' symbol- 
ized the character of the people. This ** mafiana," of course, could be made today 
any time if efforts are directed to the sanitation of the tropics. 

The CHAntHAN. The next paper is called ''A review of the present 
yellow fever situation/' and is by Dr. Arfstides Agramonte, of the 
Univeraity of Habana, Cuba. 



A REVIEW OF THE PRESENT TEtLOW-FEYER SITUATION. 

By ARtSTIDES AGRAMONTE, 
Pro/e$$or of BaeUriology and Experimental PatiicHogy^ in ike Umvenity qfHabana, Cuba. 

At a moment when the most enlightened and civilised nations of the world are 
engaged in a merciless and devastating war, the like of which has never taken place 
in history, ancient or modem, at least with reference to its magnitude and the means 
employed for the destruction ol man and all that man holds dearest, it is well to con- 
template this gathering of representatives from other nations no lew enlightened 
or civilised, this side the Atlantic, intent upon the cultivation of the sciences, upoa 
the quest for truth, and thus directly upon the conservation and the moral and physical 
betterment of man. It is such a spectacle as the one here made evident, that serve* 
to support the tottering faith in the ultimate emancipation of mankind from the evil 
passions of the primitive inhabitants of our world, and yet congresses of the greatest 
import, scientific and religious, have been held repeatedly in the very lands that 
to-day are steeped in the blood of their men, throughout their confines raging unutter- 
able misery and woe, ruin and desolation. 

We can only hope that the present conflict may stand as an awful example to the 
future generaticms, and that our respective countries may never see the like among 
themselves. In this connection, regardless of enervating pessimism, very much can 
be accomplished by the frequent intercourse of our representatives and their meeting 
upon a higher plane than mere politics or commercialism. And what plane may be 
considered higher, of greater moral worth, than the earnest endeavor to suppress 
disease and human suffering? 

It may be pointed, I may say with pride, by every one here, to the almost extinction 
of yellow fever, for so long considered a Pan-American disease, as the result of that 
concerted international action in a good cause, intelligently and peraistently main- 
tained. Because of its gradual disH>p6arance (aside from my personal shortcomingi)^ 
the subject that I was invited to treat upon has been particularly difficult to handle* 



FUBUO HBALTH AND lODIGIKB. 101 

Yellow fever has been enuiicated from its fanner haunta, if not entirely, at least to 
sach an extent that the common diseases of infancy, not to say other infections like 
malaria, dysentery, or tjrphoid fever, have become more worthy of the sanitarian's 
consideration. This, notwithstanding, we can not lose sight of the grave problem 
which its appearance would imply to those countries that never had it, or that have 
managed to stamp it out in their territory, and so, the maintenance of a condition of 
preparedness, is no less important in connection with this contingency than with any 
other of a political or financial character. 

This is the only excuse I can offer for having accepted the honor of contributing 
this paper. 

In view of the present status of yellow fever, which I shall endeavor to make evi- 
dent, what should be our attitude towards the pml it involves? How stringent 
should our quarantine regulations be? What may be allowed now, formerly prohibi- 
tive, that will make commerce, and international relations less cumbersome? 

If we determine these points in any degree to our common satisfaction I shall fee 
thftt my efforts have not been entirely in vain. 

mSTOBIOAL SKBTOH. 

Barely to outline the history of yellow fever one must delve into the musty annals 
dating back centuries, perhaps to the period of the discovery of America. We know 
now that the records were kept then in a manner far from accurate; how ''fancy" 
took a prominent part in the description of common, everday occurrences; how the 
most trivial event was exaggerated and distorted by repetition, for the sake of 
notoriety if not for fame and profit; how iniquity, misery, and discontent were made 
light of, or silenced, if silence was conducive to the attainment of a desired purpose. 
Hence we can not wonder at the difficulties encountered by our contemporaries in 
their efforts to remove the veil that enshrouds the origin of this dreadful scourge. 
One thing seems definitely shown by the investigations made in that direction, 
namely, that whatever may have been the extent of its dissonination, the cradle of 
yellow fever was either Mexico or Central America on this side of the Atlantic, or the 
western coast of Africa upon the other side. 

Some historians, our immortal Finlay was one of them, believe that yellow fever 
existed among the Indian tribes of the Mexican and Central American coasts, even 
before the coming of Columbus, and that the discoverers carried the infection back 
with them to the Canary Islands, from where its propagation to the African Coast 
aeons feasable. Others, in view of recent finHing n as to the endemicity of yellow 
fever in west Africa, where it may have existed through centuries unknown, are 
inclined to believe that the slave trade may have been the means of infecting our 
westam hemisphere. 

Be that as it may, the fact remains that the best authenticated record of epidemics 
of yellow fever in America corresponds in time to early slavery days, and to the clearest 
description of the disease on board a vessel plying the west African waters; I refer 
to the epidemics in Habana during the years 176^1769 and to *' the fever which raged 
on board the Weasel sloop of war during the rainy season at Oambia in 1769." 

Since then the great disproportion between the increase of the white population in 
America and that of west Africa has undoubtedly been the reason why our attention 
was ever turned toward home in the desire to solve the problem of etiology and prophy- 
laxis, and how seldom we seriously considered, until very recently. Sierra Leone and 
the Gulneacoast as endemic fod of yellow fever. And so Mexico, the West Indies, and 
South America have borne the stigma of being the home of pestilence and a danger 
to all other civilised countries during a period of more than two centuries. 

Definitely established as an endemic disease in cities of the Gulf of Mexico, the 
West Indies, and Braail, yellow fever made incursions, causing terrible ravage into 
the United States and across the Atlantic, invading European p<nrts of France, For- 
toga], and Spain. 



102 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC C0NGBB88. 

In 1698 the expedition intended to capture the Island of Martinique brought yellow 
fever to Boston, losing 1,300 sailors and 1,800 soldiers, at the same time infecting the 
town. In 1689 Philadelphia, only 17 years established, suffered the first epidemic; 
in subsequent years many outbreaks occurred, the severest being in 1797 (with 1,900 
deaths), 1798 (3,500 deaths), and 1799 (with a mortality of 1,000). 

New Orleans was the American dty most attacked by yellow fever; its commercial 
relations with, the West Indies and the Mexican Gulf ports, kept infection, if not 
permanently, with yearly exacerbations from 1817 to 1858; after this the worst eftt- 
demics took place in 1867 (mortality of 3,093), 1878 (mortality 4,600). In 1905, we 
hope the last epidemic that will be seen in America, New Orleans lost about 460 lives. 

All the Southern States were destined to be overrun by this disease whenever it 
gained entrance through any of its ports, and so the epidemic of 1878 invaded 132 
towns and caused a mortality of 15,934 out of a total number of cases exceeding 74,000. 

In South America importations from the West Indies and Mexico established 
endemic foci after causing severe epidemics in various cities of Brazil as early as 1686, 
in Pemambuco, having also developed in epidemic form in Montevideo, Buenos 
Aires, and other cities on the east coast from where it has disappeared. 

The last epidemic invasion of yellow fever at all important occurred at Tocopilla, 
Chile, where the diseas«3 spread with wonderful rapidity, but was as quickly stamped 
out by the local sanitary authorities. And so, wherever it may have been bom, I feel 
that we are coming siurely to its death; it no longer holds for us that nameless dread 
which follows all mysterious things. 

QBOORAPHICAL DISTBIBUTIOK. 

We find that yellow fever has vanished from some of its former homes, probably 
forever, now constituting endemic areas of comparatively slight importance in other 
localities; for instance, Cuba and the Mexican Gulf ports have been free for many 
years, as well as the Isthmus of Panama and the West Indies, where no cases at all 
have been recorded for two years. 

During the first half of the present year (1915), yellow fever in America has been 
confined to a part of the Mexican Republic, probably kept alive by the movement of 
troops, that is, by the renewal of nonimmune element in the endemic areas, mainly 
in the peninsular of Yucatan. Sporadic cases, or cases at long intervals, without a 
dear history as to their source, have appeared from time to time at the places shown 
in the following table: 

Yellow fever cases reported in 1915 (U. S. Public Health Service): Brazil, Bahia, 
February to July, 5 cases; Ecuador, Guayaquil, February to April, 6 cases; Mexico, 
M^da, up to April 10, 4 cases; total, 15 cases. 

The very complete reports of the English Yellow Fever Commission, first and second, 
though not giving us an exact idea as to the present conditions in West Africa, point 
very directly to the fact that fever is endemic there. The commission says: 

We have therefore to recognize the occurrence amongst the natives of theWeit 
Coast of Africa of two types ol yellow fever, the one a mild type accompanied by such 
slight symptoms that its diagnosis is often very difficult, and another, tne hemorrhagic 
type, presenting all the grave and fatal characters of the disease as it commonly affects 
Europeans and newcomers into any area in which it is more or less constantly present, 
(maladie habituelle). 

If we accept, as we should, that yellow fever is an endemic disease in that part of 
the world, equally affecting blacks and whites, though not in the same degree of inten- 
sity, then we know where it shall make its last stand, when we drive it, as I am sure 
we will, forever, from America, because the implanting of prophylactic measures in 
an uncivilized community is well nigh impossible, so that it may render a sense of 
security at all in proportion to the expense and trouble it entails. 



PUBUO HEALTH AND MEDIOINE. 103 

OIS8BMIKATION OF YELLOW FEYBR. 

It has often been said, in fact, a paper was read upon the subject at the last Inter- 
national Medical Congress held in London (1918), that the opening of the Panama 
Canal, facilitating as it does the more active commercial intercourse between the 
Americas and their opposite seacoasts, as well as the more rapid and therefore more 
frequent r^ations between eastern America and Asia, was sure to be the means by 
which the disease would travel across the Pacific Ocean, thus endangering a tropical 
region of the Earth, until now, as far as we know, free from that plague. 

I took occasion to point out then, as it has been proven by the time elapsed, how, 
instead of a danger, the Canal Zone, was in fact a sanitary bulwark, or at least a veri- 
table filter through which, neither yellow fever nor any quarantinable disease could 
pass, for I was convinced that the United States Government would necessarily main- 
tain there, the wonderful sanitary control established during the period of its con- 
struction. 

Of course the danger of its spreading from one of the above-mentioned foci to any 
other part of the country or to any other country is just at present to-day as ever, except 
that the scarcity of cases where they occur now, and the better knowledge of its etiology 
and preventicm, render this danger less acute than formerly, when great epidemics 
laged in one or several ports of the Atlantic and Pacific coasts. 

In this regard it is proper to consider for a moment, the present knowledge and prac- 
tice, respectively, of the 

SnOLOOY AND PROPHYLAXIS OF THB DISEASE. 

No organism has been discovered that may be accepted upon good scientific grounds 
as the causal agent of yellow fever. Needless to say, many claims have been made by 
enthusiastic investigatorB, but all of them, from Domingo Freire, of Brazil, to Harald 
Seidelin of the Liverpool School, have been shown definitely as in grave error. The 
exact nature of the germ is therefore still unknown, though we have learned that it is 
found in the blood during the first three days of the disease, that it passes through the 
pores of a filter which holds back bacteria, that mosquitoes, who take it into them- 
selves by stinging a patient can transmit it to other persons after twelve days and that, 
if these persons are not imjnune to the disease they wiU develop an attack within six 
days. These facts were first demonstrated by the United States Army yellow-fever 
board, thus confirming and converting into a doctrine, the theory advanced 20 years 
before by Dr. Carlos J. Finlay, the theory of the man to man transmission of the dis> 
ease by mosquitoes. 

It was the establishment of these facts (the period of infectivity in man, the period 
of incubation in the mosquito and that in man), as well as the knowledge of the kind 
of mosquito, its habits, that led to the first rational campaign against yellow fever, sue- 
cessfully carried out by the then Maj. W. C. Gorgas in Habana, during 1901. As 
though by the wave of a magician's wand, the epidemic there and then subsided; 
immediately after, the same thing in Mexico; then in rapid succession, Laredo, Tex., 
Rio de Janeiro, Bahia, and Sao Paulo in Brazil, were subjected to the same methods 
of mosquito destruction and protection of the sick from ^eir bites, with the results 
that yellow fever soon disappeared from all those cities. 

Another fact of the greatest interest to the welfare of commerce and international 
relations, also demonstrated by the Army board, was the innocuousness of "fomites,'* 
tiius doing away with disinfection as practised until then, of the person, baggage, 
clothing, etc., suspected of being infected or considered as tainted. 

Sanitarians when dealing with yellow fever became interested only in the mosquito; 
the problems which they then had to solve were principally (a) to obtain knowledge 
of the relative proportion of the species Stegomyia in the locality, (6) breeding places 
of same, (e) poesibitity of their transportation at a distance, (d) their extermination by 
all means poemble. The cases of yellow fever themselves occupied a secondary plane 



104 PBOGEEDIKQS SECOND PAH AMERICAK SOIBirnFIO OOKOBBBCL 

in the order of importance inasmuch as it was presumed, when a case was discovered, 
that it had already infected every mosquito in the immediate neig^boihood; once 
the patient was put into protected wards it ceased to be of interest from epidemblogic 
standpoint. 

No mosquitoes naturally means no yellow fever; but such a consummation, much as 
it is devoutly to be wished, seems at all events impracticable and so the countries, 
whidi we may term most threatened, have been compelled to be satisfied with keeping 
down the number of insects in their towns and cities, "below the yellow fever level'* 
as expressed, I believe originally, by Gen. Gorgas, and trust upon their power of watch- 
fulness to ward off the introduction of the infection, in the hope that if by any unforseen 
circumstance such a misfortune should occur the scarcity of mosquitoes, since their 
absence is impossible, will make the chances of propagation comparatively less. 

INTERNATIONAL PROPHYLAXIS. 

This depends, as in the case of every infectious disease, upon the knowledge of the 
facts concerned in its etiology and epidemiology. As regards yellow fever they are 
mainly such as I have outlined above. Of no less importance in this connection, de- 
pendent upon the period of incubation in the mosquito, is the fact first pointed out by 
Surg. H. 0. Carter, of the United States Public Health Service, to the effect that 
secondary cases never occur before two weeks or 18 days after the primary or initial 
case; needless to say, the greatest difficulty has been, and no doubt always shall be, 
to discover the primary case in any emergency. 

The question of international defense was considered of sufficient importance by the 
Governments on this side of the Atlantic so that it was taken up at the sanitary con- 
ference which met in this city in 1905, making such additions to the articles adopted 
by the International Sanitary Conference held in Paris in 1903, as to make them ex- 
tensive to yellow fever as well as to cholera and plague. And now that the means of 
propagation became well known, it seemed more within our power to prevent its 
entrance into new fields; this could only occur by the introduction of infected mos> 
quitoes in ships, railroad cars, or in any other way transported, or by the introduction 
of cases during the period of incubation, or both ways. 

The question of quarantine as it was imposed against yellow fever, before 1901, is 
now entirely obsolete. All effort has been naturally directed to prevent the convey- 
ance of mosquitoes in vessels, cars, stages, or whatever are the means of communication 
between the countries concerned and to guard against the introduction of an infected 
individual. When this is said, one is tempted to dismiss the subject as sufficiently 
expounded, but there are certain details such as must necessarily interest more par- 
ticularly a gathering of international character, which, at the risk of "going beyond 
my depth " I beg to at least place before you for deliberation. 

We must not lose sight of the fact that tiie great epidemic foci have disappeared and 
we would not be justified in thinking of any city to-day wiih the dread that inspired 
Habana, Vera Cms, or Rio de Janeiro in former times; for that reason we can not hold 
the same quarantine measures against localities which are known to develop now and 
then a few cases of yellow fever, that we formerly did when the disease raged there in 
epidemic form, in hct, other quarantinable diseases are to-day more prevalent and 
should demand greater attention on the part of the sanitarian if we hope to ever accom- 
plish in regard to them what has been attained with reference to yellow fever. I do 
not mean by this that we should fail to watch and look with some degree of suspicion 
upon certain ports, for an evil reputation justly acquired throughout a lifetime, in 
spite of all that may be said for it, can not be suddenly and ^vorably changed. 

There are fundamental opinions that must be modified to accord with the progress 
of international sanitation, not the least important being, what constitutes a person 
ijomune to yellow fever to-day? Formerly, aside from having suffered an attack of 



PT7BLI0 HBALTH AND MB P lOlHI t 105 

tbe disMse, ih^ fact of having lived for 10 co Me c a tive yetn in a well knofwn yeUow 
frrer focoa, waa considered saffident evidence of immunity. Theee fod having 
pcacticaUy difl^ipeared the increase in the popobAlon since the diseaae waa eradicated 
from there, metns a nonimmune element that is growing with the years <A indemnity 
whidi the locality may enjoy, at the same lime that it makes so mudi keener and 
more dreadful the danger of a reintioduction of the infection and thus demands that 
it be more carefully guarded against. 

We can no longer look upon ships coming from ports where yellow fever may be 
pteaent only, with the same suspicion that in epidemic times they formerly inspired, 
since the decrea se in the chances of their infection should in justice be considered 
favorable to them and permit lees restraint in the quarantine measures, that are now 
applicable if compliance with the letter of the law must prevail over good judgment 
and a sound sanitary policy. 

Althou^ there is no room for discussion as to what constitutes an infected vessel, 
inasmuch as only one having the disesse on board or within seven days after leaving 
port can be so considered, the question as to what circumstances should warrant the 
term "suspected vessd" when applied with reference to yellow fever is one that must 
be further eluddated. I think the definition as made by the last International Sani- 
tary Conference in Paris (1911), in acceptable then, ou^t to satify the majority of 
my hearers now, more so, in face of the present status of yellow fever in America. 
''A vessel is considered suspected (or suspicious), when it has had cases of * * • 
yellow fever on board at the time of departure, or during the voynge, but no new cases 
lor seven days." 

In connection with the whole subject of international prophylaxis, it becomes urgent 
tiiat exact and early diagnosis and prompt notification of cases be made. Only thus 
can a feeling of confidence be maintained that will be condudve to a better imder- 
standing between the various governments interested. 

I firmly believe that within a short period of time, as time is measured in the history 
of the world, yellow fever, if it was not so originally, will be relegated to the condition 
d an African disease; that it shall be endemic only in the semidvilized states of the 
Central Zone, which, regardless d what we may hope or strive for, shall continue to 
be for many decades, if not the white man's ''grave" at least a peril to the white 
man's final settlement there. 

Having taken a small part in its undoing, I find it the source of greatest satisfaction 
to witness the final passing away of this terrible scourge. 

RSFSBSNCB8. 

1. Conference Sanitaire Intematbnale de Paris. Proces vorbaux, 1912. 

2. Apuntes aobre la Histoda Pkimitiva de la Fiebre amarilla, Dr. Carlos Finlay, 
Habana,1884. 

8. Dicdonario de la Ida de Cuba. Introducci6n. Pezuela. 

4. Report on the Etiology and Prevention of Yellow Fever. G. M. Sternberg, Wash- 
ington, 1890. 

6. Reports, first and second, d the Yellow Fever Commission, (West Africa), Lon- 
don, 1914. 

6. Public Health Reports, United States Public Health Service, Washington, 1915. 

7. Yellow Fever Bureau Bulletin, Vol. Ill, No. 4, Aug. 1915. 

The Chairman. A brief paper under the title of ''Liceaga and 
yellow fever'' has been prepared by Maj.T. C. Lyster, of the United 
States Army, and will now be presented as a discussion of the paper 
by Dr. Agramonte. 



106 PBOOEEDINGS SECOND PAK AMEBICAN SCIBIHIFIC C0NGBB88. 

UCEAGA AND YELLOW FEVER. 

By ICaj. T. 0. LYSTER, 
OffiM o/th$8wrgeon Oemral^ War Department 

We have seen in the last 12 yean the yellow f<»ver endemic centers shifting farther 
south, and cities, such as Habana, Panama, and Vera Cruz, have lost their unenviable 
reputation. There is now remaining but one endemic center (Yucatan) in the North 
American Continent. We know the work that has been done by Americans, but 
it may not be known to all of us here the noble part played by one of the great men 
of Mexico, Dr. Liceaga. There is a country which needed and still needs men of 
his high character, to bring up a greater Mexico, after all these years of strife and deso- 
lation. 

It was my good fortune to have access to records and official letters bearing on sani- 
tary matters concerning Vera Cruz for the last 15 years. Had T the talent for biogra- 
phy, the literature showing the reasons for the widespread knowledge of yellow fever 
would surely be enriched by a detafled history of the relations of Licesga to the excel- 
lent sanitary work which has been done in Mexico. A man can not be really jn^eat 
unless he is sincerely modest and wins his countrymen through tbeb love and affec- 
tion, as well as by their faith in his ability. liceaga had, and still has, the active 
support of those who were working disinterestedly for Mexico, and is idolized by 
those who serve under him. 

As early as 1903 Liceaga had submitted a comprehensive plan for the elimination of 
yellow fever from Mexico. Native lethargy in endemic centers, such as Vera Cruz, 
together with an acquired immunity to yellow fever, and indifference in the City of 
Mexico, on account of geographical immunity, were the most di.-ficult of sanitary 
obstacles to overcome. 

Liceaga believed that the immunity of those in Vera Cruz was acquired in an 
unrecognized form of yellow fever in childhood. Uis letters to the health authorities 
iA Vera Cruz put emphasis on the control of all doubtful and ill defined forms of fever. 
Funds were provided both by Vera Cruz and the Mexican Federal Government to 
eliminate yellow fever. As a result, we found Vera Cruz in May, 1914, after three 
years of internal war&ure, not only free from yellow fever sini^ 1909, but also provided 
with an annual appropriation of nearly 52,000 pesos for preventive yellow fever 



We found evidence of how other money was spent, and wisely spent. We found a 
city well paved and lighted, good sewerage, and an excellent water supply for a normal 
population of 35,000 to 40,000. These were the results of sani tary education, and made 
possible by such men as Liceaga as the heads of Mexican national affairs. We also 
found a network of outlying drainage ditches which only necessitated clearing out 
and extension to make diem thoroughly effective. 

By enforcing his plans for the destruction of breeding places both within and with- 
out the city. Vera Cruz became practically free from mosquitoes and thus insured 
against the spread of yellow fever. 

While the elimination of yellow fever from Vera Cms was but one of Licea^'s 
many sanitary achievements, it was a most worthy one and all America should be 
proud to claim him as one of the brilliant products of the Western Hemisphere. 

The Chairman. I shall now call for the next paper, ''Carlos Finlaj 
on the house mosquitoes of Habana," by Mr. F. Enab, of the Bureau 
of Entomology, United States Department of Agriculture. 



PUBUC HBALTH AISTD MEDICIKE. 107 

CARLOS FINLAY ON THE HOUSE MOSQUITOES OF HABANA. 

By FREDERICK KNAB, 
United Siatea Bureau of Entomology, 

Historical accounts of the discovery of the agency of the mosquito in the trans- 
mission of yellow fever usually minimize Dr. Finlay's share in the work. This is 
largely attributable to the tendency of more recent writers to content themselves 
with statements obtained at second hand. In consequence it is not generally appre- 
ciated that Finlay's theory resulted from deductions based upon the closest observa- 
tioQ. We frequently find the earlier suggestion of Beauperthuy mentioned together 
with the theory of Finlay, whereas their ideas were totally different. The former 
thought that mosquitoes caused yellow fever by inoculating man with poisonou- 
substances extracted from swamps and foul places. It is not even clear that Beaur 
perthuy distinguished between the yellow-fever mosquito {AUdea caloyus) and othes 
similarly marked species occurring al>undantly along the coast, such as Akki trniwr* 
h(/nchu», 

Finlay , from a close study of yellow fever, had become convinced that it is not trans- 
utted in the manner of ordinary contagious or infectious diseases. He was *' con- 
vinced that any theory which attributes the origin and the propagation of yellow 
fever to atmospheric influences, to miasmatic or meteorological conditions, to filth 
or to the neglect of general h>'gienic precautions, must be considered as utterly inde- 
fensible." In his conception there was concerned some virus or microOiganism in 
the blood and that this was transmissible from man to man solely through the agency 
of some blood-sucking insect. This naturally led to mosquitoes. He found two species 
of house mosquitoes at Habana, known to him under the Latin binomials respect- 
ively of Ctdex moBquito and CuUx euhennt. The former is the species now generally 
know under the names Aides calojms or Stegomyia fasciatci; the latter is the species 
better known under the names Culex quinquefa^ciatus and CuUxfaHgam, Finlayin 
studying these two species found such marked differences in habits that he was able 
to eliminate CuUx eubenns (quinquefaseiatus) and incriminate the species which was 
afterward proved to be the transmitter of yellow fever. He pointed out the character- 
istics of Culex moBqidto (^Akles calopus) which are essential to its rdle of transmitter. 
In his paper read before the Royal Academy at Habana in 1881, "El mosquito hipot^ti- 
camente considerado como agente de tran6miBi6n de la fiebre amarilla,'*^ are to be 
found recorded all the important details in the life history of the yellow fever moe- 
quito which were afterward brought forward in more elaborate form by the French 
commission to Rio de Janeiro, by Goeldi, aud by other workers. 

Finlay clearly understood the domestic character of the two species of house mosqui- 
toes. He contnk^te their habits, pointing out the bearing of the dififerences on the 
question of transmission. Cidex cubemis is strictly nocturnal, and according to his 
observations, if not interrupted during feeding takes but a single blood meal.* He 
was never able with captive females "to obtain a second bite, whether it had or had 
not laid its o^a.*' As in the European CuUx pipiens the eggs are all laid at one time 
in a mass directly upon the surface of the water and the death of the female follows 
shortly. "After having laimched their little boat of eggs, they often stretch them- 
selves out to die upon the water, and I have wondered whether the dead insects 
which R^umdr attributes to new-bom ones which have been wrecked and drowned 
at the moment of leaving their pupa shell might not be the cadavers of mothers who 
had died in order that their bodies should remain close to the ova so as to contribute 
to the feeding of their progeny." 

> Anales R. Acad. Clendas med., fls. y n«t., Habana, vol. 18, pp. 147-160 (Aug. 14, 1881). 
* Thb statameiit Is not altogether correct. This species feeds at less frequent intervals and, for the rea> 
SOBS Indicated by Finlay, is shorter lived under normal conditions of activity. 



108 PB0GEEDIKG8 SECOND PAH AMEBICAK SOIBirTIFIO C0KQBB88. 

Finlay inBistB that Cukx mosqtdto is a strictly diurnal mosquito. The finale 
must have blood for the development of her ova and begins to suck blood after having 
been fertilized. The eggs are not all developed at once and are deposited at intervals 
in groups of from 9 to 15. They are sometimes placed upon the water and at others 
''upon solid bodies not too far removed from the level of the water, so that a moderate 
elevation of that level will allow the water to cover them." Accordingly this mosquito 
is longer lived and requires and takes repeated blood meals at intervals. A female 
kept alive for 31 days fed 12 times during that period. Finlay points out that these 
repeated blood meals are an important postulate for disease transmission: 

Evidently from the point of view which 1 am considering the Culex rnosquito is 
admirably adapted to convey from one person to another a dieeape which happens 
to be transmissible through the blood; since it has repeated opportunities of sucxing 
blood from different sources and also of infecting different persons, so that the proba- 
bilities that its bite may unite all the conditions required for the transmission will 
thereby be greatly incrc^tsed. 

The sluggishness of this mosquito after a blood meal and its unwillingness to under- 
take long flights are discussed at some length and their significance in relation to the 
peculiar manner of spread of yellow fever pointed out. The often noted failure of the 
disease to spread beyond narrow limits when no appreciable barrier appeared to exist 
found a ready explanation in the reluctance of the mosquito to leave the house where 
it had fed . On the other hand the outbreaks of yellow fever at distant points could be 
explained by this same sluggish habit of the mosquito, its tendency to hide causing 
it to be carried long distances in baggage and clothing. 

The importance of all these i>oint8 has since been fully recognized and discussed 
at length by many workers in the field of yellow fever investigation. However, but 
few even of the best informed authors have realized that Finlay clearly understood 
and discussed them about 20 years before the question of the mosquito transmission of 
yellow fever was definitely settled by the immortal work of the United States Army 
commission. 

Dr. AoBAMONTE. I do not wish to decry the great glory that is due 
to Dr. Finlay. At the same time I believe we should not forget the 
work of a man who was a pioneer in the same line of investigation, 
since his conception of the transmission or the propagation, as he 
called it, of yellow fever deserves consideration. Beauperthuy was 
traveling aroxmd as early as 1840 with a microscope examining his 
patients — the skin, the excreta, the urine, etc. — things that at that 
time were only imdertaken by a man who really had great scientific 
enthusiasm and devotion to his medical practice. While he did not 
point to the transmission of yellow fever by the mosquito, he very 
directly mentions in his works that if there were no mosquitoes there 
would be no yellow fever; and he mentions, for example, the town 
and the island of Guadeloupe, in which there were great numbers of 
mosquitoes and in which yellow fever prevailed, whereas only a league 
away in an inland town where there were no mosquitoes yellow fever 
was not usually developed. Now a great many points in the history 
of this man Beauperthuy, I believe, are worthy and we should treat him 
with greater respect. I mxist take exception to the attitude taken 
by Dr. Eoiab and express my belief that his remarks were unjust in 
trying to show that his work was valueless. It was so only so far 
that it was published and buried, as usually has been the case with 
the work of our tropical investigators. In this manner Dr. Finlay's 



FUBUO HBALTH AHD MIDIOIHB. 109 

work was buried. For 20 years he defended a theory that he could 
not demonstrate, and I am sure that if he had lived in a different 
'Country, where such work was better appreciated, his worth and the 
value of his work would have been sooner apparent. 

Dr. Carter. I certainly agree with Dr. Agramonte in hoping that 
we shall soon see the end of yeUow fever. I also agree with him in 
saying that the endemic foci are becoming fewer and fewer. The 
greater ones have already disappeared. But along with the safety that 
that gives us it introduces a certdn element of danger. There are a 
great many places that used to be endemic foci of yellow fever, or 
partially endemic foci, into which the introduction of yeUow fever in 
days gone by made practically no difference, the population being 
whoUy or largely inunune to yeUow fever. As time has gone by, the 
proportion of susceptible people is becoming greater and greater. 
Take the town of Habana. In 15 or 20 years the introduction of 
yellow fever there, if there were any reasonable number of stegomyia, 
would spread as it used to do in New Orleans. We have to look at 
the thing then from two points. I wrote a memorandum to the 
health officer of Porto Rico and to the governor, stating that the town 
of San Juan was in a dangerous condition; that there had been no 
yeUow fever there for about sixteen years and they were raising up 
a susceptible population; that it was not possible for any maritime 
quarantine, comparable with any reasonable commercial advantages, 
to keep out yeUow fever eventually from such a place; that it was in 
a worse condition than New Orleans, where yeDow fever will spread 
only six months in the year, whereas in San Juan it will spread 12; 
and that it was necessary for them to do antistegomyia work. 

Instead of being too hopeful we should be, not by fear but by 
hope, stirred up to introduce into the Tropics antistegomyia work 
now. The fact of a disease being on the run is to my mind rather 
a reason for attacking it. Twenty or 25 years ago plague was con* 
fined to a small section in south China and I believe that four or 
five millions would have stamped it out; I do not believe a thousand 
millions would now do so. We have yeDow fever now in but a few 
places and it seems to me that we should not belittle its threat. Its 
threat is greater because it is in a few places. Its threat is greater 
because many places are becoming filled with susceptible people that 
were not susceptible then. 

One word in regard to quarantine. That is a big subject. It 
should be made, as Dr. Agramonte says, without any consideration 
of the rules that were in force prior to 1901. That is true; that is 
correct. It is absolutely right that oiur war is against the mosquito, 
not against fomites. Many of oiur rules, however, were founded on 
experience and, though empirical, hold good still; and I can not 
think that the rules of the Paris convention have any foundation in 
reason or experience or correct theory. I can not think that a ship 



110 PBOCEEDINGS SECOND PAK AMERICAN SCIENTIFIC CONGRESS. 

that has had no case of yellow fever aboard for seven days is simply^ 
suspicious. Why the ship may be loaded with stegomyia that have- 
had no opportunity of showing their infectivity after, say, 17 days — 
12 plus 5. The time element cbes come in, but the time element 
scarcely enters in in counting a ship immune against yellow fever. 
Unless I am mistaken, one has recently come to your port, Dr. 
Ouiteras, that had been out many more than seven days, and when 
conmiencing to load developed ycdlow fever. 

Dr. GuiTEBAS. Many more than seven days. 

Dr. Carter. I know well that in 1911 one went from Acapulco 
to Honolulu and that, when commencing to unload, yellow fever 
develoi>ed and a case developed later on in the interior. They had 
carried yellow fever as much as four weeks. To my mind time can not 
be counted as freeing a ship from stegomyia tmless you coimt a very 
long time. 

I also think, and I have preached it all my life, that quarantine 
must be used only for protection; and yet I remember Dr. Liceaga 
saying that he was able to get sanitary measures down in Vera Cruz 
partly by showing the effect that the brutal quarantine of Carlos 
Finlay had upon their commerce; that if they rid themselves 
of stegomyia and of yellow fever it would greatly diminish their 
commercial obstacles. I think, then, to be easy on the places that 
will not free themselves from yellow fever may be an injury to them 
as well as a risk to ourselves. 

There were further discussions in Spanish of this paper by Dr. 
M. G. Lebredo, of Habana, Cuba, and Dr. Rafael Gonzalez-Rin- 
cones, of Caracas, Venezuela. The discussion in Spanish was not 
reported. 

The Chairman. If there is no further discussion, I shall now call 
for the reading of the following papers: 

Consideration sur la fiftvre dite "Fiftvre de fruits," by Dr.C.Mathon 
and Dr. L. Audain. 

La profilaxia de la fiebre tifoidea por medio de la vacunaci6n, 
by Dr. Justo F. Gonz&lez. 

La Buba (Leishmaniosis Americana), by Dr. L. E. Migone. 



CONSIDERATIONS SUR LA nfiVRE DFTE "FlfiVRE DE FROTTS.'*' 

Par C. MATHON, 

ProfesBewr h la FaculU de Mideeine de Part^M-Prinee^ J7aUt, 

et L. AUDAIN, 

Direeteur du Laboratoire de BacUriologie de Port-au-Prinee^ HtAti. 

Lee aliments et les boisBons que nous in^^rons sont Buseepti^ les d/introduire dans 
notre organiame dee maladies plus on moins sm es. L'appareil qui est le plus expose 

1 Cettt ll^vre que Its Indigtaes attribuent ftux frulu wt bien oertaintment d'orlgtaie intesttnile oomns 
en ftJt fol r^tttde cUnlqne que nous allons encreprendr*. 



FUBUO HBALTH AKD HEOIGINB. Ill 

-k ces maladies est, saas contredit, k cause mdme de see fonctioiis phyiiologiques, 
I'appareil digestif. Aussi, rhjrgi^niste a-t-ii pour de oir de d^truire, par tous moyens 
-en son pou-. oir, ces gennes, a\ ant leur penetration dans le tuhe digestif et de maintenir 
I'oiganisme en bon ^tat de defense, afin que par ses seuls moyens ii arrl.e k lutter 
victorieusement contre les germes qui peu ent Ten ahir. 

Mais, a^ant d'entreprendre un tel ou.rage ie m^decin hygieniste doit connattie, 
-dans ses moindres details, riustoire clinique de ces maladies. 

U existe en Haiti, tant6t k I'etat endemique, tantdt k I'etat epid^nique une maladle 
infectieuse d'origine intestinale dont je Aais faire ici une courte etude clinique, 
d'ailleurs indispensable pour la direction intelligente d'une honne prophylaxie. 

S'il est vnd que les ententes pro oquees par une hygiene alimentaire defectueuse 
ont ete etudiees de temps immemorial, il est un fait incontestalle, c'est la grande 
-confusion qui existe encore dans la classification et mftme dans la terminologie de ces 
affections. Quand on dit d'un malade qu'il est atteint de meningo encephalite 
<;hronique diffuse, chacun comprend et il n*est plus rien k dire; mais, quand on dit 
d'un malade qu'il est atteint d'enterite, de d3^senterie, de diarrhee erte, de diarrhea 
de Cochinchine, etc., on n'en isage qu'un cdte de la question que Thabitude seule 
nous permet de comprendre, sans qu'il soit donne en aucune maniere de voir la cause 
premiere de la maladle, Tinflammation, ni le si^ de TinHammation. 

Des considerAtions d'ordre anatomo-pathologique, symptomatique et pathogeni- 
que nous ont permis en Haiti, sous I'impulsion de notre Mattre Audain, de condderer 
-et de denommer les affections gastro-intestinales des pays chauds, comme on fatit 
pour toutes les autres maladies. La nouvelle classiilcation d 'Audain est trte simple, 
comme chacun pent s*en convaincre. 

II faut considerer avant tout qu'il existe du cdte du tube intestinal deux appareila 
bien distincts: Tappareil glandulaire et Tappareil lymphatique ( aisseaux et tissus 
adenoldiens) qui, pathologiquement, reagissent d'une fa9on speciale, et, clinique- 
ment, d'une fa^n absolument differente. La cause pathologique porte-t-elle see 
effete sur le syst^me ^andulaire? Vous aves une inflammation des glandes iatesti- 
nalee et les symptdmes d'une entente glandulaire. 

Agit-elle sur la partie lymphatique de Tintestin? Vo\is a^es, sui ant que cette 
action reste localisee aux lymphatiques, une lymphangite intestinale comparal le k 
la l3rmphangite simple des mem) res, sans retentissement ganglionnaire important. 

Cette action s'etend-elle au tissu lympholde de Tintestin? Vous vous trou es en 
presence encore d'une inflammation: lalymphango adenoTdite intestinale ou enterite 
lymphatico-adenoldien, comparable a la lymphangite des membres a\ec adenite 
aecondaire. 

A. II existe, au i>olnt de vue anatomique, une grande analogie entre la peau et 
Vintestin. Les differences de structure que nous obser ons entre le derme interne 
et Texteme ne tiennent qu'i leur rdle phyoiologique different. Du cdte de la pea«, 
couche epidennique pl\is ou moins epaiase, plus ou moins dure sui ant le si^. Da 
cdte de rintestin, couche de cellules cylindriques, epitheiiales, cellules calcifonnei^ 
leucocytes. Au-dessous de la couche epidermique sous-cutanee se trou e la couche 
papillaire riche en vaisseaux sanguins et lymphatiques et surtout en f lets ner eux. 
Pour rintestin, au-dessous de la couche epitheiiaie, couche des \ iUositee, sorte de 
papilles sdllantes. Chacune des villosites posikle: une arteriole, une \ einule et, de 
I'une k I'aute, un reseau capillaire tr^ ridie. Le centra de la \ illosite est occupy 
par un lymphatique special, dit chylif^re. La villosite est compietee par une char* 
pente de tissu conjonctif et dee faisceaux musculairas horisontalement places et 
leUes par des fibres anastomoiiques o' liques. 

Pour la peau, les lymphatiques niissant au tiers da la hauteur des papilles par ua 
Cttl de sac ou una extremite affiiee. (Is aboutiasent k un reseau sous paifnllaira dani 
las mailles sont meiees k cellas des reseaux vasculairse sanguiaa de la region. De 
cel«i-ci partent das troaca i^ua voluBainattxqai aa randanl au reaeau da tlasu oallula* 
adipeux aous-cutane. 



112 PBOCEEDINQS SBOOKD PAK AMEBIOAK SCIBKTIFIC C0KQBE8S. 

Pour rintestiix, les lymphatiques nainent de deux sources diff^ntes: des villosit^ 
(vaisseaux chylif ^res) et de la tunique musculaire. ' ' Les canaux chylif^res se rendent 
directement dans la muqueuse en passant entre les glandes de Lieberkun, ou bien 
ils fonnent d'abord un r^seau horizontal superfidel situ6 k la base des villosit^ et 
autour des orifices glandulaires. Dans la tunique sous-muqueuse, les chylif^res 
constituent, en se r^uni^sant. un r^seau tranffv ersal form^ de conduits, tantdt Straits, 
tantdt larges; ces conduits accompagnent les vaisseaux de r^seau sanguin autour 
duquel ils fonnent mdme des gaines." Jusqu'id Tanalogie est trte giande entre \m 
lymphatiques de la peau et ceux de Tintestin. Les diff^nces qui existent pnr. ien- 
nent surtout, d'une part des modifications qu'a dd subir Tintestin pour assurer la 
progression du chyle (fonction motrice) et d'autre part pour pr^ser v er Torgamsme tout 
enUer des dangers qui Teussent & tout moment menace du fait m^me de la fonction 
•p^ciale de Tintestin: I'intestin est un puissant laboratoire de poisons, il est aussi 
un formidable reservoir de dangereux microbes. 

Du cdt^ de la peau, le syst^me lymphatique est d'une grande simplicity, parce que 
r^piderme offre une resistance infranchissable aux germes pathogi^nes moins nom- 
breux et surtout en contact moins intime avec les tissus. 

Pour les intestins, les dangers ^tant plus nombreux et constants parce que P^pi) 
thelium intestinal est beaucoup plus d^cat et plus fragile que T^piderme sous- 
cutan6, la nature dans sa sage pr^. oyance a multipli^ les ouvrages de defenses: 
ganglions mtent^ques, rlchesse de tissu lympholde du chorion, folUcules clos isol^ 
follicules agmin^, tons organes dont la structure est analogue k celle des ganglions; 
leur rdle est le mteie. 

Au point de vue de la physiologie g^^rale de Tintestin, qu'un germe p^n^tre, soit 
k tra^ ers T^pith^um sain, soit par effraction de cet 6pith^um k tra. era les espaces 
lymphatiques que voyons-nous: les leucoc}rtes migrateurs se portent k sa rencontre et 
la bataille s'engage; qu'il p^n^tre dans le r^seau lymphatique, le \oUk cheminant \en 
les follicules clos et les plaques de Peyer oti la lutte est encore plus \ iolente. Ge 
processus de defense toume parfois au detriment du folllcule ou de la plaque de Peyer. 
Pour mieux faire face k I'ennemi, la nature redouble d'efforts, les vaisseaux sanguine 
se congestionnent, les leucocytes se tassent, les tissus se compriment, des abcte se 
fonnent qui s'ouvrent g^n^mlement dans Tintestin, d^terminent des ulcerations 
plus ou moins etendues ou bien des eschares se produisent, s'^liminent, ocrairionnant 
des pertee de substances fort grandes. 

En resume cette courte etude nous permet d'avancer que (en mettant de cdte les 
inflammations ganglionnaires primiti-. es qui doi\ ent dtre plac^es dans un cadre special) 
la plupart des maladies se . ^res microbiennes ayant pour si^ Tintestin debute par 
une lymphangite. L'analogie se poursuit done m6me au point de vue pathologique 
avec ce qui se passe du cdte de la peau: lymphangite localisee, lymphangite plus eten- 
due determinant la tume&ctlon des follicules et plaques de Peyer, comme on voit 
une lymphangite de la jambe, par exemple, produire la tume^tion des ganglions 
de Paine; suppuration de ces organes comme pour ces ganglions; eschares k cause de 
leur structure spedale. 

En resume, le premier acte de toute attaque microbienne de Pintestin est done 
une lymphangite. Lorsque celle-ci n'est que de moyenne intensite, qu'elle n'en- 
tratne pas Pulceration des follicules, la situation est claire; la maladie e^. olue comme 
une lymphangite ordinaire. 

Si, au contraire, la lymphangite est d 'intensite plus grande que les germes franchia- 
sant le syst^me lymphatique intestinal, que les ganglions mesenteriques soient im- 
puissants k les arrdter, la fi^v re toxhemique intestinale devient une infection \ eritable 
qui peut etre eberthienne, choierique, tuberculeuse, etc. 

G'est se basant sur ces conBiderati<ms qui viennent d'etre expoeees et s'appuyant 
iur des observations cliniques, hematologiques et bacteriologiques que le Docteur 
Audain a propose la classification suivante des maladies intestinales; dasrificadon 
qui est generalement admiae en Haiti: 



PUBUO HEALTH AND HXDIOIHB. 113 

1. Lymphangite intestmale ou ent^te lymphatique, caract^ris^ cliniquement 
par un acc^ de fi^vre unique ^v^ durant une p^riode de 24 li 36 heures; aprte quoi 
tout rentre dans Poidre. 

Get BcckiB de fi^vre pent faire penser k du paludLame; mais il n'existe jamais de 
parasites dans le sang. Cette mioladie pouirait dtre identifi^ avec la fi^vre dite 
^ph6m^ des auteuis. 

2. Lymphango-ad^oldite intestinale ou >ent^rite lymphatico-ad^noldienne, carac- 
tdris^e par une fi^vre tantdt intermittente, tantdt r^mittante ou continue, d'o(i la 
Bous-diviabn en forme l^^re, moyenne et grave. Cette demi^re ayant toutes les 
allures de la grande tjrpholde des pays temp6r^; mais la 6^ro-r6action de Widal, de 
m6me que la diazo-r^tion, reste native dans tout le cours de la maladie, dont la 
dur^ est de 12 ii 30 jours. Notons ^alement Tabsence totale de parasites de Laveran. 
Mais, ce qui est int^ressant de noter dans ces cas, c'est la reaction sanguine. 

A. Dans la premiere forme, elle est caract6ris6e par de la leucocytose polynucl^aiie 
decourte dur6e(12^24 heures) et suivie d'une mononucl^ose tr^ fort6(60 k 90 pour 
cent). 

B. Dans la forme 1^^ ou moyenne, il y a toujours une dissociation entre les deux 
focteurs: facteur leucocytaire faible et facteur mononucl^aire fort ou inversement. 
En tout ^tat de cause, la mononucl^ose est toujours moins €ie\6e que dans le cas 
pr^Ment. 

C. Dans la forme grave, les deux facteurs sont faibles: h3rpoleucocytose et hypo- 
mononucl^ose ou formule leucocytaire normale. Ce n'est qn'k I'approche de la 
garrison que les deux facteurs se reinvent ou mdme un seul, ordinairement la mono- 
nucl^ose. 

8i je ne craignais d'outrepasser le cadre assign^ par le Gongr^, je m'^tendrais davan- 
tage 0ur les conditions biologiquee qui r^^issent ces diverses vari^t^ d'entMte. Mais, 
c'est I'^tude ^tiologique surtout qui doit nous arrdter un instant, car c'est elle qui con- 
ditionne les indications que doit remplir Thygi^niste. 

Abstraction faite de Tent^te glandulaire, dont Tune des principales causes reside 
dans la d^fectuosit^ de Thygi^ne alimentaire, et qu'on 6vitera en recommandant une 
alimentation saine; les ententes lymphatiques, elles, reconnaissent pour cause la 
penetration dans les lymphatiques intestinaux et le d^veloppement intensif de cer- 
tains microbes, soit par suite de leur grande virulence, soit par suite d'une defense 
ivganique faible, nulle ou tardive. 

Cette penetration est f avorisee par les eraiUures, si petites soient-elles que peuvent 
Iffoduire les corps etrangers fins, pointus ou tranchants: aretes de poissons, * * * 
larves de vers qu'on rencontre dans certains fruits. Ces larves en penetrant dans 
rintestin produisent des eraillures ouvrant par ainsi des portes d'entree aux divers 
agents microbiens qui stationnent dans cet oigane. Mais ce que font ces larves d'autres 
helmintes qui ont pour habitat Pintestin peuvent aussi le faire. Les ascaris lombri- 
coldes si puissamment armes, les trichocephales qui s'enfoncent par leurs extre- 
mites cephaliques dans la muqueuse intestinale; le strongylus, Pundnaria duode- 
nails qui vit en grande quantite dans I'intestin greie de Thomme, implante sur la 
muqueuse o(i il produit de petites hemorrhagies, les vers du fromage (larves de Piophila 
casei) pourvus de crochets aceres, peuvent, ^ n'en pas douter, produire la porte d'entree 
necessaire k I'invasion microbienne. 

En Haiti la croyance populaire est que certains fruits (cirouelles, mangues, sapo- 
tilleB) sont susceptibles de provoquer une fi^vre que Ton designe pour cette raison 
sous le nom de "fi^vre de fruits." Cherchant si quelque part de verite pouvait se 
cacher sous cette crojrance populaire, j'ai constate que, reellement k I'epoque des 
Iralts, il existait dans les selles des enfants surtout un certain nombre de vers vivants. 
Etudies au point de vue de leur armature, ces vers, ainsi qu'en fait foi la description 
•uivante, sont puisBamment armes. 



114 PBOGEEDIKGS SECOKD PAK AMEBIOAK 8CIBNTIFI0 00KQBE8B. 

La larve d'une longueur d'un centiiatoe, de couleur blanche, poesMe, au niveau 
de rorifice buccal, une paire de crochets ac^r^ dont voici les caract^ristiquee: de 
la base k la pointe 384/ii. L'armature est form^ de deux partiefl, Tune rectangulaire 
a une longueur de 204/ii but ime lazgeur de 60/c. Lee deux angles sup^rieurs de ce 
lectangle sont surmont^s de deux pointes ayant Tune 48/c et Tautre 60/c. A cette 
partie rectangulaire s'ajoute le crochet proprement dit, incurv^ sur lui-mtoie de fa^on 
i former un bord interne tr^ concave, {^a longueur de ce crochet est de ISO fi, 

Je ne crois pas qu'il soit possible de mettre en doute le Me des vers intestinaux dans 
la production de la lymphangite intestinale: il faut seulement se dire que les vers 
n'agissent pas par eux-mdmes, mais par les lesions qu'ils d^terminent et Tinfection 
qui en pent r^lter. La prince de ces vers est grande en Haiti. La statistique du 
Laboratoire de Bact^ologie de Port-au-Prince accuse 50 pour cent. C'est bien cer- 
tainement Ik Tune des causes les plus s^rieuses des diverses vaii^t^s d'ent^te lym- 
phatique qui font tant de ravages dans notre pays. 

Le Me des vers intestinaux, bien que secondaire, n'en est pas moins important. 
Aussi, Targument qu'on oppose parfois d'individus ayant des vers et ne faisant pas de 
pouss6e d'entdrite lymphatique n'en est pas un. Que d'^raillures de la peau non 
suivies de lymphangite I L'organisme qui se defend a vite fait de d^truire les microbes 
et, par une infranchissable bani^re de leucocytes, d'ext^ioriser une plaie jusqu'ii 
cicatrisation complete. 

O'est k la favour de Peau de boisson, des l^mes non cuits que les oeufe d'helminthes 
et les larves de fruits p^n^trent dans I'intestin et s'y d^veloppent. Leur seule presence 
ne suffit certes pas pour provoquer la maladie; d'autres conditions sont requises. II 
faut qu'ils aient produit des ^ndllures d'une part, et d'autre part que I'individu soit 
en 6tat de receptivity. C'est pour cette demi^re raison surtout que tous les porteuis 
de vers ne sont pas atteints de fi^vre. Les conditions de receptivity ou de non-r^cep- 
tivite morbide dans les infections intestinales d'ordre lymphatique peuvent %tte 
determin6es h^matologiquement, comme le d^montre Texamen d'un grand nombre de 
malades que nous avons suivis k ce point de vue. 

Voici les conclusions auxquelles nous ont conduit dix annees d'observations 
cllniques, h^matologiques et coprologiques: 

1. Dans rhelminthlase intestinale, sont k Pabri des infections de causes bactdiio- 
logiques diverses qu'occasionnent les vers arm^s, tous ceux dont la defense intestinale 
est caracterisee par la grande activity des elements lympboldes de Tintdstin, c'est-^ 
dire par une forte mononucieose en m6me temps qu'une fortd leucocytoee (associa- 
iioB de deux elements de la defense). 

2. lis sont k Tabri, tant que dure cette condition favorable, condition qui peut 
persister des ann^es enti^res, touta la vie m^me; mais il faut savoir qu'elle peut dis- 
parattre momentan^ment et pour un temps plus ou moins long. Lorsque le fait se 
produit, les individus qui ^taient en ^tat de non-r6ceptivite perdent cet etat et sont 
susceptibles d'etre infect^s. 

3. Lorsque Tun des elements de cette bonne defense faiblit, par exemple, qu'au 
lieu de rbyperleucocytoae, il se fait de la leucop^nie avec mononucieose ou inverse- 
ment, Tindividu est susceptible d'etre infects. 

Point n'est besoin d'etemiser cette lutte entre hygienistes et parasitolpgues. Le 
Professeur Chantemesse a bien raison de vouloir que Ton ne boive pas d'eau cental 
min^e, paice que s'il n'existe pas d'Eberth dans Tintestin. la typhotds ne pourra pas 
se produire, mdme en presence d'une eralllure intestinale. Mais les professeun 
Blanchard et Guiart ont raison de recommander la destruction des vers intestinaux, 
parce que mdme si TEberth existe dans la cavity intestinale, la fi^vre typbolde ne so 
declarera pas en Tabsence d'^raillures produites par les vers intestinaux. Ces der- 
niert surtout sont une des causes les plus puissantes de la maladie. 

En resume il faut se mettre k Tabri des causes vuln^rantes capitales puisque suis 
elles la penetration microbienne est, sinon impossible, du moins trhe difficile, et so 



PUBLIC HEALTH AND MEDIOIKB. 115 

floavenir que ai <m peut k la rigueur emp^her la typhoide de se d^velopper par lea 
pr^autions hygi^niques, on est d^sarm^ en presence du colibacille, hdte normal de 
Pintestin, cause probable de la plupart des ent^rltes lymphatiques ou lymphatico- 
addnoi'diennes dont nous venons de faire T^tude. — ^Audain: Fi^vres Intertropicales. 

Dans de telles occurrences, quel devra 6tre le rdle de I'hygi^niste? Quelles mesures 
prophylactiques doit-on recommander pour arriver k un r^sultat satisfaisant? 

Deux indications sent k remplir: 

(a) Chez les indivldus d^jk atteints, suppnmer tout apport nouveau de poison 
dans Toiganisme, ce que Ton obtiendra par un regime di^tique s^v^re; augmenter 
par tons les moyans en notre pouvoir la d^ense oiganique (MMication leucog^e), 
travailler par consequent k fortifier la puissance phagocytaire des globules saDguins. 

(b) Chez les non-infect^, empdcher 1' ingestion des eaux pollutes, des legumes non 
cuita, de certains fruits arrive k une maturity trop avanc^, autant d' elements qui 
constituent les principaux vecteurs d'oeufs de vers; maintanir Toiganisme en bon 
^tat de defense, afin que, par ses seuls efforts, il puisse arriver k d^truird les germea 
qui, malgr^ tout, auraidnt pu Tenvahir. Surveillez par consequent que sa resultante 
leucocytaire soit normale. 



LA PROFILAXU DE LA FIEBRE TIFOmEA FOR MEDIO DE LA 

VACUNACION. 

For JU8T0 F. GONZAlEZ. 
Profesor Agregado de Baeteriologia e Higiene de MantevideOj Uruguay, 

La fiebre tifoidea tlene car&cter end^mico en la Keptiblica del Uruguay, y ademds 
empujes nuurcados durante el verano y al otofio. Declina en los restantes meses del 
afio. 

Obs^rvanse en nuestro pals los preceptos generales de profilaxia, para evitar el 
desarrollo de la enfermedad de la cual vamos a ocuparnos y que incluimos en el grupo 
de las infeccionesde origen hfdrico, no obstante la dificultad que presenta, la compro- 
baci6n del bacillus de Eberth en las aguas destinadas a la alimentacidn. 

La dotienenterfa sigue en nuestro pais una marcha casi invariable a pesar de los 
esfuerzos bigienicos que se realizan, con el fin de evitar la propagaci6n de la enfer- 
medad y su dasarroUo epid4mico. 

Hace unos meses, en el Hospital yi]ardeb6 de Montevideo, se produjeron varies 
cases de fiebre tifoidea entre los enfermos alH asilados y entre el personal de enfermeros. 
Comprobamos la enfermedad clfnica y bacteriol6gicamente y procedimos a investigar 
el foco inicial del mal Eberthiano. 

La investigaci6n en el agua de bebida, del bacillus de Eberth, re6ult6 negativa. 
Se sospecba entonces que el suelo de este establecimiento hospitalario, en la zona 
destinada a la plantaci6n de legumbres alimenticias, podria estar contaminado, porque 
el agua empleada para el ri^;o de las hortalizas provenfa de un pozo, es decir, de la 
nappa subterr&nea. Las verduras podrian muy bien vehiculizar el agente pat6geno 
y producir la enfermedad entre los anlados y entre el personal de servicio, que ae 
alimentaban con eaa clase de legtunbres sospechoaaa de contaminaci<Sn. 

El an41\sis bacteriol6gico del agua del pozo, no di6 el bacillus de Eberth, en cam- 
bio, ae encontr6 una dfra elevadisima de bacterias per c. c, con predominio del coli- 
bacillus. 

Entre tanto se piensa eaterilizar eee foco de contaminaci6n haciendo un eatudio m^ 
liguroao y prolijo de la nappa aubterr&nea. Pero la tarea no aiempre f&cil, no fu^ 
poaible llevarla a cabo per tratarae de una localidad urbana. For otra parte el 
68486— 17— VOL ix 



116 PROCEEDINGS 8E00KD PAK AMERICAN SCIENTIFIC CONGRESS. 

nneamiento del suelo no logra influir a veces sobre la marcha de la fiebre tifoidea en 
algunas localidadee, y sabemos lo diffcil que resulta en dertas ocaeionee llevarlo a la 
prictica. 

Luego, puee, deede el punto de vista higi^co las reglas de profilaxia general obser- 
vadas resultan insuficientee para luchar con eficacia contra la infecci6n Eberthiana. 

Es natural y 16gico que en el memento actual, que disponemos de una arma pre- 
ciosa de profilaxia, basada en la etiologia de la enfermedad, pensemos en sacar de ella 
el mayor partldo deede el punto de vista higi^nico. 

Per razones f^Udlee de comprender que entran en relaci6n con la naturalesa de este 
certamen no podemos ser extensos y dar toda la amplitud que esta cueeti6n modema 
merece. 

El agente patdgeno de la fiebre tifoidea perfectamente individualizado a pesar de la 
afinidad con otras especies microbianas patdgenas, slrve para prevenir el desarroUo 
de esta enfermedad en las colectividades amenazadas. £1 resultado obtenido en las 
agrupadones humanas, no puede ser mia sugestivo desde el pimto de vista de la 
profilaxia verdadera y racional de la fiebre tifoidea. 

En nuestro pais preparamos un material vacclnico segdn la t^cnica del Profeeor 
Vincent. El procedimiento seguido por el Profesor Camelli, jefe del Laboratorio 
Bacteriol6gico Municipal, consiste en la de8trucci6n y eeterilizad6n por el 6ter sulfd- 
lico de los bacillus de Eberth procedentes de culturas de 24 boras en agar y en la 
emulsion de ^stos en una soluci6n fisiol^ca clorurada. 

Este procedimiento representa sobre los anteriores un verdadero addanto en la 
elaboraci6n de la vacuna. 

La acd6n biol6gica de la vacima antitffica sobre el organismo bumano, es susceptible 
todavfa de mayor esclarecimiento y es de esperarse que nuevas manipuladones e 
investigaciones biol6gicas traigan aparejada ima simplicaci6n mayor en la t^cnica. 

La vacuna que be tenido ocasi6n de emplear en el Hospital Vilardeb6 con motive de 
los cases de fiebre tifoidea mencionados, es preparada con 10 espedes procedentes de 
distintas localidades de la Repdblica. Es inoculada por via subcutdnea cada 8 dfas 
basta llegar al ndmero de 4 inyecciones. El primer centimetre ctibico inyectado 
contiene 100 miUones de bacillus, que aumentan basta U^ar a 300 miUones de gdr- 
menes muertos en la tiltima inyecd6n. 

Abora bien, teniendo en cuenta que en el memento actual se tiende a admitir que 
en el protoplasma microbiano, estd d prindpio albuminoideo que deepierta en el 
organismo la acd6n biol6gica defensiva, cabe esperar que las investigadonee encau- 
zadas en esa nueva via bagan innecesaria la numerad6n de las bacterias en la vacuna 
y que derta doeis de protoplasma microbiana que contiene el prindpio albuminddeo 
dtil sea sufidente para producir en el organismo la misma inmunidad antitifica basta 
boy conseguida. 

En esta investigad6n estamos ocupados actualmente pero nada concrete podemos 
comunicar por ahora a esta distinguida asamblea. 

El nuevo criterio con que encaramos la cueeti6n de las albdminas especificas micro- 
bianas, tiene data relad6n con un nuevo producto prepaiado y ensayado contra la tos 
convulsa por d Profesw Krauss, director dd Institute Bacteriol6gico de Buenos Aires 
y conocido en el mundo dentffico por sua numerosas producdones. 

Ei Profesor Krauss ba dado a conocer la tunica sobre que reposa la a acuna, contra 
la ''coquducfae" por d obtenida. Se trata de un procedimiento andlogo al dd 
Profesor Vincent. 

Ei esputo de un enienno atacado de toe convulsa, pre\ ia inve8tigad6n bacterio- 
16gica referente al badlo de Eocb, es tratado por el 6ter sulftirico pure y agitado 
durante laigo tiempo y emulsionado con una solud6n fisiol^ca clorurada. Td es la 
tunica de la llamada impropiamente vacuna contra la coqueluche, siendo en realidad 
un producto albdmino ter&pico obtenido por el m^todo de Vincent, el cual tiende a 
generalizarse df a a df a para la obtenci6n de la vaou na antitifica. No es en vano esperar 



PT7BU0 HEALTH AND MEDIGIKB. 117 

que las alb^lminas especfficas del badllus de Eberth nos lleven a aceptar el criterio 
ebaenado para la alb^hnino-tenpia. 

£«ta aWimino-Eberih-iprofilaxui puede conducir a una nueva via de investigaddn 
paia el tratamiento bacterioter&pico de la fiebre tifoidea. 

Teniendo, pues, ana anna poderosa para combatir el deaarrollo de la infecci6n 
Ebeithiana, la idea de una proHlaxia racional y dtil tiene que acudir a la mente de Ice 
higienistas y las raaones expuestas sobie profilaxia eepedal de la fiebre tifoidea, debe 
ante todo tener per base la \acunaci6n. 

El flaneamiento del suelo, la protecci6n de orden hfdrico, la deeinfecci6n, etc., 
deben ser relegadas al s^gundo range, como auxillares o coadyuvantes de la \ acunaci6n 
pre- enti% a. 

Per lo tanto debemos difundir el valor de esta vacuna en todos los pafses de AmMca 
donde la fiebre tifoidea es una preocupaci6n de la autoridad sanitaria; y llegar a la 
Yacunaci6n ^Kniltati'. a u obligatoria segdn los casos, para defender a las colecti idades. 
La vacunaci6n en las escuelas, en los cuarteles, c&ireles, establecimientos fabriJes y 
boepitales, debe hacerse con el fin de llegar al domlnio del mal si es posiYle, o por lo 
menos a los beneficiosos resultados que para las colectiv idades ha alcanzado la \ acuna- 
ci6n anti ari6lica frente al a irus varioloso. 

En ciertas profesiones la fiebre tifoidea hace mayor nthnero de vfctimas, debemos 
tenerlo presente para conducir la lucha 16gica y racional contra el bacillus de Eberth a 
buen tannine, aconsejando en esos cases, que los sujetos comprendidos dentro de ese 
grupo de profesiones, deben ser inmunizadoe por medio de la ^ acunaci<Sn, contra la 
fiebre dotienent^rica. 

Finalizamos aconsejando la ensefianza de ciertas nociones de profilaxia entre las 
eolecti idades, desde el punto de \ ista de la higiene social, con el fin, en nuestro case, 
de difundir los deberes y derechos que tiene el indi iduo aisladamente y frente a la 
colecti \idad ante la soluci6n del problema profilictico modemo de la fiebre tifoidea. 

BBSUMBN. 

En resumen llegamos a las conclusiones siguientes: 

1. Declaramos que la vacunaci6n antitifica es un excelente recurso profilictico, para 
pieA enir el desarroUo de la fiebre tifoidea. 

2. Que la profilaxia de la fiebre tifoidea por medio de la vacunaci6n debe ser difun- 
dida en todos los palses donde la infecci6n Eberthiana es una preocupaci6n de las 
antoiidades sanitarias. 

3. Que debe aconsejarse la inmunidad antitffica para ciertas profesiones. 

4. Que la vacunaci6n, indirectamente, favorece el saneamiento del suelo. 

5. Que deben esperarse resultados andlogos a los obtenidos por la vacunaci6n anti- 
Tari6lica, por medio de la vacunaci6n antitffica. 

6. Que serA con- eniente difundir entre la masa popular, nociones sobre los deberes 
J derechos del indi iduo aislado y de la colectividad frente al problema profilictico 
modemo de la fiebre tifoidea. 

7. Que la vacunaci6n antitffica debe ser &M:ultativa u obligatoria segdn los cases. 



LA BUBA (LEISHMANIOSIS AMERICANA^ 

Por LUIS E. MIGONE, 
Pro/e$ar de la Faeultad de Medicina de Aiunci&n, Paraguay. 

Desde hace tiempo se desarroUa en el norte del Paraguay, entre los obreros de los 
grandes establecimientos industriales de esas regiones, que trabajan en la preparaci6n 

> SicAn tl aotor bntUefio, AostregwUo, 1a palabra "baba" proTleiw de 1a •IiUmdm "boaba." 



118 PBOOEEDINQS SECOND PAN AMERICAN SCIENTIFIC CONQBESS. 

de la yerba-mate y entre loe obreros que labran maderafl, una enfennedad llamada 
"buba," enfennedad ulcerosa, de car^ter cr6nico, de deeenvolvimiento lento, que 
ataca las partes descubi^tas del cuerpo, pies, piernas, brazos, cuello y cara, y mis 
tarde invade las mucosas nasales, forlngea, laringea, paladar y labios. 

Muy a menudo eeta enfennedad detennina la imposibilidad, pasajera o completa, 
para el trabajo. 

Esta enfennedad ha penetrado, seguramente, en este pais per contaminaciones 
sucedvas de los Estados braailefios limftrofes al Paraguay, donde existfa ya esta 
enfennedad con el mismo nombre deede hace muchos aflos, segtin los autores braailefios 
y europeos que de ella se ban ocupado. Hoy dla, estas llagas se deeenvuelven en estas 
regiones de tal manera que, s^tin los enfennos que vienen de esos lugares, no hay casa 
en la que no se encuentren uno o varios atacadoe del mal. 

Hemos observado esta enfennedad en los nacionalee y en los extranjeros, en los 
hombres y en las mujeres, en los viejos y en los nifLos de pecho. 

La enfermedad se hace sentir tan teniblemente que a voces en ciertos lugares de 
100 obreros que entian en loe bosquee para el trabajo, dos meses despu^ sal^i 70 u 80 
enfermoB a la vez, con una o dos llagas, con 10 o 20, con 30 o 40 llagas repartidasenel 
cuerpo. Esto obliga a suspender la empresa. 

Varios insectos son acusados como inoculadores del virus: Ixodes, t4banos, mosquitos, 
Bimulinidos, pero los mia son los primeros. 

En el Paraguay, como en todos los pafses donde existe esta enfermedad, se considera 
a la buba como id^ntica a la sifilis, pero una sifilis rebelde al tratamiento eq>eclfico: 
de allf resulta que su estudio etiol6gico pennaneci<S abandonado; su tratamiento, 
siempre mal dirigido, era infructuoso y el mal progresaba. 

Los m^cos, que por primera vez examinan estos casoe, sin tener en el espfritu la 
patologfa propia de estos pafses, pueden confundir con mucha frecuencia esta enferme- 
dad con la sffilis, con el lupus, con la esporotiicosis, el cincer, etc., sobre todo si ella 
se encuentra en un estado avanzado, atacando la mucosa de la nariz o del fondo de la 
boca. 

Hoy en d(a ya hay muchos trabajos pubUcados sobre esta enfermedad. 

Ella parece ser descrita ya en el afio de 1759 por Sauvage y Charluis con los nombres 
defranboesia tropical y papiloma tropicuTrif respectivamente. 

Los doc tores J. Moreira y A. Austregesilo de Rfo y B. Sommer, de Buenos Aires, han 
preeentado en el Congreso Latino Americano de 1904, que tuvo lugar en Buenos Aires, 
trabajos muy importantes sobre esta enfermedad.^ El doctor L. Zanotti Gavazzoni, 
de Asuncidn, ha publicado unas observaciones importantisimas en los anales de 
nuestra Universidad sobre el mismo tema.' Se puede decir que sea ^1 el primero que 
se ocup<S en este pais de la buba y de su diferencia con la sffilis. 

En los primeros trabajos de Charluis y de Austregesilo se encuentra la historia de la 
enfermedad en America y un notable cuadro diagn6stico de la buba. 

Los trabajos del Profesor Aquile Breda, de Padua, los de Majochi, y BoselLini, de 
BoloHa,' los de Fiocco y Verrotti ^ tambi^n nos son conocidos. En todos ellos se 
eucuentra la bul a diferenciada de la sffilis. 

Por otra parte, en todas las obras cUsioas de enfermedades tropicales y de derma- 
tolofffa se encuentra la buba confundida o como id^ntica al pian o/ramhoesia o al 
yawos^ en confusi6n con tilceras de loe pafses tropicales. Hoy dk, gracias a loe 
estudios modemos, se puede diferenciar estas enfermedades, antes confundidas, y 
unificar los diferentes nombres que se han dado a la misma enfermedad en los diferen- 
tes pafses. 

i Segundo Congrao Latino Americano, 1904, Boanos Alrei, T. lU. 

1 Lute Zanotti Cavauonl. Analei de la UnlTenidad del Paraguay, 1904. 

• Soil 'Btlologia del Babas, Bolofia, 1900. 

« Undeeima rlankme de la Societa Italiana di Dennatologia. Roma, 90 de abrtl de 1906* 



PUBLIO HEALTH AND MHDIOINB. 119 

En el Pang:i]ay, sele dael nambrede "buba" alaqueenel Bnsil se llama ''bouba;" 
Etfntndia en Boli* ia y Perd y tUeera Torrealba en Colombia; yo cieo que la iUeera d$ 
Baurik de Fbianhofl, Leiihmaniion$ rino-bueo-foaingea de Splendore y Carini, etc., 
etc., son todas una misma enfennedad, con manifestacionea olceroeas del cutis y de 
lai mucosas naBo-buco-faringea. Es una sola enfennedad produdda por una sola 
espede de LeUkmania, 

Escomel,^ de Arequipa, ha dado una buena descripci6n dfnica de la Etpundia del 
Perd; Laveran y N. Lanier* han descrito la LeMmania, agente de la infeccidn, bajo 
el nombre de Leishmania trdpiea^ yariedad ameiicana. Laveran ha propuesto el 
nombie de LeUhmanium$ amerioana. 

En el Paraguay hemos tenido la oportunidad de estudiar esta enfennedad en toda 
■u evoluci6n. Hemos visto que en la primera fas (Jaz eutdMa) cuando las llagas se 
encuentran en la superficie cut&nea de las extremidadee, sobre el cuello o cara, ellas 
tienen mucha semejanza con el Bot&n de Biskia o de Alepo, con la dJUii, etc. 

Generalmente la enfermedad comienza por uno o varios eritemas papuloses, muy 
proriginosos, como si fuesen producidos por las picaduras de insectos, tan abundantes 
en esas regiones. Dos o tres dlas despu^ se fonna sobre uno o varios de estos eritemas 
un punto pustuloso, grueso como la cabeza de un alHler que no tarda en vaciarse. 
Al vaciarse queda una pequefia cavidad profunda, de donde sale un Ifquido sero- 
gomoso que al endurecerse forma una costrita negrusca. 

En las regiones donde abundan estas llagas exists la creencia que ellas son produd- 
das por picaduras de ganupaUu o ixodn* {amhlyommM). 

En efecto casi todos enfermos que hemos examinado acusan a estas garrapaUu como 
etigen de sus males. 

Cuando el deatro ha logrado hacer penetrar su rostro en la piel, es diflcil desprenderlo 
sin que esa parte no quede incrustada en la piel. Esta picadura causa un prurito 
intense que obliga al enfermo a rasparse continuada y fuertemente con las ufias hasta 
escOTiarse. Los obreros que conocen esta consecuenda, no arrancan violentamente 
el 4earo, lo calientan ligeramente con un dgarro encendido hasta que de por s( se 
desprenda; en este case la picas^n no es fuerte. 

^ embargo he visto enfermos cuyas llagas iniciales est^n en la caia, en las orejas, 
consecutivas a picadunw de mosquitos o t4banos {critopt) u otros insretos. Otias 
▼eces he visto desarrollarse sobre picadunu o raigufios con espinas en las plantas de 
loe pies. JanUui he visto desarrollarse sobre el cuero cabelludo, como si una solud6n 
de continuidad de la piel fuesenecesaria para que el virus penetre y origins la Uaga o 



Una ves la dlcera fcmnada, crece, se cubre de su costra negnuca espesa y dura, la 
ptel drcunvedna se pone turgescente y un poco edematosa; de muy pruriginosa que 
em al inidarse, ahora se pone o poco dolorosa, o dolorosa. Si se aprleta la costia, deja 
vpKncen a loe lados un Ifquido 9er(hjiundenU> de olor f^tido. 

Estas dlceras son orfgenes de linfangitis, verdaderos cordones duros, de color rojo, 
subcutineo que a la preei6n deja aparecer sobre su extremidad en la dlcera un Ifquido 
uro-pwuUnU). En el trayecto de esos cordones linf&ticos se notan unos n6duloM 
bastante gruesos que se abren y foiman nuevas llagas. 

Cuando se eleva la costra de una llaga, se ve un fondo rojo, camoso, botonado, que 
saogra con la mayor ^Mdlidad; el borde est4 cortado a pique y no hay descolamiento. 
Este borde tiene todos los caiacteres de una herida at6nica: maigen Ifvido, hipertro- 

> BnlltUn dt Pftthologto BzoUqne, T. IV-JaUo 1911. 

SBonttlndtPiUbolocieSzoUqMT. V-1913. 

* 81 rrolwor Nwmuam, de Ie Bacoela de V<twlD>ria de Toloaa, haolMlfkisdo lew isoin into tnwlimnadoi 
fM MB los AmUl 9^m mm$ fXtUMk Bmeajd o ftliM eerbaU m AvMifomma KmMMii Keeh (ivfcM teespi 
Isfv) Amt i^ om mt fo$$mm Ntumtnn (gMteb^ pptaml o piUM) poropi en ninfat de AnM^om mM ^^ ^ ' 
mtntt,} Nueetns forrspeiM de montes ofreoen edn variedadee dwoonoeWM tegdn el Profeaor Nottall 
de 1* UnlTenldad de Cambridge. 



120 PBOCEEDINOS SECOND PAN AMEBIGAN SCIENTIFIO C0NGBB8B. 

fiado, un poco dirigido hacia fuera. Estas dlceras al cabo de aiete u ocho meoes, 
cuian espont&neamente, sea en su totalidad o en parte. Las llagas qne se cuian dejan 
una cicatriz indeleble, de boide m^ o menos estrellado o iiregular, de centre apeiga- 
minado, acr6mico, trasliicido, dejando ver las pequefias arterlolas neo-fonnadas. 
Esta cicatriz es caracteriiBtica. 

Los ganglios linf&ticos regionales son dolorosos al principiOi despu^ el dolor desapa- 
rece; ellos no toman nunca su tamafio natural. 

Oomo sfntomas genendes, es notado una fiebre veepenl, dolores articulases, cefa- 
lalgia, curvadura pero en el perfodo de infecci6n cut^ea. 

Las tilceras que quedan se desenvuelven lentamente, algunas se elevan sobre el 
nivel de la piel, se hacen papuloeas, o camosas y hdmedas, dejando correr un Ifquido 
seroso sin tener tiempo de fimnarse la costia: ^sta es la huba karddeea hUmsda; o bien 
la llaga se hace seca, se cubre de costra y se llama a ^sta la bvba $eea. 

Hay dlceras del tamafio de una moneda de 20 centavos, otzas son m^ grandes y 
otras son tan grandes que cubre todo el dorso del pi6 o toda la parte anterior y posterior 
de la piema o del brazo o antebrazo. Al cabo de dos o tares meees, o m^ tarde, que 
las llagas descritas sean o no dcatrizadas, empiesa su manifeetaci6n sobre las mucosas 
nasalee o laringeas, esta es la faz segunda que comienza: la/at muoomi. 

Cuando la llaga inicial eet& en la cara, entonces la mucosa nasal sufre muy pronto. 
Hay casos tan de^graciados que dos o tares meees de curarse unas Insignificantes llagas 
ya que est6 o no completamente cicataizada la piel, ya empiezan en las mucosas nasales 
las ulceraciones. 

£1 enfermo experimenta una dificultad en la respiracidn nasal, la pronunciaddn se 
hace nasal, un catarro sero-pwrulerUo, miB o menos tefiido en sangre, aparece. Si se 
examina la mucosa, se la ve infiltrada, roja, cubiwta en parte de una costra amarilloita 
sobre el septum nasal. 

Sobre uno de eetos puntos se prohindiza la leaidn y perfora con frecuenda el septum 
pero sin epistaxis. 

La infiltracidn progresa, el enfermo no tarda en sentir una aspereza y sequedad 
de la garganta o del velo del paladar. Poco a poco se espesan y se ponen granulosas 
estas mucosas; se espesan los pilares, las amigdalas, la campanilla. £1 enfermo sufre 
un poco al tragar los alimentos secos. M^ tarde el enfermo toee y la voz se hace nmca: 
la laringe se infiltra, las cuerdas vocales se cubren tambi^n de granulaciones. 

Cuando se observa un caso ya un poco avanzado se ve una infiltraci6n general de la 
mucosa del fondo de la gaiganta con neoformaciones granulomatosas caracterfsticas. 

Del septum nasal destruido, el cuerpo mismo de la nariz es atacado, ella se hace roj% 
espesa, aumentada de volumen y edematosa. £1 labio superior prdzimo a ella, 
tambi^ sufre la miama infiltracidn, los pelos caen, los ptoulos se infiltran y se pone« 
tuigescentes. La ulc^aci6n invade de la mucosa nasal, la piel de los hordes de las 
narices, de los ptoulos y labios. La piel destruida es reemplaiada per una gra- 
nulaci6n ya seca o ya hdmeda que de el aq;>ecto de un verdadero lupus ulceroso y 
con el cual muy a menudo se confunde. 

A medida que la ulceraci6n se extiende en el exterior, en el interior las mucosas 
tambi^n se espesan, se hacen granulosas a tal extreme que el velo del paladar, la 
<ivula, los pilares, las amigdalas forman una masa comtbd enrojedda, granulosa, 
sangrando con la mayor facilidad. £1 itmo de las fouces se encuentra aaf reduddo, 
estrecho; la faringe y laringe sufren lo mismo. 

El enfermo, en esta drcunstancia es ifono y se nutre dificilmente, m4xime cuando 
todos los dientes estan atacados de una infiltraci6n periiSstica o de una alveolitis 
secundaria. 

Jam^ he visto, aun en los casos muy avansados, lesiones sobre la lengua y lesiones 
oseas verdaderas. 

Como f^kdlmente se comprender&, un medico que no haya observado enf ermos de 
esta naturaleza, conftmdird ttdlmente con la if/liiff, el luptu, el otfnoer, etc. 



PUBUC HEALTH AND MEDICINE. 121 

Esta segunda faz del mal podrd formar un capftulo especial de rinolaringologia, 

Cuando el enfermo lleva este mal durante 10, 15 o 20 afios, se ve que la infiltraci6n 
progresahastallegaraloBgrueeos bronquios, provocando fiebre, hectiquez, denutricl6n 
o coiisunci6n hasta la muerte. 

Jam^ hemofl observado lesiones de los 6igano6 digeetivos, o lesbnee deeas pfodu- 
ddas como continuaci6ii del mal. 

Aflf mueren los bubdticoe que no ban tenido la precauci6n o la oportunidad de 
hacer curar su llaga inidal. 

Todoe los enfermos avanzadoe, con ledonee en la mucosa naso-bringea, precisa- 
mente moetiar&n la dcatriz de una llaga inicial que data de 2 o 3 afios ati&B. 

Etiologia, — ^En el curao de esta exposiddn, nosotros bemos dicbo, segtin afiimacidn 
de los enfermos, ser un ixoda el que inocula el virus. Pero bemos tenido la oportu- 
nidad de atender otros enllagados cuyas llagas no provienen de picaduras de insectos 
pero que sf se ban desarrollado sobre una pequefia excoriaddn de la piel, becba con 
la ufia o con las espinas en esas regiones, como si el virus espeiara una soluci6n de 
continuidad de la piel paia penetrar y desarroUar el mal. 

Examinando el pus que sale al lado de las costras las mis nuevas, y coloreando 
con el Azul de Marino o con la 8oluci6n Giemsa, es muy ttcil comprobar la presencia 
de numeroeoe eorpHMCuloB de IMhmann. Las gruesas cilulas epiteliodes ton las que 
contienen mis. 

Este parisito se parece mucfao al oorpiiKulo del Botdn de Biebra o de Alepo, expli- 
cindose asf la identidad attibuida por Ulysse Paranhos entre el bot&n de Biskra y 
^Ueera de Batard estudiada por Hj^ la cual seria un caso de buba en su primera b» de 
desarrollo. 

En los casos avansados es dificil comprobar la presencia de Leiihmannia^ pero se lo 
«ncuentra siempre. En el caso de C. A. de 14 afios, con aspiiar con la jeringa un poco 
de linfo del tejido gianuloeo, se pudo encontrar iicilmente. 

Asf se ha llegado a encontrar los mismos corpdsculos, encontrados por Paranhos, 
Carini y Splendore, etc., en los casos semejantes a los mfos. 

Lo que yo no he podido conseguir es lainoculacidn en los animales. Lahe ensayado 
sobre perro, gato, nuestro mono {Sebus lividinoBta^ sin obtener ningiina lesion impor- 
tante. 

He examinado lesbnes cutineas de los penos de casa de los obreros que trabajan 
en las regiones infectadas sin encontrar Leiekmannia. Tampoco nada he encontrado 
enlasangre. 

Digno tambi^ de notaise es que el bubitico no preeenta Leuhmannia en su sangre. 

He pretendido ensayar las culturas de los medios de Novy y MacNeal y en sangre 
citratada pero sin obtener 6xito. Esto seri por ^ta de una buena ttoiica. 

Blitoiogia patoldgica. — La biopda practicada de algunos tumores en su primer 
estado de desarroUo y en su completo desanollo, ofrece algunos caracteres en el tejido 
sabcutineo y en el cutis propiamente dicho. Si se compara un poco de piel sana 
al lado de una plena llaga, se ve que el dermis es edematoeo; las papilas de Malpi^ 
€0tin como aplastadas algunas o prolongadaa otzas pero separadas de entre sf, a causa 
del edema 

Las papilas a medida que se van acercando a la parte del dermis infiltrado, se ven 
extenderse en profundidad, hasta que ll^gan al pleno irea infiltrado en que ellas 
•e deshacen. La fluxi6n inflamatoria esti caracterizada por el cdmulo de c^ulas de 
pequefia dimension, linfositos y por c^ulas polinudeadas que se efectda en la extremi- 
dad de una papila de Malpighi como si alll estuviera el virus quimiotixico. 

Poco a poco la infiltraci6n celular se hace espesa, eUa forma un verdadero n6dulo 
inflamatorio, las papilas desaparecen observindose restos epitdiales entre las c^ulas 
invasoras. Lo mismo pasa con la c^lula de las glindulas sudoriparas y cebiceas. Una 

ildeatldsd dtlaitflMrsttfc BuMHtf Boidn d€ AUpo o 4€ BUkn por Ulysse Paranhos. Instltnto Pas- 
tMTde San Pablo, IMO. 



122 PBOGEEDINOS SECOND PAN AMERICAN SCIENTIFIC CONQBESS. 

ves destniida la capa basal de la epidermiB, ella no tarda en destruirse por complete 
7 la dlcera se fonna. Los vasos capilares lin^ticos se hincban, dlstingui^dose bien 
las c^lulas endotelialee y algunas con par&sitos. 

No hemoB notado la formaci6n de ovinias gigantes' en las lesbnesbubiticas, aun 
en loe casos muy antiguos. 

Los m^todos empleados para la coloraci6n y fijad6n son: Soluci6n Giemsa y Schau- 
dinn, sirvi^ndonos del xilol acetona en diveraas proporciones paia decolorar. 

Para el diagn^Ico <}e Leishmannia se necesita raspar un poco los "granulomas," 
o tomar los Uquidos que salen por los bordes de la costra o bien aspirar con una jeringa 
y colocarlo despties con Giemsa. 

Resumen del tratamientc—CuBudo el mal estd en su origen el tratamiento es fdcil: 
catistico, termocauterio y un poco de yoduro de potasio y de ars^co por boca, son 
sufidentes. 

Cuando el case es avanzado, es diffcil de sanar. Las cauterizadones igneas y el 606 
dan bastante buen resultado, pero es necesario aplicarlo tres o cuatro veces consecu- 
tivas. 

Cuando el mal ba penetrado en la mucosa bucal o nasal, es muy tenaz. El mal se 
modifica notablemente con la hectlna con el 606 o con el orsudan o la soamina, pero 
la curad6n se hace lentamente y ayudado con los catisticos locales. Las granula- 
ciones de las mucosas oirecen poca resistencia al termocauterio como si fuesen de 
manteca. 

Los trabajos redentes de Caspar Viana ' nos ban llamado la atend6n y podemos 
asegurar que el em^tico produce efectivamente, ei) inyecdones intravenosas y en la 
proporcidn al 1 por dento, muy buen resultado. Solo que la sal es muy iiritante en 
case de tratarse de em^tico no muy puro. 

Conviene hacer notar que todavfa despu^ de tres o cuatro aplicadones del 606, atbi 
se encuentran los par^itos, y a veces hasta despu^ de tres meses de tratamiento por 
medio de la soamina, como si estas sustandas arseniales no tuviesen acd6n alguna 
sobre estos protozoarios especfficos. 

La Leigkmaniosis Ameritana existe en el Paraguay, probablemente introducida por 
contaminaciones sucesivas de los fistados limftrofes brasilefioa. Ataca a la especie 
bumana sin distinci6n de edad ni de sexo. Esta enfermedad es producida por una 
Leiskmaniay la Leiskmania trdpiea. 

Los medicos que no conocen esta enfermedad, la pueden confundir con el lupu$, 
can la lepra, con el cdncer o con la sifilis, 

Los patologistas americanos o europeos que de ella se ban ocupado le ban dado 
diferentes nombrea, o bien la ban confundido con otras enfermedades tropicales, 
cuyos agentes pat^genos son distintos. 

En los pafoes americanos tambidn recibe nombre distinto. Asf en el Paraguay y 
en la Argentina la llamamos Bxiba; en el Brasil, Buoba; en el Perd, Espundia o Uta; 
en Colombia, iflcera de Torreaiha, etc. Es necesario pues una deBignaci6n cientlfica 
y t&nica de esta enfermedad en los diferentes pafc^ en donde ella existe. 

La enfermedad se manifiesta por una o por mdltiples llagas cut&neas en su primer 
perfodo, y por tilceras de' las mucosas nasales, feiingea y palatina en su segundo 
periodo. Las tilceras pueden ser secas o bdmedas. Son por lo general redondas y 
de bordes cortados a bisel. Aparecen de preferencia en la partes descubiertas del 
cuerpo, brazes, piemas y cara. Las manifestaciones mucosas, o sea las del segundo 
perfodo, pueden faltar si la cura de las llagas iniciales ba side rdpida u oportuna. 

Esta enfermedad no es aguda sine eminentemente cr6nica. 

1 FrtDobliildallBftUiitoPMtmirqMtnlM^flntllaborfttoriodeLftTt^ 
oon Mta indloaoI6ii noestia. 6l en tmoaso de t^leen buba M Br*$Uf eocontndo flo Roma, podoeompiro- 
bar la prflsaoda de oflolas gigantet, elementos no eocontrados por nosotros. No habii habldo elementot 
baoUar«8 en aqofiUa manUvtaoidn flstodiada por ^r La baba no ezoloye al lop». "BoUeUn de Patho- 
logle Exotlqae, mano, 191S." 

* Arohl. brafUero de medhina, alio U, ntUnerol . 



PUBLIC HEALTH AKD MEDIODirE. 128 

8u anatomfa patol^ca es dlstinta de la de la sffilis, del lupus y del epitelioma. 
Su ageute pat^geno ee ya bien conocido y merece pues que sea una enfennedad 
distinta. 

En cuanto a su manera de infecci6n hay mucho que estudiar. Lo m^ verosfmil 
es que algiin insecto la facilite, aunque a vecee basta una 8oluci6n de continuidad 
superficial para que se desarrolle. 

El tratamiento preventivo es atin nulo; el curative se reduce a los c&usticos, anti- 
86pticos o estirpaddn de la dlcera Inicial una vez bien diagnosticada. £1 606 da 
bastantes resultados favorables, pero ayudado siempre con los antis^pticos extemos, 
para combatir la infecci6n mixta. El em^tico tambidn da buenos resultados. 

The Chaibkan. The following pap>er8 will be presented before this 
session of Section VIII as read by title: 

Nota sobre a extinc^fto completa da febre amarella no estado de 
S. Paulo (Brasil), by Dr. Emilio Ribas. 

La fidvre typholde en Bolivie, by Dr. Nestor Morales V. 



NOTA SOBRE A EXTINCgAO COMPLETA DA FEBRE AMARELLA NO 
ESTADO DE S. PAULO (BRASIL). 

Per EMILIO RIBAS. 

S. Paulo come^ou a combater com successo esta molestia antes mesmo que os 
estudos realixados em Cuba indicassem a applica^fto das medidas espedficas pan sua 
extinc^. 

E isto verificou-se, porque nfto se conhecendo os meios scientificos para combatel-a, 
todas as annas foram empregadas e, entre as medidas de excellente efficacia 
prophylactica, destacou-se a remo^fto das aguas estagnadas, providencia indispensavel 
e de exito seguro na guerra de exterminio do unico agente provado na transmiss&o da 
febre amarella. Este resultado foi de mode evidente notado em Campinas e no 
importante porto de Santos, cidadee flagelladas intensamente por esta molestia 
durante longos annos. 

Deede que foram conhecidas, porem, as experienclas da commisrik) norte-ameiicana, 
cbefiada pelo Dr. Walter Reed, e depois de repetidas em S. Paulo com o fim de 
arredar objecyGes menos justas contra as conclusdes tiradas em Havana, o combate & 
febre amarella foi entfto firmemente dirigido e com exito seguro em todos os f6cos da 
molestia. 

Embora convencido dos resultados brilhantes das experienclas da commissfto 
americana, nfto s6 pelos detalhados relatorios recebidos, como por cartas e tel^grammas 
que me foram dirigidos pelos Drs. Carlos Finlay e James Carroll, pedi ao Govemo de 
8. Paulo a repeti^fto dos estudos sobre a transmissfto da molestia, porque surgiram no 
nosso paiz ob jec^Oes que pareciam fundadas, por parte de profissionaes honestos e com- 
petentes, alguns at^ professores das nossas faculdades de medicina, que, partindo 
do facto de ser Havana um f6co intense e secular da molestia, admittiam a hypothese 
de ter side a febre amarella propagada por outro mechanismo que nfto o mosquito nos 
casos dos estudos experimentaes. 

As experienclas sobre a propaga^fto da febre amarella, realizadas no Hoq[>ital de 
laolamento de 8. Paolo, e as piovas epidemiologicas obtidas em diversos f6co6 deste 
morbus muito impressionaiam e concorreram para a acceita^fto immediata da pro- 
phylaxia especlfica no Brasil. Foram seis as pessoas que expcmtaneamente se deixa- 
imm picar p^os moequitos que haviam sugado sangue de doeotes graves de typlio 
icteroide antes do quarto dia de moleetia. 



124 PBOOEEDINGS SBOOKD PAN AlCEBICAN 8CIENTIFIG OONaBESS. 

O resultado foi o mais convincente pofldvel: tres pacientes que, com grande fre- 
quencia, permaneciam nos f6cos intensos da doenga, n9o apresentaram symptoma 
algum do mal de Si&o e oe outaros tree, residentes em localidades immunes, revelaram 
evidentemente o quadro clinico do vomito preto. 




No primeiro grapo noe achavamos o muito conhecido e estimado scientiBta Dr. 
Adolpho Lutz, o Sr. Oocar Moraiia e eu. 

Fasdam parte do segundo gnipo os Srs. Andr6 Ramoe, Domingos Pereira Vas e Ja- 
nuario Fiori, que foi um caao clinico muito claro, como se veiifica no seguinte diagram- 
ma, que moetra alguns detalhes interessantes Bobre propaga^fto do morbus. 



PXIBUO HKALTH AKD MBDICIITE. 



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pete febre amarella em Sorooabe (1900- Mortalidade pela febre amarella em Rfbelrio 
Wii). Preto (1908-1914). 



126 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

Como Be sabe o typho americano, oiiginario do Novo Mundo, teve oe seus principaes 
f6co8, desde de epocamui remota, no golpho do Mexico, nas Andlhas e na America Cen- 
tral, irradiando-se deetes pontoe, geographicamente estrategicos, para flagellar oe outros 
paizes das duas Americas. Em consequencia das enormes devasta^des deete flagello, 
contam oe historiadores que na terceira expedi9&o de Colombo, i qual nSLo adheriram 
OS homens livres, pelo terror que inspirava a despovoadora peete, teve o govemo 
hespanhol necessidade, para o fim de fundar as primeiras colonias, de lanyar mSuo dos 
condemnados, promettendo-lbee a libeidade. 

Este facto e muitos outros, poeteriormente conhecidoe, demonstraram claramente 
que a febre amarella foi, atravez dos seculos, o maior estorvo ao progresso das 
naydes americanas. 

nosso Brasil victiraado por diversas vezes em remotes tempos, foi ultimamente 
flagellado durante nais de meio seculo. 

Agora, grayas, porem, & prophylaxia espedfica, a sua transformaySU) sanitaria foi 
completa, vencemos o inimigo capital do nosso progresso. A nota que apresento, 
al^ de documentar os resultados obtidos com a exclusiva applicaySo das medidas 
para o exterminio do unico agente provado da transmiasfio do mal — a Stegomyia 
/(uciaia — 6 tambem uma justa homenagem aos sclentistas norte-americanos que, com 
o seu saber, direotamente concorreram para a soluySo do humanitario problema. 
De facto, nada 6 mais significativo para provar que os ensinamentos de Havana 
tiveram decisiva influencia nas campanhas contra a febre amarella em S. Paulo, do 
que 00 dlagrammas s^:uintes: 

Estes diagrammas demonstram claramente que ha 11 annos completes cessaram em 
todo o territorio do Estado de S. Paulo as aasoladoras explosOee do typho ictoxnde, 
gramas i guerra de exterminio aos mosquitos. 

Em Sorocaba, depois de uma enorme epidemia definida por 2.322 doentee e 877 
obitos, nem um s6 case de febre amarella se verificou no decorrer dos 14 annos 
seguintes. 

Nesta cidade foi obtida nitidamente a prova epidemiologica, antes de se conhecerem 
detalhadamente em nosso meio os brilhantes resultados a que chegou em primeiro 
logar o General Wood, govemador da ilha de Cuba e medico do exercito americano, 
que empregou para o saneamento daquella ilha os mesmos preceitos postos em acySU) em 
Sorocaba e finalmente o mesmo resultado favoravel foi alcanyado em Ribeirdo Preto, 
onde a observaySU) epidemiologica 6 por certo muito interessante, pela circumstanda 
de nSo se terem feito ahi desinfecydes ou obras de saneam^ito. 



LA FlfiVRE TYPHOlDE EN BOUVIE. 

Par NfiSTOR MORALES VILLAZON, 
DirecUur de VlmtUut National de BacUriologie, ex-Doyen de la FacuUi de Midedne de 

La Paz, Bolivie. • 

LA VAOUNOTH^RAPIB DS LA FitVBS TTPHOIDB EN BOLIVIB. 

Parmi toutes les entity morbidee connues en Bolivie, la fi^vre typholde a toujours 
^t^ une de cellee qui out fait le plus de victimes dans toutes les classes de la 8od6t^. 

Cette maladie existe k I'^tat end^mique dans preeque toutes les villes populeuses, 
at tout particuli^rement k Cochabamba, Sucre et La Paz. 

La forme end^mique est ordinairement bdnigne, et sa courte Evolution se termine par 
la gudrison. U n'en est pas ainsi des cas 6pid^miquee qui, d'habitude, fauchent des 
villages entiers et laissent des zones immenses de territoire sans bras pour les cultiver. 

Les 6pid6miea apparaissent rarement dans les villes ou dans les villages considto- 
blee; elles attaquent de iMr6f6rence les cantonnements des indiens et y produlsent, 



PX7BU0 HEALTH AND MEDICINB. 127 

quand olles s'y sont enracin^, jusqu'^ 90 pour cent dee d^te. Pour bien com- 
prendre ces effets teiribles de la fi^vre typholde, il eet n^cessaire d'avoir presentee 4 
Pesprit lea drconstancee qui d^terminent la vie de Tindien, soit dans la plaine, soit 
dana lea hauteurs dee Andes. 

Sa maison, a neuf metres carr^ au maximum; les murs et le toit sont faits de terre 
m^langte avec de la paille; Tentr^, tr^ ^troite, n'a qu'un m^tre cinquante de haul, 
sur 50 il 60 centimetres de laige. Ge n'est que par cette petite ouverture, close la 
nuit par un grosder tissu de laine ou par quelque porte rudimentaire, que Tair pent 
pto^trer 4 Tintdrieur. C'est dans ce mis^ble r^uit que vit toute la famille, qui 
compte tr^ souvent de huit k dix personnes, sans compter qu'avec les maitres du 
logis vivent les animaux domestiques, tels que poules, canards, dindons, cochons 
d'Inde, etc. 

Les agglomerations comportent un nombie variable de ces pauvres chaumi^res, 
extr^mement froides en hiver; il y en a des groupes de huit, de cinquante, cent et 
quelquefois davantage, abritdes contre la violence du vent, au pied d'un monticule, et 
prte de quelque courant d'eau. 

L 'alimentation de Tindien qui vit dans la plaine est tout k ^t diffdrente de celle 
de rindien qui habite dans les regions froides. L'indien de la plaine se nourrit 
surtout avec le ma!s cuit ou en forme de soupe; il ne mange presque jamais de viande; 
quelques pommes de terre cuites et quelques legumes font son bonheur; il faut ajouter 
la feuille de coca qu'il a dans la bouche du matin au soir; cette coca et le maXs griU6 
fonnenty dans les 6poques peu productives, son unique alimentation. 

La boisBon ordinaire de Tindien est I'eau, que tons les habitants puisent k la m6me 
source. Lee jours de f^te ou de r^jouiBsaaces publiques, tons boivent la "chicha," 
qui s'^bore de la fayon suivante: Lee femmes moulent le maXs et ferment avec la 
fiurine de petites boules qu'elles introduisent dans leur bouche; elles les mastiquent 
avec ardeur, p^n^trent de leur salive cette farine et Texposent ensuite au soleil. Cette 
substance, que les indiens appellent **mucku, " est r^l^ment principal de la chicha 
(tchictcha). On melange le mucku avec une quantity plus ou moins grande d'eau que 
Ton fait bouiUir, puis on la met fermenter dans de grands vases de terre qui peuvent 
contenir jusqu'^ cent litres et quelquefois davantage. On a soin de boire cette 
preparation aussitdt que la fermentation tumultueuse a cess6; sans cette precaution 
la chicha se convertirait bientdt en vinaiere. 

L'examen microscopique montre que le ferment de la '* chicha" est un saccharo- 
myces tr^ ressemblant k celui du vin. 

Avec une augmentation de 800 diam^tres on pent distinguer des cellules ovales et 
arrondies, les unes plus grandes que les autres. On y voit aussi des cellules qui se 
divisent directement par "mamelonnement." 

Au contact de I'hematoxyline, le corps protoplasmique se colore et laiase aperce- 
voir des granulations di verses et aussi de petites vacuoles qui ne se colorent pas. 

Si Ton mdle ce saccharomyces avec du mo(it de vin, la fermentation est visible 
»pr^ 24 heures et se manifesto par la production de grosses bulles de gaz. A la 
snperficie du mo(it, le ferment depose une pellicule de couleur blanch4tre. II eet 
remarquable que dans ce milieu, en plus des cellules que nous avons d6}k signaiees, 
il se forme de longs filaments semblables aux elements cellulaires que nous avons 
decrits plus haut. 

En resume, le ferment de la chicha n'est qu'une variete du microderme du vin. 

L'indien du haut plateau se nourrit de mala moulu et de '*chufio" (tchugno). Le 
chufio est la pomme de terre que Ton a soumiae k Taction combinee du froid de la 
Gcmiill^ et du deae^hement ; operation qui a pour effet de la reduire d'un cinquieme 
ou d'un aixitoe de aon volume primitif et de lui donner la propriete de ae conaerver 
indefiniment. Get indien ne mange preaque jamaia de legumea, maia il conaomme la 
coca en plus grande quantite generalement que Tindien de la plaine. 

Ge n'eat qu'exceptionnellement qu'U mange de la viande fratche; il uae de viande 
deaaechee de brebia, connue ici, aoua le nom de chalona (tchalona). 



128 PBOGEEDINGS SECOND PAN AMEBIOAN 80IENTIFIC 00NGBE88. 

Sa boiflBon est ^galement I'eau; il ne boit I'alcool que dans les grandee f^tee, en 
lui ajoutant deux ou trois parties d'eau; dans cee occasions il en absorbe une grande 
quantity. 

Je fais noter ce fait afin de faire mieux comprendre le poorquoi de la mortality 
excessive de cette race causae par la fi^vre typholde, ainsi que les grandes difficult^ 
qui s'oppoeent k son traltement efficace. De tr^ nombreux et tr^ distingu^ m^e- 
cins boliviens attribuent unanimement k la doth^ent^rie de la race indigene, des 
caract^res sp^ciaux, qui en font un type particulier. 

Un m6decin tr^ competent et qui a fait ses Etudes en Europe, le Dr. Hermog^e 
Sejas, fut chaig6 de combattre la fi^vre typholde dans la province d'Arque et publie 
les remarques suivantes sur les caract^res de cette fi^vre: 

''II y a deux causes pour lesquelles la fi^vre typholde qui attaque les indiens du 
haut plateau soit tr^ maligne et d'une gu^rison difficile: 

''1. L'extraordinaire malpropret^ dans laquelle ils vivent. Jamais ils ne se bai- 
gnent ni ne se lavent la bouche; jamais ils ne nettoient leurs habitations qui ne sont 
que de misdrables huttes de 3 metres de haut, avec une seule porte d'un m^tre de 
pur n'a huttes pleines de fum^e oh n*a jamais p^n^tr^ la lumi^ du soleil, oil Pair 
hauteur; jamais circuit. Dans ces trous obscurs et ^troits, au milieu d'un amas inde- 
scriptible, les indiens pr^parent leurs repas, mangent et dorment; ils s'y entassent au 
nombre de cinq, six ou davantage, hommes, femmes et enfants, sains et malades 
fi^vreux k cdt^ les ims des autres, m&chant la coca nuit et jour. 

'' 2. L'indiff^ence, T^tat de l^thargie dans lequel est plough Tindien I'emp^hent 
d'observer les precautions hygi6niques les plus ^l^mentaires ou de prendre les remMes 
les plus salutaires. Si on lui recommande, par exemple, durant une forte maladie, 
de laisser sa coca ou de ne prendre aucun aliment solide qui augmentera sa fi^vre, 
11 feint ne paa comprendre et il mange le chufLo et les pommes de terre comma 
d'habitude. A cause de ces imprudences, la fi^vre augmente tr^ rapidement et 
la mort s'ensuit g^ndralement vers le huiti^me jour, c'est-^-dire dans la premie 
p^riode, quand, au contraire, dans les villes, la fi^vre typholde n'atteint ses victimee 
qu'apr^ quinze ou vingt jours, c'estr^^iire entre le premier et second sept^naire. 

*' II faut encore ajouter k ces causes la terrible coutume qu'a Tindien de boire 
Talcool pur, ce qui le predispose k cette maladie. 

" J'ai remarque que cette rapidity des progr^ de la fi^vre est due k la coutume 
fatale qu*a Tindien, de ne jamais observer de di^te pendant sa maladie; il continue k 
mastiquer des substances solides et aussi la coca. La mort survient, comme je Tai 
d6j^ dit, presque II la fin du premier sept^naire.'' 

La consciencieuse observation du docteiur Sejas montre Textraordinaire malignit6 
de la fi^vre dans la race indienne; il est facile de comprendre par la description faite 
plus haut, combien est difficile Tassistance k des malades qui se trouvent k de 
grandes distances des centres peupl^e, manquent de m6decin, de remMes et desquels 
U est impossible d'obtenir aucun changement ou modification du cours de leur vie 
ordinaire, et qui n'acceptent pas les meeures ordonn^es par Thygi^e. 

BA8B DB LA VAOGENATION ANTniPHIQUB. 

Nous connaisBons que les vaccina produisent Timmunite, en determinant la forma- 
tion dans I'oiganisme animal, d 'elements de defense connus sous le nom general de 
"anticorps." 

Les essais preiiminaires de vaccination remontent k une epoque tr^ lointaine, et 
Ton pent dire que ses premiers principes furent etablis en 1798, d'apr^ les etudes 
faites par Tillustre investigateur Jenner. 

Plus tard, en 1881, le Professeur Pasteur fit entrevoir par ses deiicats travaux sur le 
bacille antracis, les avantages que la therapeutique pent obtenir des vaccines micro- 
bicnuoa. En co qui concpme particuli^rement la vaccination antitiphique, c'est le 
Profoasour rhantcinnss'' qtii, on 18S7, o'^n\'a 1p premier de don ner rimmunlte aux 



PUBUO HBALTH AND HEDIOIKB. 129 

•n ima ox de laboratoire contre rinfection Eberthienne, grftce 4 rinjection sous 
eotan^ de produits Bt^rilis^ par la chaleur. PuIb les travaux de Widal, Kliockwicz, 
Snarelli, Bruchettmi, qui firent au«i dee eends sur lee animaux pour 6tudier Taction 
preventive dee vaccinee bacillairee, firent soup^onner Tavenir r^eerv^ k la vacuno- 
th^rapie. 

En 1896, Pfeifler et KoUe en AUemagne, et Wright en Angleterre, appliqu^rent 
cee m6thodee prophylactiquee k Teepee humaine. Quelque tempe apr^, en 1899^ 
GhantemeBse vaccina tout le personnel de son service d'hdpitaux, employant des 
cultures chau£F^ 4 100^. 

Les r^niltats de la vaccination antitiphique, sent aujourd'hui pariaitement v^rifi^, 
et il nous suffira de dire que pendant la guerre du Tnmsvaal, dans I'lnde et pendant 
la guerre contre les Herreros, la vaccine pr^eerva compl^tement lee soldats qui y 
furentsoumis, tandis que lee non-vacdn^ avaient une morfoit^ plus ou moins 61ev^ 
et une mortality qui n'^tait pas k designer. 

Poet^eurement on put observer un fait semblable, pendant les ^pid^mies d'Avignon 
O'uin et ao(it 1912), de Paimpol et de Puy-PEv^ue (octobre et novembre 1912) dans 
lesquellee la vaccine eut une double action: limiter I'^pid^mie et garantir toutes les 
personnes susceptibles de contagion. 

On commen^a la vaccination dans la flotte de guerre fran^aise en 1912 et les r^sultats 
furent parfaitement appr^iables. Sur 67.947 personnes nonvaccinto, dans le terme 
de sept mois, on put observer 549 cas de fidvre typholde et 118 d'embairas gastriques- 
f^rilee; tandis qu'en ^galit^ de circonstances et conditions, 3.650 personnes vac- 
cin6ee, biisant vie commune avec les pr^^entes, ne pr6sent^nt pas un seul cas 
de fi^vre typholde. 

Le Profeeseiur Vincent, qui, avec Ghantemesse, fut le grand propagandiste de la 
vaccination antityphique en France, rendant compte devant le Congr^ International 
de M6decine de LondriBB de Tann^ demi^, de ses investigations, fait remarquer lee 
brillants r^eultats obtenus dans Tarm^e fran^ise du Maroc, Alg^rie et Tunisie, lieux 
oh la dothi^nent^e qui atteignait jusqu'4 168,48 cas, avec une mortality de 21,13 pour 
cent, deecendit rapidement k une proportion pas plus grande que 0,18 cas et 0,09 pour 
mille de d6c^. 

VAOGINS BHFLOTAs CONTRB LA SI^VBE TTPHOIDE. 

On pent les grouper en quatre vari^t^: 

1. Ceux qui contiennent des bacilles vivants, chaufif^ ou non. A ce groupe appar- 
tiennent les vaccina employ^ par Castellani, Nicolle, Connor et Gonsey. 

2. Ceux qui contiennent des bact^ries mortes; ceux eont les plus nombreux et les 
plus connuB. Nous pensions le vaccin Wright, qui est compost de bacilles peu 
virulents de 10 k 12 jours, st^rills^ k 60^ et m^lang^ k une petite quantity d'une 
substance antiseptique; le vaccin Leishman, qui difif^re de Pant^eur uniquement par 
sa culture qui dure seulement 48 heures, et la sterilisation qui se fait k 53^; le vaccin 
Bassange-Mayer; cultures tr^ virulentes sterilis^es k 90^; le vaccin Wasserman- 
Kitassato; cultures sur g^ieose, sterilisees k 90^ evapor^es au dixi^me, pr6cipitees par 
I'alcool; le vaccin Snarelli; cultures en g^ieose de cinq k six jours, sterilis^es k 120^; 
le vaccin Shiga; cultures sur gei^ose, sterilis^ee k 60^; le vaccin Pfeiffer-KoUe; cultures 
sur g^ieose chauff^es k 60° et m^lang^es avec trols pour cent d'adde ph^nique; 
le vaccin Fierbert-Moreschi; cultures sur g^ieose, sterilisees k 120°; le vaccin Chante- 
messe; cultures sur g^ieose sterilisees k 56°, emulsionnees dansde I'eau physiologique; 
le vaccin Ferr£n. En ce qui conceme ce vaccin, je dois falre remarquer que le 
c^l^bre bacteriologue barcelonais, docteur Jaime Ferrin, me prie, dans une lettie que 
j'ai re^e de lui le 17 Janvier de Tann^e en cours, de faire remarquer qu'il y a 25 ans 
il a commence Templol de son vaccin, ayant fait les premiers essais de vaccination 
en 1887. Le Dr. Ferr&n signale que sa methode est tr^ ressemblante h la methode 



130 PBOGEEDINOB SBOOKD PAN AHEBIGAN 80IBNTIFI0 G0KGBE8S. 

claseique de Wri^t, et qu'elle a beaucoap de details tedmiquee, qui la font semblable 
au produit 61abor^ k La Paz; vaccln am^icain de Riusell; poes^de grande reaeem* 
blance avec celui de Leiahman; lee cultures se cbauffent de 56^ k 56° ; on lee ^muleionne 
dans du s^rum pbysiologique, puis on y ajout« 1 pour cent de tricresol, que Russell 
d'apr^ see Etudes d^uit Hre le meilleurantiseptique, ajrant la propri^t^ tr^ impor- 
tante de faire conserver plus longtemps k la vaccine son activity; vaccin Morsdes; 
^labor6 k PInstitut National de Bact^ologie de La Paz. 

£n ce qui conceme ce vaccln je dois entrer dans quelques details car, quoique 
dans sa preparation on suive un proc6d6 semblable a cehn couramment employ^ dans 
les produits similaires; 11 a, cependant, quelques points techniques qui le diff^ren- 
clent dee autres vacclns. 

D'abord, pour faire les cultures, au lieu d 'employer la g^l^ose qui aujourd'hui est le 
moyen d'^lection, pour la plupart dee bact^riologistes; j'emploie le bouillon qui, 
d'apr^ mon opinion, a Tavantage de profiter, int^gralement, des produits grace 
auxquels le bacille d'Eborth provoque la formation d'anticorps defensifs. 

Afin d'^viter de multiples details de technique bact^riologique, je mentionnerai 
seulement que les organismes bact^iens d^terminent Taction defensive, soit par les 
endolisines, soit par les exoiisines, dont la production est plus abondante dans le 
liquide. Pour ne citer qu'un seiil exemple il suffit de signaler ce qui se passe avec le 
bacille de Klebs-LoefBer, dont les cultures en s^rum, de mdmequ'en g^l^ose, donnent, 
une quantity m^prisable de toxine, tandis qu'il y a une abondante production dans un 
milieu liquide, comme le bouillon Martin. 

Ge principe g^n^ral de bact^riologie s'e£Fectue avec le bacille d'Eb^th, cette 
affirmation pent 6tre v^rifi^ en filtrant lee cultures k travers une bougie Kitassato. 
Le liquide clair, qui reste dans la partie filtr^ et qui ne contient pas d'organlsmcs 
bacillaires, est dot^ de propriety immunisantes qu'on peut facilement verifier par des 
inoculations dans la s^rle animale. Partant de ce principe, il est facile de comprendre 
que, quand il s'agit de preparer un vaccin actif, 11 est indispensable d 'employer 
des cultures liquides qui, forewent, doivent contenlr une quantity plus grande 
d'antig^ne. 

Je prepare le bouillon de la mani^re suivante: 

Je fais mac^er pendant deux heuris dans de Teau bouillie et froide, les parties 
les plus puepeusee de la viande apr^ les avoir depouUl^es deleurs parties grasses 
et les avoir d^coup^es en petits moreen ux. Oes temps ^coul^, je jette le liquide de 
maceration, le remplagant par un nouveau dans la proportion de 500 grammes de 
viande k litre d'eau distiliee. Je laisse de nouveau cette maceration en repos pen- 
dant deux heuree et je prepare ensuite le bouUlon peptonise selon le precede ordi- 
naire. Moyennant la leg^re modification apportee dans la preparation du bouillon, 
j'obtiens que celul-ci soit beaucoup plus limpide et clair que celui qu'on emploie 
generalement; j'evite en plus qu'un exc^ de substances solides, specialement 
d'hemoglobine dissoute et de peptones, se predpitent pendant la culture, donnant 
u la formation de grumeaux. 

Le bouillon est distribue en ballons Pasteur, d'une contenance de 250 granmies* 
ayant soin de ne mettre dans chacun d'eux que 100 grammes, afin qu'il y ait une 
abondante oxygenation qui favorise le vigoureux developpement des bacteries. 

Pour les semis j 'emploie sept espies de bacteries de differentes pro enances, et 
dans la forme suivante: Allemagne, Paris, Vienne, Etats-Unis du Nord-Amerique, 
Argentine, Chili et La Paz. 

La purete des cultures se verifie, grSce k des semis en gelatine. De la gelatine je 
e^me k nou\eau k la geieoee, laquelle se maintient k la chaleur d'une etuve k une 
temperature de 37° pendant 48 heures. Ce temps ecouie, je prends les cultures en 
geieose, pour les resemer dans du bouillon. Dans les semis je n'emploie pas le fil de 
platine, parce que je ctoLb qu'il est difficile de prendre la mdme quantite chaque fois, 
d'oik, comme consequence logique, un developpement plus abondant dans les ballons 
qui ont re^u plus giande quantite de semis. 



PUBLIC HEALTH AND MEDICINE. 131 

Dans moQ procM6, je fads lee aemlB moyemiant im ase de platiLne, de deux mili- 
gnumneB de capacity, ce qui me donne la certitude d'avoir 8ein6 met balkma, avec 
one quantity plus ou moins ^gale de bacilles. 

Selon la quantity de vaccin que Ton d^eiie preparer, j'ensemeeoe avec chaque 
race bacillaire, Bolt deux, tmis ou quatre ballons, ayant soin que' chaque race mnt 
repr^aent^ toujouis par un nombre ^l de ballons. 

La culture se &dt dans Tetuve r^l6 k 37^, la retirant au bout de 42 heuie exactea; 
on numtote ensuite par centimetre cube, suivant le procM6 ordinaire de compaiai- 
son avec les globules rouges. 

Si la proportion nous donne le chiffre d^sir6, qui est de 1,000,000,000 de bactMes 
par centimetre cube, on continue Top^tion jusqu'^ la fin; en cas contiaiie, on 
r^jette les ballons qui ont un d&. eloppement excessif ou insuffisant. 

Les cultures sent soumises k T^hauffement au bain-marie k 53^ pendant deux 
beures. On melange ei^niite le contenu des diff^rents flacons dans un ballon d'une 
contenance de 2 ^ 3 litres et Ton ajoute au tout une solution de lysol, dans la proportion 
de 0,25 gramme pour cent. 

U ne reste plus qu'ii distdbuer le vaccin dans des ampoules st^rilis^es en verre, de 
1 & 2 centimetres cubes, que Ton sterilise de nouveau k la temp^ture de 53^ pendant 
deuxheures. 

Pour r6pondre k certaines indicatbns, je prepare aussi un vaccin deiay^ que je 
distingue moyennant la formulesui ante: V.M.2V. Ceproduitcontient 600,000,000 
bact^es par centimetre cube, et il est £orm6 de parties ^gales de bouillon, de culture 
et d'eau physiologique. 

8. Vaccins sensiV ilis^: Le type en est constitu^ par celui de Desredka, qui de- 
puis 1902 pr^onisa sa m6thode d 'immunisation moyennant les vaccins sensibilis^ 
£Ue conaiste en r^um^ k mettre les bacilles d'Eberth en contact avec le s^rum 
antit>i>hique et k filtrer le s^rum apres les 24 heures, k laver les bacilles, et finale- 
ment k les mettre dans une solution d'eau sal^. Les bacilles, ainsi pr6par^, con- 
tinuent ilAivre, ce qui permet, d*apres Topinion de leur auteur, une plusgrande 
^ergie d'action. 

La premiere application de ce vaccin k I'espece humaine se fit par Broughton 
Alcock et les r^sultats obtenus permirent leur grande gdndralisation. 

Nous pouvons, dans ce mdme chapitre, inclure le vaccin Ranault, qui consiste en 
cultures de bacilles typhiques qui ont perdu toute virulence, gr&ce k une exposition 
prolong^ aux ra3ron8 ultra-violets. 

4. Vaccins qui emploient des agents chimiques: Le plus connu et qui, pendant 
ces demiers temps, a acquis une juste renomm^ est celui du Professeur Vincent. 

L'auteur emploie des bacilles typhiques de di£f^ntes provenances (10 races) ; il les 
cultive pendant 24 heures sur g^lose en bottes de Roux k dS^. Ensuite le contenu 
des bottes est 6mulsionn6 dans 200 cc. d'eau physiologique sterile, puis on y ajoute 
de rather. Le melange est fortement agit^ plusieurs fois et maintenu pendant 24 
heures k la mdme temperature que celle du laboratoire. On recueille la partie de 
r^ulsion qui sumage sous la couche graisseuse et on la soumet k Taction du vide, 
moyennant la trompe d'eau. Par ce procM6 on obtient Tdvaporation de Pother. 

La preparation est r^partie dans des ampoules de 5,10 et 20 cc. fermees k la lampe. 
Chaque centimetre cube de cette Emulsion contient 400.000.000 k 420.000.000 
bacteries. 

Le laboratoire de Val-de-Grftce prepare aussi un vaccin par autolisie. 

MANltEB DB PRATIQUBB LB VAOCIN. 

Les vdes qu'on emploie pour introduire le vaccin dans Toiganisme humain sent 
qnatre: 4:la rectale, la bucode, la sous-cutan^e et Tintrarveineuse. 

Voie bnccale: On emploie des vaccins morts k 53^, faisant ing^rer 10 & 20 centi- 
metres cubes par jour, avec des r^sultats, paraft-il, favorables. Le docteur Abraham 
P^res MiWS de Cuba est un des premiers qui ait employe cette methode. 
68486— 17— VOL ix 10 



182 PBOCEEDINOS SECOND PAN AMEBIOAN SCIENTIFIO GONGBESS. 

Voie rectale: O'est k Conrmont at Rochaiz, que revient le m^rite d'avoir, les premien, 
pr^oziis^ la voie rectale, moyennant dee todmee compoe^e de 10 k 100 cc. de 
vaccin st^rilis^ par la chaleur. La r6action est presque toujoursnulle, et lee lavements 
s'appliquent k cinq jours d'intervalle. Le Dr. Darier croit que cette m6thode est 
siire et efficace. 

Voie sous-cutan^: Est celle qu'on emploie de pr6f6rence et elle 8'iq)plique moyen- 
nant une petite seringue de Pravaz, par injections sous-cutan^. 

Les precautions k prendre pour appliquer Finjection ne different en rien de cellee 
coununment employees pouries inoculations hypodermiques. 

Les points d'ilection varient quelque peu selon les auteurs, chacun d'eux ayant 
des r^ons auxquelles ils donnent la preference. Ainsi quelques-uns indiquent la 
partie posterieure du thorax, dans le point interscapulidre; d'autres, la paioi de 
I'abdomen et quelques-uns encore la partie posterieiire du bras. 

Pour moi je conseille la partie ext^rieure du bras, au niveau de Tinsertion deholde. 
Les raisons pourlesquelles j'ai cette preference sont: la sensibilite qui, k cet 6ndroit» 
est insignifiante, et la facilite pour decouvrir cet endroit du corps sans deshabiller 
rindlvidu, comme il arrive quand on choisit la region interscapulaire. 

L'injection doit se faire de preference Tapr^midi, ayant sotn qu'elle soit 
rigoureusement sous-cutanee, car j'ai vu que les reactions douloureuses et violentesse 
sont toujours presentees dans les cas oh Taiguilld d'inoculation avait penetre ou tiop 
superficiellement ou trop profondement. 

RiAcnoN phovoquAb par le vaocin. 

Les differentes formules de vaccines donnent aussi lieu k des reactions differentes. 
Ainsi la primitive de Wright doime lieu k des phenom^es assez douloureux, avec 
augmentation de volume sur le point injecte, hausse de temperatiire souvent con- 
siderable, vomissements, diarrhees et cephalalgie. Avec d'autres types de vaccins, 
lee reactions sont moins importantes, de mdme que la douleur est presque insignifiante. 

Je ne discuterai pas si le vaccin qui prodult une reaction ou celui qui ne la produit 
pas est meilleur; je crois que les deux extrtoies sont nuiaiblee et que I'ideal d'un 
bon vaccin deviait 6tre, et serait, celui qui, avec une moindre reaction, donnerait un 
inf^-rTTw^im d'immunlte. 

Quant au prodult eiabore k Tinstitut, nous pouvons grouper les phenom^es aux- 
quels il donna lieu, en trois categories: peu importants, moyens et violents. 

Au premier groupe appartiennent les cas dans lesquels la temperature est monteet 
jusqu'^ 38^.5; au deuxilme de 38^.5 k 39^.5 et au troisi^e k40^et mtoe davantage. 

II resulte de mes observations que le premier t3rpe se realise sur 10 ii 15 pour cen 
des cas, le deuxitoe sur 80 pour cent et le troisitoe sur 5 pour cent. Done la reaction 
moyenne est presque constante. 

Le type de la courbe thermique, est le suivant: Au bout de 4 heures la temperature 
attetnt son maximum, puis elle commence k decliner pendant 24 heures jusqu'i 
revenir k son etat normal. 

II se produit dans certains cas, dans I'apr^midi du deuxidme jour, une leg^d 
hausse de la temperature de 2uelques dixi^mes, toujours peu importante. 

Quant aux manifestations locales elles n'ont aucune importance, se bomant k un 
durcissement peu douloureux k la pression, de la grosseur d'une pidce de monnaie de 
5 francs. Parfois se preeentent aussi dee Infarctus ganglionnaires sous-axillaires, qui 
disparaissent rapidement. 

Sur un nombre de 5.000 k 6.000 inoculations preventives que j'ai faites, ei 
suiviee de pr^, pas une fois je n'ai remarque lee nausees et vomissements signaies par 
la plupart des auteurs. 

En fait d'accidents rares, Tunique signaie jusqu'li present par un des aides du 
laboratoire, est une violente epitaxie, survenue l*aprfefl-midi m@me de la vaccination. 



PXJBLIO HBALIH AND MBUdNE. 138 

Nous avons efifectu^ daas la pratique deux inoculations succeesiveB a^par^es par 
un intarvalle de 10 joun. 

Oidinaiiement, la deuzi^ma Injection pioduit une reaction means intense que la 
premiere. La temperature ne numte qu'4 38^ et descend compl^tement au bout 
de 10 ou 12 heures, de mani^ que le cycle ^volutif s'effectue dans un temps plus 
court qu'A la premie. 

Pour mesurer rimmunit^ donn^ par le titre du s^rum en aglutinines, au troisi^me 
ou quatri^me jour apr^ la seconde inoculation, j'extrais de Textr^mit^ digitale de I'in- 
dividu quelques gouttes de sang et je fais ensuite la reaction d'aglutination m61angeant 
i une goutte de s^rum jusqu'ii 100 et 150 pour cent de bouillon de culture. Dans 
la grande majmt^ des cas, la reaction a 6t6 absolument positive, mdme k la doee 
de 1 pour 250, ce qui prouve sans discussion la bont4 de mon pioduit. 

Je ne pretends pas que la quantity d'aglutinines dans le s^m sanguin soit suffi- 
sante pour juger en dernier r^sultat d'un produit de cette nature. O'est un 
chapitre tr^ pen ^tudi^ de la science bact^iiologique et tr^ probablement destine k 
sttbir des modifications s^rieuses; mais il est certain que n'ayant pas un autre nxoyen 
de contrdle, r^aeigie de la reaction aglutinante est digne d'dtre prise en compte 
et sous ce point de vue mon vacdn a produit la formation d'aglutlnines en proportion 
plus grande sur les autres produits similaires. 

PHASE NBOATIVS. 

"Wrigfat le premier, et d 'autres auteurs ensuite, d^rivirent sous ce nom une tend- 
ance plus grande, de la part de ceux qui avaient 6t6 vaccinas, k contracter la fi^vre 
penduit les 8 ii 10 jours suivants celui de Tinoculation. Plus tard des observa- 
teurs d'un m^te incontestable mirent en doute Texistence de cette p^iiode negative, 
se baeant sur le fait de ne Tavoir pu verifier. 

Pour ce qui conceme mes Etudes, je dois d^larer que je me suis tiouv^ dans des 
conditions particuli^rement favorables pour constater ce ph^omkie, car comme je 
I'ai prte^emment dit, dans la race indienne Tisolement n'est pas possible et les 
individus malades vivent ensemble avec lee sains, dans de misdrables huttes d'lm 
espace excessivement rMuit. 

11 est Evident, que si la pMode native existait r^llement, la contagion devait dtre 
beaucoup plus facile et fr^uente, ce qui n'eut pas lieu ime seule fois. 

Les diff^ientes commissions qui vaccin^rent dans les peuplades d'indiens de Arque, 
CSiangolla, Isladel Sol, Carangas, Punata, Jestis de Blachaca, Mocomoco, Comarapa, Piil- 
quina, Umala et autres endroits situ^ k des bauteurs de 500 k 4.100 metres au-dessus 
du niveau de la mer, d^larent parmi les individus vaccinas et vivant dans les 
m6mes babitations oil se trouvait la fi^vre en pleine pMode, n*avoir pas observe 
un seul cas de contagion, ce qui prouve le pouvoir pr6ventif de la vaccine, la non-ex- 
istence de la p^iiode native et ce qui est tr^ probable encore, que dans un indi- 
vidu d^j^ avec des prodromes, on pent, grftce k la vaccine ^viter le d^veloppement 
de la maladie. 

D08B PBiVBNTIVE. 

Quant k la quantity de bacilles qui est ndcessaire pour produire rimmunit^ 
effective, Tavis des auteur^ varie dans des limites trop amples, en soite qu'on peut 
affirmer, qu*il n'existe pas une dose unique et d^termin^ avec caract^re gto^ral. 

Chantemesse indique le nombre de trois mille millions de bact^ries, distribu^ en 
4 injections, s^par^ les unes des autres par un intervalle de sept jours minimum et 
14 maximum. 

Ardin, Delteil, N^gre emploient le vaccin sensibilis^ de Besredka et effectuent 
4 injections k intervalles de trois jours. 

Jaime Ferrto fait une premiere inoculation de 2 centimetres cubes, moiti^ dans le 
bras droit, moitie dans le gauche. Sept k huit jours apr^ il refait une application de 
la mdme quantity. 



134 PBOCEEDINQS SECOND PAK AMBBIOAN 8CIEKTIFIG OOKOBESS. 

Pour Vincent, le mieux serait pratiquer 4 injections, k doees cioiaBantes de 0,50, 
0,75, 1 et 2 centimetres cubes distributes de huit en huit jouiB. II est 4 remarquer 
que ce vaccin contient seulement 400.000.000 de bact^es par centimetre cube. 

Dans ma pratique je me borne k faire deux injectums d'un demi centimetre cube: 
la premiere, avec une teneur de 500.000.000 de bact^ries, et huit jours apr^s une 
autre d'un centimetre cube. 

Pour la race indienne il est n^eesaire de chercher un pioc^6 d'immunisatioa 
qui ne n^cessite pas beaucoup d'inoculations successiveB, et ced pour plusieun 
raisons. D'abcnrd k cause des ^aormee distances auzquellei se trouvent les villages et 
hameaux; dans des endroits d^poiurvus de toute renource avec dee chemins d^tes- 
tables pour les mulets les voyages font beaucoup souffirir les envoy^ et leur caosent 
d'innombrables fatigues. Le caract^ supontitieux et apinr^hensif des naturels est 
ensuite la cause que, si Ton a pu obtenir qu'une fois ils se soumettent k Timmunisa- 
tion, la l^g^re fatigue quails ^prouvent lee terrorise et il est ft peu pr^ impossible 
de leur faire accepter une deuxi^me, et, comme il est naturel, bien moins une troisieme 
ou quatri^me vaccination. 

On doit pr^tendre en Bolivie, plutdt que des immunisations de longue dur6e, une 
immunisation qui, rendant refractaires, quand mime ce ne serait que pour peu de 
temps, tons les individus d'un endrdt d^termin^, emplcherait la propagation de I'^pt- 
d^mie et T^pouvantable mortality qu'elle cause. 

B^SULTATS DB LA VACCINB PRl^VENTIVS. 

J'ai signal^ en passant dans un des chapitres de la pr^sente ^tude les avantages 
obtenus par la vaccine employee comme agent pr^ventif. Je vais maintenant ctter 
quelques statistiques en plus, pour ^tablur une compaiaison entre ce qui s'est pa8i6 
dans d'autres pays et ce que j'ai pu observer en Bolivie. 

J'ai d^}k fait remarquer que c'est k Wright que Ton doit les premian essais de 
vaccination antitsrphique; en cons^uence c'est I'Ang^etene qui la premiere 
b^n^fida de cet agent th^peutique. 

Tout le monde sait que Tarm^ anglaise au Transvaal eut k subir dans une proportion 
alarmante, la prince, parmi les troupes, de la fi^vre typholde, qui causa de nomlneux 
d^^e. C'est ]k que les meilleures Etudes statistiques furent iutes en mime temps 
que comparatives et dont les chifEres sont lee suivants: 

Ladysmith, gu^re du Transvaal, 1906, vacant, 1.705; cas, 35—2,05 pour cent; 
morts, 8—0,47 pour cent Non-vaccin^, 10.529; cas, 1.489 — 14 pour cent; morts, 
329—3,13 pour cent. 

Dans d'autres colonies anglaises les r^sultats furent: Inde, 1900, vacdn^ 5.999; 
cas, 52—0,87 pour cent; morts, 8—0,13 pour cent. Non-vacdn^ 54.554; cas, 731 — 
1,69 pour cent; morts, 24—0,48 pour cent. Inde, 1901, vacdn^ 4.833; cas, 32—0,66 
pour cent; morts, 3—0,06 pour cent. Non-vacdn^ 55.955; cas, 744 — ^1,33 poor 
cent; morts, 9—0,36 pour cent. Inde, 1907, vaccin^ 2.207; cas, 0,68 pour cent; 
morts, 0,13 pour cent. Non-vaccin^, 8.113; cas, 2,13 pour cent; morts, 0,52 pour 
cent. Malta-Gibraltar et Cr^te, 1910, vaccin^ cas, 0,53 pour cent; morts, 0,89 pour 
cent. Non-vacdn^, cas, 30—0,04 pour cent; morts, 1,69 pour cent. 

Amirique du Nord. — Dans ce pays grftce k la generalisation de la vacdneet aux lois 
qui Ta dfclar^e obligatoire dans Tarm^e, la typholde a diminu^ dans une proportion 
telle qu'elle fait penser que sous peu les statistiques n'enregistreront pas un seul cas. 

Etats-Unis, 1909, cas, 175; morts, 16. 1910, cas, 142; morts, 10. 1911, cas, 44; 
morts, 6. 1912, cas, 9; morts, 1. 

Allemagne, 1904-1907, vaccinas, 7.287; morts, 24—0,35 pour cent; non-vaccines, 
9.204; morts, 116—1,26 pour cent 

Fhmce, epidemie d'Avignon, 1912, vacdn^s, 1.366; cas, 0; morti, 0; non-vacdne^ 
687; cas, 155; morts, 22. 



PUBLIC HEALTH AND MEDIOINE. 



135 



Alg^rie et Tuniaie, vacdn^ 10.794; caa, 0; morts, 0; non vacdn^ 6.293; cas, 
168—44 pour cent; morts, 21. 

Bolivief 191S, — ^Ma statastiqiie ne peut dtare conduante sur ce point; j'ai d^k 
indiqu^ lee raiaons qui m'emp^ch^nt de faire une 6tude plus complete. 

La vaccination ayant 6t6 6(tectai6e dans une region d^tennin^, la commiasbn 
Banitatre attend seulement 8 2i 10 joun, et» si dans ce terme aucun nouveau malade ne 
se pr^nte, elle quitte rendroit infect^, laisnnt k Tautorit^ locale le soin d'averUr 
imm^diatement si de nouveaux cas de typhoSde se pr^eentaient 

Par cons^uent ropinion sur laquelle je me base pour juger de reflScadt^ de la vac- 
cine, repose sur le fait snivant: Dans les villages soumis k la vaccine, Tdpid^mie a dis- 
paru compl^tement, de nouveaux cas ne s'6tant pas pr^sent^ dans un tenne qui, 
jii8qu*4 present, atteint huit mois comme maTimum et un mois comme minimum. 

Uniquement dans deux endroits la fi^vre fit un retour offensif , ce qui me permit 
de faire une ^tude importante sur Tefficacit^ pr^entive de ma vaccine; ces deux 
endroits furent Arque et Punata, dans lesquels T^pid^mie, apr^ avoir disparu, 
revint au bout d'un certain temps avec nouvelle vigueur, ce qui motiva renvoi de 
nouvelles commisBions, chaig^ d'annoter soigneusement les cas dans lesquels une 
p^sonne vaccinae aurait contracts la fi^vre. 

A Arque, tant par la d^laration des autorit^ qui par ocdre du Gouvemoment 
firent une soigneuse Investigation, comme par le rapport du commisaionn6, Ton sait 
que pas une seule fois on ne vit que les individus vaccinas eussent pns la maladie; 
quoiqu'ils v^cufisent dans des huttes infectes et malsaines avec leurs parents maladee. 

A Punata le Dr. Villarroel d^lare avoir vu deux cas uniques d'individus qui 
iqyrte avoir M vaccinas prirent la fi^vre. Ces deux cas sont les seuls od dee indi- 
vidus vaccinas aient subi la typholde. Dans les autres endroits, comme on peut le 
voir d'apr^ les tableaux que je transcris ci-dessous, les ^pid Ernies ont disparu dans 
un terme de huit k quinze jours. 

Vaceination, 



Dates. 



1918. 

CommlnioD Dr. Mendoia,da34 de Joillet 

aQ28d'aoCkt. 

Commission NavArro, mraie dAte 

Commmton R«A)el, saptembre 14 k sep- 

timbrsSO. 
Commisalon Balcanr, septembre 90 aa 

15 octobre. 
Commlsikm OilhiMla, ootobre 8 k ooto- 

bnl4. 
CommJssloii NaTarro, ootobra 21 aa U 

novsmbre. 

CommtasioiiaTai^,ootobn39 

Commisstoo Dr. PeOaranda, ootobre 14. . . 
Commissioo Antonio Mo raJes. noTsmbre 30 
Commission Dr. Villarroel, dsoembre 9. 

CommiBlon Dr. Aramayo, dAwmbre 80.. 
Dif 



1914. 

eommlssion Dr. Mercado, JauTler.. 
Commission Dr. Saens, terikr 18. . 

Tribunal do mMedne, mars 4 

Commission Rooabado, mafs 28. . . 

Oommisslon Vargas, mafs 10 

DiTsraeaoommisdons 



Endroits. 



Arqae, Colcha, Berengoela 
y Torsmna. 

Changolla e» Tarata 

WadKTsoL 

Arqoe, Coloha, Berengoe- 
la, Toosoma. 
Provinoe de Carangas 

Mooomoco 

Tarij^TllleetTlUages. 

Umala.. 
Ponata. 

Potosi, Tille et Tinans. . . . 
Pnlacayo. Hospltaks, 
Achacachi, eto. 



Comarapa et TamMllo 

Vallasrande 

TarlJa 

Qoechisla 

sioasioa 

Omro, Potosf,eto 



Nombre 
de vao- 
dnte. 



250 
800 

427 

850 

600 

850 
800 
220 
500 

150 
780 



4,42 7 

800 
200 

100 

100 

500 

1.000 



lUsnlUts. 



L'^pid^mie se pr^senta 

de nouveao. 
Ne se pi^senta plus. 
Ne se pr^senta plus. 

Ne se prfeenta plos. 

Ne se pr^senta plus. 

Ne se prteenta plos. 

Ne se prteenta plos. 
Ne se pr^seota plus. 
Ne se urtfsenta plus. 
L'^piddmie se prteenta 

de nouveau. 
Ne se pr<Ssenta plus. 
Ne se prteenta plus. 



Neseprteentaplos. 
Ne se pr^senta plus. 
Ne se pr^senta plus. 
Ne se presents plus. 
Ne se pr<<senta plus. 
Neseprteentaplos. 



186 PBOOEEDINGS 8BC0KD PAN AMEBIOAN 8GIEKTIFI0 G0NGBE88. 

Vaocin CUBATir. 

PBSMiiBES Etudes. 

La presque totality dee auteura qui ee eont occup^ de bact^rioth^rapie accordent 
k Eug^e Fraenkel d'Hambouiig le m^iite d'avoir ^t6 le premier k appliquer 1e vac- 
cin comme agent, non pas prophylactique male curatif . C'eet en 1892 et 1893 que 
cet auteur mena k bonne fin see ^tudee, ayant compris dans see expMenree 57 malades, 
8ur leequelfl le nouveau traitement donna des r^sultats si favorables qu'ile faisaient 
d6}k pr^voir les avantages qu'avec le temps on pourrait retirer de son emploi. 

Weisgeberber, dans son excellente th^ sur ''L'6tat actuel de la vaccination contre 
la fi^vre typhoTde/' croit que ce fut Eichhols, qui dans I'Airique AUemande du Sud, 
sur 68 malades fit avant Fraenkel des exp^encee avec la vaccine comme agent 
curatif. 

Ferrdn affirme que c'est k lui qu*on doit Pemploi du vaccin comme agent curatif; 
ayant depuis 1887 fait diverses investigations, qui revendiqueraient pour lui le 
m^rite de droit de piimaut^. 

De son c6t4 Chantemesse fait remarquer que c*est k ses Etudes et k celles du Pro- 
f esseur Widal que le triomphe de la vaccinot^rapie antityi^que est dA. 

Plus taid une v^table phalange d'investigateurs ont effectu6 des essais plus ou 
moins favorables; les mdmes que je transcris d*une commimicatbn faite par le 
Professeur Arnold Netter, k la Soci^ M6dicale d'Hdpitaux. 



PUBUC HEALTH AND MKDICINB. 



137 



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FUBUO HEALTH AND MEDIOIKB. 189 

Examinant le tableaa pr^c^ent, on voit que jusqa'aujourd'hoi let statifltiquen 
pluB nombreuBes sont cellee de Petrowitch avec 460 malades et la mienne avec 344. 

Je dole faire noter que je ne marque pas plua de deux cents cas qui de diff^nta 
points de la R^publique m'ont ^t^ communique (Dr. Qerahi d'Oruro, Dr. Aremayo 
de Potosf, etc.), parce que je ne possMe pas les observations cliniques completes et 
que je d^ire que ma statistique soit s6v^ autant que possible. 

Ajoutant aux 344 cas les deux cents pr^cit^, j'aurais une statistique globale de 544 
malades soign^ avec un r^ultat toujours favorable, ce qui me placerait & la tdte de 
tons les auteurs d'apr^ le nombre de malades traits. 

Pour 6purer ma statistique, je vais supprimer les cas sans ^tude clinique complete, 
et les 100 de 1914, dont la documentation ne m'est encore pas parvenue totalement; 
de mani^ que ma statisique sera r^uite k 234 malades, avec deux d^c^. 

D'apr^ les tableaux trac^ par le Dr. Villanoel, on pent classer les 234 malades 
en 6 groupes distribu^ de la laigon suivante: 

Premier tableau. — Nous prendrons comme type Dionisio Gonz&les, 7 & 13 jours de 
maladie, commence le traitement: Premier jour, temperature 40*^, injection vaccin 
Morales d*un demi centimetre cube; deuxi^e jour, temperature 36*^.5, injection « 
6tat general, bon; troisi^e jour, temperature 36^.5, injection vaccin national, 
quatri^e jour, convalescence. Dans ce tableau sent compris 126 malades. 

DenxQme tableau, — Francisco Delgadillo, 4^8 jours de maladie, temperature 39*' 
le premier jour du traitement, injection vaccin; deuxi^me jour, temperature 38^.9, 
reaction locale intense, injection Tapr^ midi; troisieme jour, temperature 38", 
reaction locale intense, injection; quatrieme jour, temperature 37^, langue et etat 
general normaux; convalescence; comprend 43 malades environ. 

Troiiihne tableau, — Juan Ml. Garcia H., quatre jours de maladie, avant traitement, 
temperature 39^.8, injection; deuxi^me joiir, temperature 38^; troisieme jour, tem- 
perature 39^, une heure apr^ Tinjection, frissons, hallucinations, deiire violent; 
quatri^me joiir, injection, etat le mdme; sixi^me jour, m^me etat, injection; douzi^me 
jour, temperature 39^; vingti^me jour, convalescence. Comprend 42 malades. 

Quatrihne tableau. — Antonio Ugarte, quatre k huit jours de maladie. Premier 
jour, temperature 40^, injection vaccin Morales, deuxi^me jour, temperature 
38*^, injection d'un quart de centimetre cube; troisi^me jour, temperature 37^.8, 
traitement voie interieure; cinquieme jour, bypothermie, i^petit demesure, con 
valescence. Comprend 9 cas. 

Cinqmhne tableau. — Escol^ica Quinteros, ftge avance, 60 2i 80 ans, 7 & 10 jourH 
de maladie, temperature 39° le premier jour du traitement, injection matin, et soir 
hausse de temperature pendant deux heures plus ou moins. Deuxi^me jour, hypo 
thermie, traitement voie interieure; troisi^me jour Thypothermie s'accentue; 
necessite cafeine et autres tonicardiaques; quatri^me jour, suit Thypothermie, 
mauvais etat general; cinqui^me jour, dec^s. Comprend deux cas. 

Sirihne tafr^eou.— Type: Mariano Condori. Temperature au moment de Tinjec- 
tion 40^.5. Inoculation matin et soir d'lm demi centimetre cube le premier jour; 
un centimetre cube le deuxieme et le troisieme jour; demi-centimetre cube le 
quatrieme et le cinquieme jour. Dans ce tableau on remarque la chute brusque 
de la temperature apres la septieme injection. 

Je dois 4 titre de document d'etude ajouter un dernier tableau, ainsi caracterise: 
Non jeune, du service des hdpitaux, k son arrivee en Italie prit la fievre typholde 
par contagion. Traitee par un coUegue, elle presenta comme caractere special 
rhyperthermie excessive, avec des temperatures de41 et42 degree qui ne cedaient 
k auctin traitement. Au bout de 15 jours et en plein etat de toxhemie, le coeur 
defaillant et pouls filiforme; on fit plutdt par acquiescence que parce qu'on attendait 
une action efficace du vaccin, des injections d'un demi-centimetre cube pendant 
deux jours. La temperature ceda k la premiere inoculation, tombant de 40 ^ 38, 
et retat general de la malade fit concevoir quelque espoir. Au bout de deux jours 



140 PBOCEEDIKGS SECOND PAN AMEBIGAK SCIEKTIFIO 00NGBES8. 

la tozh^mie avait continue see progr^ et une hemoptysis abondante survint, dont 
la cause m'est inconnue, et la mort se produlsit imm^iatement. 

Je ne mentionne pas ce cas dans ma statistique, de mdme qu'un autre dans lequel 
au bout de dix-huit jours et en pleine p^ode d'agonie, on fit, k titre de tentative 
desesp^r^e, Tapplication du vaccin. 

Dans lee deux cas T^tat des patients ^tait tr^ grave, et on eut recoura k la vaccine 
comme une demi^ ressource. 

lUduisant les tableaux qui i»^Ment k une expression plus concrete et aboolue, 
qui facilite leur interpretation, nous avons les chiffres suivants: 

234 malades trait^s. 

190 (tableaux 1, 2, 4, et 6), dans lesquels la dur6e maximum de la maladie fat 
sept jours. 

42 avec une longue Evolution, sans complication et sans d^c^. 

Deux malades qui moururent au cinqui^e jour, mab de typholde des vieillards 
qui est tr^ mauvaise. 

La proportion de mortality des statistiquee plus nombreuses est la suivante: Fraen- 
kel, 8,77; Petrovitch, 3,04; Sadler, 10,22; Morales, 0.85. 

D08B8 THiRAPBUTIQUBS. 

L'avis des difF^rents auteurs qui se sont occup^s de cette question varie beaucoup 
en ce qui conceme la quantity la plus convenable de vaccin qu'il est n^cessaire 
d'employer et au moment 1e plus favorable pour faire les injections. 

Cette diversity d*avis se doit autant au different crit^rium des exp^rimentateurs, 
conune k ce que chacun d'eux employa des produits diff^rents, avec un index bext^- 
rien divers; de sorte que les r^eultats ne peuvent, dans aucun cas, 6tre comparables. 

Josu6 et Belloir injectent trois fois 200.000.000 de badlles, avec douze heures d'in- 
tervalle; la culture est prise du mdme malade. 

Netter applique 500.000.000 de badlles (sterilises) sensibilises k chaque fois, pendant 
trois jours suivis. 

Meakins emploie la dose de 1.000.000.000 de bacteries chaque hult jours; Ardin- 
Delteil, la mdme quantite mais chaque trois jours. Boinet, egale quantite durant 
quatre jours suivis. 

On voit done, avec quelle difference la valeur therapeutique de la vaccine est 
appreciee. Pour les uns les doses massives doivent, de preference, etre employees; 
tandis que d'autres croient que les doses moderees, frequemment repetees ont plus 
d'efficacite. 

Quant k moi, void mon procede: Matin et soir pendant deux jours consecutifs, 
j'injecte des doses de 500.000.000 de bacteries. Si apr^ ce traitement la temperature 
baisse k 38, je suspends les inoculations; mais, si la temperature se maintient eievee, 
alors je fais une cinqui^me, sixi^me et exceptionnellement une septi^me injection. 

Seulement dans un cas on employa des doses plus fortes; ce fut avec le malade du 
Dr. Luis Martinez Lara, auquel on fit trois applications de 1. 000.000.000 de bacteries. 
Je crols qu*il n'y pas de ralson pour employer des doses aussi eievees. 

ACnON DU VACCIN. 

Pour donner une idee complete de la mani^re dont le vaccin agit, je vais raconter 
le premier cas ot il fut applique. 

Vers la fin du mois de mai de Tannee demi^re, au numero 41 de la section de Mede- 
cine de THdpital Landaeta se trouvait Tindien N. N., ftge de 20 ^ 25 ans. L'examen 
clinique reveia une typholde dans le quatri^me ou cinqui^me jour de son evolution, 
avec tous les caract^res classiquee. La reaction de Widal et la diazo-r^action de 
Eh rlich, confirm^rent pleinement le diagnostic . Nous pouvons classer cette tyi^olde 
entre celles de moyenne intensite, avec une certaine tendance k rhyperthermie qui 
B'Avait pas cede aux fortes doses de quinine. Decide k easayer la vertu curative 



FUBLIG HEALTH AND MEDICINE. 141 

du vaccin et apr^ une longue et Uborieuse ^tude sur la s^iie animale, coura- 
grasement coUabor^ par lee Dra. Juan Medina Vaca et Luis Martfnes Lara, je fia la 
premi^ injection d'un demi-centim^tre cube le matin du 27 mai. 

Deux heures apr^, la temp^ture, qui au moment de Tinoculation ^tait de 39^, 
monta 8/10, tombant le lendemain k 37,8. On r6p6ta lea inoculations, la tempera- 
ture se maintenant k 38, et baissant le quatri^e jour d'une fagon definitive k la 
normale. 

L'observation qui pr^cMe est, avec peu de variantes, la mdme qui se r^p^ta dans 
touB les cas, exception faite de ceux lemarqu^s par le Dr. Villanoel dans le D^parte- 
ment de Gochabiunba, et dont revolution fut plus longue. 

Je dois {aire remarquer que les reactions douloureuses avec deiire furent frequentee 
sortout dans les individus alcooliques; tel qu'il aniva durant repidemie de Punata. 

Je dois de mtae appeler Tattention sur le {ait particulier que, hors trois ou quatre, 
peut-^tre cinq, malades qui {urent soumis au r^ime lacte, U hit impossible avec les 
autres de r^gler leur nourriture, ni mtoie d'obtenir leur isolement et de leur faire 
boire de I'eau cuite. 

Les indiens ont constamment re{use tout changement dans leiur coutumes ordi- 
naires. 

COMPUCATIONS. 

Je ne puis sur ce chapitre dtre tr^ aflSrmati{, car comme je Tai d^}k dit plus haut, 
les differentes commissions chaigees de combattre la typholde, rest^rent seulement 
huit k dix jours dans les lieux inlect^; de sorte qu'elles ne purent appr^der les 
complications qui ont pu survenir apr^ la maladie. 

Quant k celles qui pendant le cours de la maladie se presentent, je peux unique- 
ment affirmer que les frequentes hemorragies, signaieee par quelques auteurs comme 
un fait habituel du traitement vaccinotherapique, ne figurent pas dans mes observa- 
tions ni comme plus graves ni plus {r^quentes que dans des autres formes de traite- 
ment. 

CONVALS8CBNCB. 

Un fait flignaie par les Drs. ViUarroel, Mendoza et Sejas, est que les malades trait^s 
par le vaccin ont une convalescence beaucoup plus rapide que quand le patient est 
flonmis k d*autres moyens thdrapeutiques. 

Les forces re iennent rapidement, Tapp^tit est exag^re, et au bout de six & huit jours 
maximum, le malade a repris ses energies; de sorte qu'il ne consen e aucune conse- 
quence de son infection. L*exemple le plussurprenant que j'aie remarque dans cet 
ordre est celui de Mile. Maria Teresa Olagui el, ftgee de 14 ans, qui attaquee de 
dothienenterie exceptionnellement gra e le 19 fe^ rier, put le 28 du mdme mois aller 
jusque chez moi pour m'exprimer sa gratitude, ne donnant aucun aigne que seulement 
one semaine aupam ant elle avait ete sur le seuil de la tombe. 

LA ttfhoIdb bn bouvib. 

La typholde fut en Boli^ie une entite morbide, d'une vaste etendue geographique 
M ses degats se {aisaient sentir dans tons les coins de la Republique. 

I^es epidemics etaient parfois tellement gra es qu'en 1912 les proprietes voisines du 
he Titjcaca perdirent presque 70 pour cent de leurs laboureurs, et demierement k 
HauilUunarca d'apr^ le teiegramme que je transcris ci-dessous et qui fut remis par 
la premiere autorite politique de cette pra ince, on remarque qu'avant Temploi du 
%accin il y eut dans un seul Aillage 200 dec^. L'aide Nestor Orihuela, emoye 
quelques jours apr^ cette \ eritable hecatombe, guerit, grftce k une acti % e campagne, 
49 malades et eteignit compl^tement repid^nie. 

Void le teiegramme: "Eucalyptus, le 14 Octobre. — Directeur de Tlnstitut de 
Bact^iologie, La Pas.— Vaccine k Carangas succte complet.— Nous parcourilmes les 
villages de Corque, Curaguara, Turco, et HuaiUamarca, c'est4-dire, une etendue 



142 PBOCEEDIKOS SECOND PAN AMEBIGAN 80IBNTIFIG CONQBESS. 

d'environ 80 lieues. Trois cent cinquante vaccmations preventives furent ftdtes 
et 40 malades gu^is. A^ ant de pratiquer la Aaccination, deux cents indiens monru- 
rent k Huaillanuurca, d'apr^ les renseig:nements des indiens. Details par courrier. 
A. Illdnez, Sou8-Pr6fet de ia Province." 

De ce moment^ k I'instant oh y^cna ces lignes, il n'y a pas dans toute la R6pa- 
blique un seal cas de fi^vre typhoTde; de sorte que beaucoup d'existencee sent con- 
serve pour le commerce et la richesse publique. 

LB VACCIN A l'i&TRANGBR. 

Sur demande faite par diff^ntes autorit^ sanltaires ou politiques et par per- 
Bonnes particuli^res, nous avons remis du vaccin aux endroits sui^ ants: Ctdli 
(Santiago, Arica, Tacna), Argentine (Salta), Cuba (Sagua ia Qrande), P^rou (lima), 
Mexique (Yucatdn), Etats-Unis (New-York). 

durAb du vaocin. 

II n'ost pas encore possible d'assurer pour combien de temps le vaccin conser ; e 
son acti it^ complete. Les premieres Amissions 6iabor6es Pan dernier vers la fin de 
mai, se sont consen ^ sans alteration dans tous les climats, depuis le climat presque 
glacial du plateau andin, sous des temperatures de 10 et 12 degr^s au-dessous de zero, 
jusqu'au climat ardent des plaines de Santa Cruz, avec 30 et 35 degres au-dessus 
de zero. 

En date du 20 avril, afin de verifier Pacti^ ite du vaccin, on fit des experiences 
sur la serie animale dont les r^ultats, qui feront Tobjet d'une seconde communi- 
cation k TAcademie de Medecine, sont les suivants: un lapin des Indes de 460 
grammes, qui Cut injecte de 1 cc. de vaccin antityphique, de la premiere emission, 
qui fut eiaboree vers la fin du mois de mai 1913, eut une eie . ation de temperature 
deux heures apr^s Pinoculation de 40,6 degres. Le lendemain cette temperature 
tomba k 38,2, chifFre normal. 

Injecte, un autre lapin pesant 490 grammes, d'une dose ^ale de ^accln anti- 
typhique mais de treizi^me emission, eiaboree pendant le mois de mars de Tannee 
en cours, donna comme elevation de temperature 40,5 deux heures apr^s, re v enant 
le lendemain k 38,2, ou ce qui est la mdme chose k la normale. 

Cette seule obsen ation dans laquelle les temperatures s'eie\^rent d'une Ca^on 
tellement ressemblante dans les deux cas, ne serait pas suflSsante pour en tirer des 
conclusions definiti\es et deduire que le premier vaccin a\ait conserve toute sa 
force, et pour avoir un renseignement de plus k ajouter k cette interessante question, 
j'ai precede k Texperience sui ante: Deux lapins de mdme poids furent respecti.e- 
ment injectes avec du vaccin antityphique de la premiere et demiere emission; 
huit jours apr^ on injecta aux deux par la voie intraperitonienne 1 cc. de culture 
virulente de bacille typhique. Chez le lapin traite par le -vaccin de la premiere 
emission, la temperature s'eieva rapidement k 41 degres, baissant deux heures apr^s 
k la normale. Celui injecte avec le \ accin de la demiere emission, eut une eleva- 
tion de temperature qui arriva k peine k 39,8, tombant au bout de 24 heures au type 
egalement normal. 

D^ ce moment ils ne subirent aucun malaise; leur appetit etait excellent et ils 
paraissaient n'avoir aucunement souffert de I'inoculation de cultures virulentes. 

Deux lapins injectes en m^me temps avec des cultures typhiques, mais qui n'avaient 
pas subi Taction du vaccin, eurent des temperatiures tr^s variables, qui se main- 
tenaient encore au bout de dix jours k 39,8 et seulement apr^s vint ime longue con- 
valescence avec ime perte considerable de poids. 

Les observations precitees sont convainquantes d'apr^s mon opinion et prouvent 
deux choses: 1% que le vaccin eiabore k Tlnstitut National de Bacteriologie de La Paz, 
au bout de 11 mois a conserve toute son activite; 2*, que son action efficace de defense 
s'est montree egalement moyennant I'inoculation de cultures de bacille typhique , 



PTJBLIO HEALTH AND MEDICINE. 148 

c'e0t k peine si une l^g^ et inaigmfiante fi^vie 66 produisit (^i^vation de tempera- 
ture), tandis que lea t^moinfl souffrlrent gravement. 

CONCLUSION. 

Pour terminer, je croifi de men devoir de manifester que, d'apr^ mon opinion, la 
v-accinoth^rapie de la fi^vre typhol'de est destin^e h substituer toutes lee autres formes 
de traitement connues jusqu'aujourd'hui, et siur lesquellee elle a les avantages suivants: 
facility d 'application, mortality minime et le manque jusqu'^ ce jour de centre- 
indications qui pourraient faire craindre son application. 

Monsieur le Directeuo' de Vlnsiitui National de BacUriologie Dr, Nistor Morales F., 

Prhent. 

Gomme membre de la Commision Sanitaire, chaig^e de combattre r^pid^mie de 
fi^vre typholde qui se d^veloppa dans lee Provinces de Arque et Tarata du D6- 
partement de Oochabamba, j'ai eu Toccasion d'exp^iimenter Tapplication de votre 
vaccin antityphique dont j'ai Thonneur, me r^f^rant k Tordre de rintenogatoire 
formula par vous, de certifier les r^ultats sur les points suivants: 

Premier. — Dans les multiples foyers ^pid^miques qui existent k Arque, comprenant 
neul r^ons dans les hauteurs de la section de Golcha, deux dans la section de Chan- 
goUa, Tacopaya, et trois regions de la Province de Tarata, le personnel de la commis- 
sion ex^cuta d'apr^ les tableaux nominaux remis k cette Direction, 700 vaccinations 
preventives et 40 inoculations curatives, obtenant un r^sultat plus que satisfaisant, 
tel que la gu^rison de tous les malades et I'extinction de repid^mie en moins d'un 
mois; d'oii Ton d^duit que le vaccin fut employee non seulement comme agent 
]Nn6ventif mais comme agent curatif . 

Deuxiime, — Dans les reactions autant locales que g^nerales des vaccinas pr^ven- 
tivement, jamais aucun accident malheureux ne s'est pr^sent^. Dans lee typhiques 
les reactions thermiques auxquelles la vaccination a donn^ lieu, se sent montr^es du 
cdte de la defervescence, apr^ la troisi^me inoculation dans la plupart des cas et 
dans quelques-uns apr^ la deuxi^me, comme le font voir les graphiques port^s k 
votre connaiasance; avec la baisse de la temperature ont coincide I'attenuation et 
Parrot des autres symptdmes morbides, obtenant au bout de quelques jours la guerison 
du malade. Base sur ces faits de contr61e personnel et sur les r^ultats obtenus avec 
un succ^ semblable par les Drs. Sejas et Villarroel, qui eux aussi, ont combattu 
repidemie precitee, je consid^re que la vaccine antityphique constitue un puissant 
remMe capable par lui-mdme de faire disparattre et de prevenir I'infection typhique. 

Troisihne. — Dans le cours de repidemie des provinces citees plus haut de Oocha- 
bamba, on employa seulement le procede vaccinotherapique excluant tout autre 
traitement. 

QyatrOme.—Aytait intervention de la vaccination antityphique, la mortalite etait 
considerable, d'apr^s les renseignements foumis par les autorites et les doutes. Lassi- 
tude, manque d'appetit, epitaxis (presque tous les malades presentaient ce sympt6me) 
mal de tete violent, insomnie, enfin le tableau initial de I'infection t3n;>hique; puis 
la fi^vre, le deiire, le caract^re de la langue, les perturbations intestinales les roulades 
de la fosse iliaque, quelques manifestations bronyhiales et pulmonaires, si frequentes 
dans cette maladie et autres symptdmes que je ne mentionne pas pour dtre plus bref, 
guid^nt mon jugement pour faire le diagnostic que j'ai signaie. Les sept malades 
etaient dissemines en different hameaux voisins du Saladillo de la fa^on suivante: 
2 k Agua Blanca, 3 k Jagtle, 1 k TEstanque; 1 k San Pedro; la plupart etaient dans le 
second septenaire, k San Pedro c'etait une jeune fille de 14 ans, plongee dans la plus 
grande mis^ et qui presentait la forme typique de la fi^vre ataxe adinamique. H 
est inutOe de dire qu'aucun d'eux n'avait ete traite si peu que ce sdt, ni qu'ils ne 
pratiquaient mdme pas les r^lesd'hygi^e les plus eiementaires, vivant en repugnant 
pdle-mdle avec les individus sains, mangeant et buvant ce dont ils avaient envie, et 
se levant pour faire leuis necessites. Tout ceci explique Textraordinaire gravite de 
revolution du proems morbide. 



144 PROOEEDINQS SECOND PAN AMBBIGAN 80IBNTIFIG C0NQBB88. 

En presence de la sftret^ que lee renaeigneinente cliniques me donnaient, je n'h^ritai 
pas k appliquer imm^diatement lee injectioiui de e^rum antityphique, pr6par6 k 
rinstitut de Bact^iiologie, par le Dr. Nestor Morales yillaz6n, et que le Pr^fet avait 
eu la gentillesBe de me procurer. 

Matin et soir je pratiquai k chaque malade une injection d*un demi-centim^tre 
cube et j'eus la satis&u^on de constater un r^ultat splendide k partir du deuxitoe 
jour du traitement. Chez un malade il suffit d 'im jour de traitement pour que la 
temperature revint k son ^tat normal et les symptdmes qu*il pr^ntait disparussent; 
chez les autres une tranche amelioration se produisit k la quatri^me injection, et chez 
la malade de San Pedro k la cinqui^me injection je pus la considerer hors de danger. 

Apr^ la demi^ injection je restai deux jours de plus observant les rdsultats d^fi- 
nitifs et attendant de nouveaux cas qui ratifiaasent les triomphes obtenus sur les an- 
terieuiB. Aucun ne se pr^sentant j'entrepris mon voyage de retour, regrettant de ne 
pas pouvoir repasser k Gapillas par manque de temps et k cause du r^tablissement non- 
d^finitil de ma sant^. 

Je dois faire un acte de justice envers le jeune honmie Manuel Montafio qui fut 
mon collaborateur d^vou^ et qui m'accompagna dans toutes les excursions que matin 
et soir j'avais k faire pour visiter les malades. Cest 2l lui que je recommandais de 
continuer k me foumir teiegraphiquement des renseignements sur les malades; ces 
renseignements ont confirm^ pleinement la complete gudrison de ces derniers. 

Je traitai aussi la convalescence de tous ceux qui» avant mon arriv^e, etaient tomb^s 
malades, employant pour cela le r^ime tonique et reconstituant consellie pour 
ces cas. 

Avant mon arriv^e k Saladillo il y eut les malades suivants: Agua Blanca, 25; 5 
d6ckB; k San Pedro, 12; 2 d^c^; k Saladillo, 3; pas de d^c^; k JagUe, 14; 3 morts; k 
I'Estanque 9; 1 d^c^, qui ajout^s aux sept cas trait^s par moi donnent un total de 
70 malades et 11 d^c^. 

Refiechissant sur les causes qui ont pu determiner ce proc^ infectieux, j'en ren- 
contre Pexpllcation dans la mauvaise quality de Teau. Ce sent des lieux depourvus 
d'eau courante et leurs habitants doivent employer I'eau qu'ils retiennent dans 
des excavations faites dans ce but. Pendant la saison des pluies ces depdts-li se 
renouvellent constamment, mais dans la saison s^he, Teau qui n'est pas renouveiee 
prend mauvaise odeur et subit des decompositions de tout genre, et Ton sait que 
le microbe d'Eberth, agent producteur de la typholde trouve dans Teau un excellent 
milieu de developpement; Pingestion de ces eaux produiairent les premiers cas, 
la malproprete, le manque de precautions hygieniques se charg^ent de propager la 
maladle sous forme epidemique. 

Je dois faire remarquer une circonstance: le village de Comarapa est k mi-ch^nin 
entre Capillas et Saladillo et cependant repidemie sauta, on pent le dire du premier 
au deuxitoe point sans attaquor un seul individu du village; cellt est dfi 2l un ruisseau 
.que ce dernier possMe et q\ii l\ii foumit de Peau propre et pas contaminee, qui le 
sauvegarde des infections intestinales du genre de celle dont nous nous occupons. 

Je terminerai. Monsieur le Prefet, ce point de mon rapport avec les conclusiaDS 
suivantes: 

1. L'epidemie qui se developpa aux environs du village de Comarapa fut la fi^vre 
typholde. 

2. Les sept typhiquee tndtes avec le vaccin preparee k Tlnstitut National de 
Bacteriologie par le Dr. Nestor Morales Yillaz6n ont gueri compietement. 

3. Hors le traitement hygienique general, aucun autre que le serum n' a ete employe 
pour les 7 malades predtes. 

4. Je crois que dans la mauvaise qualite de Teau reside Torigine de Pepldtoie. 
Je profite de la presente occasion pour exprimer au Gouvemement, par Fintenne- 

diaire de Monsieur le Prefet, la necessite d'etabHr d'urgence un service reguUer 
sanitaire dans cette region. 



PUBLIC HEALTH AND MEDICINB. 145 

Toute cette region se prdte & ragiiculture et mtoe & P^evage du b^tail, car h eziste 
en eCfet sur les collinee et dans lee vall^ dee labourages plus ou moins 6tendus, et 
dans lesquels les produits de la contr^ viennent admirablement; mais iin obstacle 
eziste qui s'oppoee & son prpgr^ puisqu'il d^cime lee bras ou lee inutilise pour an 
labeur actif. c'est le paludisme. C'est la maladie dominante dans toute la contr^ 
et, enracin^ et propag^e de telle fagon, qu'il n'y a pas dans toute I'ann^e une saison 
dans laquelle elle ne se pr^sente, et il est trke rare qu'un m^ecin ne rencontre dans 
tous les habitants de cette h^on quelque vestige lointain ou r^ent de Finfection^ 
malarique. 

n est certain que le paludisme dee r^ons temp^r^ ne rev^t pas la forme aiguS et 
maligne des climats tropicaux que nous avons eu Toccasion d'observer au Beni, mais 
il n'en est pas moins vrai que, malgr6 sa b^nignit^, il finit par causer de s^eux boule- 
versements, affaibUssant les personnee auxquelles il s'attaque, minant Porganisme 
le rendant prdt k contractor lee infections secondaires. D'autre part c'est Ik Tunique 
obstacle qui empdche la population d'augmenter, car il s'abat surtout sur les enfants 
du premier ftge, et ceux q\ii en ^*happent se d^veloppent alors dans une pauvret6 
ovganique extreme, soutenue souvent pendant leur existence par la t^nacit^ de la 
maladie. 

L'histoire de la decadence de la valine de Mizque, florissante auparavant, est 
un ttooignage frappant du labeur destructif du paludisme. Fampagrande qui 6tait, 
il n'y a pas longtemps, un centre de commerce assez important, se trouve aujourd'hui 
converti en un triste hameau depuis que le paludisme y fit son apparition et je ne 
m'avance pas trop en disant que cette maladie est 1' unique entrave au progr^ de ces 
r^ons. 

Maintenant que les pouvoirs publics s'int^ressent k encourager notre commerce k 
renforcer noe Energies productrices, k aider I'augmentation de notre population, qui 
est la base de Pagrandiseement national, ils sont oblig^ d'entreprendre I'oeuvre 
homanitaire de combattre la maladie qui flagblle ces malheureux villages, en employ- 
ant pour cela les ressources dont dispose la science. 

Tout d'abord, et comme oeuvre initiale, s'impose la n6ceesit6 de la crtetion d'un 
poste pour un m6decin titulaire, dont la rMdence serait fixte k Comarapa, et qui 
serait chaig6 de surveiller les environs et de Mre surtout une guerre sans merci au 
paludisme. Cette base Stabile, on pourrait ensuite accorder un vaste plan sanitaire 
qui en peu d'ann^ donnerait les plus beaux r^sultats. 

Propi^taires des lieux infect^, ayant atteint dans quelques endroits le tiers de la 
totality des habitants. Avec le traitement par vaccinothtopie il y eut seulement 
on d6c^ sur lee quarante malades traits. 

Cinqmhru. — Quant k la dur6e de la maladie par le traitement vaccino-antityphique, 
on a observe que la baisse thermique s'effectuait du troisi^me au quatri^me jour, 
c6dant graduellement les jours successifB les autree manifestations symptomatiques, 
jnsqu'au sixidme ou huiti^me jour oti la gu^rison du malade s'accentuait. 

Ces r^sultats mettent en Evidence la bont6 et Tefficacit^ de ce nouveau traitement 
qui non seulement attaque la cause m6me de la maladie, mais r6duit considerable- 
ment le temps de son Evolution. 

Dr. Jxius F. Mkndosa.. 

La Paz, le 13 novembre, 1913. 

The Chaibmak. Through the courtesy of the author, the following- 
named printed volume is presented to the congress through Section 
VIII: La blastomicosis humana en el Perti y Bolivia, by Ekimundo 
Escomel. Arequipa, Perti, 1914. 

The session adjourned at 6 o'clock. 



GENERAL SESSION OF SECTION Vm. 

New Ebbitt Hotel, 
Wednesday morning, December £9, 1915. 

Chainnan, William C. Qobgas. 

The session was called to order at 9.30 o'clock by the chairman. 

Dr. Caeteb. Mr. Chairman, we were imable to avail ourselves of 
the assistance of Dr. Vital Brasil, as he foimd it impossible to be 
with us. The following report prepared by the majority of your 
committee on the amendments suggested by Dr. Guiteras is now 
submitted: 

Referring to the matter of amendments to the International Sanitary Convention 
submitted to us, this committee is of the opinion that all changes in said convention 
oug^t to be considered and acted upon by the Sanitary Conference of the American 
Republics, which meets at Montevideo for that purpose, and therefore the amendments 
proposed should be matter for such conference to consider, together with such opinions 
as may have been expressed by other members of this section. No report on this 
subject, then, from your committee seems called for. 

Dr. Kobeb. I move the adoption of the report. 

Seconded and approved. 

Dr. George M. Kober took the chair. 

The Chaibman. The following papers wiU be presented at this 
session: 

The alcohol and drug habits and its prophylaxis, by Dr. Harvey 
W. Wiley. 

Os fumadores de maconha: efiFeitos e males do vicio, by Dr. 
Rodrigues Dona. 

El problema del alcohoUsmo y su posible soluci6n, by Luis L6pez 
de Mesa. 

Lucha contra el alcohoUsmo, by Dr. Ricardo Sarmiento Laspiur. 

THE ALCOHOL AND DRUG HABIT AND ITS PROPHYLAXIS. 

By HARVEY W. WILEY, 
CarUribuUng Editor, Good Housekeeping Magazine, 

What is a drug habit? The taking ol any stimulating, exciting drug which has no 
food value, and which produces directly excitation of any of the organs of the body 
or nerves controlling them in such a way as to suggest or compel a repetition of the 
dose, is a drug habit. The drugs which are commonly used for this purpose are alco- 
hol, tobacco, opium and its derivatives, chloral, cocaine, acetanilid, phenacetin, 
146 



PUBLIO HEALTH AND MEDICINE. 147 

andcaffein. There are many other drugs which tend to produce a habit without 
appealing to the sense of artificial relief, as, for instance, those which are used habitu- 
ally to correct constipation. These drugs, however, are not so commonly employed, 
nor is the habit which they induce difficult to overcome. A very distinguished friend 
of mine told me recently that he had been taking for years sodiiun phosphate, regu- 
larly, as he would his meals. He had grown into the conviction that his physical 
well-being would be so disturbed by the omission of this dose that he did not dare to 
leave it off. 

The habit-forming drugs which are most extensively used are alcohol, nicotin, and 
caffein. If we class as drug addicts those who have acquired the habit for one or more 
of these drugs the number of them in the United States would be very close to half 
or two-thirds of the population. When we speak of drug addicts, however, we usually 
have a mcnre restricted sense and refer rather to those who are slaves to opium or the 
coca leaf and their derivatives. I, however, for the purpose of this paper include all 
drugs of the class mentioned above. 

The methods of acquiring these habits are so well known that I need not dwell 
long upon them here. Unfortunately for the reputation of the medical profession, it 
is certain that a very large percentage of the cases of opium addiction is due to the 
use of this remedy in some form in regular medical practice. The same is true, 
though to a less extent, of cocaine. In regard to alcohol the case is quite different. 
A half or a third of a century ago alcohol in some form was very conmionly adminis- 
tered as a remedy, and doubtless in these cases the alcohol habit was often acquired 
in this way. At the present time the use of alcohol in any form in medicine, except 
as an external application, is becoming extremely rare, and no notable percentage of 
alcohol addicts to-day can justly claim that they have become so through the minis- 
trations of the medical profession. In so far as the use of tobacco is concerned, the 
medical profession is entirely innocent, as tobacco is rarely, if ever, used as a medicine. 

The drug habit is usually the result of imitation — ^in oth^ words, of example. If 
parents use a drug at home the children fall into the same habit. It is rather embar- 
rassing to explain to the child that father or mother may use wine, or whisky, or 
brandy, but ^e child must not. It is equally difficult to explain why the grown per- 
sons of the family may use tea and coffee and the children are denied this privilege. 
The child learns from his parents. He imitates his parents. He wants to act as they 
do. He makes the same motions with his body as they make. He leams to walk as 
they do and to talk as they do, and naturally he leams to eat and drink as they do. 
But every child who has been properly taught to avoid tobacco, when he grows to be 
a schoolboy or a freshman is very likely to think it more or less manly to use tobacco. 
How many boys have been led astray by this false idea of what manliness consists of. 
If a classmate uses tobacco his chum is likely to indulge in the same practice. 

F^tunately in many States fhe use of tobacco, especially cigarettes, by minors is 
an offense against the law. In many colleges and universities, also, the use of tobacco 
is discouraged. But nevertheless the use of tobacco is not in any way regarded as a 
social crime. In fact, it is looked upon as an indispensable adjunct of social affairs. 
When the dinner is over the men retire to the smoking room. In so far as equal rights 
are concerned there is no reason why the women should not do the same instead of 
going to the gossip room. That men should segregate themselves when they smoke is 
a silent tribute to the other sex. Otherwise there would be no reasonable excuse for 
segregation. Often young women encourage their admirers to smoke. In all these 
ways the tobacco habit is encouraged. 

In this country, at least, the use of alcohol is, as a rule, discouraged by all persons, 

except at dinners. The youth of the country are not by any means so obnoxious to 

the acquirement of the alcohol habit as they were in former years. More and more 

restrictions of a l^gal nature against the use of alcoholic beverages are coming into 

6848(^-17— VOL IX 1 1 



148 PKOOEEDINGS SECOND PAN AMEBIOAN SCIBNTIPIC C0N0BES8. 

vogue. The area of prohibition is constantly expanding. The social protest against 
the use of alcoholic beverages is growing stronger. The propaganda for prohibition is 
becoming more widely spread, and all of these forces are tending to repress the 
communication and spread of the habit. 

In regard to the more potent drugs, such as opium and coca and their derivativee, 
the restrictive legislation is more effective. Not only is there State and municipal 
regulation of the traffic, but now we have a national law which, while far from per- 
fect, is doing much to curb the possibilities of the acquirement of the habit of using 
these two drugs. One of the chief faults of these restrictive laws is the concession 
which is made to almost all of them of the use of certain minimum quantities without 
restriction. There is no question of the fact that the insertion of such proviso in 
National and State laws is a mere concession to Mammon, which was secured by a 
desire to placate the dealers in these drugs. If one can secure with impunity a pre- 
scription containing a small amount of opium or coca or their derivatives, he has only 
to make arrangements to get a sufficient number of doses to secure the effect which 
he is seeking. The regulatory laws applying to conmierce in these articles should 
extend to even the minimum quantities which are employed in ordinary medi- 
cation. In point of fact, the administration of any of the derivativee of opium or of 
coca should be surrounded by the strictest safeguards. There are so many other ways 
of relieving pain which are not likely to form the habit that the physician should 
hesitate a long while before either morphine or cocaine is employed. It is a re- 
sponsibility which should affect the conscience of the physician keenly, and which 
in no way should be subjected to evasion. 

It is difficult to make a census of the number of drug addicts in the United States. 
In most cases the victims of the drug habit are thoroughly ashamed of their pitiable 
condition. No one, as far as I know, is proud of the fact that he is a drunkard. No 
one that I know boasts of the fact that he takes morphine or cocaine daily. No one is 
proud of the fact that he uses tobacco. No one boasts of the fact that he could not 
live without coffee, tea, or coca cola. The progress in ethical culture and in manli- 
ness and womanliness of conduct have driven drug addicts to cover and made it more 
or less a stigma to be known as such. Thus, any attempted census of the number of 
addicts must be more or less difficult to make. 

Commissioner of Health Lucius P. Brown, of Tennessee, made a very extensive 
study of the probable number of drug addicts in that State, and he found that there 
were registered in Tennessee in harmony with the provisions of the antinarcotic law 
of that State 2,370 persons of all ages and colors, of whom 33.1 per cent were males and 
66.9 per cent females. This was a census of those persons only who used opium or 
cocaine or their derivativee. 

Dr. Martin I. Wilbert, of the Public Health Service, has contributed an interesting 
and valuable document on this point. In a pamphlet entitled ' ' The nimiber and kind 
of drug addicts, " basing his computation on the data obtained by Dr. Brown, he esti- 
mates that in the United States there are 118,000 drug habitues of opium and cocaine, 
consuming approximately 1,416,000,000 doses per year. Including the illegitimate, 
that is, illegal, use of narcotics, at a certain estimated ratio over those declared, Wilbert 
finds that there are not more than 187,000 users of opium and its derivativee in all 
parts of the United States, and he adds that there are probably 150,000 cocaine addicts 
in the United States, making a total of something over 300,000 of both kinds of victims 
in this country. The committee of the American Pharmaceutical Association esti- 
mates that in this country the total number of victims of opium and cocaine are not 
much in excess of 200,000, and Wilbert is of the opinion that this is a figure that ia more 
nearly correct than that based upon the data gathered in Tennessee. 

One of the principal objections to the enforcement of the Federal antinarcotic law, 
known as the Harrison law, was an appeal to sympathy for addicts suddenly deprived 
of their daily dope. While it is true that there may be some intense suffering, as with 
the delirium tremens after a debauch of alcohol, it is better, in my opinion, to let a few 



, . .. I PX7BU0 HEALTH AND MEDIOIKB. 149 

victimfi suffer acutely rather than to threaten the whole mass of the people with dis- 
aster. Wilbert quotes from the coroner's chemist of Cook County, as reported in the 
journal of the American Medical Association, that during the month of March, 1915, 
seven deaths occurred in Cook County that were indirectly due to the sudden cessation 
of the use of morphine. Four died from taking an overdose of morphine. One of 
them died from a dose of Dr. Wetherby's Remedy, a morphine cure containing over 
17 grains of morphine sulphate per ounce. 

'Mlbert has collected data, also, relating to the origin of drug addition, particularly 
that drug addiction of opium and cocaine, and quotes from Dr. Terry, the health officer 
of Jacksonville, Fla., in the Journal of Public Health for 1914, that 54.6 per cent of 
morphine victims came from the use of physicians' prescriptions or similar prescrip- 
tions administered personally; that 21.6 per cent acquired the habit through the 
advice of acquaintances who were, for the most part, themselves drug addicts; through 
dissipation and evil companions, 21.2 per cent; through chronic and incurable disease, 
2.4 per cent. These conclusions of Terry agree very well with those found by Dr. 
Brown, of Tennessee, who is of the opinion that from 90 to 95 per cent of the persons 
habitually using narcotics never have had and never would have any necessity for 
their use. 

It is of interest to inquire how long it b necessary to use a drug of this kind, especially 
opium or morphine, in order to acquire the habit. There is no possible way of defi- 
nitely answering this question, because it is more a personal factor than it is a factor 
of the drug itself. Some persons would acquire the habit after a few days of use, while 
others might use the drug for a month, two months, or three months, without acquiring 
the habit. It is of little utility, therefore, to discuss this point, as the only safety lies 
in abstention. 

From what has been said above the means of preventing the drug habit are apparent. 
First of all, education. Education, not of the drug addict but of the people at large, 
and this education must begin at the bottom and not at the top. Children must be 
instructed from the very beginning of their career in regard to the dangers of drugs 
^f this kind. Parents are imder obligations to protect their children, by a proper 
instruction and example, from these dangers. The school is the next place where 
this instruction should be continued. The school teachers of the country should be 
thoroughly acquainted with the facts relating to the acquirement of these habits and 
the dangers of acquiring them. Regular instruction should be given in our schools 
respecting the desirability of refraining from the use of alcohol in any of its forms, 
tobacco, opium, cocaine, tea, coffee, and synthetic drinks, such as coca cola, con- 
tuning caffein. 

I believe more in education than I do in legal restriction. I must confess, however, 
that legal restriction seems necessary in respect of some of the more dangerous drugs. 
In other words, I would faivor rigid control of traffic in alcoholic beverages, in opium 
and its derivatives, and in coca leaves and their derivatives. I would not be in favor 
of any restrictive legislation respecting tobacco and tea and coffee, except in so far 
as children are concerned. I would, however, apply very restrictive legislation to 
all 83mthetic drinks or preparations containing any of tiieee habit-forming drugs. 
The natural articles might go, as far as grown people are concerned, without regula- 
tion, but the synthetic articles should be rigidly forbidden. What advantage is it 
to the parent, for instance, who teaches his chil(hren at home not to drink tea or cof- 
fee, while they go to the drug store and buy a synthetic beverage, which contains 
the very element, caffein, which the parents are guarding their children against? 

Dtb. Fisher and Fisk say in their new book ''How to Live, " page 65: 

Among the poisons which must be kept out of the body should be mentioned habit- 
forming drugSj such as opium, morphine, cocaln, heroin, chloral, acetanilid, alcohol, 
caffein, and mcotin. The best rule for those who wish to attain the highest physicai 
and mental efficiency is total abstinence from all substances which contain poisons 
including spirits, wine, beer, tobacco, many much-advertised patent drinks served 



150 PROCEEDINGS SECOND PAN AMEEICAN SCIBNTIPIC CONQBESS. 

at soda-water fountains, most patent medicines, and even coffee and tea. Many so- 
called patent or proprietary medicines contain habit-forming drugs, especiall^r mor- 
phine, coal-tar preparations, caffein, and alcohol, and depend lately for their sale 
upon the effects of these harmful substances. 

In a recent article in Good Housekeeping Magazine on the dangers of the use of 
tobacco I say: 

While tobacco, next to alcohol, is the most generally used narcotic or sedative, it 
stands on an entirely different plane from that occupied by alcohol, opium, cocain, 
and other dangerous and seductive drugs. As has been indicated in the preceding 
sections, the use of tobacco is popular and does not yet generally off^id the public 
taste. To be sure, its use is surroimded with restrictions which oug^t at least to call 
the attention of the people to the ^t that there is something wrong with it. From 
the ethical point of view this condition is, of course, restrictive, but from a moral 
point of view the use of tobacco is practicall>r unhinaered. The man who indulges 
to excess in alcoholic beverages loses, to a certain extent, his standing in a community, 
but from a moral point of view the character of the smoker still stands untouched. 
As long as ministers of the Gospel, school teachers, business men, captains of industry, 
women leaders of high society, and young girls, continue to promote and encourage 
the use of tobacco, the habit will not be re«krded as a moral obliquity. The readers 
of Good Housekeeping ought to consider tne promiety of consiBtently discouraging 
such an expensive, useless, and dangerous habit. Their boys and girls should be told 
the truth about tooacco and the havoc it works. They should be taught by precept 
and example that it is not manly or womanly to use it. If it were mamy to use 
tobacco it certainly would be womanly, and yet 90 per cent of the readers of Good 
Housekeeping would be horrified to think ot the use of tobacco becoming as general 
among girls and women as it is among boys and men. Let us take care that no such 
condition arises. Let us, by precept and example, discourage the tobacco habit. 
Let us encourage our formers to plant a less acreage of tobacco and a greater acreage 
of potatoes. 

Many pathetic letters are received from wives and mothers asking for a *' tobacco 
cure,'' that the habit may be vanquished merely by dosing, without any effort or 
self-denial or duffering on the part of the habitu^. There is no such cure known, 
though tonics, restraint, and certain drugs mav be used under observation to assist 
the patient if he is ready to cooperate, ^ut tne patent medicine man who sends a 
secret preparation, and at long distance guarantees a ''cure" is only indulging 
false promises of his kind. Strength of will can not be supplied from a bottle or a pifi 
box. The football player lays aside his cigar, pipe, or cigarette, aided only by a 
nourishing diet, fresh air, exercise, and an overwhelming desire to throw aside every 
handicap that he may "make good" and win the game. Surely any sensible boy or 
man. when once convinced of the dangers of the habit and the physical and mental 
hanoicap that it represents, would and could make an equal effort to "make good'' 
in the race of life. 

I appeal to the mothers of the country. Consider the following facts concerning 
the boy who uses tobacco: 

1. He will acquire a habit which will bring him into sympathetic associations 
with the boys who are going to the bad. 

2. He will be a slave to a habit which segregates him from the decent crowd ol 
travelers and spectators. 

3. He will join the procession that is made up of maichen with hesitating stept, 
shaky hands, and palpitating hearts. 

4. He will unfit himself for athletic sports and high attainments in his studies. 

5. He will weaken his resistance to disease and fall an easy victim to infection. 

6. He will exclude himself from many activities leading to higher pay and 
preferment. 

7. He will waste large sums of money while doing himself lasting and even iaM 
injury. 

8. He will mcHre readily become a victim of alcohol, cocain, opium, and otiier 
narcotic drugs. 

9. He will mar the efficiency of his work. 

10. He will shorten his life. 

11. His presence will disclose itself to the nostrils of the next. 

12. He will finally become a slave to tobacco and other kindred masters of misery. 



PUBLIC HEALTH AND MEDICINE. 151 

OS FUMADORES DE MACONHA: EFFETTOS E MALES DO VICIO. 

Por RODRIGUES DORIA, 

Prcfiuor de Medicina Publica da Faculdade de Direilo e cathedraticOj em dispanibilidade, 

da Faculdade de Medicina da Bahia. 

ActQeUement daos la plopart des pays da monde, I'homme, ft qnelque rang de la soei^t^ qa'il apparti- 
• nne, ftdt osage poor sa satisltetlon personalia daoertalnes substances toziqnce, particnlidrement excitant ca 
twar son STSttena nenrenx. Get osafo remonte anx ^poqoes les pins reoul^, se perp^tae de gdn^ration 
•a ftetfration en se translbrmant parfois soivant les caprices de la mode, et va souvent Josqu' h Tabus 
oocasionnant alors les tronbles les plos varlte oomme formes at oomme intensity.— Dr. Roger Dapony, 
Le$ Ophmami. 

Os Chinezes, vencidos em 1842 peloB Inglezes, tdveram de se submetter & ganancia 
commercial dos brancos civilisados, que os obrigaram a abrir de novo os sous portos 
e consentir na importa$&o do opio, que tan to tem estragado e deterlorado a milhdes 
de filhos do Celeste Imperio. vicio de fumar a dr6ga n&o ficou, porem, limitado 
^uelles povos orientaes; acompanhou os usuiaiios desse commerclo nefasto, e hoje 
Ua as suas devasta^Oes em varios paizes da Europa, espedalmente na Inglaterra e na 
Franca, onde se encontram em maior profus&o as casas de fumar o chandoo ou o droes, 
"]6 o vencido que se vinga do seu vencedor/' diz o professor E. R^gis, no Prefacio 
do Le$ Opumianee do Dr. Roger Dupouy, " inoculando-lhe sua perigosa paixfto atavica, 
o que Brunei soube com propriedade chamar uma avaria Extremo Oriente." 

Outrotanto podemos tambem dizer: os nossos antepassados, avidos de lucro, fizeram 
o baizo trafico da came humana, no come9o da nossa forma^&o, at6 1851, quando foi 
decretada a prohibi^fto de impc^tar os pretos africanos, arrebatados & fnii9ao selvagem 
das suas terras, para serem aqui vendidos, como escravos, que as leis assim os recon- 
hedam. Em 13 de Maio de 1888, por entre alegrias e festas, foi promulgada a lei 
que aboliu a escravid&o no Brazil e integrada a nacionalidade com os libertados, tor- 
nados ddadfios; mas no paiz j& eetavam inoculados varios prejuizos e males da exe- 
cravel institui^fto, dlfficeis de exterminar. Dentre esses males que acompanharam 
a ra^ subjugada, e como lun castigo pela usurpagfto do que nuds precioso tem o ho- 
mem — a sua libardade—nos ficou o vicio pemicioso e degenerativo de fumar as sum- 
midadee floridas da planta aqui denominada fumo d*Angolay maconha e diamba, e 
ainda, por corrupt, liaTii&a, ou riamba, 

A paJavra yumo, que quer dizer propriamente os gazes nuds ou menos densos que 
se desprendem dos corpos em combustfto, substituiu no Brazil, quer no conmiercio, 
quer em outras relayOes, o vocabulo tabaco para designar a nicotiana tahacuMy seja 
a planta viva, sejam as folhas preparadas para serem fumadas, como quando sfto 
enroladas em corda, ou dlspostas em mandcas — expressilo brazileira dada aos m61ho8 
(manojos) de folhas proprias para a confecg&o dos charutos. A analogia do uso das 
fdhas da diamba e da nicociana certamente determinou a denomina^ de fumo 
d' Angola, derivada ainda dessa parte da Africa occidental, possess&o portugueza, 
donde naturalmente nos veio a planta. Por este nome ouvi muita vez chamar o 
vegetal em Sergipe e Alagoas, nas maigens do rio S. Francisco. 

Nos diccionarios da lingua portugueza de Adolpho Coelho, Aulete, Silva Bastos e 
outros, 16-ee que a palavra "liamba,'' o mesmo que pangoy indica herva do Brazil, 
da iamiHa das myrtaceas (canjidbie eatxva indica) ^ ^'de cujas folhas, diz Moraes, os 
negros usam como tabaco, que fumam em cachimbos, e Ihes produz o effeito pemicioso 
do opio; por isso fd em tempo a sua venda prohibida por posturas munidpaes da 
Camaia da Cidade do Rio de Janeiro; tambem Ihe chamam liamba e riamba.'' * 

I Fwtoras da Oamara Mimidpal do Rio da Janeiro, Seocio Prlmeira. Sands PnbUoa, TH. 2*. Sobre 
▼«iidadaisiisrasareBadle8,asobrabolleario9.|7*. HaprolifbldaavcodaeoasodoPiodoPango,bem 
eoao a suassriaplB dalla sa easts p«rt)lloasi m aoatraTantores serto moltadoa, a saber, o Ttndedor em 
901000, a €assoravos,emaispcssoas qua dalle nsarem, em SdiasdeCadte. Pago da Camara Manidpal do 
Rio da Jaoslio am sesslo de 4 de Ontnbro de 1880. O Presidente, BmUo it OUoMm Bra§a,Joafuim Jcei 
aom, Ammh Joet Bfbdro is (^nJka, /oOo JoU is CitnU, BmHtmi JoU ie Amitj9, 



152 PB0CEEDING8 SECOND PAN AMEMOAN SOIBNTiriO C0NQBB8S. 

A planta n&o 6 entretanto brasileira, como pensam os primeiroB lexicographos 
citados, e informam algunB fumadores, que dizem f6ia primitivainente usada pelos 
indios. Minha atteny^o foi chamada para a maconha, e seu uso no Brazil, depois 
da leitura de um trecho da obra de Bentley — A manual of hoUm^ — no qual, tratando 
da familia das Gannabinaceas, e referindo-se & Cannabis saJtiva^ e a sua variedade 
indica, diz o autor: ''Esta planta 6 igualmente conhecida sob o nome de Uamha, 
na Africa occidental, onde i empregada para fins intoxicantes sob os nomes de nuiconta, 
ou makiah,** Conseguintemente, o facto de ser o vegetal largamente usado pelos 
pretos africanos, nas antigas provincias, hoje Estados, onde elles abundavam, a 
paridade dos nomes que aqui so&eu ligeira modifica^So, mudanga apenas de uma 
letra— maconha, llamba ou liamba — e o appellido de fumo d' Angola, indicam bem 
a sua importa^SU) africana. Em 1910, quando eetive na presidencia do Estado de 
Seigipe, pude fazer a identificag^U) da maconha coin, o canhamo, cultivando alii a 
planta com sementes adquiridas nas margens do rio S. Francisco. 

]6 principalmente no norte do Brazil onde sei achar-se o vicio de fumar a maconha 
mais espalhado, produzindo estragos individuaes, e dando por vezes lugar a graves 
consequencias criminosas. Neesa parte do paiz, primeiramente se desenvolveu a 
lavoura da canna de assucar, e foi grande a importac&o de escravos, que mais tarde, com 
o augmento grandemente remunerador do plantio do caf^, nas provincias de S. 
Paulo e Rio de Janeiro, eram vendidos para o sul. Os indios amansados aprenderam a 
usar da maconha, vicio a que se entregam com paix&o, como fazem a outros vicios, 
como o do alcool, tomando-se habito inveterado. Fumam tambem os mestizos, e 6 
nas camadas mais baixas que predomina o seu uso, pouco ou quasi nSo conhecido 
na parte mais educada e civiU^ula da sociedade brazileira. ''Na Africa, diz Charles 
Eloy (Diccionaire encyclop^dique des sciences m^cales, artigo nasch\dt\ das 
margens do Mediterraneo at4 o Cabo da Bda Esperan^a, 6 vulgar o empr^go da cannabis 
indica, e nas diversas partes da Asia mais de duzentos milhOee de homens tSko escravos 
deste habito." A esse numero pode-se accrescentar o de centenas, ou antes, de 
milhares de brazileiros. 

A Africa jd havia recebido a planta da Asia, onde nasce espontaneamente ao p6 das 
montanhas al6m do lago Baikal, e em outros sitios, e com a qual preparam o luucMch. 
Taes sSU) os sens effeitos pemiciosos, que delle deriva a palavra assassino, vinda do 
arabe hachich, ou p6 das folhas do canhamo, com que elle 6 preparado (Adolpho 
Coelho) . Diccionario da lingua ingleza de Webster consigna esta mesma etymologia. 
Conta-se que na idade media, entre 1090 e 1260, os principes do libano, espedalmente 
Hassam-ben-Sabak Homairi, appellidado o VeUio da Montanha, fazia os sous soldados 
usarem a planta, para fanatizal-os, e, com furor, assassinarem os inimigos, e a l^enda 
chamou-o principe dos haschischinos. 

O cultivo da maconha, ou do canhamo, entre n(56, n&o 6 laigamente espalhado, por 
nSo ser aqui utilisada a liamba na industna das fibras textis, e somente empregada 
como planta da feliddade, causando as delicias dos que a fumam pelo extasis em que 
entram. Esse cultivo 6 acompanhado de praticas fetichistas, que bem fazem lembrar 
a celebrada mandragora da antiguidade. Os mysterios que cercam os cuidados com 
a planta concorrem para Ihe dar mais valor, exal^ar as suas virtudes, excitando a 
imaglna^^U) dos ignorantes, suggestionando-os. Os meus coUegas e amigos Drs. 
Aristides Pontes, clinico em Aracajd, e Xavier do Monte, em PropriA, attendendo 
bondosamente as minhas solicita^Oes, fizeram em Sergipe, nas suas respectivas cidades 
inqueritos, que muito me v&o auxiliar na confecgSU) deste ligeiro e despretendoeo 
trabalho. 

A planta, da familia das cannaUnjaceaM^ ^ herbacea, annual, attingindo em Sergipe, 
como verifiquei, um metro e meio mais ou menos de altura, dioica, com folhas inferi- 
ores oppostas, e altemas as superiores, estipuladas, de limbo profundamente fendido, 
com 5 e 7 lobulos, de bordas serrilhadas. A inflorescenda feminina 6 em esplgas 
compostas; as flores s&o regulares, na axilla de uma bractea persistente, que envolve 



PUBLIC HEALTH AND MEDICINE. 153 

o fructo, o qual 6 urn achenio, amarello eecuro, com venulaydes claras. As inflores- 
cendaa masculinas silo em cachos de cymos. As inflorescencias occupan os vertices 
das hastes. 

Dizem os cultivadores que o vegetal macho nfto attinge o cresclmento, nem tem a 
abundancia de ramificac&o da planta f emea, e s^ mais delgados os seus ramos. Isto 
talvez devido aoe culdados malores que teem com a femea, empregada do preferencia 
em todos os mysteres, excepto, na medicina popular, quando d&o em infusfto contra 
as colicas uterinas. Somente neste caso recommendam as infloresceuclaa e folhas da 
planta ma$culina, 

E* sem a menor duvida o vegetal cultivado e usado no BrazU sob a denomina^ de 
maconha, fumo d' Angola e diamba, nada mais do que o canhamo— CcmTui&M sativa, ou 
a sua vaiiedade incftca, que nos paizes quentes adquire propriedades mais activas e 
eneiglcas, e com a qual os asiaticos preparam o haschich e outras misturas, e cujas 
folhas, colhldas na ^pocha da flora^&o, e deseccadas, sSU) por elles fumadas, sob a de- 
nomina^ de gunjah, 

Quando a planta attinge certo desenvolvimento, e tende a serami£car, procedem ao 
processo da capa0o, que consiste em cortar o olho ou o rebento terminal, para provocar 
o desenvolvimento de olhos lateraee, e, portanto, produzir maior ramificag&o, & semel- 
han^a do que fazem os cultivadores da nicociana. 

Essa opera^, effectuada no segundo mez da vegetal, nSo deve ser feita em 
presen^a de mulheres, que n&o podem tocar o vegetal, principalmente em occaaifto 
das regras, pois faz machear a planta, isto ^, esta produzird inflorencias masculinas 
que 8&0 as menos apreciadas. Essa lenda a respeito da mulher menstruada 6 bem 
velha, e j& Plinio, o Antigo, dizia que t&o violenta era a toxicidade do sangue menstrual 
que o seu contacto, ou mesmo o seu vapor, podia azedar o vinho, tomar estereis as 
sementes, queimar as plantas novas, matar os enx^ios, seccar os fructos, e diversas 
coisas mais. Durante a opera^ feita sobre o fumo d' Angola, o operador deve ter 
o ciddado de n&o dizer obscenidades, nem assoviar, o que commumente fazem os 
lavradores durante o trabalho do campo, porque dar-se-iam os mesmos resultados que 
a approxima^ ou o contacto de uma mulher durante o catamenio. 

A colheita se f az na maturidade da planta, e sfto usadas de preferencia, ou quasi 
excluaivamente, as inflorencencias femininas, com os envolucros floraes e bracteas. 
Essas partes sfto deseccadas & sombra, expostas a correntes de ar, e depois algumas noltes 
ao rolento para reeeberem o sert^no e ficarem curtidaSf ou sofirerem fermenta^fto, 
o que as toma, dizem, mais agradaveis ao fumar, modificando esse proctsso a acrides 
da planta e abolindo as suas propriedades nauseabundas. 

A maconha 6 ordinariamente fumada pura, ou mlsturada ia vezes ao fumo — nicoc- 
iana — em cigarros, cujo envolucro 6 felto de bracteas de milho (Zea mais) das mais 
centraee, por serem mais delgadas e maclas, ou em cachimbos, depois de separados 
oe fructos, o que fazem collocando as infloreecencias na palma de tuna mlio e com a 
outra Imprimindo um movimento rotatorio sobre a massa. O f omilho do caoiiimbo 6 
na maioria dos casos de barro, grosseiramente confeccionado, e ennegrecido, depois 
de cosido, com a fumada de certos vegetaes reeinosos, que os toma luzidios exterior- 
mente. Nas maigens do rio de S. FVancisco fazem tambem o cachimbo de pedra. 
A capaddade do fomilho ^ igual a dos cachimbos conmiuns de g^sso, ou de espuma, 
ao qual 6 adaptado um tubo de desprendimento da fumada, f eito de madeira. Esco- 
Ihem para isto ramos de um vegetal a que donominam canudeiro^ pau de cachmibo ou 
canudo ds pita, Carpotroehe brazUientit Endl, Bixacea$f em virtude de ter o caule 
fistuloso e do mesmo diametro em grande extensfto. Com um furfto aquecido ao rubro 
removem os restos da medulla, e ds vezes enfeltam-nos toscamente com annels e 
liscos, exteriormente, feltos a fdgo (pyrogravura). Alguns servem-se tambem dos 
ramos da coirana, Centrum laevigatum, Schl«»cht, da familia das solanaceas. Para 
mitigar a acp&o irritante da fumaya que provoca tosse, e ia vezes faz espirrar, adaptam 
o cadilmbo a um dispodtivo, em imitagfto ao cachimbo turco, e pelo qual a fumada 6 



154 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

lavada, deixando n'agua, se^ndo dizem os fumantee, o sarro, e ficando mais fresca, 
agradavel, aromatica (?) e activa. Esse dispositivo consiste em uma garrafa com- 
mum, ou em uma cabaya, que 6 o fnicto de uma cucurbitacea, Lagenaria vulgaris^ do 
qual extrahem as sementee e a pdlpa por um furo no ponto da inser^fto do pedunculo. 
Esse fructo tem a perspectiva de 8, sendo o bdjo inferior muito maior do que o superior. 
Chamam-n'o tambem grogoi6, nome proveniente de grogolxy que quer dizor ''vaso 
cheio d'ae^a em que se immerge o tubo dos cachimbos para reahiar o fumo'* (Silva 
Bastos, Dice, portuguez). Como se v6 dos desenhos, introduzem o tubo do cachimbo, 
que tem uns 30 centimetros, mais ou menos, pelaboccadaf2;arrafa, at^ mergulhar na 
agua, que em certa por9ao ostA no interior. Este 6 o dispositivo mais rudimentar, e 
fumam applicando oslabiosdirectamentesobre a bocca dagarralaquenSo fica de todo 
obturada, e onde chupam, precisando um certo exercicio para conse^i^uirem af«pirar 
hem a fuma^a. Uma dapla tubuladura, sendo um dos tubos curvos para embocadura, 
ji 6 um apdrfeiyoamento. No dispositive da cabapa fazem um orificio no bdjo menor, 
onde collocam um pequeno tubo de taquary, meroitachys daussenij gramineaSy onde 
chupam, puxam a fuma^a, como se exprimem os praticantes. As vezee aspiram 
directamente, pondo os labios sobre a cabala. Esses carhimbos constituem um 
arremMo do narghileh ou cachimbo turco, usado nas casas de fumar o opio, ou nos 
bazares arabes onde se fuma o haschich. Ao cachimbo com o dispositive da garrafa 
ou da cabala dfto, na giria dos fumantes (Aracajd), o nome de Maricas, Os mais 
refinados no vicio, fazem no tubo do cachimbo, na parte que fica fora da garrafa ou da 
cabala, um pequeno furo para se desprender um pouco da fuma^a^ que nSo f oi lavada, e 
provocar espirros, irritando a pituitaria, e const^tumdo isto um epiphenomeno po^^tico 
do vicio. O Maricaa 6 companheiro inseparavel dos canooiroe e barcaceiros. E' 
tambem apreciado entre elles o borborinho que ao atravessar a agua produz a fuma^a 
sorvida em profundos e esfor^ados tragos. 

uso do canhamo 6 muito antigo. Herodoto falla da embriaguez dos Scythas que 
respiravam e bebiam a decocgfto dos grftos verdes do canhamo. No livro de Botanica 
do Dr. J. M. Caminhod, que foi professor desta materia na Faculdade de Medicina do 
Rio de Janeiro, l^se que o famoso remedio das mvXhera de Diospolis, bem como o 
nepenlheB de que falla Homero, e que Helena recebera de Polymnesio, en^ a cannabis 
indica. Os Cruzados viram os effeitos nos Musulmanos. Marco Polo observou nas 
cdrtes orientaes entre os emirs e os sultOes. £' muito usado no valle do Tigre e Euph- 
rates, nas Indias, na Persia, no Tukerstan, na Asia Menor, no Egypto e em todo o 
literal africano. Com o canhamo se prepara o Aaac^icA, como jd foi dito, e ainda 
pouco conhecido na sua manlpula^; o povo do Oriente fuma o p6 das folhas e flores 
no narghileh. 

Entre as differentee mistiuus em que entra a planta formando a sua base, e que tem 
nomes diversos, os mais usados sfto o dawamec (da Arabia), o mapouchan (do Cairo) , 
e o maoou (de Calcutd). Naquellas partes os hachahs, comedores, bebedoree u fuma- 
dores, consomem o Juuchieh em estabelecimentos especiaes ou matdieehdi, semel- 
hantes ia casas de fumar o opio. 

Entre n^ a planta ^ usada, como fnmo, ou em infus&o, e entra na compoeig&o de 
certas beberagens, empregadas pelos /«t<tceiro9, em geral pretos aMcanoe ou vdhos 
cabocloe. Nos candomblh-AeBiaB religioeas dos africanos, ou dos pretos creoulos, 
delles deecendentes, e que Ihes herdaram oe costumes e a f4, ^ empregada para pro- 
duzir hallucinacOee, e excitar 00 movimentos nas dansas selvagens deesas reunites 
barulhentas. Em Pemambuco a herva 6 fumada nos ootimM*— lugares onde se faz^n 
06 feiti^os, e efto frequentados peloe que vfto alii procurar a sorte e a f^cidade. Em 
Alagdas, nos sambas e batuquee, que efto dansas aprendldas doe pretoe africanos, 
usam a planta, e tambem entre os que porfiam na coleheiaf o que entre o povo mstico 
consiste em dialogo rimado e cantado em que cada replica, quasi sempre em quadras, 
come^a pela deixa ou pelas ultimas palavras do contender. 



PUBLIC HEALTH AISTD MEDICINE. 155 

Dizem que a macoDha os toma mais eepertos, e de intelligencia mais prompta e 
fecunda para encontrar a ideia e achar a consonancia. Vi algumafi vezes, quando 
crian^a, nas feiras semanaes de Proi^rid, minha terra natal, & noite, ao ceasar a vendagem, 
individuos se entregarem i, praticade fumar a herva nosdispoedtiroBrusticos jd deecrip- 
tos, dos quaes muitoe se servem promiscuamente, sorvendo em haustos prohindos a 
fumarada apetecida, depois do que entrava o desafio ou o duello poetico; alguma vez 
a contenda tomava fei^ differente, e exigia a interven^fto da policia para apaziguar 
OS contendores exaltados. E' fumada nos quarteis, nas prisdes, onde penetra ia 
eecondidas; 6 fumada em agrupamentos occasionaes ou em reunifies apropriadas e nos 
bofdeis. Muitos fumam isoladamente & semelhan^a do uso do tabaco. 

Os symptomas apresentados pela embrlaguez da maconha s&o vaiiaveis com a dose 
fumada, com a proveniencia da planta, que pode center maior quantidade dos prin- 
cipioe activoe, com as suggestGes, e principalmente com o temperamento individual. 
Urn estado de bem estar, de satisfac^ao, de felicidade, de alegria ruidosa sfto os effeitos 
nervosos predominantes. E' esse estado agradavel de euphoria que leva a maior 
parte dos habituados a procurar a planta, a cujo uso se entregam com mais ou menos 
aferco. As ideias se tomam mais claras e passam com rapidea deante do espirito; 
OS embriagados fallam demasiadamente, d&o estrepitosas gaigalhadas; agitam-se, 
dansam, pulam, caminham; mostram-se amaveis, com expansOes fratemaes; v6em 
objectos phantasticos, ou de accofdo com as ideias predominantes no individuo, ou 
com as suggestfies do memento. Dizem que a embriagues da maconha mostra o 
instincto do individuo, como se attribue ao vinho— tn vino verittu. Algumas vezes 
dfio em beberagem para obterem a revela^ de segredos. A esse estado segue-se in 
veses somno calmo, visitado por*Bonhos deliciosos. Ha na embrlagues da maconha 
o facto intereesante de, 9,p66 a dissipa^ dos phemomenos, lembrar-se o paciente de 
tudo que se paasou durante a phase do delirio. 

O Dr. Aristides Pontes, que conversou com Pescadores habituados a usar da maconha, 
ouviu que, quando se encontram no mar em candas ou jangadas, fumam em grupos 
para se sentirem mais alegres, dispostos ao trabalho, e menos penosamente vencerem o 
frio e as agmrasda vida domar. Denominam a$»embleia a eesa reunifto, e come^am 
a sesBfio, fumando no cachimbo Maricaa, no qual cada um puxa a iua tragada, 
na i^irase por elles empregada, para exprimir o esfor^ que exige o cachimbo tosco e 
a quantidade maior da fuma^ que procuramabs(Mrver. Depois de algumas fumaradas, 
tocados pelo efifeito da maconha, tomam-se alegres, conversadores, intimos e amaveis 
na palestra; uns contam historias; taes fasem versos; outros teem hallucina^fies 
agradavelB, ouvem sons melodiosos, como o canto da sereia, entidade muito em v^ 
entre elles. Um deeses, caboclo, robusto, de 43 annos de idade, fumando a herva ha 
nuds de vintia annos, sem apresentar perturba^ da saude, informou que a usava, 
quando se sentia triste, com falta de appetite e poucadisposi^So parao trabalho, princi- 
palmente i noite, quando ia para a pescaria, flcando saturfeito, disposto e podendo 
comer copiosamente. Dizem que faz cesMr as caimbras que exi>erimentam ao entrar 
n'agua, & noite. Ao Dr. Xavier do Monte releriu L. 8., a quem conheyo, homem de 
45 annos de idade mais ou menos, robusto, que fumou a maconha, como experiencia, 
sentindo-se al^gre, achando gra9a em tudo, dando estridentes gaigalhadas a todo 
pioposito, como um louco e tinha muita feme. Comeu desmesoradamente, e ap^ 
cesBou o delirio, entrando em somno profundo e calmo. Dizem que o assucar de canna 
fas cessarem os phenomenos da embiiaguez. Alguns misturam-no com as folhas no 
cachimbo. 

Jd Moat e de Lens aconselhavam o uso do canhamo na hypocondiia, na morosidade 
e no spleen. 

E' tambemnotado portoda a parte esse augmento de appetite, que fas emprsgar a 
planta como aperitivo, excepto nos iniciantes, que iM vezes teem nauseas e vomitos. 
Kaempfsn menciona a feme eamna como symptoma do hoKhUhmno. O appetite, 
porem, se perde e embota nas intoxica^fies intensas e na fcnrma chronica. 



156 PBOGEEDINGS SECOND PAN AMBBIOAN 80IBNTIFIG G0NQBES8. 

Villard, citado per Charlee Eloy, observou no Cairo, entre os himadoreB do ha»(Mch 
esBSk erupgSo de alegria retuinbante, palrice, comgrandevolubilidade, gestoe rapidos e 
gaigalhadas. Notou que as hallucina^Oes se relacionam, nas casas de fumar a herva, 
com as figuras pintadas nas paiedes, e que muita vez reflectem as ideias dominantes 
na pessda e d'ahi o estado de beatitude, de sena^Oes indiziveis de felicidade, de 
languidez, com crea^dee imaginativas bizazras dos oiientaes. 

Em uma nota do livro Lea OpiomaneSf jd citado, se 16 a seguinte descrip^fio de Sachs: 

"0 hadndi produz 00 effeitoe seguintes: ar se adelgaga e paiece center suaves 
perfumes. Tudo 6 bello e radioeo. Sente^e prazer em viver. Sob sua influencia 
fiz passeios soberbos; meu arrebatamento foi alem de toda expresBfio. Sua influencia 
depende do temperamento de quem o usa. Faz alegria; produz gargalhadas pelo 
motive o mais futil. Exagera o appetite, toma eloquente, gracioeo, encantador. 
Sob sua influencia durante duas horas me ezprimi em versos livres; as rimas eram 
ricas e as ideias perfeitamente sensatas e sQguidas. Sens inconvenientes sfto a sensa^So 
de um estrangulamento mais forte do que no opio, uma tinta livida, esverdinhada, uma 
feme que nada aplaca, algumas vezes desejos sensuaes loucos, com requintes impos- 
aiveis de sensualidade * * * a produgSo de ataques epilepticoe e perturba^Oes 
ataxicas." 

Nas expeiiencias de Villard, as ideias se succedem com rapidez, se contradizem, se 
entrechocam, as palavras se comprimem para exprimil-as, e toman-ee incoherentes. 
O intoxicado ouve o murmurlo de luna fonte, julganae no meio do mar, transportado, 
embalado em um barco, ao lado de bellas mulheres; ora assiste a um fdgo de artificio, 
tendo a cabe^a cercada de uma aureola brilhante, a brincar com os anjos. Wood diz 
que para o haschichado a dura^ de um minuto representa um seculo, um estreito 
aposento alaiga-se at4 a immeniddade; transpCe mares, continentes, atraveesa os ares, 
seu esplrito perde o sentimento da extens&o. 

quadro symptomatico pode ser diverso. £' conhecido nos lugares, onde abusam 
da maconha, delirio, a loucura transitoria, e mesmo definitiva, causadas pela planta, 
e com phlaionomia perigosa. Os embriagados tomam-ee rixosos, aggressivos, e vSo at6 
& pratica de violencias e crimes, se nSo sfto contidos. Um trabalhador, pardo, de 30 
annos, robusto, referiu ao Dr. Xavier do Monte ter fumado a maconha, como remedio 
para ddresde dentes, elogo sobrevieram-lhe suores fries e abimdantes, lingua pesada, 
pegajoea, e delirio. Tudo o amedrontava, via-se perseguido pelo povo, sentia fome 
devoradora, e depols de ter comido uma por^^ de batatas doces e f arinha de mandioca, 
foi melhorando, at^ voltar ao estado normal. 

Do inquerito feito pelo Dr. Aristides Pontes, que 6 medico da Escola de Aprendizes 
Marinheiros de Aracajd, ouviu a um saigento da mesma esc61a, ccmtando 28 annos 
de idade, que, quando aprendia na Escola de Macei6, aos 16 annos, vendo frequente- 
mente um preto velho africano fumar a maconha no Mcarioa$^ experimentou a herva em 
cigarro, sentindo-se logo tonto e vendo tudo gyrar ao redor de si. Per mais baixo que 
Ihe fallassem, ouvia as vozes em alta tonalidade; tlnha hallucina^Oes auditivas e 
visuaes, ouvia cantos de passaros, e via vagalumes no ar. Tinha a impressOo de que 
tudo la cahirsobreelleeestendia OS brakes para seamparar. Sentia as pemas pesadas, 
fatigadas, e a impressOo de que estava a subir uma ladeira; as ideias eram confusas. 
Adormeceu, e quatro horas depots despertou, sentindo apenas fome intensa, ch^gando a 
comer 6 p&es de 200 grammas cada lun. 

Um preto carregador, de 39 annos, de disposi^fio alegre e risonha, fumou a maconha, 
e sentiu forte excita^fto, deu para pular, coirer; depois dormiu, e sonhou coisas mara- 
vilhosas, passando mais ou menos neete ultimo estado por dois dias. Diz ter melhorado 
de caimbras e ddres rheumaticas de que sofiEria. 

Essa incessante necessidade de locomogfto ^ refoida por Henri Cazin que diz tel-a 
visto sQguida de proetra^So e syncope. 

Um magistrado de Seigipe referiu o facto de um seu estribeiro, rapaz de 16 annoo, 
mais ou menos de modes humildes, qual teve delirio furioso, aggressive, tendo side 



PUBLIC HEALTH AND MEDICINE. 157 

trancado em um quarto onde entiou em somno prohmdo, do qual despertou, eentiiido 
canaago elanguidez. 

Referiu-me o phannaceutico militar Oandido Correia que, em Obidos, no Estado 
do F^tfi, onde estadonava o 40 batalhfto de artilhaiia, um soldado, ali^B de boa con- 
ducta, foi Bubmettido a concelho de guena, e soffreu penas, por haver fumado a 
diamba, pela pimeiia vez, e entrado em delirio furioeo, tentando matar um capitfto 
em cuja caaa entrou, armado de &ica, tendo ferido uma outara peesoa. Tambem 
rdeiiu-me o phannaceutico Mafifei, que funccionou na GommiBBfto militar, a qual, 
nestee ultimos tree annoB, tra^ou os limites entre Brazil e Venezuela, ter visto metter 
em camiaa de for^a dois soldadoe, em delirio furioso, por haverem fumado a herva. 

Ob commandanteB doB batalhOeB, noB Estados do Norte, tiU> for^ados a terem uma 
grande vigilancia, para evitar que a maconha entre nos quarteis, pelaa conBequendas 
deBBstroBBB, como brigaa, aggreasOes e crimes. 

Em Penddo (AkgOas) para evitar perturbagOea que se davam naa feiras, as autori- 
dadea poUdaefl^ rigoroaamente, prohibiam a venda da maconha. 

A loucura pode ser a conaequencia do uao da herva. Officiaea do 33 batalhSo de 
in^mtarla, que jd eatadonou em Aracajd, referiram que o aoldado Jofto Baptista, de 
30 annoB, moreno, entregava-Be ao vicio de fumar a liamba, e tinha exaltacCea me^Jo- 
maniacBH, dizendoHse general, Deua, etc.; deeenhava no paaseio do quartel navioa, 
noB quaea, em marea tempeBtuoaoa, &zia longas viagena. Uma vez tentou agredir 
um official, acabando na loucura que o fez excluir do exerdto, aendo mettido em 
cuBtodia. 

Utitiaam-Be ia vezea da droga oa soldadoa que querem dar baixa, para aimular a 
loucura e illudir a inBpec^fto medica. 

"A aliena^ mentel, eBcreve Charlea Eloy, 6 um doa phenomenoa terminaea do 
vicio. No Egypto, o numero de alienadoa augmentou parallelamemente ao uao do 
ha$Mehf e a loucura tem a f<kma monomaniaca com hallucina^Oea. 

No livro Le$ OpiomaneSf j& citado, Id-Be que, ao contraiio do que ae obaerva na 
intozica^U) pelo opio, em certaa fdrmas do hawchichiamo agudo, a embriaguez 6 muito 
maiB povoada de hallucina^GeB, maia barulhenta, e Pouchet deBcreveu-a do aeguinte 
mode: "Alguns individuoa tiU> tomadoa de delirio furioao que obriga a amanal-oe, 
paia pdl-oa na impoasibiidade de offender; dfio gritoa estridentea, reviiam e quebram 
tudo o que ae acha a aeu alcance; tdm oa olhoa fixoa, a iauce injectada, a aneatheaia 
completa. Oa malaioa e oa javaneaea chamam a ease OBtado de furia Amohf porque 
aadm gritam oa intoxicadoa: Amok! Amok/ (matal matal) ''Se ae interrogar, diz 
Roger Dupouy, eaaea individuoB, ao aahirem de uma criae de amok, dizem que viam 
tigrea, javalia, veadoB, cftea, diaboa, que ellea qumam matar. Etiologica e clinica- 
mente o amok deve ser imputado ao ha$chieh, e nAo ao opio. Ellea misturam o can- 
hamo ao opio e, aegundo Jeanaelme, o bangy que 6 uma mistura de folhas e fructoa do 
canhamo, 6 no Oriente frequentemente aasociado ao opio, e provoca uma agitato 
particularmente violenta. O Chang ou gimjah doa indioa, o etrar, o hif doa arabea 
(extiacto de canhamo deatinado a aer fumado), o chira da TuniBia, nfto bSo outra coifla 
aenfto preparadoa do hasckickf diz o meamo autor, deatinadoB a aerem fumadoe; Bfto 
aa vezea miBturadoa ao opio, e aeua effeitoa bSo mais nocivoa." 

O uao da maconha, em d^aea moderadaa, eatimula a circula0U>, augmenta o calor 
peripharico, e acalma oa gaatialgiaa, deapertando o appetite, e exdta oa oigftoa da 
locomogio. Ab d^aea altaa, m^mente noB novi^oa, produz nauaeaa, vomitoa, languidei 
peao noa membroa. 

Sobre oa oigioa aexuaea parece exercer uma ac9fto exdtadora, que pode levar a 
grande lubriddade. A maior parte doa fumadorea ouvidoa diaaenm que a herva 
oorrige "oa eatzagoa da edade." Um aoldado contou ao Dr. A. Fontea que quando 
fumava a maconha aentia effeitoa aphrodiaiacoa, tinha aonhoa eroticoa, e poUu^Oea 
Doctumaa. Ease effdto ae eetende ia mulherea. O Dr. Alexandre F^reire, medico 
que execceu a diiuca em mna vilk do interior de Seigipe, referiu ter viato uma mulher 



158 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

embriagada pela maconha de tal f6nna excitada que, no meio da nia, nfto mostrando 
o menor reepeito ao pudor e fazendo exhibiydee, solicitava oe transeuntee ao commercio 
intenexual. As prostitutas, que ^ vezes se dfio ao vido, excitadas pela dzoga, 
quando fumam em sociedade, entregam-se ao deboche com furor, e praticam entre 
ellas o tribadismo ou amor leebico. Villard viu em um bazar, no Cairo, uma mulher, 
que se fazia notar pelas excentriddades, maniiestando uma grande excita^So: rosto ver- 
melho, olhoe brilhantes, cabellos em deec^em, narse sem motivo e falava sem cessar, 
agitava-ee feizia meneios, ia de um individuo a outro . . . com grande hilaridade 
<^ aasembl^a, e soltando de vez em quando um ah prolongado, que os arabes presentee 
imitavam, e que entre elles 6 indicio de uma profunda voluptuosidade.'' 

abuso da substancia tem effeito opposto; todas as func^des nervosas se deprimem. 
Os inveteradoe e os insaciaveis no vicio podem entrar em um estado de cachexia, que 
nfto permitte viver muito tempo. Emmagrecem rapida e consideravebnente, ad- 
quirem cdr terrea amarellada, dyspepsia gastio-intestinal, phy8ion<«iia txiste e 
abatida, depressfio de todas as func90eB, broncbites. Neese estado quasi sempie a 
morte sobrev^m em pouco tempo, e diz o povo haver uma phtyaica da maconha, de 
f6rma aguda e rapida, exterminando a vida em dois ou tres meses. Nesse estado de 
maeonkismo chronico, o vicio 6 imperioso, dominante e tyrannico. Villard observou, 
nos bazares arabes, os viciosos irreductiveis '^acooorados a um canto, extranhos ao 
que ali se passava; rosto sombrio, olhos fixos, tragos repuchados, s6 despertando para 
de novo tomar o naighileh, onde aspiravam bruscamente alguns servos, para em se- 
g:uida deixar cahir a cabe^a pesada sobre os joelhos/' Sahem um instante do torpor, 
olham embruteddos ao redor, e apenas respondem aos que os intenogam. Neese 
estado perdem toda a aptidfio profissbnal e toda habilidade. Os nossos arruinados 
pelo vido voltam ao cachimbo logo que se vae disaipando o deliiio, e deq>ertam do 
torpor. 

A embnaguez causada pela fuma^a da maconha pode-se estender a outras peesoas 
que nfio a fumam, e apenas respiram o ar della impregnado. Contou-me o pharma- 
ceutico C. Correia, j& mendonado, ter visto em Obidos cahir em narcose a senhora de 
um medico militar, que se achava perto de um fumante na mesma sala. 

Sfto dtados os phenomenos de atordoamento e vertigens causadas pelas emana^Oes 
das cultures do canhamo, e que sSo iavoreddos por um sol ardente. Frovavelmente 
sSo effeitos da canabina ou sen prindpio volatil que ee derrama na atmosphera. 

Entre n^ este effdto nfto 6 mendonado em virtude de serem limit4>das as planta^Oee 
do canhamo, somente com o fim de ser fumado, nfto se conhecendo a utilidade industrial 
das fibras do liber, devendo ali^ a actividade da planta, aqui pioduzida, ser grande. 
O canhamo obtido na Inglaterra, diz Bentley, varia tanto em actividade que nfto sfto 
certos OS sens effdtos, e por isso nfto 6 muito empregado. Na Sueda nfto tem ^eito 
embriagante, e na Russia os fructos, de albumen deoso, sfto empregados na alimenta^ 
das aves, e mesmo do homem. 

Na medidna popular 6 enize nde empregada a maconha como fumo, e raramente em 
infusfto; 6 dada na asthma, onde ali^ a toese provocada pela fuma^ fee receiar um 
ueo mais extenso na moleetia; nee perturba^dee geetio-inteetinaee, nee nevralgias, nee 
colicas uterinas, e finalmente como aphrodisiaoo. Pereira chama o canhaieo hileii- 
ante, inebriante, fatntasmegotico, hypnotico ou sopoiifico, e estupe&cieiite ou neiootioo, 
tees sfto OS effdtos multiples por eUe produzidos. 

Como devem ser coneiderados os actos praticad o e pelo individuo em eetado de 
embnaguez pela maconha, ou pelo canhamo? 

Quel o grfto de imputabilidade que se Ihe attnbuir, e, conseguintemente, a reeponea- 
bibdade peloe arimee commettidoe nesee eetado? 

Quel a capacidade para exercer oe actoa da vida dvil? 

O codigo pmud brazileiro, de referenda ft reeponsabilidade, die: 

Artigo 27 Nfto rfU) criminosos: 
i 4^ Os que seaduurem em estado de completa piiva^ de sentidos e de inteUigenda 
no acto de commetter o crime. 



PUBLIC HEALTH AND MEDICINE. 159 

Comqnanto a redac9&o defeituosa deste paragrapho j& tiveose dado occasifto ao 
redactor do Codigo de dedarar que por um erro typographico figura a palavra sentido 
em vez de eensO) comprehende-ee bem que a lei penal nfto pode tomar responsavel 
peloB crimes commettidoe aquelle que no momento da acg&o se acha em estado de 
nfto c<Hihecer o val<»r do acto praticttdo e suas consequendas, e nfto esteja em estado 
de liberdale de pratical-o, condi^Gee esBenciaee ao d61o e ft culpa. "Qualquer acto," 
dis o Prof. Ziino, "que esteja alem da esphera racional, volitiva e moral, nfto pode 
eer itnputavelt e quem o pratica nfto 6 obrigado a responder por elle diante da justi^a 
doe tribunaee. Crimen enim oontrakitur n et voluntas nocendi intercedat Const. 1^ 
ad. L, Comeliam d$ dear,, C. IX, 16; " ou como ensina Pellegrino Rossi, "1^ que o 
agente tenha podido conhecer a existencia do dever e a naturezadoactoem si; 2** que 
tenha comprehendido que o seu acto tenha por indole violar o dever; 3^ que seja livre 
de commettel-o, ou de se abster." 

Aos crimes praticados durante a embriaguez i>ela diamba se devem applicar as 
di8po8i90eB penaes relativas ft embriaguez alcoolica — O estado de delirio produzido 
X>ela maconha coUoca o indivlduo em um estado de loucura ou insania, que o priva da 
consciencia e da liberdade necessarias ft responsabilidade; mas pode-se a respeito 
desta embriaguez raciocinar como o prof. Dr. Charles Mercier acerca da embriaguez 
alcoolica. *'E' perigoso admittir em absoluto a excusa da embriaguez na justifica^fto 
do crime; e quem voluntariamente bebe at6 o ponto de se tomar um pengo para a 
sociedade, deveria ser punido em toda a plenitude por qualquer offensa praticada 
no estado a que o reduziu o seu proprio abandono." O sentimento de justi^a, porem, 
se oppde ft puni^fto sem as condi^des da imputabilidade acima reiferidas. A lei 
ingleza nfto admitte a embriaguez como escusa do crime; colloca-se, portanto, num 
dos extremes da questfto, desde que por si s6 a embriaguez jft 6 considerada um de- 
licto. A lei penal brazUeira, sem deixar de admittir a excusa do que pratica imi 
crime no estado de delirio que traga a aboli^fto da consciencia e da liberdade, qualquer 
que seja a causa, fez da embriaguez uma circumstanciaattenuante dos crimes, somente 
quando ella 6 accidental, e nfto procurada para infimdir coragem, ou 6 habitual e 
turbulenta. 

O f 10 do art. 42, que enumera as drctmistancias attenuantes, assim resa: — "Ter 
o delinquente commettido o crime em estado de embriaguez incompleta, e nfto pro- 
curada como meio de o animar a commetter o crime nesse estado, nfto sendo acostumado 
a c(»nmetter crimes nesse estado." 

Esta disposi^fto pode ser perfeitamente applicada ao embriagado i>ela maconha. 

Relativamente aos actos da vida civil a embriaguez aguda, transitoria, nfto justi- 
ficaria medidas de interdi^fto, alifts i>erfeitamente applicadas ft embriaguez chronica, 
tal como a descreveu Villard. Todavia, o estado de euphoria que o individuo, nfto 
dominado e perturbado permanentemente i>elo vicio, sente ao fumar a herva, pode 
conduzil-o, nas suas expansOes, a ]»raticar actos da vida civil, que Ihe tragam serias 
obriga^Oes, como contractos, doagOes, vendas, assignatura de letras, os quaes nfto 
deven subsistir, provado o estado em que se achava o individuo no momento de assumir 
essas obriga^^tes, sendo at6 certo ponto comparavel esse estado ao da primeira phase, 
ou ao periodo medico legal da paralysia geral. 

testemunho do individuo intoxicado pela maconha nfto pode ter valor. E' em- 
pregada peloe africanoe para obter declara^des, confissOes, revela^Oes de segredos 
e abrandar lesistencias em materia de amor (filtio). 

De que meios se pode lan^ar mfto para extinguir, ou dominar o vicio? 

Extnordinaria ft a fasdna^fto que exercem as drogas estimulantes e narcoticas 
sobre o organismo humane, muito principalmente se o terrene estft preparado para o 
bom deeenvdvimento do habito, se alguma tara degenerativa exists congenitamente, 
ou se vidoe anteriores predispuzeram a economia a novos vidos; sfto frequentes as 
assoda^Oes do alcooUsmo com outros vidos, e com o habito de fumar a maconha. 
Do inquerito a que tenho procedido a respeito do use de fumar as summidades flori- 
das da planta que faz o objecto deste trabalho, 6 elle muito disseminado entre pessdas 



160 PBOCEEDINGS SECOND PAN AMERICAN SCIBNTIFIO C0NGBE88. 

de baixa condiy&o, na maioria analphabetos, homens do campo, trabalhadores 
nuaes, plantadores de arroz, nas margeoB do lio do S. Francisco, canoeiroe, Pescadores^ 
e tambem nos quarteis pelos soldados, os quaes ainda entre n6s sfto Urados da escoria 
da nossa sociedade. Todos os soldados do exerdto que estadonaram no Amazonas, 
Pari, Maranhao, e nos outros Estados do norte at6 Sergipe, mas prindpalmente noa 
primeiros mencionados, e com quem conversei sobre o assumpto, me dedararam ter 
visto fumar a maconha, e os sous effeitoe ddeterios. Varias pessdas tdm-n'a usada 
por munitos annos, moderadamente, sem inconvenientes palpaveis, experimentando 
apenas a sensa^fto de uma ligeira euphoria. Sfto os sobrios, como os ha em rela9fta 
ao alcooly que parcimoniosamente usado, pode at6 ser uma neceesidade, no pensar 
do prof. Charles Mercier, para fazer desprender as energias latentes ap^ o esgotamento 
das fadigas do dia, assim como f&z o assucar que se ajunta ia aguas gazozas, provo- 
cando novo desprendimento de addo carbonico. 

O systema nervoso, no seu aperfeigoamento evolutivo at^ o homem, parallelamente 
com as vantagens adquiridas, como uma intelligencia penetiante, sensibilidade 
apurada, tomou-se mais exigente pdoe estimulantes, e por isso mabindinadoesujeito 
aos habitos pemiciosos como o vido da morphina, da cocaina, do alcool, o toxico 
rei, ao qual Shakspeare achou mais apropriado o nome de diabo (cfevtZ), da nicodana, 
do canhamo, e outros. ''Em rela9&o d moral/' diz W. A. HoUis, ''na, historia da 
vida dos animaes inferiores ha sem duvida muitas outras leipdes, que seria vantajoso 
copiar." Nos degenerados e tarados, nos descuidados, o habito se estabelece, e com o 
habito o embotamento do systema nervoso, que reclama novos e cada vez mais fortes 
estimulos, e conseguintemente nudor d6se do veneno. 

"0 gosto do homem i>eloe toxicos embriagantee, escreve o Prof. E. lUgis, querido 
ou instinctivoy ^ em todo o caso, tfto velho quanto o mundo.'' Sujeito ia dores phy- 
sicBs, como todos os outros animaes, e ainda &b penas moraes, diz Botta, o homem se 
eeforya por escapar a sua existencia real, e procura em imi mundo imaginario a felid- 
dade fictida de sous insaciaveis desejoe. 

Na Penitenciaria de Aracajd, onde de alguns annos para c4 6 prohibida a entrada 
da maconha, por causa dos disturbios por ella motivados entre presos, os sentendadoa 
se entregavam ao habito de fumal-a "para alliviarem o espirito acabrunhado pela 
pri^U), e terem por esse modo momentos de distracy&o e alegria." 

A ddr physica 6 muitas vezes a causa do vicio. As nevralgias dentarias, as d^es 
rheumaticus, as gastralgias, as colicas uterinas em estados dysmencHrheicos, deter- 
minam muitas vezes o emprego da planta pelos sens efteitos narcoticos e analgeeicos; 
e obtido o resultado benefico, nfto hesitam os pacientee em voltar d herva em um se- 
gundo accesso, ou como preventivo, e dahi se gera com facilidade o habito e o vido 
de fumar a maconha. 

Os pezares sfto outra causa frequente do vicio: para esquecer, embora transitma- 
mente, incommodos moraee, suavisar a dureza de uma vida atribulada, e passar mo- 
mentos alegres, distrahidos, esperan9080s, acalentados na phantasia alacre que os 
embala no espa^o, como as espiraes voltejantes do fiuno traiyceiro, os abandonadoe 
da sorte se entregam ao dominio da herva; se nlU> 6 um forte, o naufragio 6 irremediavel, 
prindpalmente se & ddr moral estd assodada a tara organica. 

A imitagfto 6 frequentemente uma causa do habito, espedalmente nos jovens. 
Como na nicociana, de uso universal hoje, muitos se entregam ao vido de fumar a 
maconha por ver fumar aos outros, que por sua vez influem aos inexperientes, con- 
tando-lhee com enthusiasmo os gozos ineffaveis e os prazeres encantadores que a herva 
proporciona. Di-se coisa semelhante ao que se passa com o vicio do opio, somente 
aqui n&o s&o instruidos e letradoe os propagandistas, como os de que falla o Prcrf. E. 
R^gis, nos seguintes termos: "Coisa ciuiosa, todo letrado que aspira os vapores da 
dr6ga (o opio) se julga na obriga^&o, sincera ou n&o, de glorificar publicamente os 
sous encantos; todo fiunante toma-se um tentador; por um requinte de vdupia per- 
versa, esse pecador tem necessidade de arrastar outros em seu pecado.'' £ um senti- 



PUBLIC HEALTH AND MEDIOIKB. 161 

mento genJ do homem nfto querer eetar 86 na queda, e eese sentimento egoista se 
exprime bem no riffto popular: "Mai de muitoe consdlo 6/' quando consdlo e satis- 
fa^fto devem ser o bem de todos. 

O amor doe prazeree e da sensualidade, uma vida indisciplinada e deecuidosa, sempre 
avida de novas e extranhas sensa^Gee, que 6 o apanagio doe gozadoree e sybarifitas 
conduz igualmente oe desregradoe a procurarem no viclo a felicidade e oe gozoe, que 
artificiaes e passageiros Ihes caiisam o extasis produzido pela absorpip&o da fumaga ^ 
planta maravilbosa. 

Uma instruc^o bem dirigida, refor^da por principioB de eft moral, o conhedmento 
claro do mal, necessariamente revigoram e f ortificam o animo para a reeistencia ao vicio 
de qualquer natureza: nfto obstante espiritos lucidos, geniaes, instruidos, como T. de 
Quincey, Coleridge, Edgard Poe, Baudelaire, e outros, entregaram-se ao uso do opio, 
que tanto exaltaram nas suae produ^des literarias. Recentemente se tern chamado a 
atten^So, na Franca, para o vicio de hmiar o opio, espantosamente disseminado, sendo 
as casae de fumar a dr6ga frequentadas por pessoas de certa instruc^fto, como os officiaes 
da armada, nos portos de Toulon, Marseille, Brest, etc. Comquanto o uso de hmiar a 
maconha, no Brazil, ainda esteja, como foi dito anteriormente, limitado Is classes 
ignorantes, tenho noticia de alguns fumadores com um grio de instruc^fto regular, e 
de um funccionario publico, bastante intelligente, dominado pelo vicio. Como quer 
que seja, creio na instruc^So e na educay&o como bons preservatives do habito pemi- 
doeo, incumbindo aos poderes publicos melhor cuidarem deste magno problema, t&o 
deectirado entre n6s, onde o analphabetismo 6 a regra. 

A prohibig&o do conmiercio da planta, preparada para ser fumada, puderd restringir 
a sua dissemina^ progressiva. Sei que em alguns Estados do norte as violencias com- 
mettidas durante a embriaguez da maconha tto levado as autoridades policiaes a 
prohibir a vendagem da herva nas feiras. Em Penedo, segundo informa^Oes que me 
deram, eesa prohibi^fU) tem dado reeultados, quasi extinguindo as brigas provenlentes 
da embriaguez pela maconha. 

A cura individual depende da capacldade revigorante do animo do vicioso e da 
disdplina de sua vontade, sem a qual nada se pode obter. A respeito deste vicio t§m 
perfeita applica^ as palavras de Lydston, com rela^fto & embriaguez alcoolica. 
Exaltando a educa^&o physica como elemento poderoso no tratamento da embriaguez, 
accrescenta: *'o elemento psychico deve ser sempre tomado em considera^fto, pois sem 
a sua coopera^lU) todo tratamento 6 futil." 

E 6 assim que nada existe sobre a terra absolutamente bom ou absolutamente mdo: 
ccmipete ao homem, no seu aperfei^oamento, utilizar-se da primeira face, dominando e 
tomando inefficaz a s^^unda. Os dons da natureza podem se transformar em verda- 
deiras calamidades quando mal empregados. As mais notaveis e maravilhosas desco- 
bertas do genio e do saber do homem, por maiores vantagens e proveito que possam trazer 
& especle, muita vez se tomam em arma destruidora e fatal. No processo da evolu^fU) 
nto chegou ao homem a capacidade de voar, que parou em certos reptis, no dragfto 
voador (Draco volans), o qual, no dizer de W. A. HolUs, '*reteve a arte de deslizar 
atravez do ar." A vida de peixe por sua vez desapparece no memento em que a 
creatura humana se destaca do seio matemo para viver vida propria. ''E esse primer 
da arte que 6 o homem,'' na phrase inimitavel e sublime do autor do Hamleto, "nobre 
em sua razfto, infinite em suas faculdades, expressive e admiravel em sua for^ e em 
sens movimentos, semelhante ao anjo pela ac^&o, pelo pensamento semelhante a Deus, ' ' 
se corta os ares nas azas dos sens inventos surprehendentes, fazendo a viagem das aguias, 
que perderam o dominie das alturas atmosphericas; ou quando corre debaixo das ondas, 
espantando os peixes no seu viver aquatico; nem sempre est&o colhendo beneficios ao 
b^ estar de sens irmSos na superficie da terra: esses portentosos engenhos de seu in- 
comparavel talento, quaes sfio o dirigivel ou o aero-plano, e assim tambem o barco sub- 
marbiho, estfto actualmente empregados exclusivamente no funeeto mister da dee- 



162 PBOOEEDINGS SECOND PAN AMEBIOAN SOIENTIFIO 00NGBE8S. 

trui^fto, da extermina^fto do que ob pdvos europeuB, empenhadoe na maiof guerra que 
jamaifi o mundo vio, tdm de maifi eeperan^oBO e forte« 

No terreno da therapeutica, os reeultadoe esplendentes que fomece, nas mftoe jmi- 
dentes e praticas do medico, essa gomma concreta das papoulas^—o opio— o rei da ddr, 
e sob cuja ac^fto marvilhosa cessam estes sofirimentos physicos, que tanto perturbam o 
cuno das molestias, tern o seu reveno no habito nefasto de comer ou fumar a dr6ga. 
A cocaina, de recente descoberta, se causa estupenda admirac&o peios sous effeitos 
analgesicos locaes, permittindo sem ddr a realiza^fto de deticadas opera^Oes druigicas a 
que assiste, quasi como um extranho, o proprio padente, tem-se tornado entre oe povos 
civilisados e nevrosthenicos um flagelo. 

E o quanto se poderia dizer do mais antigo talvez dos vicios, da intozica^fto por ex- 
cellenda, da embriaguez alcoolical 

A raga preta, selvagem e ignorante, resistmite, masintemperante, se emdeterminadae 
circumstancias prestou grandes servigos aos brancos, sens irmftos mais adiantadoi em 
civilisa^fto. dando-lhes, pelo seu trabalho corporal, fortuna e commodidades, estragando 
o robusto oiganismo no vicio de fumar a herva maravilhosa, que, nos sens extasis lan- 
tasticos, Ihe faria rever talvez as areias ardentes e os desertos sem fim de sua adorada 
e saudosa patria, inoculou tambem o mal nos que a alstaram da terra querida, Ihe 
roubaram a llberdade preciosa, e Ihe sugaram a seiva reconstrutiya; e, na expressfio 
incomparavel do grande e genial poeta americano, o mavioso Longfellow, a ra^ ex- 
poliada, como o Sans&o da Biblia 

*'The poor, blind slave, the scoff and jest of all, 
Expired, and thousands perished In the fall." 

NoTA— S6 ap6s a minha volta do Oongresso Scientifico Pan- Americano f oi que recebi 
o resultado do inquerito, a meu pedido feito, pelo meu collega e amigo Dr. Francisco 
Fonseca, clinico na cidade de Marolm (E . de Sergipe) , na zona de sua pratica. Essas in- 
forma^des confinnam pontes tratados nesta Memoria, e foram princlpalmente fofnecidoe 
por um fumante inveterado de 60 a 65 annos, robusto, musculoso, sadio, attribuindo o 
seu vigor ao habito de fimiar maconha, desde rapaz, no Estado das Alagoas, de onde 6 
filho, residindo ha muitoe annos em Pirambd, povoagSo e prala de banhos em Sergipe. 
Nessa povoayfto, e outras proximas, onde existem muitos pescadores, o vicio 4 grande- 
mente disseminado. Em logares de Sergipe e Alagoas, nas margens do rio de S. Fran- 
cisco, cultivam a planta, que vendem, preparada para ser fumada, sob a denomina^ 
de pelotas, pela f6rma que tomam as inflorescencias, e d razfto de 3|000 o kilo, e 301000 e 
401000 a arroba. 

Os informantes fazem as declara^6es com difficuldade e timidez, receiosos de uma 
acgfto policial. Nesses logares fumam em reunnides e logares determinados. 

Indaga^des obsequiosamente feitas em Penedo, por obsequio do Ooronel Job6 An- 
tonio da Silva Costa, e em Villa Nova, do Coronel Los^ Lessa, tambem me chegaram Is 
mAos tarde, mas me eram conhecidas as ref erencias feitas, e estavam exaradas no meu 
trabalho. 



LUCHA CONTRA EL ALCOHOUSMO. 

Por RICARDO SARMIENTO LASPIUR, 
Cirujano Je/t de lo» Ho$pitdU$ de Buenoe Airee, Argentina. 

"Contra un enemigo que amenaza al individuo en su salud moral y fldca, la faniilia 
en su foco, la raza en su reproducci6n, el pais en su vigor, la humanidad entera en su 
esencia, la ciencia y la filantropfa deben dirigir en comdn acuerdo una formidable 
coalici6n."* 

> Rene Bromard. 



PUBLIC HEALTH AND MEDIOINB. 163 

Siendo, indlscutible que la de6poblaci6n, la degeneraddn, la criminalidad y la 
locura, no reconocen en la mayorfa de los casos otro agente detenninante que el alco- 
holismo, y ante el numeroso contingente que aporta el alcoholista y su prole a las 
enf^medadee infeccioeafl, los gobiemos, los medicos e higienistas, economistas y 
legisladores, deben aprestarse a la lucha, extremando todos los medios para salvar 
de 8U acddn a media humanidad. 

Desde lu^o, hay que dirigirse al factor etiol^co, combatir el mal en su esencia, 
puesto que la cura del alcdliollsmo adquirido, no hace nada mis que atenuar el mal 
de algunos, sin consecuencias serias para las otras vlctimas, porque detria del alco- 
holista quedan una cantidad de nifios, retardados y empobreddos en sus medios 
iisicos e intelectualee, los que a su vez predispuestos y siguiendo el camino trazado 
por sus padres, hai^ otras tantas vfctimas. 

De manera que tratar al bebedor, y aislarlo, del medio social en que vive, para 
evitar su deplorable influencia, no es sino resolver una parte del problema, puesto 
que, como hemes dicho, no evita al mal reproducirse, y hacer nuevas vlctimas que 
^stas a su vez procreando lo etemizarto afectando intensamente a la colectiLvidad. 
Asf, pues, es indispensable tratar la causa; pero como esimposiblesuprimir el alcohol, 
hay que dirigirse y luchar con todas las energfas para suprimir o por lo menos amen- 
guar la alc6holizaci6n. 

Es alll donde se han dirigido todos los pueblos civilizados que han comprendido 
y han palpado los terribles peligros que entrafia el vicio del alcohol. Y es por ello 
que la lucha ha adquirido una intensidad gradualmente credente en Inglateira, 
Am^ca, 8uiza, Suecia, Alemania, etc., y Rusia donde la cuestidn del alcoholismo 
es un objetivo permanente no s61o para los poderes ptiblicos, sino tambi^n para las 
clases ilustradas de la nacidn 

Las sociedades de temperanda se han multiplicado, la propaganda en contra del 
alcohol asume las propordones de verdadera guerra, se han creado establedmientos 
eefpeciales, privados y ptiblicos para la cura de la borrachera; asilos donde el alco- 
h61ico puede no s61o encerrarse espontdneamente, sino tambi^ ser legalmente 
secuestrado y mantenido con un fin de utilidad y seguridad pdblica. 

Los pafses del Norte de Europa, donde menos se habfa arraigado el abuse del alcohol, 
fueron los que dieron el ejemplo m^ radical. Uno de los primeros en ponerse en 
campafia fu6 Magnus Hus, en Suecia, y sus indicadones fueron eepedalmente teni- 
das en cuenta por las autoridades, tanto que el gobiemo sueco dict6 en 1885 una legis- 
lad6n especial que di6 fructlforos resultados. Las 1,300 destilerias con que el pais 
contaba, fueron reduddas a 300. Se facult6 a las munidpalidades para prohibir las 
ventas de alcohol al por menor, y se disminuy6 el nfimero de despachos de bebidas, 
lo que progresivamente ha ido acentdandose hasta el extreme de que existiendo en 
el memento de entrar en vigenda dicha ley una tabema por cada 100 habitantee, 
diaooinuyeron en poco tiempo a 1 por cada 5,000. 

En Finlandia la prohibid6n fu6 m^ absoluta todavfa, hasta el extreme de no 
permitir bajo ningdn pretexto la venta al menudeo de ningiina clase de bebidas 
alcoh61icas. Sin duda alguna, sus resultados fueron soiprendentes, hasta el punto 
de que en 1850 habla 1 tabema por cada 100 habitantes y en 1900 s61o habia 1 por 
cada 9,000. 

Inglatena tambi^ ha tomado severas medidas, gravando con fuertes impuestos 
la venta de alcohol bajo sus diferentes formas, y tratando de neutra4^ las casas 
donde se exi>enden bebidas espirituosas, creando cafto y restaurants de templanzas. 

Estadbs Uuidos, es el pais que mds se ha distinguido en la campafia contra el alco- 
holismo. El gobiemo ha anexado al ministerio de instrucddn ptiblica, el departa- 
mento nadonal dentffico de temperanda, que da ensefianza antialcohdlica a una 
gran cantidad de educandos. 

Y exige a todos los fundonarios ptiblicos que formen parte de esa sodedad, que 
Ueven el distintivo espedal de ella. La primera sodedad de temperanda fu6 fundada 
68436— 17— VOL ix 12 



164 PBOCEEDINGS SECOND PAN AMERIOAN SCIENTIFIO CONGRESS. 

en New York en 1808, eu vida fu6 corta, pero dej6 la eemilla, y lu^o se fundaron 
muchas otras, hasta que en 1826 se fund6 la gran sociedad The American Temperance 
Society. 

En Italia y Alemania se ha tornado m^ o menos id^nticas medidi^. En la primeia, 
por una ley que no data de mucho tiempo, deroga las franquicias a la libre producci6n 
del alcohol, dando con ello un gran paso en el terreno de la lucha anti-alcohdlica. 

Como hemes dicho, todos los palses han bajado a la lucha, empleando todos los 
medios a su alcance, todos en^rgicos y algunos particularmente originales, como el 
empleado por Suecia, conocido con el nombre, de aistema de Gotembouig, que con- 
siste en que el privilegio de vender bebidas fuertes lo tiene una compaflla por acciones, 
cuyos miembros estiman menos el interns pecuniario que el de disminuir la venta y 
vender bueno. Establece un cierto nthnero de tabemas, cuyo reglamento tiende a 
disminuir la venta, tanto como sea posible. Los empleados de esta compafila son 
pagados por afio y no tienen ningtin interns en vender. 

Y, los beneficios pecuniarios de esta compafifa son empleados en obras de interns 
ptiblico. Ha dado resultados notables, puesto que ha disminufdo grandemente el 
alcoholismo y sub consecuencias. 

Rusia participa del mismo principio, pero lo ha hecho de otra manera; ha cerrado 
una cantidad de tabemas y ha puesto muchas por cuenta del estado sin ningtin interns 
de vender. Tambi6n ha obtenido excelentes resultados. 

Los medios propuestoe para detener la marcha invasora del alcdiolismo son de 
dos 6rdenes distintos: unos se concretan a la curacidn de los bebedores y a la protec- 
ci6n de la sociedad, otros a la profilaxia del alcoholismo y disminucidn del consumo 
de las bebidas alcoh61icas. Para conseguirlo es necesario que la acci6n pdblica y 
privada se unan, desarrollando una labor proffcua, perseverante y entusiasta. 

Para Uegar a tales resultados hay que insistir en el aumento del impuesto al alcohol, 
Bobre todo de las bebidas destiladas, en raz6n de su pemiciosa influencia sobre la 
salud pdblica. 

Reducir el alcohol de consumo a su minimum de nocividad, evitando los fraudes 
y falsificaciones por un severe control, efectuado constantemente por inspectoree 
t^nicos. 

Poner obstdculos a su fabricaci6n. 

Hacer efectiva la rectificacidn obligatoria de los alcoholes, y llegar pronto al mono- 
polio de la venta de los alcoholes por el estado. Este se puede ejercer sea sobre la 
fabricacl6n, sea sobre la rectificaci6n, sea en fin sobre la venta de este producto. El de 
la venta, es el que debe adoptarse, puesto que sabemos que los alcoholes comerciales 
contienen ima cantidad de productos t6xicos, y que cuando son librados al consumo 
sin previa rectificacidn, importa un grave peligro para la salud pdblica. 

En varias naciones de Europa se han establecido, sobre diversas bases, slstemas de 
monopolio del alcohol, pero el que ha dado los resultados m^ satisfactorios es el de 
Gotembourg, implantado en Suecia y Noruega. 

Para restringir el consumo de bebidas espirituosas se han propuesto dos clases de 
medios: los medios de represi6n y los medios morales. 

La represi6n de la embriaguez ha dado lugar a numerosas discusiones entre los l^gis- 
ladores en lo que se refiere a las medidas que deben adoptarse a ese respecto, y a sub 
resultados. Sin entrar a analizar la mayor o menor rae6n, que tenga cada uno de ellos, 
debemos ace^tar como beneficiosas todas las medidas que se tomen; sea la aplicaci6n 
de multas a los bebedores, sea la permanencia en las casas de correcci6n; todas pueden 
obrar y obran, aunque sea muy d6bilmente sobre el espfritu d^ borracho; y si no 
obrase sobre 61 directamente, por lo menos serviria homo ejemplo para aquellos que no 
Bon inveterados. 

Deben pues, dictarse severas medidas a este respecto. 

Otro medio para reprimir la borrachera, consiBtirfa en la inteniacidn de los alcoholistas 
en los asilos y caaas creadas al efecto; mixime cuando se sabe que el beodo es un ser 
peligroso para sf mismo, para la sociedad y para el estado. 



PUBLIC HEALTH AND MEDICINE. 165 

Esta 66 una medida que se impone, tanto mis, cuanto que es reparadora para al 
sociedad y para eilos; debe hacerse en asiios especiales, donde olvidando el vicio, se 
lee haga trabajar, y se lee haga comprender por medio de ensefianzas diariae las terri- 
bles coosecuencias que les acaireard el vicio a que se ban entregado. 

Entre los medics morales, debemos citar en primer lugar, la reglamentaci6n y la 
8upre8i6n de las tabemas; en s^undo lugar, la propaganda antialcob61ica y la funda- 
ci6n de sociedades de temperancia, y en tarcer lugar, los medios morales propiamente 
dichos. 

Las tabemas desempefian im grau papel en nuestra sociedad modema, y ee sin 
duda una ds las causas m^ poderosaa del alcoholismo. 

La instrucci6n y moralizaci6n del pueblo, debe tenerse muy eepecialmente en 
cuenta. Es el nifio, el que debe ser el verdadero campe(5n del anti-alcoholismo del 
porvenir; debe ser preparado para la lucha desde su primera edad, la que debe con- 
tmuar en la segunda infancia y en la adoleecencia, de manera que cuando adulto 
ya, empiece a ejercer su influencia ^i la lamilia y en la sociedad, eet^ impr^gnado 
de BUS deberee y pueda luchar con resultados. 

La ensefianza en la escuela; el maestro, desempefia tambito un papel importantisimo 
en esta magna campafia; ensefiando a sus pequefLos discipulos las verdaderas pro- 
piedades del alcohol, el uso que deben hacer de 41 y los peligroe que les acarreard su 
abuse. En la Argentina se dictan cursos obligatorios, clases especiales, conferenciaa 
sobre alcoholismo, a los obreros, a los soldados, etc. 

Hemos dicho ya, que todos los pueblos civiUzados, dindose cuenta de los progresos 
que hace dia a dfa este terrible flagelo social, se hablan aprestado a la lucha fundando 
sociedades de temperancia, que son m^ eficaces en la lucha antialcohdlica que todo 
el cdmulo de medidas fiscalesque hadictado el legislador para impedir la propagaci6n 
del flagelo. 

La influencia de las sociedades de temperancia en la campafia contra el alcoholismo, 
es de resultados incontestables, y su obra salta a la vista en los pueblos que las han 
institufdo, como: Estados Unidos, Inglaterra, Suecia, Noruega, B61gica, etc.; y donde 
han adelantado notablemente en estos <iltimos afios, debido a haber incorporado aa 
movimiento a las mujeree y a los nifios. 

En nuestra Repdblica, algo se ha hecho, debido a la pr^ca constante de hombrea 
de ciencia, como el doctor Domingo Cabred, que no ha perdido oportimidad de 
difundir por todos los medios a su alcance, los peligros y las medidas que deben 
adoptarse, para oponerse a la propagaci6n del flagelo que mina las bases de nuestra 
sociedad. 

La lucha antialcoh61ica en este memento se ejercita de la manera siguiente: 

1^. La ensefianza obligatoria antialcoh61ica en las escuelas. Sobre esta medida, se 
pronunci6 el Congreso Pedag6gico reunido en Buenos Aires en diciembre de 1900, 
aprobando undnimemente el veto propuesto por el Dr. Cabriod, sobre ensefianza anti- 
alcoh61ica y sobre f imdaci6n de sociedades infantiles de templanza. El curso libre y 
gratuito sobre alcoholismo, establecido, por Decreto del gobiemo nacional, bi6 el 
primer paso dado en el sentido de la ensefianza antialcoh61ica obligatoria en las escuelas. 

2°. Restricci6n de la fabricacidn y de la venta del alcohol, por grandes impuestoe. 

3°. Disminuci6n de los derechos de importaci6n al caf4, al te y a la yerba mate. 

4°. Disminucidn de los impuestos a las lecherlas. 

5°. Aumento de los derechos de importaci6n a las esencias y 6teres usados en la 
fabricacidn de licores y aperitivos. 

6^. Se establecieron penas privativas de la libertad para los autores del delito de la 
de8tilaci6n clandeetina. 

7^. Ho6pitalizaci6n obligatoria, de los alienados alcoholistas y de los ebrios con- 
Buetudinarios, dejando al criterio m^ico fijar el tiempo que debe durar la existencia 
hospitalaria del enfermo. 

8^. Creaci6n de una cobnia agricola para la asistencia de bebedores no alienados. 



166 PEOOBEDINGS SECOND PAN AMERICAN SCIENTIPIO CONGRESS. 

9°. Educacidn obligatoria de los hijoe de los alcoholistas. 

En cuanto a las medidas que corresponden a la iniciativa piivada, y que se ban 
puesto en prdctica eon: 
1^. Creaci6n de sociedadee de templanza, para adultos. 
2°. Creaci6n de sociedadee infantUes de templanza. 
3^. Fundaci6n de cal6s y lestaurants de templanzas, de salas de lectura, etc. 



EL PROBLEMA DEL ALCOHOUSMO Y SU POSIBLE SOLUaON.' 

Per LUIS L6PEZ DE MESA, 
Bogotdj Colombia, 

Una de las funciones mis dtiles de los Congresos Intemacionalee es, a mi mode de 
ver, la de dar un veredicto sobre las cueetiones cientificas ya dilucidadas en el eetudio 
pormenorizado de los tratadistas, el presentar a la sociedad bumana la sfnteeis de los 
eshierzos parciales que inicie aplicaciones pr&cticas. 

En este sentido nada m&s importante para un Congreeo Intemacional de Medicina 
que el estudio de aquelloe flageloe que como la tuberculosis, la sifilis y el alcobolismo 
constituyen la m&s seria amenasa para nuestra eepecie. 

Por ello voy a proponer un voto razonado sobre la re8tricci6n del alcobolismo, 
siguiendo de un mode preferente las fases que este problema tiene en mi patria, y 
atendiendo s61o a las ideas generales, sin entrar en pormenores ni citas de textoe. 

OAUSAS. 

El alcobolismo es ima enfermedad social en el triple sentido de que es consentida 
impunemente por la sociedad, transmitida por el contagio moral y creada por dese- 
quilibrios tambi6n sociales. A la manera como las virtudes en determinada exalta- 
ci6n se truecan en un vicio complementario, tambi^n asi las funciones de nueetro 
organismo pasan en voces de su ordenaci6n fisioldgica a perturbaciones que son del 
dominio de la patologfa. Gada funci6n desviada o exagerada es ima causa patoldgica, 
desde la irritabilidad elemental, dig&moslo asf, basta los m&s nobles procesos morales. 
Es el case del tomador de bebidas alcobdlicas que pervierte el simple acto de satis- 
facer la sed en una toxicomania delet^rea. 

Sobre el instinto de satisfacer una necesidad orgdnica como es la ingeetidn de llqui- 
dos, causa primordial fisiol6gica, y sobre la existencia en el mercado de bebidas alco- 
b61icas, causa social, tambi6n primera, tejen su marafia inextricable las mil causae 
secundarias del alcobolismo, que bacen de 61 un problema de mdltiples factores indi* 
viduales, sociales y legales. 

Hfbrido de la miseria y del lujo, la bumanidad tropieza con 61 en todas las edades 
y en todas las esferas. Compaflero de la tristeza y de la alegrfa, de la fatiga y del ocio, 
es la sirena l^endaria que fascina y estrangula al individuo bumano en el encanta- 
miento de sus parafsos artificiales. 

En el individuo aproximadamente normal se inicia el alcobolismo segdn las leyes 
psiquicas del bdbito por la repeticidn, por la pasi6n que engendra y que, como todas, 
es una idea tenaz que dilata en tomo suyo emociones subordinadas con un imperio dea- 

1 Bste trabigo fii6 presentado al oonoono que el Ministerio de iDStmoddn PtlbUoa abfM eon motlvo del 
Congreeo Cientiflco Panamericano de WaahlDgton, y el J uradocaliflcadoroompueeto por los doctores Roberto 
Franco, PomplUo Martines, Carloe Esgoerra y Jorge Vargas exposo: "El problema del aloohoUsmo y ia 
posible soloolon ha llamado tamblto particolannente noestra atencidn. DebemoB alabaren 41 mis que 
todo la importanola de stks ooncloBlones y sa hermosa redacddn. Dleho trabi^o pnede Uegar a ser panto 
de partida de la luoba antialoohdUoa y atkna U eeriedad de on JBiolo rigoroeamente cicDtf^ 
y elegante que oonrenoe y agrada. 



PUBUO HEALTH AND MEDIOINB. 167 

p6tico sobre toda la economfa orgdnica, y por la rnds y m^ acentuada decadencia 
general que exige para el complemento de las funciones el t6nico fugaz, pero ya 
impreecindible, del alcohol. 

En eeta clase de individuos se verifica el contagio por la sugestidn que ejercen las 
bebidas alcoh61icas mediante su presencia, curiosidad; mediante la insinuaci6n 
amistosa, compaflerismo; mediante la oportunidad de eludir un eetado de tristeza 
ocasional o de exaltar una emoci6n alegre. 

En nuestra patria hay regiones en donde sigue un camino m&s francamente social, 
como en Boyaed y Oundinamarca que han hecho de la chicha un complemento de 
alimentaci6n y un liberador de la humildad y melancolfa de la raza indlgena, que 
vegeta tristemente en la pobreza y en la mugre. En el Tolima y en la Costa Atlintica 
satisface la sed de esas llanuras ardientes bajo la forma de guarapos fermentados y de 
ron. En Antioquia obra sobre la raza a mi ver por tres causas primordiales: por la 
cuidadosa difusi6n que hacen del aguardiente de cafLa los rematadores de esta renta, 
pues crean en los pueblos tabemas que, con el nombre de eatancoSt son el sitio mds 
atrayente como lugar de descanso y de solaz, y difunden en cada una de las veredas^ 
con un esmero industrial prodigioso, las ventas de bebidas alcohdlicas; siendo una con- 
dici6n de notoria superioridad en los empleados de esta renta de aguardientes el que 
sepan difundir y estimular el hAbito, como me consta por las excitaciones y aplausos 
que transmiten los rematadores a bus subaltemos y por el sobresueldo que cobran 
6stoe de su misidn propagandista. Tal sistema de privilegio fu6 ensayado en Suecia 
p<v Gustavo III en 1780 con tan alarmante resultado que hubo de suspenderlo poco 
despu^; y si en Antioquia ha side hasta ahora benefice es por el celo riguroso de los 
contrabandos y el alto precio del aguardiente que estipulan los rematadores, lo que 
CQmx>arado con la destilacidn ad libitum y la consiguiente baratura de otros tiempos 
constituye un progreso en la restricci6n del alcoholismo. Otra causa se deri va de una 
condici6n psfquica de la raza antioquefia: dotada de una grande capacidad para el 
trabajo y de una imaginacidn verdaderamente prodigiosa, se encuentra con mucha 
frecuencia ante el malestar de una suma de energlas ociosas que crea el aburrimiento 
y dste a su vez incita a la bebida seductora y eflmeramente eficaz, pues la falta de 
snficientes industrias y el escaso movimiento comercial hacen que en muchas pobla- 
ciones la vida se deslice dentro de una monotonia abrumadora y de una ociosidad 
inconveniente, a pesar de las notables cualidades de ese pueblo para el trabajo, verdad 
Ma que denota las corrientes de emigraci6n a que tiene que condenarse. Por dltimo, 
hay una causa social, que es la carencia de distracciones honradas en un pueblo que 
b61o tiene trabajo y fiestas rellgiosas, que es poco sociable, porque la mujer no desem- 
pefia ahf su acci6n social de refrenadora de la juventud, como es el hecho dondequiera 
que se comunica discreta pero frecuentemente con los hombres, pues estoy conven- 
cido de que ella es doble t6nico: funcional, haci^ndolos m&s emprendedores y viriles, 
mis audaces, en una palabra, siendo como es y hay que decir las cosas cientlficas con 
paUbras exactas, su tercera gUndula genital; y un t6nico moral educative, suavizando 
las duras maneras del hombre, credndole una atm^sfera de idealismo en derivaciones 
artlsticas, y de seducci6n pundonorosa. 

Las distracciones sociales, los sporU, los cinemat6grafoe, los teatros, etc., alejan 
prodigiosa^iente de la bebida, pues el vicio es sobre todo ocasional. Una observaci6n 
fdcil nos demuestra la disminuci6n que ha sufrido en Bogotd con las representaciones 
cinematogr&ficas y el reciente entusiasmo deportivo, que distraen de la tabema a 
centenares de individuos. La vida de los estudiantes americanos que tienen la 
imaginacidn pura y los mtlsculos fattigados por el ejercicio se revela como ejemplar al 
lado de los estudiantes del centro y del sur de America que Uevan la imaginaci6n 
calenturienta y la voluntad propicia al desenireno moral. 

El aislamiento relative en que se educan loe j6vene6 antioquefios respecto de la 
eociedad viene, pues, a sumarse a las otras causas del alcoholismo. Ese pueblo no se 
ha degenerado en el alcohol, a mi ver, por la resistencia de su raza, hablando en 



168 PBOCEEDINGS SECOND PAN AMERICAN SCIENTiriO CONGRESS. 

t^rminoe imprecisos para una aplicaddn diferencial, de su raza, digo, y de aquella 
coetumbre, resto de una moralidad excelente, de no tomar bebidas alcohdlicas aino 
ocasionalmente, es a saber: en los dfas feriados y en descansoe de su ruda labor, lo que 
hace que el alcoholizado cr6nico sea relativamente escaso adn. Quizd el aguardiente 
que consume sea tambi^ menos dafioso, pues no tiene sino pequefias cantidades de 
esencia de anis que mezclan en la destilaci6n de los guarapoe. Pero no es diffcil prever 
un deterioro de la raza, y ya se ven las psicopatfas y neurosis con bastante frecuencia, y 
la criminalidady homicidio y heridas es muy notoria; el misticismo domina a la mujer, 
sobre todo, que depositaria inmaculada de la moralidad de la raza, se desvla mis bi^n 
hacia el idealismo asceta. Y hago un poco de hincapi6 en este pueblo, porque 61 es 
atin la mejor reserva nacional para la colonizaci6n de nuestras selvas y el desarroUo 
de la industria, fecundo, vigoroeo e inteligente como se muestra todavfa. 

Y no es que sea un pueblo vidoso, abstinente me parece, ya que no alcanza a con- 
Bumir dos litres de alcohol per capita: mis ello es que otros factores confuses atin me 
inclinan a pensar que en nuestra zona y en nuestras condiciones de vida social el 
peligro se hace sentir con menos cantidades de alcohol que en otras partes. ^Nuestra 
pereza, nuestra ne\m)si6, nuestro metabolismo viciado no indican acaso un teneno 
propicio para la intoxicaci6n alcoh61ica? Estudiando en este mismo pueblo antio- 
quefio no ya al individuo o a la sociedad en general, sino las familias, podemoe ver 
con relativa frecuencia un decaimiento por el alcohol: de hombres patriarcales que 
se hicieron a una posici6n sobresaliente por su esfuerzo personal, surgen despu^s de 
una o dos genera<;iones seres viciosos que conducen la familia a la oecura esfera del 
proletariado. Familias enteras son una aflictiva trama de intelectuales, locos y alco- 
holizados, en quienes el talento, superior a veces, 86I0 sirve para hacer mis visible y 
penosa la d^eneraci6n. Pero hay un fen6meno social interesantfsimo en Antioquia, 
que hace mis plausible una lucha antialcoh61ica, a saber: algunas poblaciones que 
surgen al amparo de industrias como la minera, en regiones aisladas y de mal clima, 
se forman en gran parte con los deeechos de la sociedad, viciosos, vagabundos y bandi- 
dos, y no pasan dos generaciones sin que esa cepa, al parecer tan peligrosa, est6 repre- 
sentada por muy virtuosa sociedad, tan cambiados a veces, que hasta de radicales se 
truecan en conservadores muy sumisos e irreprochables feligreses. Y no es esto uno 
contradicci6n de las leyes de la herencia, sino el ejemplo de que los factores del vicio 
son atin menos orginicos que circunstanciales, como fu6 mi objeto hacerlo notar al 
insistir sobre las condiciones en que se desarrolla el joven antioquefio. 

La miseria, causa econ6mica que estudian con ahinco los soci61ogos europeos, es, 
entre nosotros al menos, un factor menos importante, porque generalmente me ha 
parecido consecuente y no casual. Mucho se ha hablado entre nosotros de una deficien- 
cia de alimentaci6n en la Altiplanicie andina oriental, que dizque conduce al use de los 
excitantes alcohdlicos. Esto merece un estudio muy razonado, pues creo que el 
problema es inverse, a saber: que el abuse de las bebidas engendra la Insuficiencia de 
alimentaci6n. 

Hay en el habitante de esta Altiplanicie una di8minuci6n de la urea y del icido 
drico que va hasta 8.02 en las 24 horas para la primera; y un aumento de los productoB 
amoniacales intermedios que alcanza a 0.15, lo que %ignifica, ademis, que no hay 
una compensacidn. Esta inperfecci6n ureogen6tica es mis notoria en la clase obrera. 
Por otra parte tenemos ima temperatura normal de 36.5. Como la media de gl6bulos 
rojos por milimetro cdblcos es entre nosotros de 4,800,000 con 83.21 de hemoglobina, 
y respiramos veinte veces por minuto una atmMera pobre en oxigeno— 0.192 de 
gramo por litro— nos queda un deficit de oxigenaci6n, a pesar del desarrollo toricico 
que en parte la compensa, y un deficit del metabolismo azoado. 

El consume de came del habitante de Bogoti apenas alcanza a 124 gramos por d(a, 
y en la clase pobre hay necesariamente una participaci6n menor de este promedio, y 
las albdminas vegetales no son suficientemente compensadoras por su elaboraci6n 
mis diffcil, mis alejada de la capacidad digestiva del hombre. Este dato serfa conclu - 



PUBLIC HEALTH AND MEDICINE. 169 

yente ai no se pudieran aducir razoneo en contra: el eoldado nuestro tiene por alimenta^ 
ci6n principal una eopa abundante de maiz, trlgo, cebada o legumbree con un plato 
de papaa, irn pequefio troBO de came cocida y un pan pequefio y hace un trabajo que 
exige 2,800 csJoiias por lo menos, adquiriendo, ademis, desarrollo fisico notable. Esta 
alimentaci6n es semejante a la que el pueblo consigue a 20 centavos diarioB, mitad de 
8U Balario mds o menoe. 

Qu4 eo, puee, lo que ocurre? Que el soldado no toma chicha y el obrero sf ; que ^ta- 
va creando una insuficiencia hep&tica con infecci6n gaatrointeetinal cr6nica; primer 
factor, org^mico. Y que el ai>etito por la bedida hace consumir en ella el dinero que 
puede servir para una Bana alimentaci6n; seguno factor, econ6mico. Luego la insu- 
ficiencia de nutrici6n depende de la chicha, segtin mi mode de pensar razonado, y 
de las condiciones del clima. 

La elaboraci6n defectuoea de esta alimentaci6n esti comprobada por la casi uni- 
versalidad del artritismo entre noeotros y nuestra depresidn de &nimo el reumatismo 
articular agudo es de ima frecuencia alarmante y algunas afecciones neuroartrfticas, 
la colitis mucomembranosa, y la neurastenia sobre todo, crecen dia por dfa en todas 
las esferas sodales. 

La £ona en que vivimos ejerce tambi^ una acci6n depresiva. Pensando muchas 
vecee en la alegrfa sana y fecimda que traen los viajeros que de nuestra patria van a 
Europa y Estados Unidos, en aquella exaltaci6n de la voluntad que demuestran en 
el tono franco y vivaz de su conversacidn, en la frase predsa que lanza ideas con brio, 
y en la imaginaci6n que asocia proyectos de trabajo en dUatadas perspectivas de 
futuro, pensando en todo ello, digo, comprendf ima vez que hay un factor meeol6gico 
importante. ^Qu6 les ocurre a ustedes cuando van a Europa? pregunt^ a un inte- 
lectual que regresaba por entonces, y con una maravillosa imagen me respondi6: 
"Es que alU sentimos por primera ocasi6n, despu^ de los dias de nuestra adolescencia, 
una primavera espiritual. " Y es cierto. Algo les ocurre como un rejuvenedmiento 
como el entusiasmo de ima primavera, con la placidez de su verdura y el nuevo 
despertar de la luz. 

Buscando ima explicaci6n de la influencia depresiva de nuestra zona, he pensado 
que la repetici6n mon6tona de una misma percepci6n o serie de percepciones fatiga 
los sentidos y el alma, asi como la vista de una luz igualmente coloreada conduce a la 
locura a los supliciados que a ella son sometidos, o como la repetici6n de un sonido y 
aun de una palabra nos trasUnma. Creo yo que nuestra zona con la monotonia de su 
estacidn permanente, la eecasa variedad de su naturaleza y de su atmMera, apaga la 
vivaddad del espiritu, enerva el musculo y deprime la voluntad. Esto puede com- 
probarse por el mayor entusiasmo que se observa en un dfa que aparece luminoso 
despu^s de una serie de inviemo, y aun en las horas de un torrencial que sigue a laigos 
dias de verano. 

Por eso he crefdo que el Tr6pico no dar& nunca una clvilizaci6n aut6ctona sino una de 
infiltntci6n, por la acci6n capilar, dig^oslo asf, de las corrientes circundantes. 

De otra parte surge tambi^n el alcoholismo: la herencia similar de los padres alco- 
h61icos y la desemejante de los psic6patas, neur6ticos, sifilfticos, debilitados por la 
senilidad y los agentes pat6genos, trae al mundo seres de un funclonamiento inarmd- 
nico que los \\e\& por un contagio mis r&pido, predispuestos, o por una \ erdadera 
toxicomania, degenerados mentales, al alcoholismo. 

Me adhiero a la opini6n que hace del quimismo celular el sustenticulo de la herencia 
y creo que el germen sufre en su composici6n f ntima — micelas de Naegeli, plaamonas 
de Wiener, como quiera interpretarse, variaciones adn desconocidas, pero en algima 
manera Imaginables, segdn los experimentos realizados en los vegetales (vid europea) 
para la creaci6n de ^ ariedades por medio de una modificaci6n quimica. Asf es mis 
ficil entender que un organismo intoxicado de ima u otra manera d6 g^nnenes vicia- 
dos que no pueden diferenciarse en 6rganos armdnicos ni veriflcar las asimilaciones y 
adaptaciones a que deben someterse para prosperar dentro del mode de ser de su 
eepecie. 



170 PEOCBEDINGS SECOND PAN AMEBIOAN BOIENTIPIO OONGBEBS. 

Este vicio constitucional de las c^iilaa germinativ&fi se traduciii en el ser adulto 
por deficiencias oig^cas, las que, a su vez, pueden afectar directa o indirectamente 
al sistema nervioso, como ee el case de las neurosis y psicosis que se producen en el 
adulto por la alteraci6n directa del cerebro o de cualquier otro 6rgano. 

En lo que respecta especialmente al alcoholismo, encontramos en los predispuestoe 
una nerviosidad que puede venir de un desequillbrio funcional del sistema nervioso 
o de otro 6igano cualquiera. Esta nerviosidad presenta todoe los grades, desde la 
emotividad casi normal hasta la fobia. 

La felicidad es resultante de la armonla; y la euforia es el resultado de un hinciona- 
miento arm6nico de nuestro organismo. Los predispuestos al alcoholismo, como 
en general todos los toxicdmanos, experlmentan como resultante de su funciona- 
miento perturbado una intranquilidad continua o peri6dica que se traduce en timldez, 
melancolfa, miedo, ansiedad, en una palabra, en las emocionee y sentimientos de- 
presivos; y mds tarde por una reaccidn de rebeldia en irritabilidad, odio, misantropia, 
egoismo, caracterlsticas de todoe los desadaptados sociales, famlliares, individuales y 
sexualee. Un dfa de esos el desequilibrado oig&nico tropieza con una droga o con un 
licor que le da una armonla fugaz a su organismo: \e roeados los horizontes de la vida, 
una cenestesia engafiosa le da percepciones de propio vigor y entereza. Es el paraiso 
artificial que surge como espejiamo en el desierto de una melancolfa conturbadora, y 
ya no ser& posible desechar el nepente. 

En mi pr&ctica he anotado procesos similares, conformes al deecrito en los morfin6- 
manos, dips6mano6, eter6manos, etc. Y es ya de obser\-aci6n comdn el recurso de los 
toxic6manos que cambian de excitante, haci^ndose tomadores de caf^ los dips6manos, 
de cocafnalos morfin6manos, de cloral, de 6ter, etc., segtin hallazgos de ocasi6n. 

Puede uno preguntarse si hay una pasi6n definida por las bebidas alcohdlicas antes 
del resultado de un primer ensayo, y yo llego a dudarlo en mucha parte. La pre- 
sentaci6n clfnica que hace un dips6mano es la de ima locura peri6dica depresiva, ya 
complicada de ideas delirantes, de fobias, de un estado en general francamente psico- 
p&tico, ya en nftida diferenciaci6n. Uno de ellos con quien habla hecho previo 
compromise se me presenta un dia y me dice: ''Tengo el ataque.'' No se ha tomado 
una copa adn, estd d6bil, presenta la cara del suMmiento, temblor r&pido, miedo 
obsesionante, anorexia, insomnio, inquietud, sus manos frfas eet&n cubiertas de sudor 
y en su cara hay como una sombra de vejez. Ye en perspectiv'a la copa redentora y 
s61o se contiene por un esfuerzo de voluntad ya prevenida por mi. Le aplico una 
fuerte dosis de estricnina en inyecci6n hipod^rmica y le veo transformarse. Esa noche 
estd con amigos, ve licor y no lo prueba. Cesa la acci6n t6nica antes de veinticuatro 
horas y recae en su depreai6n de la cual vuelvo a sacarlo con nueva dosis de estricnina. 
Ahf no hay vicio, es psicosis y nada m^. 

Los morfin6manos org&nicos que he tratado me han hecho revelaciones semejantes 
de melancolfa con fobias de una gran perturbaci6n psfquica. Desde pequefios han 
sidoraros:retrafdos,alocados, irritables. . . . Lamorfinafu6unhallazgoparaelequili- 
brio fugaz, como las combinaciones y sustituciones que hacen lo confirman. 

I Hay, me he preguntado a voces, una dipsomania permanente, no peri6dica7 Asf 
lo creo, como hay melancolfas cr6nica8, psicastenias y neurastenias y definiti\as. 
Gonozco un case en que el ciclo dipsomanfaco es semanal. 

Por todo esto, que no analizo m&s por ser otro mi objeto, me incline a que es preciso 
hacer dos capf tulos aparte, el de los viciosos accidentales y el de los \ iciosos orgdnicos, 
y llamar a esta fonna sencillamente, sin m^ divisiones, la psicopatfa toxicomanfaca, 
adscribi^ndola a las locuras depresivas. 

Tenemos, pues, varias causas del alcoholiono, que para precisar mejor podemos 
reunirlas bajo denominaciones sint^ticas: causas antropoI<5gicas, como dicen los 
tratadistas de Derecho Penal modemo, a saber: las perturbacionee oi^nicas que 
conducen a una depresidn, toxicomanlacos, abtilicos, desadaptados por debilidad o 
pen^ersidn. Causas sociales: la industria de bebidas alcohdlicas, la deficienda eco- 



PUBUO HEALTH AND MEDICINE. 171 

ndmica que posteiga la elevacidn moral, la deficiencia de educacidn que deja inculta 
la Yoluntad leactiva, la faltA de distracciones sanas que den el tdnico de la alegrfa 
a las multitudes. La iufluencia de loe climas enervanteS) causa mesol6gica. Y, por 
tiltimo, el ejemplo, causa moral. IL&y tambi^n causas familiares que por reducirse 
f&cUmente a las anteriores no hay para qu6 diferenciarlas. 

Entre nosotroe prlman los siguientee &u;tores: la existenda de bebidas alcoh61icas 
al alcance de todos; la acci6n depresiva del tr6pico; la deficiencia de la educacidn; 
la transmisi6n por herencia similar y desemejante, y por contagio; y la carencia de 
distracciones sustitutivas. 

XTB0TO8. 

La humanidad cuenta con las bebidas alcoh61icas desde la ^poca legendaria de Dioni- 
806 Osiiis y Xo^. Pero hay dos grandee dif erencias entre el mimdo antiguo y el mo4^mo 
respecto del alccdiol: la antigtiedad no conocla las bebidas destiladas y aromatizadaa, 
con mucho las mia peligrosas, pues fueron quizd los ib:abes los primeros en ensefiar a 
Europa la destilacidn del vino, y en llamar a su producto ''el sutil/' con una palabra 
que resulta ir6nica. Al siglo de las luces corresponde el triste honor de haber per 
fecdonado y en su mayor parte inventado la destilaci6n de las melazas y de los distintos 
miUceos, entre loe cuales la papa con su alcohol amilitico; y a 61 corresponde la 
industria de centenares de licores aromdticos con base de esencias deletdreas. El 
mundo antiguo se embriag6 con vinos y bebidas fennentadas, siendo, pues, franca- 
mente enolista, al modemo le cupieron en suerte el etilismo, el absintismo y el usismo 
en general. La otra diferencia fundamental es que los antiguos se embriagaban y 
los modemos se alcoholftan. Porque si bien es verdad que la cirrosis, Hipdcratee y 
S6neca lo dejan entrever, y las perturbaciones nerviosas existieron, como ocurri6 
a Lticulo en el ocaso de su vida y de tantos otros se dice, no habia una producci6n 
suficiente, ni una vida propicia para el hdbito alcoh61ico genenJizado. 

£1 siglo XIX marca el progreso del alcoholismo a la vez que inicia su estudio y su 
remedio. En 1850 se consumfa 1.46 de litre por cabeza, y lleg6 en 1900 a 4.66. Hubo 
en verdad, y subsisten, altemativas de consume que ajMnrtan dos ejemploe aprove- 
chablee: la acci6n ben^ca de la lucha antialcoh61ica y la necesidad de intensificarla 
en una ruta definitiva para que no recaigan los pueblos en el vicio. 

En Colombia tenemos cuatro bebidas dominantes: el aguardiente de cafia, la chicha, 
el guaiapo y la cerveza. El consume de licores extranjeroe aunque no es despredable, 
comporta menos peligros por su precio y menor radio de consume. 

Colombia, con una poblaci6n aproximada de seis millones, consume anualmente 
unos once millones de litros de alcohol o sea poco m^ o menos dos litres por cabeza. 
De estos solamente unos ciento veinte mil litros de licores extranjeroe y el reeto de las 
bebidas nacionalee enunciadas, que eet^ en la proporci6n de cinco millones cuatro- 
cientoB mil en chicha, tree millones quinientos mil en aguardiente, im mill6n seiscien- 
tos mil en guarapo y doscientos mil en cervezas, anotados en ntimeros redondos y 
segtin cilcuios meramente aproximativos pero razonables. 

El consumo de estas bebidas se reparte en la NacitSn distintamente, siendo generali- 
zadoB el consumo de los aguardientes y cervezas, con un m4ximum en Antioquia y 
Caldas por lo que hace a los primeros, m^ circimscrito a la Cordillera oriental el uao 
de la chicha; y peculiar de los climas templados el guarapo. 

Pueden considerarse como grandemente adulterados y nocivos los licores extranjeroe, 
cofiac, whisky, vinos blancos, tintos y secos, como de vicioea preparaci6n algunoe 
nacionales, a saber: la chicha, que es una fermentaci^n de la haiina de maiz y que 
tiene de 6 a 10$!^ de alcohol, 10.65 de azdcares, 10.80 almidones, 7.70 de glicerina, 6.15 
de ^dos de fermentaci6n, 1.60 de aceite especial de mafz y sobre todo un principio 
azoado t<Sxico, del orden de las ptomafnas, que parece ser la causa de las perturbaciones 
m^ serias del Uamado chichismo. 

El aguardiente es producto de destilaci6n del guarapo (jugo de cafia de aztkar fer- 
mentado) o bien de una soluci6n de panela (producto de evaporaci6n de este jugo), 



172 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

con un poco de esenda de anls. Tiene unoe veinte gradoe Cartier. Con un poco mis 
de esencia y alcohol se le denomina anisado superior. 

Las alteraciones que producen estas bebidas son muy conocidas y apenas las anotar^ 
ligeramente por lo que respecta a los aguardientes y a la chicha. 

Las cervezas, siendo un mal menor, no las considero sin embargo tan descuidables 
como lo suscriben algunos higienistas, porque el vicio no se detiene en dosis pruden- 
tee, y en hallando excitante se cuida de alcanzar la proporcidn suficiente, como es 
fdcil observarlo y ocuni6 en Suecia en grande escala cuando empez6 a sustitulr los 
licores destilados. 

Las perturbaciones que produce el aguardiente son las mismas estudiadas en todas 
partes. Pueden dividirse en dos grandes capftulos: de los tejidos y de la nutricidn. 

La nutrici6n tiende a espaciarse, las combustiones son incompletas y aparece un 
recargo de grasa que se localiza de preferencia en el tejido subcutdneo, el mesenterio, 
el coraz6n y los rifiones. Las reacciones defensivas contra el frfo, la fatiga y las infec- 
ciones se hacen deficientemente. La decadencia general fisica y psfquica es quizi 
motivada por esta inferi(»idad y se traduce en pereza, inconstancia, tristeza, ansiedad, 
indiferencia moral y afectiva, de una parte, y en afecciones artrlticas de otra. 

Bajo el influjo del alcohol los 6rganos de toda la economia se deterioran, principal- 
mente los emuntorios y el sistema nervioeo. 

Con las primeras dosis una vasodilatacidn se establece que causa las congestiones del 
perlodo inicial de la embriaguez con bus sensadones de cabr, de agilidad, de euforia, 
de viveza mental, hasta cierto If mite en que intoxicada la c^lula, sobre todo la cortical 
del cerebro, de suyo m^ d^bil, viene un decaimiento de las fimciones que constituye 
la torpeza mental y muscular del ebrio. El alcohol recorre y afecta preferentemente 
el est6mago y el duodeno, la vena porta y el hlgado, el pulm6n y el cerebro, meninges 
y capa cortical sobre todo. 

El organismo vuelve a la normal por las primeras voces, pero poco a poco el dese- 
quilibrio mental se convierte en deterioro org^co. Es la gastritis con degeneraci6n 
gr&nulo— grasa de las gUndulas prepil<Mcas, con la tiinica mucosa comigada y esclero- 
sada en partes, en partes inyectada. Lu^^o los adenomas de las gldndulas mucosas 
y las ulceraciones m^ o menos profundas. En el duodeno obra el alcohol alteraciones 
semejantes y algunas notorias en el ciego, en el pdncreas y gUmdulas salivares. Pasa 
a la vena porta que afecta tambi^n y va al hlgado a establecer el cuartel general de 
ima patologia mis grave atin, haciendo degenerar el pam^uima hacia la transforma- 
ci6n grasa y esclerosa. En ^1 y en los pulmones se asocia con el bacilo de Kock para 
terminar su obra delet^rea por congestiones y degeneraciones sucesivas. En el cere- 
bro ataca las meninges que se cubren de placas opalinas, y vegetaciones fibrosas, como 
en general todas las membranas serosas del organismo. Hace deprimir por atrofia las 
circunvoluciones cerebrales, produciendo en la c^lula cortical una degeneracidn 
granulosa y en los vasos nutricios dilataciones que son un dafio definitive y una ame- 
naza de muerte. Los nervios perif^ricos se inflaman. Neuritis 6pticas pueden sobre- 
venir. El coraz6n experimenta mdltiples alteraciones, entre las cuales ban anotado la 
vegetaci6n en las vilvulas y manchas lechosas en el pericardio y en el endocardio. 
El testlculo se hace flojo y amarillento, en degeneraci6n grasa. El rifidn puede 
aumentar de volumen y haceise pdlido y adiposo. 

Ante eete eecono de anatomfa patol^gica, ^il es hacer la 8eparaci6n de todas las 
afecciones mis o menos diferenciadas que crea el alcohol. Por 61 se explica uno las 
gastritis, cirrosis, eeterilidad, deliiios, demencias, neuritis, etc. Y si a esto se aflade 
que el organismo asi lesionado es presa de cualquier infecci6n, comprendemos lo pre- 
cario de su porvenir y del porvenir de bus g^rmenes. 

Un punto me ha llamado la atencidn y es el de la cirrosis. Creen algunos cUnicos 
europeos que el vino da la cirrosis atnSfica clisica. En mi prictica he visto dos clases 
de cirrosis como mis frecuntes: la atr6fica en un sindromo nltido, hlgado muy pequefio, 
serosidad peritoneal abundante y pura, etc., de pron<38tico relativamente benigno; 



PUBUO HEALTH AND MEDICINE. 173 

y la cirroBifl combinada con el bacilo de Kock, de hlgado graso, de seroeidad a veces 
turbia, y que es mortal. En ningtin caso ha intervenido el vino, bebida por otra 
parte escasa entre noeotros, ni tampoco el sulfato de cal. 

El alcoholismo agudo, la embraguez, ee diferencia seglin la bebida productora, la 
C0DStituci6n individual y grado de intoxicaci6n. Es asi como existe la embriaguez 
moderada^ alegre, optimista; la delirante y convulsiva, m^ propia del ajenjo; la 
impulsiva, tambi^n detenninada por esencias o por hibridaci6n con un temperamento 
epil^ptico. Sabido ee que cada cual hace la embriaguez a su manera y quienes hay 
que ezageran los senldmientoB altruistas y urbanos como ai hubiesen tomado haahich, 
eegtin el relate de un tomador de eeta droga; quienes son agresivos; quienes en fin son 
flilencioeos y como de inteligencia embotada. Dentro de ciertos Umites, se entiende, 
que la ingesti6n muy abundante a todoe iguala en un como final y en todos se inicia 
cuando menos, una confusi6n mental y una amnesia mis o menos profunda. 

Alcoholismo cr6nico es t^rmino empleado en psiquiatrfa para designar la alteraci6n 
de las facultades mentales que ya tienden a la demencia, pero en los cases en que 
, ^sta no es atin muy marcada. En 6\ predomina la p6rdida de los sentimientos fami- 
liares, de la moralidad y de la voluntad, y ya se inicia una perturbaci6n del juicio, 
de la autocritica sobre todo, un debilitamiento de la memoria y un comienzo de delirio. 
Las pesadillas son caracteristicas por la frecuente zoopsia en el ensuefio, el temblor 
tambldn diferenciado, las neuritis, desde el simple dolor a la presi6n muscular hasta 
la par&lisis. Y, en fin, todo el cuadro de la intoxicaci6n alcohdlica como la perturba- 
ci6n de los reflejos, la pereza del iris a la luz, la neuritis 6ptica, la impotencia, las 
alteraciones del aparato digestive, de sus anexos y la alteraci6n de los aparatos circu- 
latorio y renal. Signos notorios dif erenciales son de parte de la inteligencia lavivacidad 
incongniente y la ironia que anima un rostro de capilares dilatados; y el cardcter de 
los delirioe, que parecen ser la prolongaci6n de un ensuefio. 

De alil en adelante se va marcando la demencia que intensifican las alteraciones 
ateromatosas de las arterias cerebrales y las lagunas de desintegracidn que crean sus 
pequefias rupturas. Es frecuente, como en general en toda demencia, el transferir a 
otro lo que les parece desagradable en elloe mismos, como resto de crltica de una per- 
cepci6ii errada. Esta demencia diferenciable por los signos fisicos y los caracteres del 
delirio predominante es en voces tan diffcil de distinguir de la par&lisis general que 
exige la investigaci6n de una linfocitosis c6falo-raqufdea. 

Sobre este fondo de alteraciones oigdnicas, y desde las piimeras fases del alcoholismo 
hasta la demencia, pueden suigir otras manif estaciones clasificadas aparte como el de- 
lirio tremens, el delirio de persecucidn (paranoia alcoh61ica), la melancoUa alcoh61ica, 
el delirio de celos y el aindromo de Korsakoff. He observado algunas de estas moda- 
lidades, entre ellas la melanc61ica en un caso que no podr6 olvidar por la presentaci6n 
clfnica del enfermo, que presa de una ansiedad incurable vela aproximarse el fin de su 
existencia en medio de un malestar que comunicaba al espectador la angustia de su 
pena, respirando cuarenta voces por minuto, con un pulso d^bil y de gran frecuencia 
que a voces pasab'a de ciento treinta pulsaciones: el relajamiento demencial se marcaba 
en la p^rdida de sus afectos, en el descuido de su persona y en la inmoralidad de algunos 
de BUS actos. Era un antiguo dips6mano y habfa tenido una infecci6n sifiUtica atacada 
en^rgicamente, a raiz de cuyo tratamiento sobrevino la crisis melanc61ica, como re- 
sultado de la doble intoxicaci6n y de las preocupaciones consiguientes sobre un 
flistema nervioso de suyo degenerado. 

Esto que anoto a la ligera como delineamientos generales provoca a hacer un anilisis 
detenido de las perturbaciones nerviosas, con mucho las mis importantes en esta 
materia. Es que en efecto las nociones de la neurologfa contempor^ea, si bien hipo- 
t^ticas en muchas de sus aplicaciones, aportan cierta luz explicativa del mecanismo 
de la degeneraci6n nervioea que no puede menos de detener un poco al observador. 

Dada la estructura de la c61ula nerviosa y su funcionamiento, ^c6mo la modifica el 
alcoholismo en cada una de sus etapas? 



174 PROCEEDINGS SECOND PAN AMERICAN SCIENTIPIC C0NGBE88. 

La vasodilataci6n que se establece en las primeras copas de Ucor causa una hiperhe- 
mia cerebral. La c^lula nerviosa entra en un funcionamiento activfsimo, pues sub 
excitantes m^ poderosos son la hiperhemia y el CO'. Una r&pida artlculaci6n de las 
dendritas por su amebofsmo activado y la influencia de los nervi nervorum establece 
asociaciones que se manifiestan por la vivaddad de las ideas y el torrente de imigenes 
peculiares del comienzo de la embriaguez, por la agitaci6n muscular y la exaltaci6n de 
todas las funciones. Avanzando esta intoxicaci6n los vasomotores no reaccionan ya, la 
c61ula adquiere un veneno que trastoma su quimismo y tiende a paralizar su funcio- 
namiento. En consecuencia una relajaci6n muscular y mental sobreviene. Es el 
estado de embriaguez avanzada en que el individuo no equilibra su marcha ni sus 
ideas; en que es un sondmbulo sin memoria de fijaci6n, ni juicio, pues le ocune como 
a los animales fatigados que tienen sus c61ulas corticales desconectadas por la retracci6n 
de las dendritas en estado perlado. Esta falta de asociaci6n hace que no reconozca 
las personas ni las cosas a que estd mis habituado, que no d^ con su casa y se olvide 
hasta de sf mismo. 

La sucesi6n de estas intoxicaciones va formando un proceso degenerativo. Los 
corptisculos de Nissl, sustancia energ^tica celular, van desapareciendo del centre hacia 
la periferia; la redecilla celular se espacia tambi^n: las biomeras, bioblastos del retf- 
culo neurofibrilar, mueren, el nticleo y el nucleolo, centroe tr6ficos y funcionales, no 
reaccionan, se fragmentan y desaparecen . La albtimina protopl4smica delicada y com- 
pleja se fracciona poco a poco en granulaciones grasas y crom6genas, un estado vacuolar 
se inicia: es la cramatolisis con un cambio de constitucidn qu(mica aparente, pues ya 
no se tifle con los colorantes con que se combinaba en su estado normal. Los leuco- 
citoe penetran en ella, no para restituir los cuerpos de Nissl, como es el hecho ordinario, 
sino para englobarla como a organismo muerto. Las c^lulas van desapareciendo asf 
y dejando en su lugar grasa y tejido escleroso. Las circimvoluciones se hacen m&a 
duras y pequefias. El cuadro anatomopatol6gico de la demencia gen^rica queda 
establecido. En efecto al hacer cortes de la sustancia cerebral se nota la escasez de 
las c^lulas, y al examinar a los dementee se observan sus lagunas de de6integraci6n en 
el orden intelectual y moral, sus perturbacionee tr6ficas y funcionales en el orden 
fisioldgico. 

Cdanto m£s dafioso sea el alcoholismo en los jdvenes nos lo ensefia el hecho de que la 
c61ula nerviosa es la mia lenta en sU desarrollo, pudi^ndose decir que no es adulta 
hasta los veinticinco o treinta afios, y sabiendo como sabemos que no tiene r^eneracidn 
posible, que una vez muerta no tiene sustituto. La educaci6n estd fundada fisio- 
16gicamente en el ameboismo celular, que facilita la articulaci6n de los penachos de 
Unas c^lulas con otras, que las asoda en una complexidad inextricable. La voluntad 
probablemente se conduce por los nervi nervorum a los prolongamientos protoplismicos 
para constitulr las asociaciones apetecidas. Si una intoxicacidn de la c61ula, por 
cambio en su quimismo normal, paraliza su acci6n, ni la educaci6n, ni la voluntad 
podr&n ef ectuarse, y de ahl eeas perversiones de los heredo-alcoh61ico6 y de los adultos 
alcoholizados. 

Si de este cuadro de la demencia pasamos al delirio, podemos decir que unairritaci6n 
de las c^lulas exalta su funcionamiento en una inconexi6n que no permite asociar, y 
por lo tanto comparar, criticar y refrenar. Esta exaltaci6n perturbadora se traduce 
en alucinaciones por el proceso de la transferencia, es decir: la localizaci6n en la peri- 
feria sensorial de lo que es central efectivamente — transferencia que es funcidn del 
hdbito — y asf se constituye el fondo mismo del delirio. Luego asodando la idea per- 
turbada seg(in las conexiones restantes, se forma lanovela interior de los delirios, l<3gica 
en su misma desviaci6n. 

Esta mecdnica nerviosa es cuanto podemos vislumbrar hoy por hoy, sin pretender, 
ni mucho menos, afirmarla como una verdad definitiva en este misterioso reino de 
lapeiquis. 



PUBLIC HEALTH AND MEDICINE. 175 

Analizando ahora el efecto de nuestras bebidas alcohdlicas podemoa decir que el 
aguardiente produce una embriaguez agredva y que la chicha da un embotamiento 
y una insensibilidad caracterlsticoe. Si fuera posible un paralelo absoluto diria que 
el aguardiente produce una irritabOidad moral y la chicha una insensibilidad tambi^ 
moral. Quidn sabe si a estas dos causas se deba en mucho la frecuencia de las rifiaa 
en Antioquia y el predominio del raterismo en el bajo pueblo de la Altiplanicie» la 
altanerfa all& y la socarronerla en esta otra regi6n. Son problemas de criminalogia 
apenas esbozadoe. 

En efecto, la chicha produce peculiar embriaguez que se traduce con una palabra: 
toipeza. Torpeza mental y muscular. El alcoholizado con chicha marcha a paso 
corto y contracturado, atiende mal, responde tardfamente. £s un confuso mental, 
descuidado de su persona y torpe en todas sus reacciones. Presenta a voces el sin- 
dromo de la pelagra. El alcoholizado cr6nico por aguardiente, en camino de la demen- 
d&y da la impresi6n de cierta inquietud imaginativa y motora con gesticulaci6n r&pida, 
palabra tumultuosa y una ironia a voces feliz. El intoxicado cr6nico por chicha es un 
alelado con m^ estupor y una incuria personal incomparable. Hay, pues, dentro del 
cuadro gen^co a ambos una modalidad en cada uno que hace del chichismo una 
intoxicaci6n m^ profunda y enervante. 

La chicha esti causando \ma degeneraci6n de la raza india en los Departamentoe de 
la Cordillera oriental. Es de f&cil observacidn la viva inteligencia de los nifios del bajo 
pueblo l)ogotano hasta la pubertad, 6poca en que, asf lo juzgo yo, aparece una pertur- 
baci6n por herencia homocrdnica, que los hace lerdos, himiildee, perezoeos y no poco 
inmorales. Lo creo asf aun descartando la influencia directa del licor que toman deede 
antes de ser destetados, pues en esa vivacidad de la infancia se esbozan ciertas degene- 
neraciones, a saber: la vagabunderia, el raterismo, la insensibilidad moral, la copro- 
lalia (notable por ser un pueblo de gran delicadeza en el trato con sus superiores). 
Begiones hay en el oriente de Cundinamarca en las que la acci6n combinada del bodo 
y del alcohol (chicha fermentada) ha conducido a la raza a una degeneraci6n alarmante 
a pesar de tener mucha sangre eepafiola, a una postraci6n moral intelectual y ffsica que 
es serlsima amenaza futura y ya triste preeente. En todo este Altiplano he visto tam- 
bidn un ndmero crecido de reumdticos y de cardiacos a los veinte afloe que me llam6 
la atenci6n. 

A esto se afiade que la falta de bafLo frecuente es una causa poderosa del metabolismo 
vidado y de la depresi6n funcional, y que la tuberculosis y la sffilis crecen en Bogotd 
en muy serias proporciones. La mortalidad infantil, de uno a diez aflos, ha alcanzado 
en algunos perfodos (1910) el 44 por 100 en esta ciudad. En ella misma la mortalidad 
por tuberculosis alcanz6 en 1912 y 1913 el 9 por 100, y en el Hospital de San Juan de 
DioB ha habido afio de Uegar a 29 por 100, (1895 y 1896). La slfilis crece en nuestros 
medios urbanos, y me atrevo a pensar que adn prospera. La debilidad de la raza, el 
recargo nervioso de la vida contempor^ea y los tratamientos mal conducidos son una 
cosa alarmante a este respecto. He observado tantas voces la sffilis cerebral precoz 
(menos de un afio) que me pregunto si es que hay variedades de triponema hiper- 
t6xico y neur6tropo. La sal de Ehrlich aplicada en un tratamiento discontinuo es una 
amenaza muy seiia, y a mi modo de ver en esta forma es a la sffilis lo que el opio al dolor, 
un sedante, que disimula apenas, si una prudente temp^utica no viene a conjurar el 
peligro. Remedio heroico bien empleado y combinado, requiere ima prudenda digna 
del mayor encarecimiento. 

Son, sin embargo, los efectoe familiares aquellos que mSm apenan al monJista. La 
literatura ha logrado condensar en dramas de una emod6n angustiosa el proceso fntimo 
del hogar af^ctado por el alcohol. 

Son loe primeros ensayoe del hijo o del espoeo que furtivamente Uega a su casa, 
ocultando con pundonor el trastomo mental y el desequilibrio de las i»imeras embria* 
gueces. El remordimiento del dia siguiente en una atmMera de reticendas. La 
esposa la madre que inclinan la cabeza ante un vago presentimiento y arrojan sobre 



176 PROCEEDINGS SECOND PAN AMEBIC AN SCIENTIFIC CONGRESS. 

el ser querido el manto de iin disimulo carifioeo. Es la primera cnsiB familiar que 
estalla cuando el borracho va perdiendo la timidez de las reacciones moralee y se llega 
a la casa con la cara vultuoea y el lenguaje ofensivo o altanero. La reciiminacidn 
primera y el primer desenfado. Las Idgrimas que empafian ojos discretes y queridoB 
ante el ejemplo conturbador que el ebrio da a los nifios que le contemplan con mirada 
at6nita, desconcertados y medrosos. Las Idgrimas que se deslizan silenciosamente en 
la penumbra de la alcoba conyugal antes nido de amor y hoy refugio de dolores. Las 
Idgrimas intitiles de quien ve un golpe de deshonor y de miseria cemerse amenazante 
en future que avanza con premura impasible. 

Y tras de esas rebeldlas contra el martirio que comienza, van surgiendo en el hogar 
las consecuencias fatales. Es el hambre que uno de esos dlas aparece. La desnudez 
que se inicia en las primeras desgarraduras del traje, m^ penosas ciertamente para el 
iJma que para el cuerpo aterido. La noticia del escdndalo en la tabema. La primera 
prisi6n. Y, por tiltimo, el golpe mortal: la aparici6n del vicio en otro de la casa. 

La esposa envilecida en un ambiente de dolor y de miseria ve descorrerse los dfas sin 
esperanza; ve llegar con horror la noche en que el borracho, inmundo de la cabeza a 
los pies, ocupard su lecho, y torpemente lascivo, en uto entusiasmo fugaz le dejari en el 
cuerpo un desgraciado y en el alma asco profundo. 

En onda dilatada la suma de los dolores no se cierra nunca. Tras de la vergdenza, 
de la desnudez y el hambre, cuando ya se va embotando la sensibilidad emotiva y 
moral, sugird m^ y mds aiiada la catistrofe interna: un dfa Uegari la tisis con su 
cortejo de orfandades y otro dfa la prostituci6n abrigard los cuerpos desnudos con loo 
(iltimos harapos del honor . . . Despu^ el olvido recogerd las pavesas de un hogar 
que consumi6 el alcohol. 

Sin embargo, no sucede siempre asf . Sobre la sociedad repercutird la onda de este 
naufragio. 

Consultando estadlsticas vemos que los asilos y las cdrceles encierran de \in 20 a 30 
por 100 de las vfctimas del alcohol. 20 a 30 por 100 directo a que debemos agregar las 
consecuencias de su acci6n mediata que lo elevan a la abrumadora proporci6n de un 
50. Y como los hospitales siguen ese mismo derrotero, y como la mortalidad infantil de 
^1 toma su mayor contingente, y como los d^biles mentales, que ser&n el ludibrio de la 
sociedad y el tormento de los institutores, los retrasados con el cortejo de perturbaciones 
moralee y su frecuente epilepsia, los imb^iles que a(in conservan un asidero intelec- 
tual, los idiotas, ciegos ys. de entendimiento: una verdadera falange de infortunadoo 
que son problema social que crea en su mayor parte el alcohol; y los neur6patas, 
locos, los vagabundos, los perezosos, los mendigos, los rateros, los criminales natoe le 
deben tambi^n un crecido porcentaje; tenemos que inclinamos ante la evidencia de 
que es la plaga m&s lesiva que pesa sobre la humanidad. Y si pensamos que los otros 
grandes flagelos con 61 se hermanan y de 6\ reciben su mejor abono, hay para meditar 
un instante en si hacemoe o n6 sonar la hora de una lucha definitiva. 

Un hilito de tristeza se cieme sobre la vida contempordnea. El desequilibrio mental 
ha hecho posible la profecfa de que la humanidad sucumbird en una locura universal; 
el problema del proletariado se complica diariamente; el ndmero de hospicios, asilos 
y cdrceles crece hora por hora sin ll^ar a satisfacer la demanda mSa y mds urgente. 
Es, pues, hora de reaccionar antes de que el esfuerzo sea superior a nuestras capad- 
dades. 

TBRAPiunOA. 

El alcoholismo es una endemia social que se acentu6 prodigiosamente durante el 
siglo tUtimo y que ha desafiado el rigorismo de todas las medidas profiUctieas. 

Hay restricciones policiacas, pedagdgicas, m6dicas, financieras y comerciales, etc., 
que van desde la propaganda abstinente hasta la prohibici6n absoluta, ensayada de 
un mode oficial en algunas partes. 



PUBUC HEALTH AND MEDICINE. 177 

La restriccidn ofidal por medio de ordenanzas de policia eetd eetablecida entre 
uo0otTO6, como en todas partes, sin resoltado promisorio. Deja a cubierto el alcoho- 
lismo ''a potu nimio" y se cuida 86I0 de lo que ya es irremediable: la embriaguez. 

Los impuestos m^ y m^ altos que peean sobre la industria y el comercio de las 
bebidas alcohdlicas s61o ban servido para encarifiar a Ice gobiemos con las pingtles 
rentas que de ellos derivan. 

La restricci6n en el ntimero de establedmientoe de venta hasta determinado por- 
centaje de poblaci6n es un tratamiento tenue, una terap^utica de fomentos sobre una 
gangrena alarmante, como lo prueba una comparaci6n entre Holanda y B61gica, que 
consumen ''per capita" igual cantidad de alcohol, habiendo esta restricci6n en una 
deeUas. 

La labor educacionista es tambi^n palanca de poco alcance, porque necesitarla cu- 
brir con su protecci6n todas las categorlas sociales en un esfuerzo de educaci6n intensa 
para lograr quizd 86I0 efectoe parciales. 

£1 tratamiento m6dico est& reducido a tres recursos: el de la educaci6n de la voluntad, 
tarea diffdl como pocas, que requiere cierta vocacidn de parte del medico y no poca 
voluntad ya del enfermo, el de la correcci6n fundonal: los t^nicos nervioeos ffsicos y 
qufmicos, los correctivos de insuficiencias org&nicas espedales, y por dltimo el 
remedio heroico, el intemado en una casa de salud. Pero el medico es recurso de 
mgencia ya de angustiosas situaciones, de suyo impropicias, y su acci6n estd cohi- 
bida por la voluntad del padente y la deficiencia legal respectiva. 

Ninguno de estos tratamientos aislados podri, pues, considerarse sufidente. Pero 
tres de ellos darin una combinad6n saludable: la prohibid6n absoluta de vender 
bebidas alcoh61icas, la legislad6n conducente a establecer el intemado en un asilo a 
los que se embriaguen determinado ntimero de voces, y la educad6n profiUctica 
respectiva. 

Vamos a analizar estas medidas draconianas, porque superficialmente parecen un 
juego de imaginad6n. 

El alcoholismo es una endemia social que va minando la espede humana hasta 
constituir su peligro m&ximo. Estamos en presencia de un enemigo capaz de efectuar 
un aniquilamiento de la espede, como lo acredita la r&pida desaparici6n de los Pieles 
Rojas, polinesios y africanos tratados por el alcohol de la cristiana dvilizad6n euro- 
pea. Ante 61 queda justificada toda medida de repre6i6n, como se justifica el destie- 
rro de los leprosos, la priai6n perpetua de los criminales patol6gicos, el aislamiento 
social de los pervertidos. La moral lo autoriza, y la justida humana no serd cruel si 
redime las generadones futuras, como lo manda el espfritu de conservaci6n y la misma 
dignidad de la eepetde. 

Las vinculadones tiuniliares tambi^n reclaman a grito herido la Uberaci6n de la 
mujer y de los pdrvulos, a quienes el alcoholismo martiriza impunemente con hambre y 
deshonor. 

El altruismo, la caridad cristiana, la simpatia del pr6jimo— como quiera enten- 
derse— necesita dejar atr&s este fardo de miserias para consagrar su acd6n al creciente 
desequilibrio del bienestar hmnano. La Asistencia ptiblica no debiera tener en un 
futuro feliz sine doe aplicadones: la de dar trabajo al adulto y asilo a los ancianos 
que rindieron ya una jomada de lucha. 

Ante los destines de la especie estd, pues, justificada la prohibid6n absoluta. 

Los financistas que se han encarifiado con la renta que rinde el vido tienen que 
cuiar la miopia de sos ojos y comprender estas dos verdades de sentido palpi tante: 
1.* que la contribud6n que sumimstra el vido puede subsistir e^ otra forma, puesto 
que es un hecho indestructible que prueba esa capaddad contributiva; y 2.* que el 
Estado y la sodedad pagan con creces en gastos de correcddn del vidoeo y de pro- 
tecddn de sus victimas el rendimiento de tan monstruoso recurso fiscal. Como lo 
ensefia un libro de propaganda antialcohdlica, en 86I0 los Estados Unidos hubo de 



178 PROCEEDINGS SECOND PAN AMEBICAN SCIENnFIC CONGRESS. 

1860 a 1870 un gasto de m^ de quince mil nuUonee, cien mil nifloB en las casas de 
caridad, ciento dncuenta mil condenadoe a piisi6n, diez mil locos, mil quinientoe 
aseslnatos, dos mil suicidioe, y un mill6n de huManos a causa del alcohol. Las pdrdi- 
das ocasionadas fueron calculadas en Francia un afio en mil millones de francos; y en 
1895 ga8t6 Inglaterra m^ de tres mil millones. Puede decirse que el impuesto sobre 
el alcohol es apenas el logaritmo de los gastos que 6ste ocasiona, y que un pueblo se 
harfa instant&neamente rico si, conservando los otros Stores econ6micos, desechara 
en un memento dado el alcoholismo. 

Y podemos preguntar a estos pseudo estadistas cuinto vale una vida humana, cudnto 
valen todas lasvidas humanas tronchadas por el alcohol. £1 espiritu humane queda 
adn como un enigma. Las CompafLfas de Seguros podiin valuar el precio econdmico 
de un hombre aeg6n su categorfa; pero es predso preguntarse si hay peso o medida 
paia la energla moral y la eneigia intelectual como factores ineecrutables del progreso 
de la especie. Ante un nifio fracasado pasa indiferente la estulticia humana, pero 
el fil6eofo vuelve la vista y se pregunta si alguna nueva ruta se ceg6 con esa siega. 

Ante el problema del opio en Asia y del alcohol en Africa se ha levantado este aigu- 
mento de la renta con la discrecidn que es del case, pero los m6dicos no vacilan en 
lamentarlo, como que tiene sus rafces en el cultivo de la miseria humana, y lo hacen 
para con pueblos colonos y tribus salvajes tenidoe en poco estimaci6n. ^C6mo pudie- 
ra, pues, sostener un ciudadano de un pals libre y culto la validez de un beneficio 
fiscal a cambio de una perturbaci6n econ6mica infinitamente superior y de una per- 
turbaci6n moral no menos alannante? La sola coeecha de vinos de 1890 vali6 m^ 
de cuatro mil millones de francos. ^Cu4ntos miles de millones valdrd lo que el mundo 
consume intitilmente en alcohol? ^ Y cudntos miles de millones hay que afladir a este 
gasto por los dafios que ocasiona? ^No se debe, pues, pensar que el desequilibrio eco- 
n6mico mundial tiene ahl un factor inequiparable, que quizd es este el factor supremo 
de la miseria en el mundo? 

Luego ante los presupuestos nacionales estd tambi^n justificada la prohibici6n 
absoluta. 

Si adn subsisten argumentoe en contra no alcanzo a vislumbrarlos. Quizd tma pro- 
hibicl6n brusca causarla un desequilibrio comercial ruinoso y tma rebeldia tan intensa 
que podria causar la calda de un gobiemo. Para este doble peUgro politico y econ6- 
mico hay ima Boluci6n f&dl: un impuesto adicional y tenazmente progreaivo, de los 
que ya pesan sobre las bebidas alcoh61icas, destinado a la creaci6n y conservacidn 
de Casas de Salud para el tratamiento preventive y curativo de los alcoholizados ini- 
ciarla la restricci6n sin lesionar imprudentemente a los industriales y comerdantes, y 
crearla los recursos suficientes para la profilaxis cientlfica, siendo asaz justo, porque 
devolverla a la sodedad en bienes lo que por males le sustrajera, y cerrando m£s y 
m4B el clrculo de las restzicciones se ll^arla en tiempo no muy remote a la abolici6n 
completa, verdadero desideratum* 

Y si ocurriere que el impuesto adicional encuentra ''saturado^' ya el precio de las 
bebidas alcoh61icas— K^ue no lo estd generalmente— -cumpli^ndoee entonces las leyes 
econ6mlcas disminuird el consume, y obtendremos diractamente lo que buscamos de 
im mode indirecto. 

La disminucidn del consume en Antioqula en mis de un litre por cabeza en los 
tiltimos dncuenta afios indica que es posible una dlsminuci6n de consumo con 
aumento de la renta. 

Los pueblos que tengan la costumbre de tomar vino en las comidas y los que tengan 
su mayor riqueza en esta dase de industrias resolver&n el problema mia diffdlmente 
que nosotros. Pero*no serla juidoso el que continuara el alcohol siendo en nuestra 
patria un peligro sin raz6n sufidente para tolerarlo, ni siquiera una costumbre ancestral 
universalizada. 

El segundo capltulo de tratamiento, el intemado, queda a<in como lo finico radonal, 
pues en ^1 beneficia el padente de una abstinencia absoluta, de una educaci6n de la 
voluntad y de un corrective sodal. 



PUBUO HEALTH AND MEDICINE. 179 

Y es indispensable para complementar la acci^n prohibitiva, puee el fraude se 
inidaii con ella de un modo audas y astuto. 

Pero esto comporta graves problemas. £1 intemado de loe ya dementes, ^ inler- 
uado transitorio de loe dipsdmanos, hecho generalmente cuando no lo necesitan, es a 
saber, al terminar sus crisis, son medidas inocentes. Como hay casas de correcci^n 
para menores debe haberlas para los que se inician en ^ alc<^olismo. Besulta, es 
▼erdad, una aparente restricckki de la libertad individual Ak tratar de cohibir en el 
libre ejercido de sus dereciios y tiabajos a una peisona que apeoas haya cometido la 
lalta de unas pocas embriagueces, o de hacerse notar como bebedor ooddiano de pe- 
quefias p<»rcioneB. Mas ello es que se castigan dos delitos simllares: ^ infantiddio, y 
^ alcohdizado atenta contra su prole; el suiddio, y el que abusa de las bebidas 
alcob61ica8 tiende a 61. iiia adn: se trata de una defeosa social, superior per lo 
mismo a los intereses individuales. 

£1 intemado para ser benefice requiere una legislaci6n reguladora que establesca 
la autorizaci6n para los mien&bros de la iamilia de sc^idtaria de las autoridades com- 
petentes, y la obligad6n de estas aut<mdades de proceder de ofido cada ves que llegue 
a 8U conocimiento un case determinado. 

Este intemado, por otra parte eficaz trattodose de individuos pundonorosos a6n y 
conscientes, serfa una cura por el trabajo, sobre todo muscular, y la educaci6n de la 
yduntad. Debwia inidarse desde el prindpio de la restricci6n y confirmarse a la 
generaci6n siguiente de la que sufriera la prQhibici6n definitiva, pues deiotro modo 
no habrla espado ni recursos sufidentes para aplicar justamente la ley. Es sabido, 
ademis que una generaci6n abstinente levanta el nivel de la raza de una manera 
-prodigiosa, y el intemado es un tratamiento tan eficas, que hoy mismo alcanza un 
40 por 100 de curadones. 

Por lo que respecta al tercer capf tulo, la educaci6n profiUctica, basta con enundarla 
para comprender cu^ seria su radio de acci6n y la contribuckSn que pudiera prestar 
a la soluci6n de este problems, pues es quizd el campo donde se ha inidado mis 
en^icamente la lucha antialcoh61ica. 

Quedan por tratar dos graves cuesUcmes: las bebidas alcoh61icae causan mudias 
voces un espardmiento amistoso, que discretamente usadas Uevan al espfritu el 
entusiasmo memorable de una hora de oompafierlsmo o de galanter^ social. iQu6 
hacer? ^Se tolera esto, previo permiso de una autgridad o de una junta de hlgiene, o 
se hace tabla rasa de toda tentad6n7 Ckm lo primero la espada de Damodes no serfa 
vuelta a su vaina completamente. Con lo segundo robarlamos a la humanidad un 
poco de expaDfli6n alegre cuando en verdad la vida es Arida y el dolor insiste tenaz- 
mente. . . . 

£1 otro problema es el expendio como droga, en verdad iicil de resolver aparente- 
mente cuando se piensa que comportarla una prescripci6n m^dica, pero ezpuesto sin 
embargo cuando sabemos que la UMHrfina y sus hermanos de vicio son propinados 
abundantemente a los padentes sin que haya modo de sorprsnder el fraude p<Mr aquella 
etema connivenda entre el interte del comerciante y el inters del consumidor, bene- 
fidados mutuamente a su manera. 

Mas ello es que atin asf tendrfamos hecho mia de la mitad de nuestro camino profilic- 
tico, y estarfamos preparados para un futuro m^ riguroso. 

No quieio de prop6sito deliberado entrwr en la enumeraci(ki de las bebidas que 
deben ser eliminadas del mercado, poique este es un detalle indtil en un estudio de 
ideas generales y sencillo de establecer en la hora propida. Bespecto de nosotios eg 
predso anotar desde ahora, eso sf , la necesidad urgente de que la chicba sea eliminada. 
Recuerdo que en un tiempo, reciente atin, se implant6 en Galdas este vicLo con tanto 
entusottono, que en pocos meses se observaron caeos de alcoholismo, y bast6 un grava. 
men pn^bitivo para desarralgario. Algo semejante deberfa haceme en los Departa- 
mentos con este y otros licores como el aguardiente, el ron, el cofiac y ese mundo de 
vinos mSm o menos adulterados que se consumen en variadas proporciones segdn loe 
b&bitOB regionales. 

6848^-17— VOL IX 18 



180 PBOCEEDIKGS SECOND PAN AMEBICAN SCIENTIFIC C0N0BE8S. 

CONCLU816N. 

No es diffcil prever sordas resistencias, entre las cuales no seiia la menor el calificar 
de ut6plco eete intento. Sentemoe desde ahora la v^ad y digamoe que iit6pico 86I0 
ee lo que no puede realizaise con las fuerzas normalee del hombre, y que fuerzas y 
derecho le asisten en eete case para enarbolar la bandera de previ8i6n y de cultura 
con un gesto que no tiene de heroico m&B que el no ser frecuente: y nunca eeril una 
audacia el pensar que las facultades del hombre ae hicieron para veneer laa dificul- 
tades de la vida. 

Oreo, puee, haber dejado razonado el siguiente voto que someto a la aprobaci6n del 
Congreso: 

£1 Congreso Gientifico Fanamericano de WAshington encarece a las Naciones repre- 
sentadas en ^1 la restriccldn gradual del alcc^olismo haeta su aboUci6n, inici^dola 
con un impuesto adicional y prudentemente progresivo sobre las bebldas alcoh6licas, 
dedicado exclusivamente a la creaci6n y conservaci6n de OaBas de Salud donde eean 
intemados por disposicidn legal los reincidentes de embrlaguez y los notoriamente 
incllnados a la bebida, para que en ellas beneficien de un tratamiento "preventivo." 

Col. John Van R. Hoff. I move that the resolution proposed in 
the paper of Dr. Mesa be referred to the committee on resolutions. 

Seconded and approved. 

The Chaibman. These papers are now open for discussion. 

Dr. Tom A. Williams. The problem of alcoholism is even more- 
extensive and profound than the prevention of overt bad habits like 
alcohol, morphine, etc. It is rooted in the psychic foundation of the 
individual who indulges. I observed a smile in the audience when 
Dr. Wiley told of his boy, but I can confirm what he says with my 
own boy, who is now 9^ years old, and from what I have seen of 
many little patients who have been directed by me in rational 
psychological ways when I was consulted about the nervous troubles 
which arose from mismanagement. 

Persons who become addicted from social reasons or because 
they are oversuggeetible are easily reached by prohibition. They 
have no real inner temptation. The diflBcult problem is the psychas- 
thenic person. In the search for euphoria, such persons adopt many 
other expedients than alcohol. One girl, for instance, an account 
of intense mental suffering, used to pour boiling water on her feet. 
Some have recourse to superstitious practices, carrying this even to 
the way in which they put on their clothes. One of my patients 
woidd take two hours to dress in the morning, even though helped 
by his father and mother — ^a time they could ill spare, the father 
being a United States Senator. The agony of the obsessions of 
these people can hardly be comprehended by those who have not 
felt it. Even suicide may be tried to escape from the sxiffering. 
The cause of their sufferings is often purely psychological and can 
be removed by proper readjustment of their attitude toward life. 

The reaction to narcotic drugs is more dependent upon the indi- 
vidual than upon the drug itself. Either expansive and joyous, 



FOBLIO HEALTH AND MEDICa[2ra. 181 

or depressive and sad, reactions may residt from the same drug in 
different people. 

Even the removal of the speqific craving for alcohol, if it could 
be done by an antibody, woidd not cure these individuals, as the 
problem is much deeper. Dr. Doria's very learned treatise upon 
the takers of cannabis indica in Brazil is a beautiful illustration of 
this very point. These people seek for happiness and they find it 
in the temporary stimulation of the drug they take. They have 
the sensation so well described by the poet Bums when he said, 
"Kings may be blessed, but Tam was glorious, o'er all the ills of 
Jife victorious." When a miserable, half-starved peasant can feel 
like this, who can blame him for taking narcotics ? Let us beware, 
lest in prohibition of alcohol, we do not drive people to worse vices. 
To prevent this we must see that human lot is ameUorated and that 
wise psychological management is given our children. 

The Chairman. I shall now call for the reading of the following 
papers: 

An inquiry into the causes of crime, by R. B. von KleinSmid. 

Pauperism, by Edward T. Devine. 



AN INQUIRY INTO THE CAUSES OP CRIME. 

R. B. VON KLEINSMID, 
PrenderU, University of Arizona. 

A student in the field of criminology ia forced to wonder at times whether there is 
any other field in which it is possible for him to encounter so great a diversity of 
opinion or such extreme and opposing views. It is to be said, however, that con- 
dnsions heretofore reached have come laigely from empirical sources alone rather 
than from scientific investigations, and that the extreme positions held are those 
dictated by the an^es from which penal and conectional problems have been ap- 
pfoacbed. In genersl, these conclusions may be grouped as four in number. 

The first is that, to a greater or less extent, every man is guilty of crimes— the detec- 
tioQ, conviction, and sentence of some avoided (mly because of concomitant circum- 
stances. Were the eye of the law trained as carefully upon the free as upon others 
who are compelled to pay the penalty of their misdeeds they too must suffer the di^ 
grace and the punishment meted out to other ofienders. In other words, all have 
conunitted and do commit crimes, and it is very laigely a matter of chance as ta 
which ones reap the just luurvest of their antisocial seed sowing. Out of this theory 
has grown the belief that, by no means, are all of our criminals incarcerated in insti- 
tntions, nor indeed our wont ones, but that there are many, as Tarde points out, 
who even go 80 far as to make a profession of the criminal life, operating with a cunning 
which, with rare exceptions, evades detection, and so escapes the poialty. 

The eecond belief on the part of certain of those who give attention to the problem 
ci crimen is that all criminals are vicious men, and consequentiy it is the duty of so- 
ciety to hunt them out whefever they may be found in order to mete out to them 
that degree of punishment appointed by legislation for the particular crime committed. . 
Out ci the attitude at this faith have grown the hi^ wall, the whipping post, and tho^ 



182 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

dungeon, together with all means of discii^iiie and puniahment which humiliate ayid 
degrade, in the conviction that the vidous must be cowed and made afraid to vent 
their nefarious temper upon a society strong enough and determined enough to cope 
with them and to demand of them an eye for an eye and a tooth for a tooth. 

Another view held particularly by these of sociological interests is that tcanQgresson 
4>f the law would be very few in number, if any, except f<n' the peculiar and con* 
lamin a ting social environment. Those of this belief hold that society is to blame 
-directly for the existence of the so-called criminal class because she neglects to con- 
duct her economic and social afburs so as to surround all of her members with those 
influencee which make for good alone. 

BtSl a fourth omdusion is to the effect that all criminals are defectives and that 
no man of normal mental and physical status commits a crime. On the grounds of this 
belief there have sprung up among us, in the last few yean, a number of serious 
and, more recently, oiganised attempts to investigate the field of crime for the pur* 
pose of detennining the degree of abnormality of those who have been convicted 
and incarcemted. 

While the truth is not to be found exclusively in the theory held by any one of 
these particular groups, it is not at all unlikely that there is a considerable element 
of soundness in the aiguments of all; in foct, may it not be the case when investiga- 
tions will have continued for a greater length of time and more exhaustive study 
will have contributed more generously to the sdence of criminology that it will be 
discovered that there is a large element of identity in the theories advanced and that 
these various condusions are not antagonistic to so great a degree as supposed? Until 
quite recently the sdence of crimindogy was regarded as a legal sdence exclusivdy. 
Now there are indications that there are many who believe it to be a purely sockd 
sdence. On the contrary, if there be a sdence of criminology— which some deny — 
there are those who insist that it has its origin in the sciences of medicine and psy- 
chology. The legal sdence emphasizes the responsibility of the present criminal; 
the social sdence, the responsibility of society from which he came; the medico- 
psychological sdence, the responsibility of his ancestors not less than that of the 
individual criminal himself. May it not be that these different positions, too, have 
come about only because of varying ai^pioaches to the same truth? U we grant that 
the individual offender is vidous and should be punished according to the law, we 
still have to account for the fact that this man is vidous and some other iBemben at 
aodety are not. If we giant that the eaymaameat from friiidi he came wae am- 
dudve to criminal activity, we still have to account Ux the fact that many othMs 
from the same environment do not beccnne offenden. Giant a vidous attitude in 
his case and cardessness and neglect on the part olsodety to create a proper ettviimi- 
ment for him and we are conhxmted with the fact that it waa this particular individual 
who committed the crime who doubtlev carries within himself the cause of his mi*- 
deeds. However, just as surely as we discover from a dinical study of the individual 
that the probaUe cause of his own downfall rests in his constitutional inferiority, we 
shall find it neceonry to lay the Uame lor his condition in laife part at the door 6t 
short-sighted society and her instittttiona. Rwm the standpoint, then, of tiie dinical 
research laboratory let us see what situation presents itselL 

One has not labored long among those convicted of crime belore he is steoogly 
impressed with the fact that he is dealing with beings of retrograde type— beings 
who fall api«edably below the recegniied standard of normality, and who, in a very 
large percentage of cases, bear about in their bodies the marks of this degenenusy. 
In this matter, however, one must needs exerdse the greatest care to avdd the common 
error of conduding that the presence of one or more diaicatsristics, usually accepted 
:4 stigmata of degeneracy, is proof positive that the aubfect is subnormal: the Darwin 
•ear, the Mord ear, or the ear marked with the entire abssnco of the lobulus, the mal- 
formed palate, pdydactytism or hypertrichosis any ol these sMy be fouiid in the 



PUBUC HEALTH AND MEDICINE. 183 

particultt individuAl in wbom the cloeeflt ftnftlysifl will fftii to find any hma for a 
daaification Mow the normal; and yet the nmnber of these Btigmata and their vario^ 
oomhinations so frequently found among those convicted, of course, is soflicient to 
cause their presence to be regarded as a usual accompaniment of criminal aetiTity. 
Assymetry of the face, microcephaly or macrocephaly, dental deformities, strahimuB, 
microphthalmia, pigmentary retinitis, albtnisn, syndactylism, misplaced and mal- 
formed limbs, flat feet, hypospadias and hermaphrodism— these ^and many other 
signs of degeneracy are constantly met with. 

We do not seek to establiih a causative relation here but merely to observe the 
accompaniment of stigmata with crime, lliis of itself is of the utmost importance. 
On the otiiflr hand so frequent and so serious are the various physical and physiological 
abnormalities and defects as to challenge our earnest efforts to discover this dowrgla- 
tionship. Phimosis, enlarged tonsils, adenoids, bad teeth, defective vision, poorly 
developed chest, stooping shoulders, pulmonary lesions, valvular heart lesions, and a 
serious nervous condition brous^t on by eye trouble of one sort or another; "a sub* 
normal temperature, associated with an accelerated pulse and respiration," as noted 
by Dr. Sleyster, "perversions of the sexual instinct, uncontrolled desire for liouors^ 
migraine, disorders of the nervous system, insensibility to pain, defects of speech and 
reduced physiological tension,*' as pointed out by Dr. Bowers; impotency and ster- 
ility; while by no means is this list to be accepted "in toto" as naming positive evi- 
dences of degeneracy, all of these conditions are bound to assert themselves among 
either the primary or secondary causes of crime. 

Ftom the philosophical standpoint it may be that we are not ready to admit of any- 
thing more than a parallelism between mind and matter, yet it must be admitted 
that a oetiouflly defective body could not express rig^y a mind of even supernormal 
capabilities. "Aye, there's the rub." As though not sufficiently afflicted with 
l^ysical and philosophical defects, the criminal elate are lacking pathetically in 
mental abiUty, and it is an invest^tion along this line that, in my thinking, we 
anive at the real, fundamental, efficient cause of the greater proportion of crime. 

It has been recognized for some time that the criminal class, as a whole, are of a low 
mental order, and yet only within the last two years have a sufficient number of 
laboratories been operating to furnish sudi data as would support a rather wide^qfiread 
belief by the results of sdentifk; investigation. In this work, however, there is much 
yet to be desired. The tests themselves applied in the various clinics are to be more 
thoroo^y tested, cotre c ted, and adapted through a longer period of time and with 
a greater number of aubjects. Too few scientists wdl trained for the work are in the 
field ; and there is lacking at present a sufficiently strong public sentiment to demand a 
breaking away from tradition in the handling of law violators, and to insist upon the 
adoption of metiiods prescribed by the sdentBIc diagnoses of the cases. Nevertheless 
the returns to date are indicative and of very valuable significance. The New York 
State Refbrmatory for Women at Bedford HUls reports that 87 per cent of its inmates 
are defective. J>t. Ftank L. Christian, of the Reformatory at Ehnira, reports 42 per 
cent defective. Results of our own laboratory work in the Indiana State Refcmnatory 
at JeffenonviUe, show quite 50 per cent to be subnormal. Returns from reliable 
sources at work among juvenile delinquents show a percentage as hig}i or higher. 
Iliere is tittle question that when terminology and definition, standards and methods 
of procedure are agreed upon among the various laboratories, the variation of results 
win fall within a rsasonably small margin of difference. All of this suggssts that in 
the past we have disregarded quite entirely the peculiar mental conditions of what 
likely will prove to be at least one half of the population of our penal and correctional 
institutions. This situation belies the very purpose for which these instituttons 
are founded and maintained. Moreover, were this condition of these offenders known 
before trial, conviction, and sentence, it is quite certain that the necesnty of diff^rr 1 1 
disposition of the cases would have been recognised. 



i84 PROCEEDINGS SBCQNP PAJ^ AMBWOAN SCIENTIFIO 0ONGEE8S. 

Ilie r&ng6 kai degree of delectivenesB affoid ftn inter^flting study. We have those 
'of x>ositive psychosie— the insane, including alcoholics, drug fiends, epileptics, and 
4eeble-minded — ^imbeciles, morons, and those of but slight subnonnality. As a class, 
vt course, all these reveal to the clinician a long list of symptoms and reactions, which 
would have led an alienist at once, under any circumstances and surroundings, to a 
correct diagnosis of their condition. While this group, representing approximately 
50 per cent of the population of our prisons and reformatories, is disposed of com- 
paratively easily* the remaining inmates, sharing with the subnormal many of the 
mental and psychic stigmata peculiar to the criminal class, form a group which fur- 
nish a problem of the greatest complexity. Anomalies of intellect, emotion, and wiU 
are ever3rwhere presenting themselves for analysis. Dr. Harold W. Wright, in a 
recent niunber of the Journal of the American Medical Association, calls attention 
to the fact that all offenders are characterized by one or more of the following attri- 
butes: ''Exaggerated suggestibility; exaggerated egotism; emotional instability; a 
lack of altruistic or unselfish sense; a lack of the power of sustained energy; that is, 
abnormal nervous fatigue; a tendency to the easy disintegration of consciousness, 
which permits the brutal or inferior qualities of the subconscious mind easily to 
become dominant when temptation occurs, and to be ungovemed by the critical 
quality of the conscious mind; even when the critical function is sufficiently aroused, 
the power of direction by the wiU is in abeyance.'* The offender is marked, too, 
by instability and eccentricity, is given to self pity, moroseness, fault finding and 
hatred, and is therefore resentful and retaliative; he is lacking in the ethical sense 
and consequently is presumptious; he is deplorably deficient in judgment. All or any 
of those characteristics may be possessed in such a degree as to make it practically 
impossible for the unfortunate so to deport himself as to satisfy the conditions of good 
citizenship and healthy social relationships. 

Responsibility for crime in the manifestly subnormal is quite out of the question; 
these wiU always be mere children and require a guardianship; the perpetuity of 
their kind among us is quite entirely a matter of eugenics; but who shaQ say tl^kt tlM 
majority of those not classified as defectives by present-day tests would not be able 
to find Actual defense of th^ crime in their own infirmities? Indeed, there are 
those who chose to call such ''bordepdand cases,'* bdieving that as all feeble-minded 
persons are potential criminals, so large numbtts, at least, of tiiose criminals usually 
regarded as normal require only a peculiar series and setting of stimuli to reveal such 
serious defects as to prove the existence of positive subnormality, and Qften dear-cul 
psychoses. 

If asked the question, "Why did. you conmiit the crime for which you are paying 
the penalty?" and pudied for an answer beyond that bom of the memory of the 
mere [Measure or gratification in the reward of the act, many must honestly answer, 
** I really don't know; I guess I couldn't help it." Either some instinctive tendency 
of low order, undeveloped and uncontrolled, pushed on the unfortunate individual 
to criminal reaction, or aome specific mental function, too weak to do its office work 
or perverted in the nature of its activity, compelled an inability to resist temptation 
when it offered. Take a case or two in point. 

Westlake, No. 40M, is an habitual criminal, a native of the State of Kentucky, 
whose mother committed suicide at the age of 39. For some time previous she had 
been a nervous wreck, and had been separated from her husband for two years. The 
son never saw or heard of his fitther after the separation, at which time he was 7 years 
of age. Ait&c the death of his mother he fell into the hands of an aunt and attended 
public schools mum or less rogulariy. He fadled of pnunotion twice, because of lack 
of attention to hiswork,.and finally left school at the seventh grade. His associates 
were bad. He drank moderately, smoked cigarettes, and early suffered venereal 
diseases. His first anest was at the instance of his aunt, who, no longer able to con- 
trol hini, hoped by this means to ke^ him off the streets at night. His second arrest 



PUBUO HEALTH AND MEPICINB. 185 

ms for petit larceny— he took money from the cash drawer of a pool room at night. 
He next broke into a store with others, stealing kidves and revolvers. Again, with 
companions, he attempted to burglarise for the purpose of getting money with which 
to secure a room in a hotel for unmoral purposes. The crime for which he was sen- 
tenced to the reformatory consisted of the theft of a motorcycle. 

His physical condition at this time is fairly good. He is small in stature, but fairly 
well developed and not unattractive in appearance. He is not lacking in genend 
intelligence. The Binet test classifies him adult, while he grades of high ordering 
information and other tests. In general, however, there is revealed an unsettled 
condition of mind. The nervous status of his mother, probably before his birth and 
during his early childhood, her consequent neglect of him and her suicide, all must 
have served to react upon him in such a way as to impress him for life with a lack of 
normal nervous organization and to stamp his subconscious mind with a character 
conducive to instability and consequent immorality. The correctives of judgment 
have never been furnished. For him the easiest way out is the best way. Some 
worthy ideals of boyhood may have prevented criminal activity earlier in life; but 
after the first offense relieved the tension, others, all of the same nature, followed 
with quick succession. He is of the type that seeks pleasure in the activities sug- 
gested by the complex of emotion, as completely regardless of the intellect as though 
it did not exist. When once an action is begun the power of inhibition is paralysed. 

An example of the bom criminal is found in Eastman, No. 4062, about 21 years of 
age, swing a sentence of from 2 to 14 years for assault and battery with intent to kill. 
He is a native of Buffalo, bom of Polish parents. His father was a common laborer 
up to the time of his death by accident four years ago. Eastman had no formal school* 
ing prior to the age of 8 years, when he was arrested and sent to a private reform 
school at Buffalo. Here he remained for six years. After his release, arrest followed 
arrest, until he was sent to the Elmira Reformatory on the charge of burglary* Panded 
in 1912, he, with three companions, worked his way West to Indiana as a common 
tramp. On being ordered out of a box car wherein they were stealing a ride, the gang 
opened fire on the train conductor, severely wounding him. From an early age East- 
man's companions were bad. His' jail and reform surroundings probably only accen- 
tuated his disregard for the rights of others. He used both liquor and tobacco, con- 
tracting the habits when a mere boy. His physical condition is fair, though he is 
not free from certain physical stigmata. He cbdms to have suffered a fracture of the 
flkull some years ago, from the effects of which he has not fully recovered. This acci- 
dent, however, was not experienced until after his life of crime had well begun. 
His mental tests were marked by a general spirit of indifference on his part. He 
cared not at all to make a creditable record for himself. Attention and application 
were out of the question with him, though he did not lack so seriously in point of 
general information. He was not interested by those motives which usually govern 
action. He confessed that he had never worked and did not care for the money 
iR^ch labor earned. Thorou^y selfish, he has no r^;ard for ideals of honor, and no 
respect for law and order. He is not impressed with the heinousness of his crime, 
nor feels any pity or remorse because others have been made to suffer throu^ him. 
He furnishes a q>lendid example of those in whom there is an entire absence of the 
normal development of the instinctive tendencies in the ethical q>here. 

A type of criminal throu^ passion is Southern, No. 4065. He is 20 years of age, son 
of temperate law-abiding American parents, both living and living together. He 
remained in school through the eighth grade, where he failed in grammar, because, as 
he says, he liked arithmetic so much better that he put in his best efforts on that branch. 
After leaving school he purchased a car and opened a taxicab business, which he con- 
ducted for three years. After bankruptcy he became an instmctor in a school for auto- 
mobile drivers. He smoked cigars, but confessed to no other bad habits. He was 
both honest and industrious. His single crime consisted of stealing an automobile 



186 . PBOOEEDINGS SECOND PAN AMERICAN SCIENTIFIC C0NGBE88. 

&oin an old gentleman who employed him through two weeks to overhaul his machine 
and then refused to pay him a fair wage, taking advantage of the fact that no contract 
had been made at the time of engagement. Enraged beyond control at this perfidy, 
Southern ran the car away to be revenged . His only motive was to get even . He was 
arrested, convicted, and sentenced for grand larceny. Physically he is none too strong. 
He has suffered from hernia from childhood and has had venereal disease. His men- 
tality, in general, is of high order. He easily grades adult with no marked deficiency 
in the tests applied, and yet, brooding over a wrong so accentuated his anger at his 
un&dr treatment as to cause him to lose all control of himself. Here, too, as in the 
second case, the power of inhibition under severe strain was not sufficiently operative 
to support good judgment by strong will. 

Time will not allow a consideration of examples of the merely accidental criminal 
and of the weak subject of suggestion. These classes, too, show a defect of specific 
function which places the subjects completely at the mercy of circumstances. 

Crime, then, is more than a mere accompaniment of defective mind . It is the natural 
outgrowth of faulty mental processes. This doubtless accounts for the fact that pun- 
ishment can not ciire the criminal, nor even deter others from committing crimes. It 
is foolish to insist that punishment deters the criminal even from repeating his crimes. 
Surely there is no fact more clearly proven to the criminologist than this one. Insti- 
tutions of pumshment only serve to augment the antisocial attitude of the criminal 
and to return him to society even determined to perpetrate more daring crimes than 
he had known before. Statistics from investigators the world over call our attention 
to the fact that crime among us is increasing at a very inpid rate. Treatment, not 
punishment, is what is needed^ intelligent, sympathetic, and scientific treatment under 
the best conditions and by the best advised scientiBts that can be seciired for the work. 
This is not a call for the intioductibn of sentimentality; there are indicati<ms in many 
quarters that we have too much of the maudlin already. Warden Francis insists that 
the greatest menace to our progress in institution affairs to-day is "the long-haired 
man and the short-haired woman," and he is rig^t. 

Instead of indulging in expressions of sentimental regard for the unfortunate offend- 
ers, society should rather give herself to the most careful investigation of those tolerated 
and even encouraged practices which everywhere are shown to be those agencies that 
contribute to the perpetuity and to tiie multiplication of the criminal class. 

Of a total of 416 new arrivals at the Indiana Reformatory in 1913, 246 came from disor- 
ganized families, and approximately this same proportion has been maintained through- 
out the last 10 3rearB; that is to say, that 60 per cent of the criminal class, as represented 
by ttke boys of our institution have not had the possibility of normal family training. 
In a very laige number of the disrupted homes divorce had been granted. In other 
cases the father, the mother, or both have died. Neglect of youth makes directly for 
crime. Clearly, it seems to me, society has a duty to perform by the children in disor- 
ganized homes. No one of us but recognizes the large place the home should and 
does take in the normal development of the child. Where its influences are made 
impossible because of one reason or another it is obligatory upon the state to act in loco 
parentis in <Mder to assure the child that training without which we can not hope fen- 
his normal development. 

Again society not only harbors but seeks to profit by such agencies as play upon the 
weaknesses of the weak. Fifty-nine per cent of the inmates received within the past 
8 years at the same institution were users of intoxicating liquors, 80 per cent used 
tobacco in one form or another, while 50 per cent were addicted to .the use of cigarettes. 
Whatever may be said in the way of excuse for a moderate use of alcoholic beverages 
and tobacco among adults, there can be no justification whatever for the use of these 
drugs on Uie part of adolescents; but in spite of legislation, the one purpose of which in 
to make it impossible for the ruination of the boys of our country to follow from these 
sources, the process continues among us to an ever increasing extent. 



PUBLIC HEALTH AND MEDICINE. 187 

Most States of our Nation boast rigid compulswy education laws. In spite of this 
fact, over 10 per cent of the men entering one institution are absolutely illiterate, 
while the number who have reached the high school in educational progress is prac- 
tically n^ligible. Of nearly 500 arrivals last year II only claimed to have completed 
the twelfth grade; three of these had entered college and one the theological seminary. 
The greatest number left school at about the fourth grade. Here again so loi^ as we 
are content to legislate merely for the purpose of keeping our State assemblies out of 
miKhief while in session, with little thought of enforcing the laws which they make, 
we need not look for a bettering of those social conditions, out of which we annually 
recruit our law violatora. 

Fully one-third of the new registrations of last year were idle at the time of commit- 
ting the crime for which they were convicted. This is not to place the blame either 
here or there, and yet it was no more true in the days of our youth than it is now that 
the devil himself puts to work any man who stands on the street comers with Ids hands 
in his pockets. 

It may be argued that the various social agencies are not to be blamed for the lack of 
results in their attempts to train those whom we have shown to be either mental defec- 
tives or at least more or less seriously disturbed in mental function. Nevertheless, we 
do insist that where the peculiarities of mental reaction are due to a lack of proper 
nurture rather than to a defect of nature, such oversight could and should have been 
exerdsed as would have enabled a considerable number of these men to live lives of 
happiness, harmlessness, and comparative usefulness. While investigatioB in this 
field IB still in its infancy there can be no doubt that the coming years will prove con- 
clusively what seems now to be indicated that, while the real efficient cause of crime 
is to be found in defective mental condition, the contributing agencies, in large part^ 
are those social institutions which faO to interpret the visi<m and with consecrated 
effort 80 purge themselves of carelessness and neglect as to rec<)gni£e not only their 
splendid opportunity but their grave and undeniable responsibility. 



PAUPEBttM : AN ANALYOg, 

By EDWARD T. DEVINE, 
Pro/e$»or of Social Economy, Columbia Ufdveniiiif, and Director of the New York S^ool of 

FkikmihFopy. 

Legally, in Engjaad and in covmtiies wMch have foOcwed Engjidi usage, pauperism, 
as diatinguidied from poverty, consists merely in the habitual receipt of official public 
r^ief. 

BtymologicaUy, the word is derived from the Latin pauper, meaning, as in it» 
modem French and Spanish equivalents [panvre, pobie], simply po<Mr, without meana 
of support; but when pudied farther back to its Latin and Greek origins [paucus, 
Qk. rem; pario, Gk. «op] the word signifies not indigence but inefficiency. Making 
little, rather than needing much, is its original suggestion. The pauper is thus not 
one iHio from sudden, un f e rc s oo n misfortune is reduced to need, even if that need ia 
to be supplied by public relief, but one who brings forth littfo or nodiing, the incapa- 
ble, the nonproducer. 

Economicidly, pauperism describes the state of the social debtor, the one who ie 
carried as a burden on industry and does not himself take any effective part in the 
production of wealth. 

Biologically, pauperism represents a primitive type, surviving in the straggle for 
exirtence only by parasitism; or a pathological type, emerging from abnomial 
environment. 



188 PBOGEEDIKGS SECOND PAN AMERICAN SCIENTIFIO C0NQBB88. 

Sociologically, the pauper is a deviation from the normal, incapable of assimilation 
through ordinary economic motives and social forces; presenting a distinct social 
problem, as do the criminal, the inebriate, the prostitute, the monopolist, and the 
revolutionist. 

Psychologically, pauperism is poverty plus a mental attitude in which are mingled 
discouragement, lack of ambition and imagination, thriftlessness, irresponsibility, 
passive resignation to a parasitic relation to society. Vagrancy, the technical offense 
of living without regular employment when not having other visible means of sup- 
port, and mendicancy, the soliciting of alms from passers-by, are the more active 
expressions of pauperism, of which the ordinary, superficial test is simply the neces- 
«ity for some form of pennanent relief because of fault, deficiency, or weakness of 
character. 

Pauperism must be clearly differentiated from poverty — the larger and more impor- 
tant problem — ^which presents many aspects that may be wholly unfamiliar to those 
who know only pauperism. Some of those aspects face toward economic refonn; 
others toward health, housing, or the administration of justice. 

In recent years there are two clearly distinguishable, often antagonistic views of 
poverty, one of which we may call, broadly speaking, the economic, and the other 
the biologic. According to the first view the differences among men are due mainly 
to their environment, their training and opportunities; according to the other, mainly 
to their inherent nature, their biologic inheritance, their i»otoplasm. True, biology 
concerns itself also with environmental influence, and economics recognizes unalter- 
able differences in human beings; but there is justification for the distinction, if not 
pressed too far, in that the main preoccupation of economics is with the wants and 
activities of men in society, with their actual behavior in view of the rewards obtain- 
able for given efforts; while that of biology is with generation, reproduction, and the 
<tevelopment of characteristics derived from ancestors. 

Both views are indispensable and they can be reconciled. By economic, sanitary, 
and social reforms, public hygiene and social insurance, effective organization of 
'Charity and the development of educational measures, economic poverty can be 
reduced in amount and the distinct hygienic problem of pauperism can be isdated. 
This residual problem is largely one of mental defect, calling for segregation and 
liumane treatment of individui^ and the gradual elimination of defective strains; 
but it involves also far-reaching measures which affect pauperism incidentally and 
4ure to be advocated chiefly in the interests of those who are in no danger whatever of 
l>ecomlng paupers. 

The reconciliation or assimilation of the biologic and the economic view of poverty 
justifies its consideration in a scientific congress. If we think of pauperism as mental 
<lisease or mental defect, and of poverty which is not pauperism as an economic and 
aocial condition, the former to be eliminated or relieved by eugenic and sanitary 
•measures acting on the individual, the latter to be eliminated or mitigated by economic 
prognn and social reform, resulting in greater efficiency and more just relations, we 
•are at least thinking in scientific terms, and relying upon remedies which science can 
•examine and assess. 

This view of pauperism and poverty is in contrast both with the legal conception 
which underlies English and North American poor laws and with the religious con- 
•ception which has more especially colored the charity of Catholic countries in Central 
4Uid South America. The Englidi law recognizes A legal right to relief. It creates an 
elaborate machinery for the administration of this poor relief. The almshouse * is 
its central featiue. A hospital or infirmary, and in recent years a sanatorium for con- 
eumptives and other special institutions, supplement the almshouse proper, which is 
mainly for aged infirm or chronically disabled dependents. Outdoor relief, by which 

1 Also called poor lurase, poor Item, oountj home, etc; the eqaiyalent of the Eagllsh workhouse. 



PUBUO HEALTH AND MBDIOINE, 189 

is meant assistaiice given to the poor in their own homes, is another recognized feature 
^ poor relief in nearly all communities in which the traditions and customs of the 
Engliaih poor law have been established. The fundamental idea of the English poor 
law is that the state is responsible for the relief of destitution and for the prevention 
•of mendicancy and vagrancy; that whatever is required to maintain life and prevent 
actual suffering from hunger and exposure is to be done from funds raised by local 
taxation, except of course in so far as these needs are met by relatives, neighbors, 
relief societies, churches, trade unions, or other voluntaiy agencies. When other 
sources fail, in the last extremity, there is always the public relief ofScial— overseer 
of the poor, as he is oftenest called— whose duty it is to relieve the distress. This is 
-conceived to be one of the most elementary and imperative obligations of the state, 
to be dischaiged through some appropriate governmental agency. 

The religious conception of charity, as a means of spiritual edification to the giver, 
not unfamiliar in English-speaking countries, but more emphasized and exemplified 
in Latin America, involves a different conception both of charitable relief and of the 
-destitution which charity is to relieve. Not the right to relief, but the privilege of 
:giving, is its central feature. Not the prevention of begging and of vagrancy, but the 
inevention of indifference and hardness of heart, is its aim.. ''Our families," says a 
writer in the Buenos Aires General Census of 1910, ''have been essentially charitable 
«t all times; the poor have never called at their do(»s in vain. Religious by tradition, 
inheritance, and personal connection, our ancestors were imbued with such definite 
-charitable principles that they never passed a poor p«son by. " "This is the cause, " 
4Mk]8 the AxgttitiDe commentator, "of the existence of the legion of false beggars." 

The scientific view of poverty is that it is the result of maladjustments, biologic, 
oconomic, and social, but above all psychologic, i. e., the survival of instincts and 
moiives suitable to an eariier and more primitive stage of existence, but out of place 
In the modem world, and especially in the conditions of Uf e of the western hemisphere 
in our generation. The scientific view of pauperism is that it is one of the worst, the 
most extreme of these maladjustments, with no adequate defense or justification from 
the religious point of view, no adequate provision either for r^ef or for pfevention in 
any system of poor law yet devised, yielding neither to such coercive measures as have 
been applied by the state nor to acts done under the charitable impulse, however 
«elf-sacri firing or heroic those actions may be. 

The bad traditicm, inherited equally through church and state, is that poverty is a 
t»art of the natural order of things, to be constantly relieved by charity or by the poor 
law, but constantly repeated in each generation in order that charity may be kept idive 
and that the poor law may function* The new view, the natural view, as I venture 
to suggest, for North and South America, if by natural we mean that which cQReqx>nds 
to the conditions among which we live, is that poverty is not necessary or tollable, 
tiiftt we may confidently lode forward to a time when misery, squalor, a positive lack 
of the necessaries and ordinary decencies and coadorta of life, shall be absolutdy 
onlmown among us; ^riien a standard of living sufficient for physical and moral well- 
being shall be possible for every class in society; when education, recreation, and 
leisure shall be within reach of all; when childhood shall be univenally protected, 
tile efficient working life ptolonged, disease greatly diminished and its financial bur- 
dens distributed through insurance, old age postponed and amply provided for, so that 
it does not mean economic distress. 

For the realisation of such an ideal the whole course of events in the western world 
in modem times has bemi preparing. The enormous increase of capital, the inven- 
tion and improvement of machinery, the expansion of the scale of production, the 
oiganisation of industry, the division of labor, the development of transportation, the 
widening of markets, the progress of science and of technical educati<m, the increase 
d efficiency caused by higher standards of living, and the conquest of disease, espe- 
cially of the tropical diseases, the perfection of administrative as well as of technical 



190 PKOCEEDINGS gECOKTD PAN AMEBIGAN SCIENTIFIC C0NGBE8S. 

proceases — an amazing series of revolutionary changes familiar to the whole world, bat 
of greatest significance when they are brought to bear upon the undeveloped, the alt 
bitt untouched, natural resources of our still sparsely populated continents of th» 
west — ^make possible here a civilization without poverty, a manner of Mte in whidi 
self-respecting economic independence shall be as much a matter of course as pditkat 
and civil liberty. 

This contiut between the old world and the new, between Europe and the Amer- 
icas, was obvious before the devastating European war. It will be unhappily mom 
obvious still in the yean which immediately follow the destruction of resources for 
which the war is responsible. In that destruction all the world suffers, but in th» 
nature of ttdngp the countries at war suffer most, and even the hi^iest tedmicat 
efficiency is no substitute for the capital, the productive energy, and the raw materials- 
which the war destroys. 

Our productive capacity, if it can be devoted to peaceful ends, our economic re- . 
sources, if they can be applied to the legitimate wants of man, are ample tor a civil* 
ization without poverty. We have only to apply the knowledge we afa:eady have, to 
take the trouble and meet the expense, in order to abolish poverty in the sense that 
means actual deprivation of the conditions essential to a rational, pr ospero u s, and 
enlightened existence for all those who on their part meet its essential Individual 
conditions. The comprehensive means to this end lie beyond the scope of this paper. 
The prevention of pauperism is a part— a very specific and exceptional part— of this 
larger task. 

The first and most strategic point of attack is in the treatment of the mentally^ 
defective. The report of the English Royal Commission on the care and control of 
the feeble-minded in 1908 sets forth conservatively and authoritatively the con- 
clusions on which we may base a sound public policy: 

1. That both on grounds of fhct and of theory there is the highest decree of nioba- 
bility that feeble-mindedness is usually spontaneous in origin — that is, not due to 
influences acting on the parent— and tends stroni^y to be inherited; 

2. That, especially in view of the evidoice concerning fertility, the pievviilkm eC 
mentally defective penons from becoming parents would tend laigely to d imfni a h 
the nuinber of such penons in the population; 

3. That the evidence for these conclusions strongly supports measures, which on 
other grounds are of pressing importance, for plaonff mentally defective penMBS, 
men and women, who are livQigat lai|p and uncontrolled, in institntions wMe they 
will be emj^yed and detained; and in this, and in many other ways, kepi under 
efifec^ud supervision as long as may be necessary. 

Dr. Blartin W. Barr, of Pennsylvania, writingin Charities four yean eariier, mienei 
to the modem institational care of the feeble-minded as the utitiaation oi a wa rts 
product, a forcible illustiatiQn of one of the greatest cufaninatiooB of the ninetevith 
century. The recognition of the possibilities and limitations of the mentally defactire 
leads to the creation of a sphere for him in which, trained and enconnged in con- 
genial occupations, he may attain to a certain degree of independence, and ceise te 
be either a menace to society or a helpless burden. 

It is not merely because of their biologic character that the mentally defective ai# 
unfit for parenthood. They are unfit guardians for children, being unable to give 
them moial or economic training. Their income, if earned throu^ wages, is irregular 
and insufficient to support a stable home life. Poverty, intempeianee, immondity^ 
and neglect, even of the elementary phyacal needs of childrsn, are the natural, 
almost inevitable, characteristics of their homes. Unfit to maintain domestic lifo» 
the mentally subnormal are equally ill-adapted to industrial life as oigniced in a 
regime el free competition. They can not earn minimum wages and they dag the 
wheels even of the best organised and most enli|^teiied industrns. They need 
occupation, but under special supervision and protection. Their tasks should be 
carefully selected and suited to their capacities, but need not, as is sometimes hastily 



PUBLIC HEALTH AKD ME0IOINB. 191 

iafened, l>e the dlrtieBt and most dimgreeable. The recognition of the iMrindple of 
guardianahip from in&tncy; the segregation of retarded and backward children in the 
•chools, in order that they may be studied individually, their physical defects dis- 
covered and remedied, and those who are definitely feeble-minded early identified 
and removed to appropriate institutions and colonies, except of course in those cases 
in which without undue expense or difificulty efiicient care can be given at home; the 
removal of the feeble-minded from prisons and reformatories to these special insti- 
tutions, legal punishment and reformation being obviously wholly inapplicable to 
them; and the creation in each State of a central authority— chiefly medical— com- 
parable to our commissions of lunacy, to have the oversight of all mentally defective, 
are the main features of a progressive policy for dealing with the chief cause of 
pauperism. 

Probably not more than 15 per cent of the demonstrably feeble-minded in the 
United States are as yet segregated in special colonies or institutions suitable for their 
care. It is estimated that 85 per cent of the insane are treated in hospitals constructed 
and maintained especially for them. If it were necessary to choose it is a question 
ididther it would not be i»eferable to reverse these proportions, leaving the insane at 
large, in spite of their disease, and segregating the mentally defective whose minds 
can not be cured but who can transmit their defect, with its train of pauperism, 
prostitution, criminality, and other grievous consequences. 

Alcoholism, although a recognized complication in mental instability and defect, 
deserves also separate consideration. It has been attacked as a vice, as a crime, as a 
habit, as a weakness, as a disease. It is all of these things, but here we are interested 
in it chiefly as a disease, furnishing a problem for mental hygiene and resulting in 
pauperism. The international list of causes of death recognizes alcoholism, acute 
and chronic, and from this specific disease as distinct from all organic diseases attri- 
buted to alcoholism, the United States census reports 3,744 deaths in the registration 
area in 1913, approximately one in 240 of all deaths — a number larger than the com- 
bined number of deaths from malaria, pellagra, rickets, lead poisoning, smaUpox, 
anthrax, and rabies. Its importance, however, is of course but ftuntly indicated in 
mortality tables. As an obstacle to economic independence, as a cause of that unre* 
liability and inefficiency which result in pauperism, it is probably surpassed only 
by inherited mental defect. In many parts of the world there has been organized a 
campaign against the manufacture and sale of alcoholic bev^ages, on the theory that 
the beet way to affect the mind of the inebriate, present and prospective, is to withhold 
Absolutely the means of feeding the appetite. This is a drastic, but certainly not an 
Illogical, method . Just as we seek to exterminate the tuberculosis bacillus by spitting 
ordinances, and the malaria germ by warfare on the mosquito, both of which represent 
attacks on the external or exciting cause of the infection, rather than attempts to 
buHd up resisting power, so by removing completely the exciting external cause of 
alcoholism we may hope to stamp out that disease. There are some dissenting or at 
least doubting voices in each case. Perhaps immunity or tolerance of an infection 
may be lost if for a generation or two the disease is kept at a distance through purely 
merhaniral devices. So a j^hibition era may be followed by a greater destruction 
if alcohol comes back into use. The analogy seems to be warranted. Unless we are 
afndd of humanity's loss of immunity from the conquest of tuberculosis, we need not 
lear the loss of immunity from the conquest of strong drink. Nevertheless prohibition 
Belies upon a material and coercive method, and if it should prove to be possible 
within a reasonable time to exterminate alcoholism on a spiritual basis, through a 
genuine temperance (which certainly for all those in danger of alcohdism means 
abstinence) there are those who will prefer it and think no jptice too high to pay for 
such a conquest. A wise procedure would be to found local and national associationa 
for the prevention of alcoholism, similar to those already enlisted in the world crusade 
against tuberculosis. The medical profession, recognizing the weaknesses of soma 



192 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

of itB own membera, but recognizing also its peculiar reepondbillty in all such hygienic 
campaigns, would naturally take the initiative, preventing laeh mistakes and giving 
its unique support to sound measures. Alcoholism as a physical disease, as a mental 
aMction, would thus be subjected to the same painstaking Scientific study, the same 
many-sided attack, that medical authorities and laymen have given cooperatively to 
tuberculosis and hookworm, and are now beginning to give to venereal disease and to 
iniant mortality. Out of such study and the sane experiments to which it would 
lead would come a program of social action, of mental and physical hygiene, directed 
towards the elimination of alcoholism. 

The drug habit and sexual immorality and excesses of all kinds contribute to the- 
problem of pauperism. Certain diseases like malaria and pellagra and the hookworm 
disease, which especially affect the spirit, undermining eneigy, reducing efficiency, 
lowering the standard of living, would likewise demand consideration in any complete- 
discussion of pauperism. Indeed, sickness of any kind in wage-eamerB* faunllies,. 
unless its expense is amply covered by insurance, may lead to just that kind of dis- 
couragement and hoplessness of which the pauper spirit is bred. 

Even if the native stock is not degenerate and the original capacity entirely normal, 
the educational system may be so inefficient and so ill adapted to existing conditions 
as to produce in effect a generation of paupers. Neither general nor technical edu- 
cation can make efficient workers from the mentally defective; but an inefficient and 
badly organized educational system can create a semblance of relative feebleness of 
mind and economic incapacity in what was originally the healthiest and most vigorous 
stock. 

Industrial exploitation is a contributing cause of pauperism, whether it take the 
form of excessively low wages, or a long working day, or a seven-day week, or the 
speeding process with its exhausting fatigue. So also are irregularity and uncertainty 
of employment, such as result even in periods of comparative prosperity from the 
custom of keeping about any industrial establishment, on the bait of occasional casual 
labor, a larger number of laborers than is normally required to do the work of the 
industry. 

Revolutionary changes in industrial processes, throwing out of employment those 
who can not readily adapt themselves to the new methods, are responsible for much 
of that pauperism which may be called a by-product of industry. Beneficial they 
may be to society, and at the same time disastrous to those individuals who can not 
quickly adapt themselves to the new demands. 

Any economic institution which discourages thrift and self-dependence, such as 
slavery or peonage, develops a mental attitude which may remain to the third and 
fourth generation, after the system itself has been abolished. Oppressive forms of 
taxation and of land tenure have similar effects. Class legislation and uneven admin- 
istration of justice in the courts, when long enough continued and when there b no 
adequate means of resistance or reform, may produce a pauper proletariat. 

Militarism, a feudal organization of society, and other rigid caste systems, however 
efficient they may appear externally, contain the germs of pauperism for the sub- 
ordinate classes, ^ough these germs may first develop their baneful influences only 
after democracy has replaced the social order in which they were planted. Probably 
the pauperism of backward communities in northern sections of the United States 
might be traced through genealogical studies to imported convicts of the colonial 
era, to inferior Irish immigration of the middle of the century, and to assisted criminal 
and pauper immigration from the Continent of Europe in more recent years. Proba- 
bly much of the criminality and inefficiency of large classes of southern negroes is in 
effect high grade feeble-mindedness, which did not seriously interfere with the pro- 
ductivity of directed slave labor, but is revealed under the conditions of free com- 
petition. We may expect that natiural eugenic influences, arising in the one case 
from more stable marriage and family institutions among the descendants of the slave 



PUBLIC HEALTH AKD MEDICIKB. 193 

population, and in the other from the freer mingling of urban, oemiurban, and rural 
p<^ulationfi made possible by modem methods of communication, will tend to elimi- 
nate these kinds of paupaism together with the mental inferiority to which it is due. 

Mental hygiene has its tasks with those who have the pauper spirit and with those 
who are in danger of acquiring it; but it has its tasks also with charitable givers, with 
public relief officials and with the citizens whose ideals the public relief policy of 
the State represents. Both official public relief and voluntary religious charity 
have been at bottom consciously or unconsciously pessimistic. They have assumed 
the continuance, if not tiie desirability, of a permanent daas of dependent poor. 
The hanih, unsympathetic attitude of almshouse keepers, and the sentimental, 
spiritually selfish attitude of volunteer dole-givers, are bolii out of harmony with 
the pragmatic, humane view which challenges the very existence of pauperism^ 
whidi hoi>es to put an end to the need for official poor relief and for voluntary charity 
alike. Organized charity is the embodiment in practice of this new view. It dis- 
countenances indiscriminate almsgiving and every other custom, however sanctified 
by tradition and sentiment, which encourages the pauper spirit. It demands accu- 
rate knowledge of the individual circumstances in each case of need as a basis for a 
plan of relief. It advocates inquiry and careful records and intelligent cooperation. 
It ministers to the strength and not to the weakness of those who are in trouble. It 
emphasizes family solidarity and family responsibility. It believes that the best 
occupation for a sick person is to get well, that an able-bodied married man should 
support his fomily, that mothers of young children should nurse and nurture their 
offspring, that aU who are earning to their full capacity should save something for 
future emergencies, and that those who are in need of charitable assistance should 
receive aid which in kind and in amount is determined not by the accident as to 
whether a benevolent individual passes their way, or a relief agency is or is not in 
funds, or an institution has or has not been established to provide for that need, but 
is determined, on the contrary, by a painstaking and discriminating study ojf the 
present situation and the previous experience of the individual or the family in 
question. It insists that diagnosis rather than charitable impulse should be the 
basis of every decision, though charitable impulses, thus guided and directed to 
wise action, are by all means to be encouraged and strengthened. 

Doing different things for different persons, as organized charity demands, if they 
are to be in any high degree the right things, involves the training of professional 
social workers for relief societies, for the social service of hospitals and dispen- 
saries, for the probation and parole work of courts, and for many other kinds of work 
in which a technique and special literature already exist. Such trained workers do 
not replace volunteers, but increase their number and their efficiency. We might 
well hope that this discussion would give an impetus to the establishment in one or 
more of the capitals of South America of a school of philanthropy for the training of 
social workers in all the gathered wisdom of the church, enriched and supplemented 
by the social sciences and their practical applications in all countries. 

We come then to the conclusion— that every rational economic reform, every step 
in the humanizing of industry, every means of preventing disease and of relieving 
the i>eople of its financial burdens, every substitution of a reasonable adjustment for 
a social or economic maladjustment, will have a beneficial result in drying up the 
sources of pauperism; that the frontal attack upon pauperism lies in the segregation 
and humane care of the feeble-minded, the prevention of alcoholism, and the devel- 
opment of social insurance against sickness; that to these ends the professional and 
technical training of sanitarians for the public health service and the professional 
and technical training of social workers for the tasks of relief and prevention are of 
paramount importance. 



194 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC C0NQRES6. 

Dr. John N. Hubtt. We have listened to two papers fnnn mas- 
ters of their respective subjects, and I believe that every word they 
have told us is true — i. e., that it is within our power largely to get 
rid of crime, pauperism, and poverty. The fact that these evils 
exist seems to me to be evidence at the present time of our own 
incapacity to govern, to handle things. In order to bring about 
better conditions I believe that the chUd oreed which has been pro- 
jected by the Indiana State Board of Health lays a foundation. 
It runs this way: That evory child has the inalienable right to be 
bom free from disease, with pure blood in its arteries and veins; 
every child has the inalienable right to be trained in mind, body, and 
soul, and to be protected from evil persons and evil influences, and to 
have a fair chance in life. Those inalienable rights we do not secure 
to our children. The essential thing to do is to see to it that they 
are well bom. We have long been told that you can not have figs 
from thistles. You can not, and yet we are striving for that very 
end. In these problems we may well consider the fact that the 
human race since tiie beginning of time has bestowed an enormous 
amount of energy in simply striving to find a substitute for right- 
eousness. It does not exist; and as long as by relief, by doctoring 
and by all such practices we strive to find a substitute for right- 
eousness, we are simply wasting time and energy, for it does not 
exist. In a word, my whole argument is this: Instead of striving 
to keep men out of hell, let us strive to keep hell out of men. 

Adjourned at 12.20 o'clock. 



GENERAL SESSION OF SECTION VOL' 

New Bbbitt Hotel, 
Wednesday afternoon^ December S9, 1915. 

C3i«iniiiiii, Cdi. Sokr Vak R. Hoff. 

The session was called to order at 2 o'clock by the ehairman. 

The fdlowing papers were preseiited at this seosioii, wveral of 
wfaicdi were read by title: 

Mechanical appliances in the treatment of Pyorrhea Alyeolaris, 
by Dr. Felipe Gallegos. 

S^ene del embarazo y de la primera infancia, by Dr. Atilio 
Narando. 

Puericultvra, by Dr. P. Rueda. 

La Novocafna Olicero-iodada, by Dr. Juan D. Susini. 

Los dispensarios para lactantes (gotas de leche) oomo medio 
para disminuir la mortalidad inf aatil, by Dr. Julio A. Bauza. 

O error esseueial d» peeaoa na ki brasikifa do eanmttito wrk^ 
by Dr. Rodiigues Doria. 

M6todos modemos para la preyenci6n de la mortafidad infantil| 
by Dr. Arthur L. Guerra. 

Prophylazia do ophidismo aa America^ by Dr. Vital Braral. 

Nota sobre tratamiento de la infeeeite puevperal por ka baAaa 
iibios proloi^ados, by I^. A. FiaDo Oatnnd. 

Accite respiratoria del depresor eordb, by Dr. Teodoro Huhm. 

Lepra y autosangroterapiai by Dr. liuis Zanotti Cavazzoni. 

MECHANICAL AFPUANCBS IN THE TREATMENT OF PKMOHEA ALfB- 

OLA1II9. 

By FELIPE QALLEGOS, 

Suntary tf tht Famkif e/ Ikntal Surfftry, Cotia Jlioa, Cmiir^ Jmeriea. 

Pyonfaea alyeolariB is here, m in all parts of the world, a problem which confronts 
the dentist almost daily. My experience in 29 yean' practice can be condensed as 
Idlows: 

When about half of the teeth in a mouth are badly involved with the disease^ espe- 
ciaOy when the bicuspids and fiist molars are affected, all efforts for a successful cure 
will faU. The lower indson and the bicuspids of the upper jaw can be cured more 
often, especially in the early stage of the disease. By a successful cure I mean, of 
course^ three thingpi: 1, Tho disappeaKaaoe of pus from the pockets; 2, the reaffirming 
of the teeth as they originally were; 8, the nonrecurrence of the disease. 

The litoAture on pyorrhea alv<eolariB written in the last 10 years will fill many vol- 
umes, yet I do not see many reports showing that success has been as frequent as is 
necessary and desired. Tfa^ majority of writers deal almost exdiMively with the 
cleaning operatioDS and the use of drugs, but no mention ii made to the use olmechaii" 
ioal appUanoss to help in the matter. 

1 There WM DO ftttiofnphie report of thto Msloo. 
68486— 17— VOL IX 14 lOi 



196 PBOCEEDINGS SECOND PAN AMEBICAN SCIENTIFIC C0NGBB8S. 

I make this statement: That deanlinesB, medical treatment, and rest of the diseased 
organs— 4hese three things are needed and help each other in the final success of the 
operaticm. 

As to the cleaning part I can not say anything new. The medical treatment may be 
difficult in cases needing constitutional treatment. Locally, the iodide of zinc tincture 
IB about the best that we can use, if not too strong. We are now in a very interesting^ 
period of experimentation; so tut the emetine injections, both subcutaneous and in 
the mouth, are reported by many writers as very beneficial in destroying the endame- 
has, found in the pus of the pyorrhea; and sudi discovery marks a progressive step,, 
throwing much lig^t in the etiology of this disease. 

Speaking now of the facts that I wish to emphasise in this paper, it is my expeiienoe 
that no matter how well the diseased teeth have been cleaned, and how great the care^ 
taken in the washing ahd medication of the pockets, the final effort of tiie battle has 
to be won by mechanical appliances used to hold the loose teeth in as secure a position 
as possible. No clumsy appliances, of course. Every dentist can make something to- 
suit each individual case— -narrow bands of gold, fitted on the firmer teeth; gold wire, 
either on the inside or the outside of the indsoro, resting on the gold bands; and then, 
platinum wire to tie the loose organs to the bands or gold wires. In many cases, and 
in the early stage of the disease, the platinum wire is all that is necessary to hold them 
firm. The use of such mechanical appliances is only common sense. If the ortho- 
dontist, working on healthy bcme, after he has put the teeth in the rigjit position, 
must make a good appliance to hold the teeth firmly in its new place, so that nature's 
process of repair finishes its work, how can we expect that loose teeth with a diseased 
alveolus can get well if we do not treat them similarly? The general surgeon puts the^^ 
broken bone in plaster to insure rest. Why should we dentists not do something 
similar? 

In mikVing this plea for mechanical appliances in the treatment' of pyorrhea I do not 
daim originality; nevertheless, I consider it worth while to insist on the matter, as 
it seems that many dentists expect everything from the use of drugs ahme. And 
writers in general do not mention mechanical appliances at all; some oL them because 
they consider it, perhi^, as a matter of course; othen because they have fdgotten it 
or do not give it great value. 

In finishing this paper let me call the attention of the profession to a good astringent 
medicine to be used on the gums, one whidi I have found of great service in making- 
the teeth firm again. It is a resinous red fluid obtained by making an incision on the 
bark of a tree very common in Central and South America, the Tar^ua eolarado. I 
find a notice of this tree by H. Fittier, as follows: 

Targua euphorbiacea, Croton Gossyphiifolius, Wahl.-Symb.-Bot.: 98.1791. Croton 
Xalapensis H.-B. O K. Nov. Gen. et Sp.: 85.1817. 

I find, on inquiry, that other persons think that this tree is very similar to that 
described in the National Standard Dispensatory, Philadelphia and New York, 1905, 
as a kind of dragon's blood. I have used this astringent, mixed with two parts 
alcohol, and I think it is worth while to experiment more with it. 



BEBC— mOIENE DEL EMBARAZO T DB LA PRIMERA INPANCLL 

Por ATILIO NARANCIO. 
De la FacuUad de Medicina de Montevideo^ Uruguajf, 

^Ptura que sirve este trabajo? 

Oe dirfa que mi obra es innecesaria y casi afirmaria la verdad. Hay en eUa taata* 
cosas conoddas y tal repetid6n de conceptos yulgaree que proclamada su inutilSdad^ 
no podrfa desmentirse. 



PUBUC HEALTH AND MEDICINE. 197 

Y sin embaigo entre bus p^igtnas hty algo. 

08 dirla m^s; cada texto de ciencia ampllfica loe criterioe que yo soetengo en dia- 
qukicumee seiias y traBceudentales, que me han hecho meditar laigamente y que 
▼ilflii den veces m^ que mis deehilvanadaa disertaciones. 

Y an embaigo hay en este mi libro, que lo es tambi^ de voeotras, madres por 
piimera ves, nifiae que aq>ir&i8 con legftimo oigullo a ostentar en fecha no remota eee 
honroso atiibuto, una derta drnpliddad que me atievo a inainuar, peee a mi modeetia 
y que seri seguramente la finica causa de que 41 pueda Uegar hasta vuestio cerebio de 
una manera mds suave que loe infolios de sesudos pensadoras. 

Es que mis conodmientos no son simple teoria ost^n fundados en la experienda y 
este estudio es n^ia la obra de un padre que la de un medico. 

^Peio, cu^ es mi preteno^ al esciibirio? 

CoiXf mno la de seios dtil a vosotras, madies piesentes y futuras, y por ello, me 
verbis a menudo huir de las explicadones ambiguas para deciios daramente la veidad, 
tal ouDo la sientD y c(Hno pude expresarla. 

Soniefos pues, de mis atrevidas pretensiones, p^o leedme, leedme que al pasar 
notaidia nia de una yea que algo de amor, de sincero afecto» de sano optunismo se 
respiia en las p^iginas de mi estudio; algo que os hai& tanto bien como una caiida de 
madre que adn siendo indtil es bienhecfaora; algo» que llegaii a vuestios corasonee 
oomo U mizada de un padre, que sin ser severa os encamina al bien; algo que no es 
BkkB que mi deseo de seios dtil. 

Y a lo consigo, a amablemente me decfs un dia "una vez encontr^ en esta obra un 
buen conaejo, una palabra de tranquilidad en un instuite de sosobra, una frase de 
aliento en un s^gundo de dea&nlmo, un concepto condujrente en un memento de duda, ' ' 
colmav^ mis satisfaociones, porque tal era mi dnica protenaUSn al escnbirlo. 

CAPtruLo I.— El BbbA EstX bn Oaiono. 

PRDCBRA TISrrA. 

SifUomas generaU» de embarazo--Cfuidadoi convenientei-'Lo que duhe y lo que no debe 
hacerse—MkHcoB y parteroM—iLa eUcd&n et dudoeaf 

Sefiora: os tengo que dar ese nombre, y vuestra soncisa me revela que adn no os 
hab& acostumbrado a que se os llame asf. Hace dos meses cuando en vuestra casa 
patema me anunci^istels la deci8i6n de formar un hogar, era yo quien sonreia: ocultaba 
ad mis intensos sentimientos, mis temores, mis preocupaciones. 

El trato del mMico habia con los afios afianzado la amistad y no era sdlo mi cliente, 
la que emprendia una nueva y misterioea ruta, er&is mis, er&is mi pequefia amiga, caai 
mihija. 

Al contemplar vuestra figura, vuestro talle fuerte, vuestro pecho amplio, al pensar 
que OS halUbais dotada de una voluntad tranquila y una dega fe en el porvenir, rena- 
ci6 en mf la confianxa y dije: "cumpliri perfectamente su nueva vida." 

Hoy OS vengo a ver por una indisposicidn pasajera; como tal la ha clasificado vuestro 
carifioso eqxMo. ^Yqu^T ^Sefiora, mareos, niuseas, dolores raros, arrebatos de calor 
al rostro? ^Sf? t^ tambi^ vdmitosi |Ah, sefiora} esto es m^ grave de lo que 
pens&is. Esto tendri consecuendas, pero no os alarm^is, ellas ser&n de tal grade que 
colman&n todas vuestras esperanzas. Me hab^ comprendido . . . es claio y era 
Idgico. 

iQa6 deb^ hacer? Por ahora nada. Cuidaros en vuestras caminatas, moderarlas 
hasta transformarlas en paseoe hlgi^nicos, no viajar^ en coche o autom6vil, no hards 
ejercicioe violentos y comerds . . . comed todo lo que os plazca y mucho — sano, 
nutritivo, poco condimentado a fin de que el organismo asimile por dos, ya que ese 
alimento serviiA tambidn para dos. 

Haced vuestras digestiones tranquila, reposada en un diviUi, satisfecha de la alta 
mi8i6n que estiis cumpliendo, la mis grande, la mis noble de cuantas Natura 00 h;'; a 



198 PBOCEEDINGB SBOaiO^ PAK AMBBIGAK 80IBNTIFIC C0NGBE88. 

^epaithdo. Manteneos C(Hrrecta en vuestrov plaeorav dn olvidar per eei» vneBtnw 
aecesidades. No txansaodit^m y eepera que vueetra* afickmee al balle aeite faihibMM 
par lai nuevae de madre que d^b^ ctdtivw eemendanieiile. Esto aacriflcio, pee 
otra parte, no durarA mucho y serft resarcide ooa ereoee por lae eatiBfiftoeioaea poeteriMea. 
No abandon^is vneetro higidniea bailo templado, matinal, que o# aal^asidemiK^UM 
afeeciones cutimeas m^ ttethoettte adq^oiriblea en esloa mamenKUB en que oe eneoii* 
tMa Irente al p^igre, en eendiekmee de Ugora iohriaeiM^ j cuidad TweCiPoe eeaoa, 
que a m^ de 8U ''toSette'' habitual loe deb4i9 frotavdianimie&to oon una parte de 
idcohol, agua de Colonia e el agua de vuesti^ftMnKier, en dee fleagva linpia. 

No elvid^ie de volTerme a llaaiar ti quiato mee^ o bien nquerid a ▼ueaCia pariera 
de confianza. Gualquiera de loa doe oe haremoenniche bien pieviniendo laa pequefiae 
complicadoneB podblee que nada valen cuaado se puedes tttcfimentefemediar, pere 
que ae baoen gra^ee €fttanda luMonde eldo abandonadae ee agigaataa paia tnaam- 
formaiBe en obstdculoe sevloeen el Hemettle Moldgko dek nadmoanta 

^ A qui6n debris llamar? ^A m(, o a la madamat He aU ma cuoatidn que me 
Aole8ta«e0p<mder. Sxlitea bueeaa, muyboenaay exeelenlCB partene, a td gnideque 
a eUae lee conffe d poner al mvade a mii kijoa. Pedid qw aeaa limpiaB, eacrapa- 
loeae en su eemetldo f ceOkbs aae obUgad^ Anfaa deajradar a^bien naoer Bensal- 
nrante, exjgid que al ttenor iMpAiae aeodan al fM^nltatifYO y aerte bim aervida. 
Feio, pqriairqtnocaentregoftiaeMMadwmagfliBtitnlequehacattUprt^ 
de BUS dientea y que no eaben de libros, ni ban pisado' una gala cb m^arnidai. Bn 
falta de leepoanbfildad lae haoe mie atMirlte y oe deMi cooveaoev que la sej<v 
prActfea ne podii pcrangoaane a qeien ha hecfao una laiga y Tigilada caiieta ea laa 
auIaeieumendoalaerpefieBdadeleaeaaoa, ladeneladeloaliieoe. 

^Pero, i^Btdk que eea yo qaien mantenga la dinedtet BiaB-*4aay peonlo ea 
har6 una nueva visita. Eepero no echto en aaoo zoto mis observadoneB y oe ruege 
recofd^ie siempre que hab^ perdido vueetza libertad de acd)5n y 00 hallaMia obli- 
gada a obedecer la voluntad del peq^iefto tiiaao que eet& en camino. 

aae«miML TianA. 

Fufa oZ a«re lihre—iQuJi deUia eomerf—El corU adminlieido de tortur<t^Lo§ pa$$o$ f let 
dJaeviovMa^^JSeiMBlMbuf tf Maoittci db eaiCiiaiftfw* 

Sefiora: Amablemente 00 digo que oe habile equivocado. Yuestro deeeo ha ide 
mas alU de mis indicaciones. Anotadio bien. Yo no oe exigf un enderro rlguroae 
en vuestro domidlio dedicado a vuestrae mon6tonas costumbres que penniten tejer 
la red de vuestros pensamientos alrededor del hedio ilsiol^co foturo. Os dije, Sefion^ 
nada de exceeos, caminatas, bailee, conerfes. Os ban didio quietud, y vueetre 
razonamiento ha coirido al extreme dej&ndoee dominar por el prejuido. EstAIs 
dentro del tercer mes; ee derto que no es conveniente haoer locuras, pero ee tambito 
yerdad que ese enderro es pemidoeo para vos; por ende para 41. Ese pequefio beb6 
que esti en akmino llena toda vuestra vida. Lo deeedis bello, fuerte, el mia her- 
moeo de los beb^ pasados, presentee y futures. T bien ^quer^is conseguirlo? Le 
repito, vida amplia, tranquila, sin agitadonee morales ffsicas violentas. Ahf tendia 
un resumen de mis pretensiones. 

Pero, quiero inculcaroe hasta vuestro aburrimiento mis ideas, quiero convenceroa 
hasta el cansando de que mis instnicdones os serin benefidoeas y por eeo os repetir6 
lo que pretendo de vuestra amabilidad y dd respeto que os debe imponer la denda. 
M^ a6n cuando sols, sefiora, tma de las privflegiadas de la suerte que podto ohridar laa 
necesidades de una vida material para entregaros a vuestras comodidades o a vuestroa 
capridios. 

^T si no fuera aa(7 i Ah sefiora I si fu^rais una obrera que mantiene con sn aalaiie 
la familia entera, no podrfan llegaios estos consejoe, pero recibiriiia con mia mia 
grandee simpatias^ los fervlentes votoe que expreao de una pronta aanddn de leyea 



PUBUO HEALTH AJfTD MSDICONB. 199 

de proteccidn y el deaBo que albeigo de una zealizacidn amplia de la matemidad en 
todos lo6 pafaes. 

En cambioi, 09 encoateiia en condiciones inmejocablee y dd>6iB olnne. Vuestio 
^)etito probablemente 0e redoblat^. ^Qu6 debris hacer? Comer, corned todo lo 
que 08 plasca y refos de los prejuicios de la gente que os dir^ que ciertos alimentos 
daben aer preferidoe en el estado en que oe encontriUs. Todo sirve cuando el <Ncga- 
niamo lo pide. La voz de la naturaleza, salvo en casoe patoldgicos, debe ser obedecida 
ci^gamente. 

Pero, defendeoa de loe caprichoe de la moda y de las ebligadones de la vida mundana 
y Buprimld vuestro con6. No os asombr^is. £s necesario absolutamente que b dej^ 
xelegado para el dfa de vuestra primera salida con el beb^ y entonces, quizd oigullosa 
de b que hab^is sido capaz, no os acoid^ls de H. Es una pequeila imposicidn que 
exige explicaise. ^Verdad, sefiora? Pues bien, tened en cuenta que aiin modera- 
damente apretado ser^ perjudicial al diente futuro que adoptar^ segiuramente una 
mala posicidn, Impuesta por el enci0rro obligado. ^Y sab^s a que consecuencias 
conduce una posici6n vidosa? Hay n^is, el cors^ ser& tambi^n perjudicial a vuestro 
estado porqu^ la pared abdominal^ ampliamente eldsdca, colocada entre dos fuersas 
que se contranestan— el empuje interne del pequefio que asplra a engrandecerse y la 
presidn externa del aparato de tortura— se afina, se adelgaza, pierde su elasticidad 
que no recobrar& jam^ y que es necesaria para vohrer a dares esa figura airosa que 
00 caracteriza y que servird, con s^guridad, de modelo a un cincel ezigente. 

Si OS presentdis a vuestras viaitas con un ampUo vestido, bien libre, colgante, SS^ 
hard quiz& patente vuestro estado, pero a las sonrisas deb^ responder con laafirmaddn 
oigullosa de la veidad, que no os debe produdr rubor la satisfaccidn de cumplir la 
mis alta misi6n que la naturaleza depara a la mujer. 

Deb^ sefiora, y vuelvo antes de terminar a leferirme al tema inicial, abandonar 
Yoestra inmovilidad. No os dli6 que bajo pretexto de hacer ejercicios, os dediqudis 
a deportes violentos, tales como el ''tennis" o la caiiera, tampoco os animar6 a que 
aprovechdia vuestras veladas en fiestas bailes, pero s( os aconsejo que no dejdis vues- 
tro paseo cotidiano en tren y a pb. Un viaje a las afueras en tren; un ligero paseo en 
los parques os har^ la vida amable y abandonar^ quisi esa preocupaddn violenta 
de socesos que se realizar&n fatalmente. Haced visitas, ocupaos de vuestros qu&- 
haceres y de la direcddn de vuestro hqgar, abundonando las tareas pesadas al servicb 
J pensad siempre que ningfin sacrificb es poco para cons^guir ver fuerte, sano, vigo- 
rose, al pequefio beb^ que estd en camino. 

TEMCEMA, VXairA. 

iOuUn aUmenkard oL hMt—Al^jaot de la nodriaa^Una /aUa y un erimenr-Difi- 
cultad de Ut tUcMn de nodrin^Una mala y aen peora. 

Sefiora: Redbid mis felidtadones n^is sinceras. Eso, progresa evidentemente. 
Eso es ya viaibb. No, ^For qu6 niborizaros? ^Es acaao un dellto? Gumplida la 
miixima bfblica de la multiplicacidn, os deb^ sentir rcgodjada, oigullosa, capas de 
acometer grandes acdooes. 

No dir6, sefiora, que deb^ imitar a vuestro marido que en su jtibilo de padre futuro, 
ae conddera sufidente para repoblar la Europa; pero al menos vanagbriaos de vuestra 
aeddn. La frente alta, d pecho exguido, sois cad madre. 

Anotad con cuanto m^ ardor beaar^ vuestra mamita cuando deje caer sobre loa 
Tuestros, sus ojos mansos, sondentes y lacrimosos de lutura abuela. 

Y ya que la he recordado, mientraa d prdximo diente viene en camino tratemoa^ 
asfiora, una grave cuesti6n. ^Quidn alimentaril al beb^7 Si no escuchiis n^is que 
la voe de la Naturaleza y las pdabras de vuestro corazdn estarda dispuesta a cumplir 
hastad final vuestros deberesde madre. Td es vuestra opinion, tal la mfa. Pero, he- 
ahi el partido opuesto. Lo encabaza vuestra mam4. "Sf, dice, yo os amamant^ a* 



200 PKOCEEDINGS SECOND PAN AMEBICAN SCIENTIFIC CONGBE88. 

todoe, pero eran otroe tiempos; yo era fuerte, sana, mientras td, tan d^bil, tan nerviosa, 
te fatigas tan pronto y adem^ te defonnarias. E0O es hoirible. Cuenta dies, quince 
meses eeclavizada, sin teatros, sin fiestas, ^comprendes, hija? ^No ser& demasiado 
para tl? Y tu marido tan bueno pero tan delicado ^no perderla sus ilusiones vi^ndote 
denodriza?'' 

Vuestro espoeo, pooo preparado para su papel, no quiere seguramente que se le 
eche en cara que por ahorrar unos pesos que pueda costarle el ama os obligue a cumplir 
tan desagradable como pemiciosa misi6n y se pondr& de parte de la abuela futura y 
vos, Sefiora, i qu6 v4is a hacer? 

Vuestra madre, vuestro esposo, las personas a quienee quer^is entrafiablemente os 
empujan y decidis abandonar vuestro beb^ en manos de una mercenaria que expende 
su leche al mejor poster. 

He llegado a tiempo por suerte, aunque veo que ya habfan hablado del punto. 
Prevenir mejor que curar, tal es nuestra misidn. Y bien, Sefiora, prevenida quediUs. 
Mi consejo es tenninante: Vos y nadie m^ que vos tiene la obligaci6n de «^mfttnfl Ti ^ |^ 
■sX beb^ que estd en camino; si asf no lo hici^reis cometerfais una falta y un crimen. 

Una falta contra vos misma, un crimen contra el nifio de la nodriza a quien le 
robdis su leche, y ser6is, la piimera castigada. Supiimir, despu^ de la matemidad, 
la lactancla, es dejar a medias un proceso fisioldgico, es detener la marcha regular y 
hermosa de los hechos. No lo otvid^, la naturaleza no marcha a saltos y la ordena- 
cidn de las funciones naturales es suave como la caida de los p^talos. 

tCu&ntas madres despu^ de exterlorizar tma o dos criaturas sin haberlas lactado 
quedan deshechas, quebradas, viejas y cu&ntas se han hermoseado, han vista por 
primera vez colores en su rostro y se han vuelto fuertes, vigorosas, espl^didas en 
plenas funciones de amasi 

Oometer^is adem&s, una grave falta contra vuestro hijo, el que se habia formado 
recibiendo la vida por vuestra sangre y que notari seguramente el alimento extrafio 
que le proporclonarla el seno mercenario. 

Quiero suponer, Sefiora, que os hayan elegido una buena nodiisa; que gracias a mi 
intervenci6n eetSB segura de su salud , que sea sobria, que sea honesta. Pero, ^ddnde 
encontrar ese fen5meno7 Por tma buena, darto con cien malas, y estad segura, 
Sefiora, la vuestra estari entre las cien. Os dir^ muy pronto el porqu^ de una afirma- 
cl6.% tail tcrmmajxte. Sabed tan 86I0 que 611a estd basada en una laiga experiencla. 
Mientras, no oe preocupto, yo os garantiso que sola, serais capas de llevar a hombre 
a ese pequefio beb6 que estd en camino. 

CUABTA VIBITA. 

El ama es siempre tma mercenaria—'El kijo de la nodrita — Injluencia del medio en el 
cardcur del ama—DelUo no penado por Uu leye$^La venida del ama impiica la venida 
del kijo. 

SEf^oRA: ^HabdisreAexionadoiobremisdltimascQnfidencias? |Ahl ... ^pero 
quer^ saber porqu^ os habl6 de crimen? Oreo que me seri f&cil explicdroelo. ^Ha- 
b^is p^isado alguna ves en el porqu6 de la existencia del alimento en el seno del 
ama? Y si lo hab^is pensado, vos, Sefiora, tan caiifiosa, tan amorosa de los pequefkM, 
tan alecta del futuro que viene to marcha, ^no hab^is meditado un s^gundo, en d 
hijo abandonado por la nodriza, quien corre tras vuestro dinero, vendiendo un ali- 
mento que no es suyo, que es usurpado a su hijo, thiico propietarlo de la leche matema, 
6nico con derechos y a qui^ le es necesaria como el sol al capullo de rosa? 

Vuestro hijo es despojado de su alimento porque vos esteriliziis la fuente de vida 
con que laphSdiga Natura os ha dotado, para transf(»rmarla en un adomo de vuestro 
cuerpo que no necesitarfa de 61 para ser hermoso, y en cambio le d&is una extrafia 
alimentaci6n robada a otro pequefio que gracias a 611a vivirfa y que sentiri su falta al 
par que el beso de amor que le hac6is impoaible, rob&ndole su madre. 



PUBLIC HEALTH AKD MBPIOINB. ^1 

^V^, Sefiora, cuiuato mal? 

iV^ c6mo amaigdiB intitilinente vuestra vida, porque siendo como tob todo 
CQra£6n, cuando el ama 06 diga que au hijo muere en manos extrafias, porque se le 
alimentaba mal, recibir^is la noticia lacrimoea y triste como si os arraocaran un pedazo 
de vuestro aer intimo? 

Y miezxtras— haBta por egoismo— comprended, Sefiora, que vuestra ama sabiendo 
que 8u hijo e6t& enfermo, no nutriiA vuestro rico beb^ m^ que por la bilis del dieguflto 
y no con la sana savia de la alegrfa. 

Cuando ella os diga, ' ' Sefiora, me voy , me anuncian que mi hijo esU grave y recobro 
mis derechoe de madre. Vuelvo a su lado, aunque no sea mis que para verlo morir.'' 
^Con qu^ derecho la retendr^? Y la verbis marchar pesuosa y doliente y oe pon- 
dr^ frente al conflicto de una nueva ama. 

Vuestro marido y vuestra madre negarin duramente la patemidad de los males 
consejoB y he ahf que una nube iombreaWL el cielo de vuestra dicha con un matis de 
tristezas que no se borran porque repercuten sobre la vida del ser mis querido, que es 
dlbeb^. 

Os decia, Sefiora, vuestra nodrlza seri mala. Y no puede so* de otro modo. Colo- 
cada en un medio que no es el suyo. Planta de arenal trasplantada a una rica capa 
oig^Lnica "se iri en vicios," he ahf el caso. Golosa, encontrar& como producirse una 
indigesti6n y la hari con vuestro asentimiento, porque pensar^is siempre en que el 
alimento del ama no debe ser discutido. Discola, sabri imponer sus caprichos que 
le tolerar^is por no diflgustarla. Sucia, capas de beear al nifio en la boca, con vuestra 
tolerancia porque no os sentir^is lo suficientemente en^igica para impedirseb, estando 
en ju^go la vida de vuestro precioso beb^. 

i Ah, mi buena Sefioral No olvid^is que no hay peor tiranla que la de la ignorancia. 

Hay mis, Sefiora, comet^is al contratar una ama un delito castigado por las leyes. 
Dad por sentado que el alimento es propiedad del nifio. £1 ama roba ese alimento 
para vend^roslo. Heahl el delito. Sereis c6mplicedel hurto. ^Ossonrefs? Si 
b comprendo, no serais penada por 6II0, pero ^es por esoun delito menor? |Ahl mi 
buena amiga. La naturalesa sabri castigaros mucho mis en^igicamente que lo 
harlan los hombres. 

Me decfs: "Doctor,^ y si no tuviera leche?" No olvid^is, Sefiora, que estar^ a vuestro 
lado y que mis recursos son infinites dentro de la relatividad del poder humano. Si 
no tuvierais leche, cosa improbable dado que os halliis espl^ndidamente armada para 
que esto no suceda • . . si no tuvierais leche . . . nada . . . ni un poquito . . . 
transarfa con el ama . . . pero no creiis que caiga en una contradicci^. N6. Os 
traerla el ama con su nifio a vuestro hogar. Meditad, Sefioara, el valor de mi trasac- 
ci6n y comprender6is que aunque ello imp<Mrte un sacrificio, es necesario hacerlo, por 
cuanto, y os dir6 porque— ello importa la salud futura de vuestro precioso beb^ que 
esti en camino. 

QUINTA VI8ITA. 

Bl dtmnoUo de utia nueva vida — Owmdo ee oonvenienU el ejerdeU^^DediacUndo pre- 
juidoe^Alarffor la vida inirauUnna ee ameeguir un ntAo ya cnado. 

SbAora: Perddn, me he detenido quisi demasiado sobre el tema del ama, pero 
^comprend^is, Sefiora, cuinta importanciatiene para la vida del fnturoT Ha quedado 
por dilucidar, el porqu6, si la necesidad obliga, os debris quedar con el ama y el 
hijo — lo dejaremos por hoy, porque los dfas pasan y el memento final de vueetras 
fattigas se va a coronar a corto plazo con el resplandor de la dicha. 

^En qu6 lo he notado? 

Seficnra, hace ya tres meses que el futuro cliente nos ha avisado de su existencia. 
Fu^ suave, carifioeo en su aviso, pero persistente. Ha dicho el "aqui estoy** con 
vehemencia— y recordiis que os hice notar la cara de dicha con que me b advertfsteis. 

Oada movimiento, cada golpe se traducia en una sonrisa de vuestro rostro lelix. 
Vive, pues, y sigue su marcha presurosa hacia la luz. Me acusdsteis despu^ ciertos 



202 PBOOEEDIK€» 8800HD 1^AX[ AMBSIOAN 80IBKIIFI0 OONQBB80. 

dolores en las caderas y oa afinn^ que no eran mis que defectos de capacidad. Pedia 
plasa para migrandecene y vos, Sefiora, obediente a su padido sufristeis la ampliacidn 
de Tueatra pdvis decidida % no entorpecer su marcha promisora. 

Nofl im>puaimo8 ensog^ida ayudarlo y luchando contara vueatra mal entendida 
vergQenza, deaobediente a mis mandatoa, que oa aconsejaban las aalidaa en pleno 
dia, reconiateia las calles de la Uibe del braso de vneatro eeposo, trotando fuerte en 
medio de la noche, cuadraa y mia cuadraa— y me decla hoy-— que ya no estiia fatigada, 
que oa aentis mejor, mucho mia aliviada. 

Oa dii^y Sefiora, que ai tal aucede es que el futuro diente ha encontrado el camino 
y la rata amplia que habfan elaborado loa hueaoa de vueatra cadera al separarae ha 
aido Uenado por la cabeaa del pequefto. Bien, muy bien, todo marcha a la medida 
de vueatroa deaeoa. Se cumplen fielmente las leyea fiaioldgicaa. Os dais cuenta 
ahora, en que se basa nuestra ciencia: leyes inezorables, fatales, rigen los destines 
de la vida y de la muerte; todo est& previsto por reglas observadas y siempre igualea, 
y cuando la excepcidn aparece fundando la regla, no vacilamos en afirmar que se han 
torcido los preceptos naturales, y tratamos de corregir el error. He ahl todo. 

Os halUis, Seftora, en la entrada de la dltima luna, sat^lite cuya traslacidn divide 
▼uestros meses, vale dechr, comenz&is el dltimo mes. iQn6 debris hacerT Vuelta 
«laquietud. ''H<»ror,"dir&vuestramadremanteniendounviejoprejuicio. "Ahora 
es cuando es m&s necesario que camines, chiquita.'' Error, digo yo que soy vuestro 
medico y quiero explicarme, x>orque me entender6is ttcilmente. El divine beb^ 
en camino est& ya perfectamente complete. ^Me entend^is? Ouanto m&B largo sea 
este dltimo perfodo, m&s perfeccionado vendrA a la vida y por lo tanto mis apto para 
afrontar sus peligros. 

Mi» fuerte, sufriri lasindemendas del cambio con energfas y os encontrai^is, sefiora, 
con un pequefio pronto a todo, hedio y dlspuesto a triunfar contra la enfermedad; 
▼igoroso, que absotberd su alimento con la tranquilidad y glotoneria de un ga8tr6nomo 
aeeudo. 

^Os figuriUs, sefiora, qu6 memento inestable de la vida, es el del nacimientoT 

G6modamente encerrado en predoso eetuche, arrobado por el calor ambiente, ali* 
mentado directamente con vuestra sangre, sin tener que cimiplir los trabajos inhe- 
rentes a la vida libre, pobre ciisdlida parasitaria que cumple su dclo en un instante; 
traneformarse en nn ser que lucha, se af ana y crece por cuenta propia. 

^ Y pretend^ lanzarlo cn&nto anteflt 

|Ah! n6, aefiora, detenedle, que alU progresari sin peligro. AUf os sacrificar& 
mis, es cierto, pero os ahorrar^is temores futures. 

Vuestra madre aigumenta peligros para vos. ^Pero, cuilesT ''La enormidad del 
pequefio" . . . ''Es el primero yquisA— el memento es diffdl." Estad tran- 
quila, aefiora. Estftis bien constituida, sois fuerte, vuestros diganos son sanos y 
Mbr&n cumplir fielmente su misi6n. Ser4 quiz&, un poco mis de dolor que se equili- 
brarA despu^ con un mayoi carifio. 

Por otra parte, 400 os sentMia berida en vuestras ilusiones al ver a vuestro beb4 
enclenque, raquftioo, todo vioMceo y tambkroao, cuando pod& obtener orgulloea, 
un rico infante, ya orlado, gordo, fuerte, sano y vigoroso? Estad iranquila, pues, 
cumplid mis consejos que yo velar^ porque vuestros ideales se cumplan y que sea 
hermoso ese pequefio beb6 que estd en camino. 

aSXTA VI8ITA. 

UtUidad de eitoM etmvenacionei^Paldbras que deben ter egcuchadoi por la$ madne y por 
Ia$ que nolo a o ii Oon/imUeneia de vulgaritar la denokH-^hurra dl pudor miUU y a 
laforM, 

Sefiora: Mis palabras llevadas a los ofdoe mib pddicos no produdrlan ni la nUis leve 
intend6n de pecado. Pr^dicas cientfficas, no aon para dichas en el altar de las pA- 



FUBUO HEAIJXH AHD MSmOINB. 203 

blkas criticas, sino ptam escuchadas en el ambiente familiar, junto al ledio donde el 
doUv engendra vida y donde la vida vivifica amores. 

Como tal, sefiora, os he venido hablando dalce y amidblemente, mientras vueetro 
sacroaanto destino ae cumplfa, tranqtiilo y aonriente como un cabdlero del Men. 

Fero hoy, aefiora, una filoaoffa amarga, puso on pesar en mi corazdn y una doda en 
mi cerebro 

VoSy aeftora, aab^is el bien que os deeeo, sab^ el fin de mis conaejoa, y IO0 recibfa 
con IO0 ojos bajos y el of do atento; ^serA lo mismo para todasT 

Ellas son, o ser&n madres, eea es mi fe y es por eeo qae a ellas, van mispliticas. Lo 
demis, sefiora, serd coreado por mi sonrisa tranquila. 

La maledicencia no llegarA a producirme encono, la sdtira hip6crita de los qne 
nada valen engendnuri mi desprecio y peso al mundo, marcharemos por el tinico para 
noeotroe, suave camino, el del cumplimiento del deber. 

Vos, sefiora, y con tos esa legi6n de madres que me leen, sentirdn algtin dfa esa tran- 
quila alegrfa de quien se aiente sostenido en los momentos amaigos y i>eligrosos. Yo, 
en cambio, ver6 esa nueva generaci6n vigorizada asf como el labrador contempla sus 
mioses la&a lozagantee, aeguro de que en algo ha asrudado a la santa obra de natnra 
madre. 

^Pero por qu^T me decls, sefiora, ^por qu6 doctor?; esa divagacidn, ese pai^ntesis a 
nuestras charlas amables y provediosas? \Ah por qu6! ^Lo quer^is saber? Sefiora, 
sabedlo, se ha hablado de mi discreto cuchicheo a vuestros ofdos matemos, como de 
una charla pomogrifica, se ha hecho caso onuso de su utilidad, para colocarlo en el 
** index " de las novelas pecaminosas. Se ha dicho m&a, se ha dicho de la conveniencia 
de Impedlr sus lecturas a las pequefias, futuras madres. 

iVeis sefiora, que malos! Vuelven a la rutina, no salen del prejuicio. Pretenden 
Yolver a las conversaciones secretas de am^as avezadas que repiten lo que ban podido 
entrever en el descuido de los padres y que por lo tanto describen como un misterio 
horrendo cualquler hecho fisioldgico. 

Quieren mantener aquella pemiciosa ignorancla que hacfa que nuestras madres 
rompieran el Uanto colgadas del brazo del esposo idolatrado en el momento de la des« 
pedida con igual vigor lacrimoso que el de los soldados estrechando a los suyos en el 
supremo Instante del adiiSs. 

Pero est^ peididos, pobree avechuchos pr^ist6rico6; la verdad penetra con pre^ 
teza en todas partes y ya nadie conserva esa castidad mal entendlda, efectista hip6- 
crita de conventual que era pemiciosa y nociva en la formaci6n del hogar. 

^Y si igual, sefiora, se ha de saber, no vale m^ que claramente, cientfficamente 
Uevemos a loo cerebros adn obsenrecidos, la luz de la verdad? 

Ah! sefiora, disculpad mis enojos, pero es demafdadoparami . . . y quizA para 
vos tambi^n, que hab^is oido indulgente esta expansidn de mi ser intimo amargado. 
QoiiA . . . pero . . . hemos perdido miserablemente el tiempo y no hemoa 
dicho ni una sola palabra del tema que hubiera querido tratar hoy— tema muy intere- 
Bante-^p<ffque atafie directamente a lasalud de ese pequefio beb4 que estd en camino. 

sinncA yxstta. 

EgpUeaaAn dd porque e$ neeemrio aoeptar d ama eon tu Mjo — Carifio y al%menU>— 
Dor para reeibit~^D\ficuUade$ $alvadie» — Un hum eompaHero, 

Sefiota: Os debfa la explicacidn del porque era necesaiio, ea la f&nica diconatancla 
tolerable, que el ama fuera acompafiada por su hijo. 

Oa veo ya convendda y por eUo no har6 mia fuertea loa aigumentoa de mi diaerta- 
ddn. Sin embargo, deb^ tenor preeente que toda vuestra tranquilidad depende de 
^llo y no puede ser de otro mode. Comprended, eefiora, que como reza en la "Ver- 
bena," "la gente del pueblo tiene tambi^n su corazondto,'' y que pueato a la pmeba 
ese conkz6n late y se sacude con igual f uerza que el vuestro. S«^ais impfa si afirmiiraia 



204 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

lo contaurio, y no caben en vueetra gran alma fellz pequefios distingoe de clase que por 
otra parte no albergar^ jam^ vuestro cerebro bien intencionado. 

Y bien, sefloia ^qu6 pasari teniendo a vuestro lado la nodriza con su nene? Ella 
respirar^ el aire de felicidad con que rode^ al vuestro, y la paz de su alma se tradudrd 
«n un mejor rendimiento con benepldcito para vos y con utilidad evidente para 
vuestro pequefto. 

No mis sobresaltos. Su nifio crecer& bajo la mirada maternal asf como el vuestro y 
basta quedar^is ampliamente autorizada para erigiros vos tambi^n en su egida pro- 
tectora. 

Ademis, ese exceso de carifio que ya manilestdis para ese pequefLo beb6 que esti 
en camino, lo repartir^is generosamente con el otro, a quien vos, sefiora, no considera- 
r^ jam^ como un ''parvenu" porque ^1 cede amablemente parte de su vida para 
d&rsela al vuestro. ^V^ la compensacidn? il os da una cosa que es suya para que 
con eUa consign hacer hombre a vuestro hi jo; vos le ced6is algo de aquella vuestia 
extrema bondad, en cambio del daflo que le ocasiondis. 

Adivino, sin emba):go, vuestra pregunta: ^Doctor, aeri bastante, para los dos? Si, 
sefiora, si. Sana vuestra nodriza, feliz, bien alimentada; si en su hogar de pobre, 
Uena de sinsabores y desdichas, 611a puede criar un hijo sano, hijo quizd de un engafio 
y que viene para su dolor y su vergQenza, y puede llevarlo a hombre ... contenta, 
sinti^dose bien querida, halagada por la seguridad de que no habri zozobras en el 
porvenir de ese ser que adora, sentiri doblar su vigor y llenari perfectamente su doble 
mi8i6n. 

Pero quer^, ya que os veo alarmada daros una dltima voluntad. Si vuestra ama, 
cosa improbable, no pudiera con los dos, se salvard el mal trance de una manera muy 
sencilla aunque peligrosa. Se les dar& antes de cada vez una pequefia dosis de leche 
de vaca. {Oh, sefioral os causa asombro mi trausacci6n. Es que los peligros de la 
leche de vaca se aminoran cuando es &u:tible que ella vaya seguida de im poco de 
leche matema que le sirve hasta para apresurar su digesti6n. 

Tengo, seiiora, un argumento final que me resulta convincente. ^Sab^is cuil es? 
No tiene nada de cientffico, es 861o de experiencia de la vida. 

Al proceder como os aconsejo, tendri vuestro beb^ un compafiero fiel, amoroso y 
devoto para toda su vida, por que el amor que se inicia en el seno comdn es imborrable. 

^Y sab^is, sefiora, lo que eso vale? 

El &rbol crece m^ vigoroso cuando otros mis pequeflos lo libran de los embatee del 
viento bajo. 

El hombre-cerebro iiradiari mis nltido su valer cuando otro se preocupe de desvas- 
tarle el camino de esas pequefias minudas embarazantes que preocupen intitilmente 
su marcha futura. Y eso, vos y yo, sefiora, deseamos para el pequefio beb6 que esti 
en camino. 

OCTAVA VI8ITA. 

La$ inyeceUmea y loi ane$Uiia$ en el terrible tnomenio^El doroformo^ la toaxnalgina y 
la parUxmalffia—Camejoi y dudae^La verdad et que la naturalexa e$ eabia, 

Sefiora: Pod^ preguntarme. Soy todo oidos y sabedlo bien que no quiero que 
06 intranquilicdis por nimiedades. 

^No las conaider&is asf ? 

Ah! Sefiora, cuin equivocada est&is. Es patrimonio de los d^biles el hacer de un 
fluspiro un vendabal y vos, a^&oia, no sois d6bil ; capaz como sois de acometer la magna 
acci6n de dar vida, no pod^ conaideraros ni por un instante como una cobarde. 

S6, sefiora, c6mo os him hablado del terrible memento; de inyecciones, de anestesias. 

Os han dicho, ademis, que natura f\x6 vencida por la ciencia; que el mal trance se 
pasa entre soniisss, o durmiendo. . . . 

|Pero, qu6 mal os han aconsejado, sefiora! 



PUBLIC H£ALTH AND MEDICINE. 205 

• 
Hidsteis bien, habldadome previamente y vueetra prueba de confianza merece una 
explicaci6n. 

Os han dicho: "La aefiora X ha tenido uno, doe, tree alumbramientos bajo el cloro- 
formo, y ^ viraas qu6 bien? Nada, ni un dolor, ni un peligro, su m^co fu6 tan amable 
que 86 lo admini0tr6 por pequeiiafl doeis, como elloB dicen 'a la reina ' y ahl la tienes, 
madre tree veces sin saber lo que cuesta tener un hijo." 

No ofl har6 la crltica de la actitud del m^ico porque me temo tener que discutir 
con inc<m8cientee, pero, mi deber ee poneros irente al peligro y preg:untaroB: ^Sa- 
biendo que os pod^is morir en la anestesia serais capas de dejar a vueetro divino hi jo 
sin madre? ^Por no sufrir un instante har^is desgraciado o sacrificar^is a eee peque£k> 
beb6 que eetd en camino? 

£1 dolor, sefiora, y amiga mla, lo verbis transformado en amor y enjugar^is la Uigrima 
de vueetra desdicha con la sonrisa de la felicidad. 

Con dolor, seflora, amasar^is vuestro carifio y perdonad, que os corrija esa muequita 
ir6nica con que reveUis vuestros pensamientos intimos que se podrian traducir en la 
frase que no viene a vuestros labios por siempre respetuosos, pero que traiciona vues- 
tro eetado de alma. "Ahl doctor, como se conoce que sois Sombre y no os toca 
sufrir." Sf, seflora, hombre soy, pero ^qui^n os ha dicho que los hombres no suiren? 
Pobree eeposos ante el dolor de madre, de nuestra compaflera, una sensscidn de impo- 
tencia angustiosa se apodera de nosotros y cada quejido es una dilaceraci6n de nuestara 
alma. 

Natora ha sido injusta con vuestro sexo. Ella os ha deparado los dolores fisicos; 
es gentil que los hombres guarden para si las amarguras m<»ales y s61o asi se resta- 
blece el equilibrio y la igualdad triimfa. Por ^Uo, sefiora, me v6is tan altamente 
respetuoso de vuestro sexo, y sin querer me incline reverente ante la mujer presin- 
tiendo en cada una de ^llas a una madre que sufre, a un ser que el dolor engrandece. 
No ha mucho, sefiora, nuevos procedimientos han venido a suplantar al cloroformo 
^'U el memento solemne. Las inyecciones de tocanalgina y de partoanalgla parece 
que caiman por complete los dolores y que su influencia podrfa producir un trance 
menos amaigo sin peligros. 
^V^is que os hablo dudando? 

£0 que yo, sefiora, no tengo experiencia de tal medicamento y conmigo la gran 
mayorfa de los medicos. 

Sin embargo, me aseguran que son una composici6n a base de morfina o simple- 
mente morfina a alta dosis y que en los casos empleados la enf erma queda en un estado 
let^ogico prolongado y el pequefio nace muy a menudo en semi-asfixia. 

^Os propon^is, sefiora, servir de experiencia? ^Os animiis a exponer a vuestaro 
heM a un peligro probable? ^Y si tuviera consecuencias? 

Dejad, sefiora, a la inhnmana ciencia que busque la comprobacidn en las clinicas, 
pero no me exijdis que os someta a lo desconocido, a lo im>blemitico, a lo pfrobable- 
mente male, para libraios de una cosa tan pasajera como un dolor que no ser4 tal 
cuando podiis mitigarlo con la solemne al^grla de sentir en vuestros brazes a ese divino 
beb^ que eet4 en camino. 

CAPfruLO II— El BbbA ha Llboado. 

NOVBNA VSBITA. 

8ai» madre — La obra magna de dor vida — Fe en la denda y en la experiencia — No m4$ 
vitiUu—El papel del eepoio, 

Sefiora: Sois madre; el grave trance^ ha pasado. Mece en vuestros labios la sonrisa 
de la dicha. Vuestro eeposo afligido me ha contado horrores. ^Seguramente hab^is 
sufrido mucho? pero no demasiado. !AhI — hio tanto como esper4bais! Gracias, Se- 
fiora, veo que sols sincera. Al oir a vuestro eeposo pens6: *'mi buena sefiora, me 



206 PBOGEEDIKOS SECOND PAN AMEEIGAH 8CIENTIFI0 COKOBESS. 

recibiri teguxiamente quejosa, me dir& frases cradas talef oomo: Se conoce ^e na 
8oi8 voe— podfais haber sido mia amable." Pero n6, con vuestro gesto, con eaa dolce 
miradA d« agradecimimito me pagiia con creces lot desvelos pasados. 

Sois madre, vale decir, hab6is aacendido on ancho p^afio en la escala de la vida^ 
aaf como en el mundo de loa aeres inferiorea cuanto m^s alta es la especie, mis compli- 
cada es au vida oig^ica; en loa hombrea, cuanto mia ae ban elevado, mia mlaionea 
deben cumplir. 

Pero, Sefiora, esta que Natura oa ha deparado mereceri vuestraa aatiafacctenea al 
par que vueatroa desvelos y cuidadoe. Gonatrair un hombre ea graade obea, ptept^ 
rarlo para la vida, es magna. Os encaminiia por una ruta nueva. 

^Guiles ser&n loa eacolloa que hallar^is al recorrerla? 

^D6nde la infructuoaidad en que choqu^is y recibdia vueatro primer dolor? 

En la guerra conocer al enemigo y la poeici6n que ocupa ea ganar la batalla. En U. 
vida ai conoo^ia loa peligroe Uev^ grandea ventajaa para aalvarloa y combatirlos 
aerenamente preparada. Tal aer& nueetra miaidn; y nueatra cienda y experienda, 
Sefiora, caeiin amablemente de nueetroa labioa, dichoeoa de aer ^tika a voa, encama- 
ci6n de eaa caiavana^e madrea que al recibir al hijo, ae encuentran extxsviadaa en el 
miaterie de au ciianza. 

No 08 amedrentda, aefiora, nada nuevo exiate, que no haya aido piofundamente pre- 
viato y las leyea naturalea ae cumplen irremediablemente como profedaa de un aer 
infallible. 

Aaf, que ai vueatroa temorea oa pueden llevar a aer extremoaa en loa cuidadoa hada 
eae pequefLo aer que ha nacido, no deb^ enloquecer ante el miaterio del future que oa 
dar6 a conocer con mis palabras. 

Pero, aefiora, un primer cuidado hoy. Oa hall&ia convaleciente, debilitada fiaica- 
mente y preparando alU en la intimidad de loa tejidoa la vida de vueatro beb6. 

Deb^, pu^, permanecer tranquila. 

Mafiana, cuando el nuevo cliraite reclame con aua Uantoa aqudlo que eat^ia elabo- 
rando, debris reqwndeiie con hechoa y n6 con palabraa. 

Y 61, sefiora, cuando pide, exige y no entiende razones. 

Para ello, sefiora, nada de viaitaa. Vuestro eapoeo mia locuaa que de coatumbre, 
tea contari alU en la aala toda eaa aerie de infamiaa que me ha dicho antes de ll^gar 
haata aquf, lea dir& que peea 4 kilos y 200 gramoa, que ya rfe, y quea61a61oae parece. 
Todo eao, y mdui me ha dicho, aefiora, y asombraoe; no ae ha quejado adn de aua ne- 
{ocioa, ni de au eatancia en caaa. Ya v^, aefioim, cdmo, ain querer, hab^ enloqueddo 
a un hombre. Y oomo debo predicar con el ej^npk), mafiana hablaremoa de vueatzoe 
cuidadoa a fin de que pod&ia, sola, conaeguir ver en marcha % eae divino beb^ que ha 
Uegado. 

DiOIMA ViaiTA. 

Airef luz, 9ol para la madre y d hijo — El cigarrillo patemo — El ealdo es agua — Menu 
de parttmerUa — Ledie contra ctrveza — Menik definilivo. 

Sefiora: i Y estaa tinieblas pavorosaa que os envuelvenT i Sab^ia que en la calle 
reina un sol otofial magnlfico y que paaamos por uno de los mejores diaa dd afio? | Todo 
cerrado! ^Por qu6? ^Teneia fiebre o cefalalgia? Nada. ^Entoncea a que eata 
tumba T Ah, vueetra mamil ha dicho ... Lo comprendo. 

Os dije tranquilidad, nada de charlaa importunaa pero no por eao oa iba a ezigir d 
enclauatramiento total. No, sefiora, aire, luz, vida para voe y para vueatro beb4. 
No teng&ia miedo. La luz le har& entomar los p^urpadoa pero jamia le har& mal, a tal 
grade que cuando €i pueda moverae lo tendr^ia dempre curioaeando por eaa ventana 
por donde entza d rayo de ad vivificante y aano que cdorear& aua mejillaa con tonoa 
de roaa. No temiia al aire libre. iX dari amplitud a aua pulmonea que ae adaptan 
eapl^ndidamente d medio ambiente. Temed m^ d confinado, d que ae reepira en 
eata piesa en d que ae sobreagrega el acre dor de tabaco dd cigairillo patemo. 



PUBLIC HBALTH AND MBIUOIKB. 207 

lAh>aefioi»l ^ Pretond^ justificar a vueetro aqposo ? ^^fumadopoco? Pues 
biea^ safion^ decidl«: ''£1 doctoc ha dicho que os prohibe fumar e«Eca dal nene," 
porque, sefiora, mis mal le hace eao al pequefio <diente que im aire Mo pexo caigado 
deeodfene. 

I Y que bebida indigna es eaa que veo sobre vueetoa meia de ioa? Oaldo . . . 
flaco . . . degaUina . . . Vueetra mam& tambi^n . . . Eadecirquedeadeayerno 
^abwb^e alimentado m4i que con tasaa de caldo. i No oabiie sefioia que el caldo es 
ag«a.coag!ueto a Ml y a veces con aabor de algttxia lefumbre pei» Guyo valer alm^ 
eenulo? 

Abandonad eaa; Becentiis algo nutiitiiw, fl^ido» que oe d4 iuenas. Tmatemes de 
coDapagiBar un "BMnn." Pzimeio uu poco de jam^ cocido. No os alarm^ie^ Sefiera 
Mayw, lo digeriii vuestzo nieto en cuanto cumpla sub doe afios y pcetendiie que a 
traestra eefioia hija en plenitud de salud le pueda ser nocivo. Bn seguida ua buen 
floto de sopa de avena, excelmite alimento mientzas necesit^ Uenar el est^nago 
inoaciable dei duke tkanuelo. Desde luego un buen pui^ de papas, del que ped^ 
flerviioeimplatobieaeolxaado;ycomopestie^ ^ Que querela depoetie? Unacramay 
ima ooBipela, frutaa, lo que gttst^, sefioia, y he abi Yuestro 'hne^ 

Ak enanto a bebidas, es han hablado de la cervesa y oeme de opeitunidad paisa la 
funci6n que estdis por cumplir. i Os han vanagli»iado la negia y basta ban aaeguiado 
i|ae la extiaiijefa con un jabali di«akndo oomo aarca, eala mis b^vofable? 

Puee taiea, sefioia, ahl toa<Sle otro piejuido. Eso no sirve paia aada. No aportaiA 
ni ana sola goCa al alimento del pequefio clioite, y en eambio le propotcionai&sedoa 
delew de Tieafare por el aleohol que contiene. 

Agya, agua puia, be ahf la bebida y leehe en cantidad, abunifi^te, mejer a^&n si 
eacottlBtts algttia que no haya side dilulda per la mano mereenaria del exp^mdedor. 

(km esoe dos liquidos tendinis aseguiadas las funcioBeB fisiel^gieaa ngrresarias paia 
co n e ofv ar Yuestra salud. 

TeMid eataadidoi, sin embargo^ que d mend propuesie^ es de oeaaida, amfianap 
Hiidis psflMk), viAym^M a vuestza alimeataGi^ erdlnaiia, p^rqae ^la sola sei4 
■rapm dasadar el colosal apekito del ezigente beb6 que ha Uegado. , 

unbAgima tisita. 

La/khckMfdma p $e wntagict^^Oomit^ isnmkt p Ooror— JSvorie 4$ la alimtmlmiiit 
Dupertad a un nifSo dormUAn — Comer dormido. 

Sefiora: Ese req>etable caballero que estd a vuestro lado y que segthi asQguia 
Tuestio idolatrado esposo comienza a tiranizar el hogar, va a merecer hoy una severa 
lecddn. No, no oe riiis. lEa veidad que anoche atrond la dulce quietud de vuestza 
casa am Ilantos intempestivoB? ^Es cierto que no quiere desprenderae del lugar 
de SOS delicias? 

{Ah picar6n{ hiimos ligeramente tolerantes dada su pequefiez, pero comienza a 
crecer y requeriri un fuerte correctivo a fin de que una vez por todas sepa que fl 
es aquf un intniBO, sin gobiemo y cuya tinica misidn es comer y dormir, y lo demis 
cuando le d^ la real gana. . . . 

^Anotiis, sefiora, mi tone chacot6n de hoyT Es debido al aura de feliddad que 
aquf se respire. 

Vos^ am la placidez del deber cumplido, el beb6 con la modorra del future buigu^ 
adinerado, vuestro esposo con esa sonrisa de superioridad de sujeto capaz y que lo 
ha probado hasta la evidenda y vuestra mamita con la mirada de bondad infinita 
que embellece el rostro de las abuelas; todos preparan mi espfritu hada la al^grla. 

Es que, sefiora, la yida es hermosa, cuando sabemos disfrutar de ^a, y esto que 
parece a primera vista una majaderla encierra su fondo filosdfico que quizd no pueda 
{amis desdMroslo. 



208 PBOCEEDINGS SECOND PAN AMEBIGAN BOIBNUFIC G0NGBE88. 

Y bien, sefiora, iqa6 hace nuestro p^equefio cliente? Gome y du^me, iBdemim 
lloraT Tres eosas que reglamentar a &n de hacerle comprender de una vez per todae 
que en la vida hay siempre uno que manda. 

Gomer: vuestro beb6 en este primer mes de su vida no debe satiflfacer su apetita 
mds que cada doe horae y media. 

^ Y ai llora, el pobrecitoT 

Hay un solo recurso, y es algodonane loe ofdoe. Gomprended, seflora, que ai tot 
le diia vuestro alimento antes de las hona prefijadas ^ste caer6 en el estdmago aatee 
de que el anterior lo deeocupe y el proceso fiaiol^co no podri cumplirse. 

Estos intervalos se espaciar&n pasado el primer mes, hasta tres horas. 

Adem^, sefiora, se requiere un descanso nocturne de seis horas por lo menos, a 
fin de dar descanso al6igano. 

Estos conceptos, dichos asf, a la ligera, merecer^ vuestra meditaci6n y seguramente 
en el proceso cerebral que los presida aparecer& el recuerdode c6mo fuenm ciiadoa 
vuestros hennanos y vuestra bien querida Mamita aigumentar& que ^a nunca us6 
reloj para llevaros a todos, a mayores, y sin embai]go, estSSs todos sanos y robustos. 

Podria dedros tambi6n que ''hoy las ciencias adelantan que es una temeridad/'^ 
y que por ende hay que marchar a su vera, pero quiero mejor que septo en que est^n 
fundadofl mis asertos. 

El est<knago del niflo es extremadamente tolerante. Admitiri seguramente que 
lo caigu^ cada 30 minutes o quiz&s m^ a menudo, teniendo come tinico llmite la 
glotonerf a de su poseedor. Pero un drgano a quien le exijiis tal trabajo tendr& hctal- 
mente que suMr y lo piimero ^sab^s?, lo primero que sucedeii con ^1, es que se 
dilataii, y ya en ese camino se har& disp^ptico y comenxari a devolver su contenido. 

AI principle lo arrojar& inmediatamente despu^ de recibido, caso f&dl y perfecta- 
mente curable; despu^ lo volver& a arrojar a la media hora, o a la hora, caso y% mto 
diffcil y al final ya no digerir& y vuestro beb^ enflaquecer& hasta el marasmo. 
• Quedamos, pues, convencidos, sefiora, que para que vuestro admirable pequefio 
se haga hombre, deb^ cumplir estrictamente estos preceptoe, evangelios de la buena 
nodriza. Y disculpad, sefiora, por que oe honre con ese tltulo, porque 41 es v u ee tiO ' 
mejor galaiddn. 

Sucede a menudo, sin embaigo, que a pesar de ser espadados los momentos de 
alimentacidn, el estdmago devuelva inmediatamente despu^ de ing^idoe, parte 
de su contenido. 

No OS alarmar6is por eso ^veidad? 

No, pero deb^ conegir la causa. 

Vuestro beb^ devuelve por que es un tragdn. No le quite un dpice al adjetivo. 
Trag6n, si— que ''chupa"— demasiado. Pues bien, sefiora, ^qu4 hay que hacerlef 
No dejarlo. 

He ahi resuelto el problema. Si comprobdis que escando quince minutos prendido 
devuelve, dadle trece; si con trece, dadle doce. En fin moderad el tiempo hasta 
que notdis corregido el defecto. 

Y si duerme, decis ^debo darle el alimento? Tentado estoy de respoiiii^ros: quien 
duerme, come; pero si eso dijera podrfais acusarme de error. Es que hay nifios pere- 
Bosos que no se acostumbran fdcilmente al horario alimenticio. Con 4Mob nos queda 
un tinico camino: ponerlos al seno adn dormidos. 

Gomprendo en vuestra mirada de compa8i6n la pregunta que me v^ a hacer: 
''^Pero doctor no tento Ustima de despertarlo cuando estd tan plicidamente dee- 
cansando?" No, sefiora, la listima es un sentimiento que debe ser regido por la 
necesidad y el beb^ necesita alimento. 

iPor qu6? 

Por que si lo dejiis dormir cuando despierte tragard demasiado y se enfermari. 

Los nifios asimilan una cantidad fija a igualdad de edad y el perezoso que olvida su 
hora tiene para alcanzar al diligente, que absorber el doble con menoscabo de su 
salud. 



PUBUC HEALTH AITD MEDICINE. 



20& 



D^ftmoe sentado pueo este otro precepto: ^'cuando Hegada la hora vuestro peque- 
fluelo duenne, lo pcmdr^is al eeno." 

Pero, i>od6i8 decirme ^cdmo hacer si estd profandamente donnidoT 

Nada mia f&cil. ^Hab^is visto alguna ves cebar a loo pichonee? Con apretarle lao^ 
conmisuraB del pico y x>oi^^l6 ^^ alimento sobre la lengoa ^los se apuran a deglutirlo. 
Vuestro pich6n hard lo mismo con la tinica diferencia que, como 61 no tiene pico, se la 
deber^is poner entre los labios y hacerle ligeras compresiones en las mejillas. He ahf 
resuelta la grave cuestidn. 

Os ruego amables clientee, que con deferencia me atend^is, que vayiis anotando- 
mis procedimientos porque 611os haWm factible vuestro deseo de ver truisformado en 
un perfecto hombre a ese precioso beb6 que ha llegado. 

DUODtoMA TIBITA. 

La revUaeidn HtU de midico — E$tudio de las fontanelai — La balama del pobre y la del 
rieo — Lai pe$adai^iC&mo daher ti vuestro nene progresaf — Tahlas maUmdHeas para 
coda easo. 

Sefiora: ^Os admir&is de la revisacidn prolija que bago de vuestro beb^T Goth- 
prended, sefSora, que es una m^uina pequefia, ea verdad, pero no por 6II0 meno» 
compleja, y con mi revisacidn me aseguro de que cada pien estd en su lugar, apta. 
para hacer funcionar regularmente el mecanismo. 

^ Y bioi, seftora, que he notado? Nada y mucho. 

He obeervado la cabeza, palpado su tenue eequeleto, estudiado el eqpacio de separa- 
cidn entre sub huesos (fontanelas), las he visto latir y me he as^gurado del estado de 
tirantes de las menbranas que llenan los eepacios libres. 

^Para qud? Os dird, sefiora, para nosotros el hallar bien Uenos esos espacios noa 
garaatisa la buena alimentacidn del bebd asi como su hundimiento nos advierte que* 
hay alguna causa que impide la asimilacidn. Es "2a balanM del pohre'* quien sigue 
religiosamente sus indicaciones. No es necesario que os afirme que el cliente ha 
aprovechado bien del surtidor y que sus fontanelas lo exteriorizan patentemente. 

Voe, sefiora, no necesitiis observar eeo, pues, he puesto en vuestras manos una 
balanza de relativa precisidn. ^Para qudT Ah, sefiora, sois curiosa y sin embargo, 
OS aa^gnro que no me alarman vuestras ansias de saber, al contrario, vuestras amabW 
preguntas, me llenan de satisfaccidn. 

La balanza, sefioii, serA el medio de probaroe que son ilegftimos vuctotros temores de- 
falta de secrecidn. 

^Cdmo? Pesad al bebd antes y deepuds de cada ves que dl extrae su alimento y^ 
anotad la diferencia. Os asombrardis de su glotoneria. Verdis como al cuarto d^ 
Uega a tomarse hasta cuarenta gramos por ves, es decir, que en el dia ingiere, el tu- 
nante, casi cuatrocientos gramos de rieo y sano alimento, y que iri, poco a poco,. 
ascend iendo hasta absorber al noveno mes escasamente un litre. 

]Un litre, verdad, que es asombroso! i Esta fnfima personita, capas de chuparse uik 
litro en seis vecest 

Pero tened, sefiora: ahl os dejo un cuadro consoladcnr para los casos de duda: 



Edad. 


NAflMro 
deTfloes 
pordla. 


CMltidMl 
pOTTiS. 


Total tn 
•Idia. 


Bdad. 


Nttmcfo 
deTBCM 
por dia. 


pofTis. 


Total «n 
•Idfa. 


Idia 


10 
10 
10 
10 
10 
10 


Oniiiioi. 
4 

10 
25 
85 
40 
45 


Orama. 
40 
100 
350 
850 
400 
450 


l«ra€8 


i 


Oraaiot. 
70 
75 
00 
180 
100 
170 


OraaiM. 
080 


aSi;;:::;:;;;:;;; 


2*iiia 


f7ft- 


84I1S. .. 


3* mes 


790- 


A^tm 


0*m«s 


910^ 




0*mc8.! 1... 


90O< 


> ittmuia , 


lafto 


i.oaoi 







210 PBOGEEDINOE 8B0O]n> PAK AMBBICUK SCIEirTIFIG G0KQKB88. 

Notad deid« luego la utilidad da voastra balansa para conocer como aainula el 
cliente el n^tar que le diBpenaftiB y con ^llo oa c<»venc0r6is a menudo que vuentraa 
lamentacionea aobre el poco credmieoito del beb4 son ixifundadas. Peaad al beb^ 
inwediatamanta deq>u^ del bafio todoa las diaa e inacribid oi vueatra libieta de 
ordeaada aom de ca8% sua progreaiyoi aumeutoa. Oa produdzi admiraci^n ver como 
imestro beb4 Uega a hombre: 

25a30gramoapordia, el primer mes. 

23 a 25 gramos par dfa, el Bes:undo, tercero y cuarto mea. 

20 a23 gramoa por dia» el quinto y aexto. 

18 a 20 gramoa por dia^ el f^ptimo y octavo. 

12 a 18 gramos por dia, loa tree tiltlmos mesea del primer alio. 

8 a 12 gramos por dia, el primer semestare del segundo afio. 

Retened estas ci£ras que no son ezactas pero que casi siempre se acercan a la verdad. 

Veo en vuestros ojos la duda y la alarma. ^Porqu6, Sefiora? |Ah, sil lo com- 

prendo, vuestro bebuS ha bajado de peso estos cuatro primeros dias y yo os lo habia 

advertido, como una regla fatal. En cambio ahora, afirmo aumentoe progreaiyos* 

^No comprend^is mi dualldad de criterioT Es que aqudllo es la excepddn. La 

primcra wmanaaariampre dereba|a» poirqueel niAo descaiga 8a» deaperdicioa acunm- 

ladoa y eto ae traduce en una diaminuei^n de peso, disminucidn ml «i la baIaBs% 

pero iluaoria ai deaoeatamea el lactov ennncaada. Vueairo nifio progresa desde au 

nacimiento y s^guiri poco mis o menoa^ la aigiiientft eaeala que copio de un impreao 

repartido profusamente pot d Oon^ulkine ''Gata de lacbe" <pie dirige en Moateyideo, 

el Doeloa Ju]i» ▲. Saaai: 

Onmot. 

Pesoalnacer 3,250 

Peao el primer mes .« 3, 850 

Peso el segundo mea 4,500 

Peao a los trea mesea 5^200 

Peso a loa cuatro meses 5,000 

Peao a los cinco meses 0,500 

Peso a los aeia meses 7,000 



Or 

Peso a los siete meses 7,450 

Peso a los echo meses 7,850 

Peso a loa nueye meses 8,200 

Peso a los diez meses 8,500 

Peso a los once meses 8, 770 

Pesoalaiio 9,000 

Peaa a loa doa afioa 11, 500 



O a n a ofv ad tambi^n^ eele cuadro. Oa preataii el gran aarvido de cafanar vueatiaa 
aanrosas alarmaa. Peaa, no ea cifi^ demasiade a sua totalea matemdticoa, pot^ue 
cada ser tiene una regla propia que no ae encuadra en tablas demawiado aeyeraa. 
Yer^laen 61, adem&s^ el p<»yeBir riaoefio que mpem al diyino diante y que se cumpliri 
realmente, siempre que sig^ los consejos que disperso en estas p^c^naa y que Ueaa- 
rin W aspicaci6n real qiue albeigAia de yer pueato en maicha a eate ptecioK) beM 
hallegado. 

DtaMATBBCIA yiSITA. 

^fifi^ la nmsocitfn: Lo$ ofoB mno$ y en /lu ni m L a i^Mnki purukiUa-'hmimmit 
Uamado del oeuliita^Loi ganfflkm M emlio-^Bl corardiir— JffI eamine ie Uu hm nm . 
i Vuutro hM 4% wmplitof 

Sefiora me pregunt4bais ayer" ^Pero, Doctor, es que los nifios pueden nacer con los 
ojos enfermos?" T lo hac^, al ver con que cuidado los reyisaba en mi examen 
general. 

Si, Sefiora y muy a menudo. £1 pasaje del beb^ es un escobill6n de anastre de 
<:uantos g^rmenes hay en su camino. Por eeo, y nada m^s que por eso, oa recomendaba 
«xtremar las medidas higi^nicas los ditimos dfas, y la m^or prueba de que hab^is 
•cumplido mis instrucciones est6 en la carenda de todo f endmeno irritatiyo en el aparato 
ocular del pequefio. ^Y si no fuera aai? Si aai no fuera, me yeriais correr con vuestro 
bebd a casa de un oculista. Estas afecciones de la yista en un red6n naddo son gene- 
calmente fatales, cuando por un deacuido no se tratan inmediatamente. 

Rguraos d horror de una madre, y no os hablo de una descuidada, aino tan sdlo de 
una poco preyenida, que al lleyar a su querido ingel al consultorio del medico, oye el 



PUBLIC HEALTH AND MEDICINE. 211 

fatal diagn63tico de ceguera. Y eao, que la mayorfa de las veces ^llas habfan agotado 
el repertorio caflero de medicaci6n ocular, enjuagaban loe p^adoe supurantes con 
aguaboricada; buscaban colirios de origen fannar^utico y con la convicci6n de la 
pronta desaparicidn de Iob slntomas, vivfan tranquilas. 

La oftalmla purulenta es una afecci6n grayMma que exige los mayoree desvelos 
para su cura y aobre todo el m4B ripldo tratamiento, a fin de que el pus no lunrade la 
c<3Tnea y la Ie8i6n eea incurable. 

Atenci6n, pues Sefiora, y cuidad en el futuro con los prdximoe bienvenidos, que 
tal desastre no llegue a suceder. 

Observe adem^s, el cuello del pequefio. ^Pua qu^7 Os responder^ en dos pala- 
bras: Buscaba gUndulas (ganglios). ^Y qu6 oe indica su existencia? 8u existencia 
me revela, Seflora, segdn la dlspoaid^n que 611as adopten, afecciones del oido, de la 
gaiganta, de la boca, del cuero cabelludo o estados generalee deficientes. Cu^tas 
veces la existencia de un ganglio noe obliga a investigar cuidadosamente la causa. 
Y con ^0 comprobamoe afecciones que hubieran pasado inadvertidas a expertos 
ojos de cllnico. Os ruego, teng&is en cuenta esta indicacidn para Uamarme apenas 
confirm^is su aparici6n. 

Revis^ cuidadosamente el coraz6n y comprob^ su ritmo normal, que nos asegura 
que el pequefio ha completado cuidadosamente su tabicamiento antes de venir a la 
luz. Por €[, pod^is estar tranquila, sefiora, que, como medico y amigo os afirmo que 
vueetro beb6 es ya de buen coraz6n. 

Comprob^, ademius, que los caminos vulgares de las hernias se hallaban perfecta- 
mente cerrados y que por ende era improbable su produccidn atin en los mayores 
esfuerzoe, y cuando me hube convencido de que los diganos todos ocupaban el lugar 
elegido para su perfecto funcionamiento, os dije: ''Sefiora, vuestro beb6 es completo, 
donnid tranquila y sofiad con dias de felicidad que os depanuri, a buen seguro, la 
vida de este divino beb6 que ha llegado." 

DtoMAOUARTA VISITA. 

Manteniendo el orden — Energia de lo$ primeroe dic»—El llcmto no oau$a hemioB — La 
utilidad del llanto — La diemmucidn del alimerUo caueada por noehe$ de vigUia. 

Sefiora: Oir^ vuestras lamentaciones con la estoicidad de un confesor y al final 
hablar6, porque creo que en mis explicaciones encontrar^ un lenitive a vuestras 
penas. 

Decls: "Doctor, el beb^ no espera la hora; Uora, se sofoca, grita, se revuelve en 
esa bendita cama en que me hab^ exlgido lo coloque y no puedo comprender la 
causa." 

"Doctor, me han asegurado que llorando mucho se podrfa quebrar.'' 

"Doctor, temo que con estas noches sin dormir, disminuM la provisi6n del pe- 
quefio." 

^V6is como os he escuchado? Ya no podr^is decir que mi tiranfa dentffica hace 
ofdo de mercader a vuestros lamentos. 

Os he entendido y quiero que la tranquilidad vuelva a esa almita de madre carifiosa 
que se desvela por el bien amado. 

Vayamoe en orden y no me intemimp&is mis que al final de piurafo, porque yo 
como ciertoe oradores, me inmuto, pretendo contestaros atropelladamente y quedan 
al concluir mis visltas varias preguntas sin respuesta, con pesar para vos y afliccidn 
para mi. 

Sefiora, vuestro beb^ no espera su hora porque es un vud edueadOf y al calificarlo 
asl me acuso de haber side d^bil para con €L. 

Pero, estamos siempre a tiempo para su correccidn. 

^Sab6is c6mo? 

68436— 17— VOL ix ^W 



212 PBOOEEDIKQS SECOND PAH AMEBIOAK SOIEKTIFIO 00K0BE88. 

£1 niiio no es mis que un pequefio hombre, y td Me es un animal de costumbre, 
aquel cuyo cerebro no tiene atin trasadas mis visSf ee impregnaiA ttdlmente con los 
h&bitoa que le dejamos adquirir. 

Vuestro divino nene vivid tree o cuatio dfas a vueatro lado con la fuente de sub 
satisfacciones junto a los labios, amparado al calor de vuestro cuerpo. 
En esas condidones, creed sefiwa, que es t&dl acostumbrane, y tan i&cil. 
Bien; resolvemos instituir el oiden, compramos la cama, que yo miamo exigl ser 
quien la eligiera y que segdn vuestra buena mamita es fea, demasiado simple y pobre 
como la de una prisi6n, calificaclones las tres que dicen verdad, pero que mafiana, 
OS explicar^ por que no son justas, lo colocamos en ^lla y comienzan los Uantos del 
cHente. 

Llora entonces porque no est& a vuestro lado. 

Pero, como alii esti bien, convendr& que de alii no saiga, y con vuestro asenti- 
miento, que revela sensatez, no se mover^. iQa^ puede faltarle en esa camita que 
es un nido? 

Nada. 

^Galor? lo tiene; est4 rodeado de ponones que cuidadosamente envueltos y ale- 
jados, le proporcionan un calor suave. Su estdmago se colma cuando es necesario 
para su vida. Su limpieza est4 cuidadosamente vigilada y lo mud&is frecuentemente, 
y a medida de sus necesidades. 

lQa6 mis quiere? 

Si, yo 8^ lo que quiere. 

Quiere a vuestro lado tiranizaros, impediros hasta dormir tranquila. 

^ Por qu6 no me digdis, sefiora, que dormiais feliz cuando no sabiais, si en plena 
inconsciencia, al daros vuelta, lo ibais a aplastar con el peso de vuestro cuerpo? 

Y no me mir^is como afirmando que lo que os digo sea una exageracidn, porque 
cudntas madres lloran, por un nimio descuido de resultados tan pavorosos. 

Hay m^, a vueetro lado no podridis resistir el fmpetu de besarlo apasionadamente 
cada vez que entreabriera los p^adoR, el de mecerlo en cuanto hiciera un mohin de 
disgusto ese pequefio rostro de dngel. 

Eso no le conviene al beb^ porque si lo desedis sano y fuerte es necesario no balan- 
cearlo y os dir^ el porqu^ mafiana. 

Es necesario, adem^, dejarlo Uorar a fin de que se amplifiquen sus pulmones, que 
entre en ^llos el aire a raudales y se forme alto y ancho el tdrax de atleta, que carac- 
terizard al beb^ ideal que pretendemos formal. 

En cuanto a las hernias de que os he hablado permitid que me sonrfa. 

Otro prejuicio que os ban pretendido inculcar y que no resiste ni un segundo a un 
anilisis un poco severe. 

Si el nifio tiene una hernia hay aparatos especiales que casi seguramente se la curar&n 
en los primeros afios de su vida y si no estari el bisturf del cirujano que ante su persis- 
tencia hard la cura radical en pocos minutos. 

Pero, sefiora, ^cr^eis poi ventura que una hernia se forma por el solo hecho de Uorar? 
Con tales ideas, podriiis as^urar que no hay solo nifio que no sea quebrado, porque 
todos han llorado. 

lY que pretend^is que hicieran? 

^Saben cantar, gritar, silbar? No. Entonces lloran. 

Permitidles ya que no tienen otra, su mon6tona manifestaci6n de vida. 

Pero esa no serd seguramente la causa eficiente de una hernia. 

Cuando existen son debidas a un defecto de formaci6n, a la persistencia de un con- 
ducto que debfa haberse cerrado antes de que entrara el aire en los pulmones del nifio, 
y que permaneciendo abierto permite la salida de las vlsceras con el esfuerzo del 
llanto. 

No tomto entonces como causa principal la que no es m&s que cooperadora, con 
un papel secundario y sin efecto a no existir la primera. 



^ PUBUO HBALTH AKD MBDIOINB. 213 

Quedamo6, puee, que a un nifio quebrado, que Uora se le hace viable su hernia; 
Tentaja al fin porque obliga a la instituci6n inmediata del tratamiento. 

No 06 aflij&ifi, porque el vueetTo llore, (\ ha sido cuidadosamente reviBado y os 
garantiso que eetd perfectamente concluldo. 

En cuanto a vueetro temor, no os dir^ que ee infundado; las malas noches os hacen 
mal segfuramente en vuestra misidn de nodriza y por ^llo es que me apresuro a enca- 
irilar la vida del beb^ que es tambi^n la vuestra y, como si a 61 lo dej&is uno, dos, 
tres dfas, si no es un obcecado, en las condiciones que os he impuesto, la tranqui- 
lidad volverd a vuestro esplritu y podr^b entregaroe al sueiio de^pu^s de besar son- 
riente en su nidito de amor a ese pequefio beb6 que ha llogado. 

DlftCDCAQUINTA VISITA. 

El chupete y 9U8 peligrv — El poblador de microbiaa — Calmdis d lUmto y adminxBtrdii la 

muerte-^uerra al chupete, 

Sefiora: He ahi un verdadero instrumento de tortura. 

Ese aparato indigno que hab^is olvidado sobre vuestra mesa de luz. |Qu6I ^No 
lo habe^ dejado por olvido? Ahl ese es su sitial de honor. 

Cerca de vuestras manos y de la boca del dngel. 

^Pero, entonces, sefiora, sois inocente del gran error que os hacen cometerT 

^Y qul^n? 

Vuestra mamita y varlas amigas os han dicho que con esa tetina pod^ pasar buenas 
noches, plicidamente dormlda, y que cuando vuestro beb^ llore con solo sumerglrlo 
en un poco de agua azucarada y pon^reelo entre los labios, 61 Pe calmard y rumiar^ 
8U rabieta tranquilo. 

Ah! OS han dicho eso, y vos, sefiora, etemamente obediente, claro lo habits mandado 
buBcar y estdis dispuesta a usarlo. 

Pero ^llas no contaban con mi visita. 

iTirad eeo; a la basura con 611 

Ese maldito ''chupete" ha hecho m&s vfctimas que la eecarlatina y todavfa hay 
quien lo use. 

Oidme, sefiora, madre del hermoso nene que debe ser para vos vida y felicidad, 
presente y porvenir, que debe — iqu6 digo — debe?, que ee un trozo de vos misma, 
encamado en ese misterio divino que respira, escondido en su nido de amor. 

^Quer6i8 su vida? 

Sf, y entonces, sabed: esa tetina es mala, ee peor, es perversa. 

Pero quiero justificar mi enojo, quieio que os ddis cuenta del error. 

VueetTD beb6 mantiene entie sus labioe la fuente hermoea que le brindiis y se 
lecrea en 611a seguio de que de allf no Baldr& m^s que un sano y puio alimento en 
el que la industria no se ha innuscuido y en donde la flora bacteiiana no puede ser 
prolifica porque es ahuyentada por los medios defensives con que os ha dotado natura. 

Vos, en cambio, le pon6is entre los labios un pedazo de caucho en el que se albergan 
cuantos microbios existen y del que no extraeril seguramente ningtin jugo. 

Y lo perjudic&is, no s61o porque le robiis sus derechos adquiridos al nacer de una 
mejor calidad de C(msumaci6nf sine tambi6n porque en ese pequefio "chupete" va 
muy a menudo escondida la muerte. 

No vale que lo hirv^; &talmente inaidioso y desleal como es, 61 buscar& microor- 
ganismos en vuestros vestidos, en vuestras manos, perfectamente lavadas pero no 
aB6ptica8, en la ropa de vuestra sirvienta, o en las del mismo beb6 y con su armamento 
olenaivo se recreaid en poblar la boca del cliente con cuanta bacteria maligna genuine 
bajo el sol. 

Nada digo de cuando cae al suelo y que vuestra nifiera se apresura a levantar y 
restituirlo entre los labios, porque s6, sefiora, que vuestra vigilanciase mantiene ante 
unpeHgro. 



214 PBOGEEDINGS 8E00KD PAN AMEBIOAK 80IEKTIFI0 CONQBESS. 

^Pero olvidiis seflora, que a menudo vuestrofl ojoe pueden diatiaene y el hecho 
acontecer? 

Por otia parte, razonad: el chupete causa los pequefios mdsculos destiiiadoe a la 
Bucci6ii y cuando vuestro beb6 prepare su0 fuerzas para la acometida real a que tiene 
derecho, laa encoutiar& debilitadas par el excedvo ejerdcio. 

Ademis provoca las secredones natuiales que se desperdidan dn cumpHr sub fines 
digeetivos. Verbis que la saliva aparece en abundanda en la boca y no debds olvidar 
que esta secreddn lleva aparejada por fen6menos reflejos la de los demis 6rganos, 
l^es como estdmago, hlgado e intestines que serin indtilmente perdidas, desaproye- 
chadas, siendo tan necesarias para el momento efectivo de la digestidn de los alimentos. 

Tirad, pues, sefiora, eee invento malhadado o mejor sefiora, didmelo. En nd 
bolaillo estoy seguro que no redbir& honores por mudio tiempo, porque pronto pasarA 
al verdadero lugar que le depara la cienda, que es el caj6n de los desperdidos. 

He ahf, sefiora, como sin querer he roto mi plan. Pretendla convenceros de que 
esa, mi cama, no es ni mala, ni pobre, ni lea, como lo asegura vuestra buena mamita, 
pero iq\x^ querela? hoy me he detenido demasiado, aunque creo no haber perdido mi 
tiempo, librando de un real peligro a ese predoso b6be que ha llegado. 

DiCIMABBZTA. YISTIA. 

La coma — Condiciones esencidUt — TuleSf hUmdat, cintas y puntiUaa — Coma firme, 
sin movimiento — Avi$o importante aunque jactaneioto, 

Sefkva: esa cama que ha redbido las ciiticas de cuantos la han visto, que se ha- 
hecho la vlctima de los adjetivos amables de vuestra Mamita, se impondr6 hoy a 
nuestra atend6n. 

Me decfais, ^por qu6 la habds elegido doctor, tan sendllota y deqgarbada? y d 
no OS he respondido ee porque todo llega a su debido tiempo, y ni yo quiero morinne 
ni lo har6 a mi gusto sin antes haber terminado nuestras amables pUticas — que aunque 
^llas etemas fueran, m^ lo ser&n seguramente mis deseos de vida laiga, pUUdda y 
fructifeia. 

Pues bi^, sefioia, ahl la tenuis, no hermosa en verdad, pero sf c6moda— y hasta^ 
casi . . . cad . . . afirmaria que no es fea. . • . 

Cuatro patitas rectas, dos laigueros, doe barandas, cabecera y pi^ de barrotes iguales, 
eUstico de metal dn muchos resortes ni demasiados adminfculos, y un laigo soporte 
que desde la cabecera se eleva para terminar en un gancho que mantendrti el mosqui- 
tero, he ahl todo. 

Sencilla es, tenuis raE6n; pero est& toda niquelada. 

^Querds m^ lujo? 

No tiene tules, blondas, ni puntillas, pero, i para qu6 le serviiin a ese predoso p^ijaio 
tales adomoB, verdaderos nidos de tierra, focos de bacterias, guardadores de insectos. 

La dencia os dir& siempre que eso no hard mds que poner al alcance de sus pulmonea 
un aire viciado, llenar el ambiente de impurezas, dafiar bus vlas respiiat(vias extre- 
madamente irritables con la presencia de cuerpos extrafios. 

Nosotros, ^verdad, Sefiora? no queremos eso para vuestro beb^. 

Todo lo contrario: aire piiro, oxigenado en demasia, que al distender d alv6ob 
pulmonar renueve el oxlgeno de los gl6bulos vertiginosamente; eso pretendemoe, y 
eso no se conseguiri jam&B, entre tules y cintas, entre blondas y puntillas. 

Admirad la sabiduria de la Naturalexa que ha sabido en el nido dd ave mantener 
la dificil sendllez de sus consejos. 

Pero, d la admirdis, imitadla. 

Cada hecho, cada observad6n, debe alecdonaros en la lucha por la vida. 

Habrds notado, sefiora y seguramente lo ha advertido vuestra Mamita que las 
barandas tan altas con bus barrotes parecen mantener en las celdas de una prid6n al 
predoso beb4, y es que asf debe ser, pues su middn no debe ser otza que protegeilo 
contra una podble caida. 



FUBUO HBALTH AND MEDIOINB. 215 

Los pdjazos previsoree, ahondan el nido a fin de que las sacudidas producidas por 
el viento no volteen las crfas, y habr^s observado que cuando un cicl6n eacude con 
impetus inesperados el sost^ de bus viviendas, una catistiofe conmueve los cimientos 
de la voUtil familia, dando por tierra con los pobres pichones. 

Tsxsk nuestro caso, no debemos tener en cuenta las causas naturales extrinsecas, por 
k) excepciouales, pero sf las intrfnsecas, dado que un pequefio movimiento hecho por el 
beb6, puede hacerlo caer con la suficiente fuerza para produdrle serias lesiones. 

Y pasemos a otra cosa. Notdsteis que mi cama es firme, fija, sin movimiento alguno. 
Sin las cuatro ruedas habituales, sin el eje que le permita balancearla. ^Por qu6T 
{Ah, Sefiorat he hecho la elecci6n de exprofeso. 

No quiero movimientos paia el beb6. Nada de sacudidas; aunque 61]as fueran 
levee como una brisa suave no son necesarias para su vida y son perjudidales y dir^ 
m^, altamente nodvas. 

Ese temblor, amable Sefiora, que en vuestras manos es una caricia, en las de vueetra 
nifiera se transforma en un vendabal funesto para la salud del cliente; y si el cerebro 
del hombre reeiste el sacudir de una hamaca, no as! el del niflo tiemo y delicado, casi 
OS diila gelatlnoeo y que en cada vaiv6n se moviliza y golpea contra las paredes. A 
tal grado, que el sueflo del beb6 es en tales condiciones, no el pUcido reposo natural, 
Bino m4B bien un mareo provocado. 

Por otra parte, el niflo que ha probado el amable "balanceo" acompafiado por el 
dmtico suave del "arrord" matemo, se acoetumbra, y el pequefio tirano que hay en 
cada alma humana se rebela e impone condiciones. 

iCuidado, Sefioral 

Serais entonces su esclava y ya no s61o no donniii, sino que no podri vivir sin el 
dulce balanceo o las amables caireritas de uno a otro lado de vuestro dormitorio. 

No olvid^is lo "del irbol que crece torcido, " y apresuraos a imponer condiciones, 
porque aquf es efectivamente cierto aquello que ''quien da primero, da dos voces." 

(Ah, SeiSoral me (dvidaba, nada de plumas, en las almohadas, 611as dan demasiado 
calor y provocan fen6menos congestivos. 

Una buena almohada de g^nero de algod6n, un par de buenas colchas y porrones, 
y estad tranquila; vuestro hijo no sabr& resfriaise. 

Y par dltimo, Sefiora, un consejo final que no lo tendr^is en cuenta, seguramente, 
peio que para mf tiene un fin capital: poned a los pies de la cama im cartel que diga: 
" iObjeto de artel lAdmirad, pero no toqu^isl " 

Tal aviso puede pareceros innecesario y hasta de mala educaddn. Pero no lo credis 
asi, Sefioia, son tan amantes a los besuqueos vuestras visitas y tan indiscretas que 
aabiin pasarle de mano en mano como im mufieco de trapo a ese divino beb6 que ha 
Ikgado. 

DtCIUJLBimMA VISTTA. 

Im wpa~-IfW€nUario de un ropero rieomenU pertredwdo—Mamra <U vuUr oZ bM—Lo 
que debe y lo que no debe hacer9&—El kngtuje del nifio—Lae reeervae natunUei, 

Sefiora: Me he detenido hablando con vuestro esposo, quien me ha mostrado su 
tnbajo de hoy. 

iSs^^is en qu6 se ha ocupadoT 

iN67 Pass bidn; con bus etemas manias de orden ha catalogado, conjuntamoite 
con vuestra mamita, la ropita del bebd y me ha interrogado severamente sobre las 
necesidades del pequefio. 

" ^ que cre^ necesario, Doctor, para el bienvenido, tan colosal tw ui $e au V* " ^O 
est^ de acuerdo conmigo, que es una exageracidn de mi esposa?" ^ 

He revisado cuidadosamente la lista, y iqn^ creels que he opinado? "Que dadaa 
vuestras condiciones de fwtuna no era demasiado y que con ella cuidadosamente 
guaidada serviria para la "seguidilla'* de que €i era capas." 

OiguUoeo de mi contestaddn, con una sonrisa de fuerza protectora que parecia decir 
"verdad que no ser6 el (hiico^, cohnada su satisfaccidn me entreg6 la lista que oe 
leer^y porque estoy seguro no la conoc^: 



216 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONaBSSS. 

ExUtencicu del ropero del hebi. 
Seccidn ropas. 

Gamisitas de g^nero muy fino, 4 tamafios, 1 docena de cada uno. 

Gamlsitas de franela, 4 tamafios, 1 docena de cada uno. 

Camicdtas de bombasf , 4 tamafloB, 1 docena de cada uno. 

Paflales cuadradoe de maddLs, 6 docenas. 

MantUlas de franela, 3 docenas. 

Mantillas de bombasf , 3 docenas. 

Fajas de un metro y medio de largo, 2 docenas. 

Rebozos de lana, N* 6. 

Batitas de lana (compradas) N* 12. 

Batitas de lana (regaladas), N® 7. 

Baberos de bombasf, festoneados, 4 docenas. 

Baberoe de hilo con puntillas (compradoe), 6. 

Baberos de hilo con puntillas (regaladoe), 5. 

Escarpines de lana (comprados), 24 pares. 

Escarpines de lujo (regalados), varioe pares. 

Pafluelos de batista, 2 docenas. 

Fajitas de franela pua el vientre, de 1} metres, 2 docenas. 

Gorras de lujo (regaladas), N* 4. 

Gasa as^ptlca en pedazos de 10 x 10, 3 metros. 

Falddn de lana bianco con encajes para paseo, N* 1. 

Oapa adomada con encajes para las ocasiones, N* 1. 

Faldones de bombasf para salidas ordinarias, N* 3 (salvo error u omisidn). 

Os admirdis, SetLora, y lo comprendo. 

Os hab6is excedido ampliamente i>6ro i es acaso una falta? 

Si vuestro bienestar fuera mis dudoso esa lista podrfa ser reducida a la mitad; mii 
adn, si os encontraseis en las condiciones de las m4B, que se preocupan de mantener 
la higiene de las ropas del pequetLo en su propia casa, imposibilitadas de pagarse el 
lujo de lavanderas para sus nifios. 

Pero veamos, Sefiora, ya que las ten^, ic6mo deber^is usarlas? 

Ante todo, os comprar^is un catrecito de patas laigas (1 metro, 60 centimetros), que 
OS lo hardn en cualquier carpinteria y que os prestari grandes servicios. 

^Para qu6, Doctor? 

Verels: mudar en la falda al pequefLo, es inc6modo, m4B que mudarlo en la cama, 
seguramente, pero como ^sta es en general baja, tendr^ que agacharos par demiis y 
ceder6is demasiado pronto a vuestra nifiera, la vigilante y i>erwana1f«ima operad^n de 
la mudanza del beb6. 

Por eso 06 aconsejo el catrecito que no debe tener m4B de 1 metro y medio de laigo 
y que doblado no ocupard casi espado para ser guardado. 

Os aseguro, Sefiora, que recibir^ vuestro agradecimiento por mi consejo. 

^C6mo vestirdis a vuestro beb6? 

Oolocad la camisita fina, enchuflada en la de franela y ^sta a su vez en la de bombasi 
y con las tres asf preparadas pasad imo y despu^s otro brazo del pequefio, guidndoles 
con vuestros dedoe en su travesia por la manga, dejando las aberturas de las tres hada 
atris. 

Extended sobre el catrecito, primero el cuadrado de bombasf, encima el de lana y 
arriba el de madr^ doblado en trlAngulo; de mode que el lado mia largo (hipotenusa) 
coincida con el borde superior de los cuadrados. 

Acostad encima de 611os a vuestro pequefio que ya tiene el tronco cubierto por las 
camisitas y seguidme ahoraen la operaci6n: paso la punta inferior de triimgulo entre las 
piemas del beb6, bien; envuelvo con otra pimta el vientrecito cubriendo la parte 



PXJBLIO HEALTH AKD MEDIOIKE. 217 

inferior de las camisetas, muy bien; con la otra marcho en direcci^n contraria y 
vuelvo a envolver el vientre y la parte inferior del torax, y ya tengo mi primer paflal 
colocado. 

Pero, seflora, ^veis como soy prdctico? y sin embargo me he olvidado de algo 
previo: un cuadrado de gasa as^ptica en el ombligo y para mantenerlo un par de 
vueltas con la pequefia faja de franela y ato con la cinta de hilera. 

Sigo, y OS mego no os alarms, que esto es m^ diffcildesciibirlo que hacerlo. 

Coloco los escarpines y ato d^bilmente la cinta de sost^. 

Vamos ahora, a nuestro cuadrado de franelas. Un lado lo arrollo al cuerpo del 
cliente y como excede mucho a los pies, lo doblo en su parte inferior a una altura tal 
que permita a los piececitos extenderse libremente; con el otro lado paso en direcci6n 
contraria por encima, y pronto el de franela; 

Repito la operaci6n con el de bombasi. 

Tomo la faja, previamente arroUada con la cinta en la parte m&i interna y a la 
altura de la parte m&s inferior del t6rax, sin comprimirlo. ^Ois bien? sin apretar, 
fluavemente le doy tres vueltas cuerpecito y ato. 

Con el rebozo, repito la operaci6n de los pafLales y lo fijo con dos alfileres de nodriza, 
uno en la vuelta de abajo y otro asegurando el borde libre y con la batita de lana hago 
la misma operaci6n que con las camisitas, pero, dejo la abertura en la parte anterior; 
fijo el babero y cantando victoria puedo, Seflora, marchar con vuestro beb^ al polo. 

Nada de gorras, dejad que el buen aire y el buen sol desinfecten el cuero cabelludo 
y no tem^is que vuestro beb^ se resfrie por eso, porque no conozco ninguna especie 
microbiana que atraviese el crineo para albergarse en la nariz y provocar un resfrio. 

Las guardar^ para las visitas de cumplido cuando el cliente se aderece con el rico 
fald6n de encajes y la soberbia capa que hard estremecer de envidia a cuantas madres 
flientan sobre d la irritante desigualdad de nuestra sociedad cristiana. 

{ Perd6n, Seilora, es un grito del alma, que como es el primero,deb^ perdonar? 

^Sab^ que me ha costado trabajo la descrii)ci6n? 

Pero, tenia tanto inter^ en hacerla, que no lamentar^ jam^ el haberla producido. 

Hab^is oMo hablar m&i de una vez de la conveniencia de fajar las piemas a fin de 
que no crezcan torcidas, de envolver los brazos hasta una cierta edad, de arrollar al 
pequeiLo como si fuera uno de esos largos caramelos que compribamos en nuestra juven- 
tud y chupdbamos con Igual fruici6n que la experimentada por un buen sefior fumando 
su habano de postre. 

Esos errores han desaparecido cad en la sociedad que habitamos, corridos por la 
ciencia que demuestra que un nifio que pueda libremente mover sus piemas camina 
tres meees antes que un enclaustrado. 

Pero todavla verbis a muchas madres que comprimen el tiemo cuerpecito del nifio 
con la faja, temerosas de que un frio les provoque un ataque de colitis. 

Con ^Uo demueetran no entender el lenguaje del nifio, tan f&cil de interpretar para 
una madre inteligente. 

Ver^, Sefiora, c6mo se traduce f^ilmente ese lenguaje. 

Vuestro beb^ Uora; bien, estari mojado, os decis. 

Lo acostdis y comenziUs a desprenderlo. 

£1 llanto cesa; es sdlo un gemido. El beb^ os dice con eso ''esto v& bien, mamita, 
seguid sacando.'' 

Lo dejdis completamente desnudo, el beb6 sonrie, juega con sus mamitas, pretende 
Uevarseun piececito a laboca, ^qu^osmanifiestaconeso? ''Estoy en la gloria, dejadme 

Gomenzdls de nuevo a envolverlo y la sonrisa desaparece, es que el nene expresa: 
^'estoy mejor; en verdad que estoy limpio; ^pero porqu^ recluirme?'' 

lY esa, tan ttcil interpretaci6n, cu&nto trabajo ha costado vulgarizarla? 

Sabed, sefiora, que el nifio no podri ser jam^ un abandonado de la naturaleza que 
d 611a da medios de defensa a los animales, con mayor raz6n debe d&rselos a los hombres. 



218 PBOCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGBESS. 

Somos noeotros, sefiora, loe civilizados, los que ensoberbecidcw en nuestro papel de 
seres superiores pretendemos torcer leyes inevitables. 

Nosotros que en nuestros prejuLcios y nuestros errores ponemos en peligro la vida 
de nuestros semejantes. Por eso, sefiora, os asombrar^is m^ de una vez, cuando os 
diga, dejad haoer, no oe amedrent^is; las reservas de la natuialeza son infinitas y cada 
ser trae en sf , aquilatadas, las necesarias para su triunfo definitive. 

Y ese optimismo bienhechor con que os hablo debe tranquilizaros respecto al porve- 
nir de ese pequeflo beb^ que ha llegado. 

D^CIMAOCTAVA VI8ITA. 

ExageradoMs de la vesHmentorSalida del hebS^-El bafio—iQwUn debe efeetuarlo^ — 
Condiciones del mismo — Manera de sostener ai nifio dentro del agvar-LoB lavados par^ 
dales — Necesidad de higiene. 

Ssfi^OBA: He ahf una cosa que os Uamard realmente la atenci6n« 

Dir^is: ''^c6mo doctor, c6mo, esa carga de ropa, vos que sois tan amante de laa 
leyes naturales?" 

Me adapto al medio, sefiora. 

La civilizaci6n ha defendido al hombre de las inclemencias del ambiente, ddndole 
ropas y vuestro hi jo, nacido de padres que saben usar del agradable calor de una buena 
cobertura de lana y despellejan animales para envolverse en pieles, no puede menos 
que pagar tribute a esa modalidad. 

Pero ^sto no quiere decir que yo no hay a exagerado un poco la vestimenta. Hablaba 
para un inviemo inclemente, rigiiroso, y no para todas las ^pocas. 

En verano, por ejemplo, podr^is restar ropas hasta admirar la blancura de su cutis 
en todas partes como gust^ y el chico sabr^ mantenerse en plena y lozana salud. 

Quiero recordaros, Sefiora, que es necesario lo saqu^is tan abrigado como desedis, 
transijo en ^llo, pero lo llevaHais a respirar el buen aire sano y puro que oxigenard sua 
incipientes pulmones. 

Llegada la tercera semana, elegir^is un dfade sol y alas doce o una de la tarde 
debris abrir ampliamente la puerta de la habitaci6n a fin de que por 611a pase airoso y 
fragante ese capullo que va a recibir el bautizo de la vida libre, y he tardado tanto en 
daros tan grata nueva por el rigor de la estaci6n, si fuera en pleno estfo, hace ya echo 
dfas que vuestro divino beb6 entomarfa sus p&rpados admirados d^ tanta luz y entre- 
abrlrfa sus labios al recibir la brisa, ansioso de acapararla para si. 

Quiero tambi^n, Sefiora, antes de terminar eeta segunda serie de amables conver- 
saciones iniciadas, cuando el divino beb6 hizo su primer mohin de disgusto, hablaros 
de algo que aunque b6, que ya estd instituido en esta vuestra casa no b6 como se ha 
hecho hasta ahora. 

Se trata, Sefiora, de la ''toilette*' del cliente. 

^Quer^ saber c6mo debris hecerla? 

Os lo dir6 en cuatro palabras. 

El bafio es una costumbre sana, de sabia higiene pr^tica, que asegurar& una salida 
franca de la trasudaci6n cut&nea, permitiendo una r^ulacidn de la temperatura 
interna y siendo una ayuda eficiente a la funci6n renal. 

Traduciendo mi frase un poco libremente, os dir^ lo linico que deber^is recordar: 
"El bafio del beb^ ser& para vos una r^la invariable. Serd una de vuestras obliga- 
ciones primordiales; sano, dadlo todos los dfas y enfermo todas las vecee que el medico 
ordene." 

iPero, c6mo? 

Muy fdcil. 

Tenuis en vuestras manos la pequefia bafiadera pintada al esmalte que si no fuera asf , 
08 dirfa, tomad cualquier recipiente de lata suficientemente amplio, lavadlo cuida- 
dosamente y pedidle a vuestro esposo que os d6 una prueba de sus mdsculos com- 
primi^ndolo lateralmente, hasta ovalizarlo. 



PUBUO HEALTH AND MEDICINE. 219 

Ten^ un jab6n de coco, de Espafia, Marsell^s de almendras, cualquiera que no 
tenga esencias violentas, una eeponja fina, on poco de talco finamente pulverisadoy 
agua fria y caliente y ya tenuis de todo. 

Un poco de voluntad y a la obra. 

Preparad el bafio a treinta y aiete grados, o m^ f^il combinad aguas hasta que 
sumergida vueetra mano no Bint^is ni frfo ni calor, y cuando llegu^ a eee punto, 
agregad un buen jarro de agua frfa. 

Desnudad rdpidamente al beb^ y colocaos a la derecha del bafio. 

Con vueetra mano izquierda envolved el nacimiento del brazo izquierdo del beb^, 
cuatro dedos pasando por debajo y el pulgar por el hombro. 

De este modo la cabeza del cliente tendii un apoyo en vuestro antebrazo que la 
har& levantar o bajar a voluntad. 

Sumergidlo rdpidamente en el agua y con vueetra mano libre enjabonadle r&pida- 
mente la cabecita cafda hacia atr&s, a fin de que el ]ab6n no vaya a los ojoe y enjuagad. 

Lateralizad la cabeza a uno y otro lado y repetid la operaci6n, cuidad entre las 
piemas y en todas las partes donde se formen esos riqufsimos rodetes, eetirando la 
piel a fin de impedir que en 611ob se hagan f ermentadones, origen de eczemas y otras 
afecciones de la piel. 

Ya todo enjuagado, en la operaci6n completa no deb^ emplear aniba de tres 
minutos, lo retirdis y lo envolv6is en la toalla, friccionando suavemente con 611a, lo 
empolv^ con talco impalpable. 

Ahl tenuis desciita una operaci6n que nadie mia que vos debris practicar. 

iPoT qu6? 

Forque vueetra miiada vigilante y amoroea deecubriii en la piel delicada del nifio 
la m&i pequefia alteracidn y permitir& a vueetro medico daroe im remedio o un consejo, 
caei elempre lo tiltimo y en caso extremo lo primero. 

Nada de perfumee. ^Para qu6? ^Quer^is algo m&B bien oliente que un beb6 limpio? 

£1 bafio general podr& ser repetido en el dia, en el beb^ sano y lo ser& seguramente 
cuando enfermo, x)ero no ahorr^is pequefias'' toilette" beneficiosas para la delicada 
piel del nifio y el ol&to de los circunstantee. 

^No OS figurdis, sefiora, con que sensaddn de di^gusto y de compafli6n repaiamos a 
menudo en madres que no olvidarfan jamais el mis pequefio detalle de eu peinado o 
de Bu veetimenta y que os presentan un beb^ mal oliente? 

^Cuintas veces, sefiora, asistiijcios a una afeccidn de la piel que se inida en el polvo 
de ahniddn lermentado en los pliegues de gordura del pequefio? 

^En fin, sefiora, y cu^to tenemoe que luchar con el prejuicio de madres que ocultan 
una llaga supurante del nifio porque por ^llas salen los nudos humoree del (nganismo? 

Pero, quedad tranquila, sefiora, que pronto antes de lo que pens&is, quizi verbis en 
marcha este divino beb6 que ha llegado. 

GAPtruLO III. — ^El BsBi bn Mabcwa. 

DtoMANONA VI8ITA. 

SH primer raJHo-^us eiMido9 y nu eompliieadoni$^Sl bono en ea$o de enfarmedad 
Loe ecMemae — Origen inUetinalSufieU y neoeearia curMlidad. 

Sefiora: Heme aqui obediente a vuestro Uamado, dispueeto a oiroe seguro de que 
voestioB temores no Uegarin jam^ a impresionanne seriamente y no porque yo no 
tenga una migaja de carifio a esa ricura de beb6, aino porque ^Uos son hijos de vueetros 
amantfgimos sentimientos de madre novel. 

El evidente, ofgullosa mamita, que vuestro beb6 ha progresado rdpidamente ^gracias 
ami? 

No. GiaciaB a vos y a su con8tituci6n que le permiten salvar los obst^ulos de la 
■abida con la tranquilidad de quien Uene alas. 

Hoy, sefiora, es vuestro primer diqgusto; mi cliente se ha resfriado. 



220 PBOCEEDINGS SECOND PAN AMBBIOAN 80IBNTIFI0 C0NGBE88. 

^Por qu^? Vale, quiz& m6B, no averiguarlo, por cuanto es tan leve la cauea, que a 
menudo queda en el teireno de las supodcionee. 

^Exceeo de abrigo habitual?— Quizd. 

Una corriente de aire Mo que ha pennitido a las bacterias vulgares hacer presa en la 
la mucosa nasal del beb^. Puede ser. 

£n fin cercior^monos del hecho y trataremos de curarlo. 

El punto de origen del mal es la nariz. Pues a 611a. Una 6oluci6n de sales de plata 
que 06 receto depositada en gotas dos o tres veces al dfa, dominai& el mal. 

Lo tendr^is abrigado, en una atmdsfera tibia, peio ozigenada. 

Plretendo con 611o aBegurarme de que no ser^ capaz de colocar, en un reverbeio a 
alcohol o kerosene, en una estufa a lefia, carb^ o gas, im recipiente con agua y hojas 
de eucaliptus dentio de vuestro dormitorio cerrado. 

Permito si, calentar la habitacidn, mantenerla a una temperatura constante de 16 
a 18 grades, hervir eucaliptus, etc., pero a condiddn que una de las puertas permaneeca 
abierta, de manera que vuestro beb^ no redba directamente el aire, pero que 6ste se 
renueve ampliamente. 

Aire tibio, htimedo y oxigenado. 

Tres condiciones que apresurar&n la cura del resfrfo. 

Haciendo asf , no tem^ complicaciones puknonares. 

Alguna vez, quiz&B, un poco de inflaniaci6n a las ftm< gH<^lfta (gUndulas) que curar^ 
con lavajes de agua b6rica, o una obturaci6n de la comunicaci6n del ofdo con la naziz 
que podr& i^roducir una inflamaci6n del oldo medio, o fiebre de origen intestinal posible 
ya que los pequefios degluten las flemas, y nada m&B. 

lY nada m^? ^Os parece poco doctor? 

No, no 06 alarm^ revistaba posibilidades, quedad tranquilla, ten^ medico, 61 
sabrd hallar la pista de los males y no permitirles tomar cuerpo. 

Os repito que debris quedar tranquila, i)ero conviene a vos, que sois inteligente y 
cuidadosa, el poneros sobre aviso a fin de que cualquier coea inexplicable que encon- 
trdis, aumento de fiebre, Uanto frecuente, reqpiracidn anhelosa, me llam^is. 

iY suprimo el bafio, Doctor? 

I Ahl no, sefiora. ^Por qu6? 

^Vos tambi^n cre6is que pueda hacerle mal? Gonvenceos de lo contrario. 

Si hasta ahora el bafio era conveniente, ahora es neceeario. 

La limpieza de la piel abre una via de escape a una cantidad de sustancias t6xicaB 
disueltas en el sudor, y si no lo bafi^ la descamaci6n natural de la piel, con la secre- 
ci6n grasa de bus gUndulas y el polvo del ambiente formar&n im dique insalvable a 
aquellas secreciones naturales. 

Hago notar para vuestia satis&ccidn personal que entre los divines rizos no he 
hallado caspa. 

Es una reviBaci6n estrat^gica que hago a menudo, y que me asegura que mis pree- 
cripciones han side bien Uenadas. 

No caig^is, sefiora, en el grave prejuido de permitir que vuestro nifio se llene de 
eczemas (arestfn) con la convicci6n que 611o lo library de afecdones mis graves. 

Esa horrible afecci6n que pone en un tormento al beb6 y a su madre, que os priva 
de la satisfacci6n de cubrirlo de besos, que os obliga a ocultarlo ante la mirada de 
horror que descubrfs en los ojos de vuestras amigas, no es por cierto fidl, ni necesaria, 
ni siquiera diffcilmente curable. 

Libraos, sefiora, de aquel error que cometen algunas madres afirmando que por allf 
van a salir las impurezas de la sangre, de aquel otro que os garantiza que vuestro nene 
va a ser bello, porque le dej^ su eczema, error este tiltuno fundado en que el arestfn 
toca mia ^udlmente a los nifios de tez fina y delicada. 

Pensad, sefiora, en lo espantoeo del suplicio que le produds a ese pedazo de vuestra 
alma, envolvi^ndole las manitas para que no se frote ni se arafie, con sus ufiitas cuando 
le pica. 



PUBLIC HEALTH AND MEDICINE. 221 

Recordad con que fruici6n os rasdub cuando una atrevida pulga forastera se ensafia 
en vuestra piel y como no ced6i8 en ahinco hasta exterminarla y figuraoe ahora, que 
aquella superficie costrosa y supurante produce el ardor de miles de pulgas juntas y 
convendr^ entonces conmigo, que es horrible y criminal la ignoranda de loe que 
persisten en mantener la expectativa en un eczema infantil. 

M&xime teniendo en cuenta, sefiora, que aquel se curar4 r&pidamente con simples 
medidas de higiene. 

Higiene de la piel, con vuestros bafios y lociones; higiene del intestine, foco de origen 
de todos esoB males, cambiando el regimen alimentido que es, seguramente, en esos 
casos, defectuoso, o las mia de las veces metodizando las horas de la alimentaci6n del 
beb4 la cantidad de alimento ingerido. 

Pero vos, sefiora, no os preocup^, que no rezan con vos estas advertencias, por 
cuanto b6 que vuestra obedienda inteligente conseguiri ver libre para siempre de 
tales plagas a este predoso beb^ en marcha. 

yio^sncA visiTA. 

Lo$ dienU9—8u erupei&n^Las enfermedade$ que se le cUrUmyen — Cuidadae del preeente y 

delfutwro, 

Sellora: Si; esos son losdientes,lejosatin del horde de la encfaproducen sin embargo 
fen6menoB irritativos que son la causa de la baba que hab^is notado. 

Os advierto que me admira vuestro inters en conocer la causa aun de los detalles. 
^Por qu6? Ah, sefiora, quiz& me dir6is que soy male por mi respuesta. Pero la vida 
del mWco trae aparejada terribles reveladones y alii donde uno espera madres tiemas, 
carifiosas, que vean aunque fuera por egofsmo en sub hijos la prolongaci6n de sf mismas, 
se encuentsra con pequefias almas envaneddas, que tienen del beb6 un concepto un 
poco m^ elevado que el de su mejor sombrero. 

Ayer, sefiora, visitaba a una iajnilia, pero; dejemos eso— no hagamos dLtedra de 
diinnograffa. Los dientes, sefiora, aparecen generalmente en el correr dd sexto, 
a6ptimo mes, por lo general mia tarde en los varones que en las nifias, pero, pasado el 
cuarto mes comienzan a incomodar al beb^. 

No producen sin embargo, en su erupci6n esa serie de terribles fen6menos que se lea 
atribuyen. Un nifio sano, el vuestro, por ejemplo, amamantado convenientemente; 
sin distorbios intestinales conseguir& exteriorizar sus dientes con un mf nimo esfuerzo. 
Un poco de dolor en las endas, un poco m^ de baba y nada m^. Ni un quinto de 
fiebre. Las atfecdones que generalmente se le atribuyen no son m^ que vulgares, 
pero graves empacho^(gastro-enteritis), que requeririn la presenda dd m^co. 

Ved, sefiora; que en esos casos la dencia se resuelve siempre a recetar un purgante o 
un desinfectante intestinal, y no seri, seguramente porque area que con €i conseguiri 
apresuiar la salida de los dientes, sino porque es en el intestine donde est& la causa del 
mal. 

Cierto es, que la aparid6n de los dientes, por las molestias que causan, por las 
incomodidades que producen, ponen al organismo del nifio en un estado de menor 
resistenda que lo hace m^ vulnerable a cualquier ataque microbiano. 

^Pero, deds, sefiora; si es tan poca cosa Doctor la salida de los dientes, como expli- 
dds ese debilitamiento? 

Ah, sefiora, olvidiis acaso lo que es un beb^. Tan pequefio, tan fragil, una ligera 
escaramuza para nosotros es una batalla cruenta para 61, de la que resulta victorioso, 
siempre que se halle atrincherado en un estado general perfecto que le permita no 
distraer sus reservas. 

H6me aquf, sefiora, que sin querer, he abusado de los t^rminos ^picos. Perd6n, 
porque son de actualidad y se hacen por ende ttdlmente comprensibles. 

^Quer^is saber ahora, como calmar esos dolores de las endas? ^Algdn jarabe, 
alguna droga? Nada de eso sefiora, todas las que se emplean contienen opio o cocaf na. 



222 PROCEEDINGS SECOND PAN AMEBICAN SCIENTIFIO CONGBESS. 

Por 660 ddman ^pero no dafiar&n la salud del beb^? ^Puede benefidar a iin nifio el 
HBO de alcaloidee? 

YenenoB extremadamente tdxicos, aim administrados en pequefias doeds son nodvos 
para los adultoe, con mayor raz6n para el pequefio. Os permitir6, sin embargo, que 
llev^is a sub encfas con vuestro dedo, previameimte lavado, \m poco de miel pura. 
Con ello calmar^is su llanto, fomentando en verdad la glotonerf a pero conseguir^is con 
eso que la lengua se pasee largamente por bus encfas inflamadas prududendo una 
acd6n sedante y i)or ende bienhechora. 

^ Y me pennitir^is Doctor el uso del aro ? S(, pero con condlciones. Aro de marfil 
de hueso, euficientemente grande para que no pueda Ber tragado pcH' el beb^, sin 
adomo de ningdn g^nero, ni cascabeles, ni cintas, nada que Uevado a la boca del 
nifio pueda infectarla. Un aro pelado a fin de que podiis sumergirio en agua hirviente, 
den veces al d(a si fuera neceeario. Eso, no os parecehL elegante, no bonito, pero es 
dtil y no perjudicial. 

Y ganando tiempo, sefiora, un aviso para el porvenir. Vuestro nene tendr& dientes, 
nacerdn sanos, bien colocados, en muy buenas condiciones. No olvid^ eus cuidados. 
No caig&is en el error de muchas madree que pasan mil pesares temiendo 'por el mo- 
mento de la salida y que ya en la boca olvidan higienizarloB y permiten a la carie 
hacer un nido a las bacterias mis terribles. 

Cuanto antes ee necesario cepillarlos con un poco de creta preparada o de jab6n 
bianco y enjuagarlos cuidadosamente a fin de sacar de los interstidos los restoe de 
comidas que fermentadas producen substancias corrosivas para el esmalte de los 
dientes. 

No olvid^ls que la acd6n de una buena dentadura es fundamental para asegurar 
una buena digesti6n y que una funci6n bien empezada en la boca, diffcilmente tendr& 
un fin nodvo para la vida del nifio. 

Pero, sefiora, debris dlsculparme, el haber corrido demasiado. Son tan grandes mis 
deseos, que ya veo a mi cliente masticando pliddamente grandes cburrascos y quiero 
convenceros de la necesidad de mantener su aparato dentarlo apto para tal funci6n. 
Disculpad, pues, mi apresuramiento, pero no olvid^is mis consejos. Ellos ser&n 
dtiles cuando llegue el momento que no tardari seguramente dados los progresos que 
hace este divino beb^ en marcha. 

YIoiSIMA PBIMSBA YIBITA. 

El deateU — iCSmo hacerlot — Marchar despacio es apreswrar elfin, — La mamadera y su 
preparacidn. 

Sefiora: La fuente vital con que os ha dotado Natura ha respondido a vuestro deseo 
y vuestro hijo ha cumplido su primer afio de vida, feliz, robusto, rozagante alimen- 
tindose del ideal surtidor. 

Os dirfa, sefiora, ^no es un crimen desprenderlo de tan rico bocado, a ^1 que ee 
gcdoso y ferviente admirador de la calidad del artfculo elaborado? 

Es que en verdad cuanto m^ tiempo permanezca adherido al lugar de sub deticias 
m&B benefidos obtendWL de eea sana alimentad6n. 

Sin embargo, ha llegado la hora de que hablemos seriamente del destete. Tema 
antip&tico a mi entender y que he hecho lo posible por alejarlo, por cuanto tengo la 
abeoluta convlcci6n de que cuanto m&s tiempo pennita mamar al nifio m^ garanti- 
zamoB su porvenir. 

Sefiora, vuestro nene se prende cada tres boras, es decir mama a las seis, nueve, 
doce, de la mafiana y a las tres, seis y nueve de la tarde. 

iC6mo hacer para iniciar el destete? 

Nada m£s f4cil. Suprimid el seno a las doce y lo reemplazdis por una mamadera 
de leche de vaca. ^Y c6mo prepararla? Verbis: tomad leche pura y f resca, hervidia; 
tomad agua y hervidia. Tomad, ahora, un frasco nuevo o una pajarita de porcelana 
de las que tambi^n Uaman patitos y que se expenden en todas las farmacias, hervidia; 



PUBLIC HEALTH AKD MBDIOIKE. 223 

comprad una tetina de caucho y como los anteriores, hervldla. ^Vdis c6mo repito 
*'hervidla?" Lo hago con el fin de que 06 convenz&is de que la ebulllci6n es el 
dnico medio pr&ctico de mantener as^ptico todo lo que pueda estar en contacto con 
la boca del beb^. 

Todo estd pronto. Echad ahora ocho cucharadaa de la lecbe preparada y cuatro de 
agua hervlda dentro del fiasco o la pajarita, a la que enchufar^ifi la tetina. 

Palpad por afuera si est4 a una temperatura conveniente o para mayor seguridad 
yerted sobre el dorao de vuestra mano, yolcando el frasco, unas gotas del preparado y 
si lo toleriis, pod6ts adnunistrarlo sin temor. 

Si durante siete dfas notdis que nada ha cambiado, que vuestro beb4 sigue pro- 
gresando, aumentad dos cucharadae de leche y disminuid doe de agua. Si slete dias 
daspu^ todo permanece igual suprimid el agua y dadle la leche pura que os traerd 
vuestro lechero de confianxa. 

Biea, ya ten^ instituida y probada una mamadera. Probemos doe. ^C6mo hacer? 

Mod^ic&is el horario, una le dar^ a las nueve y otra a las tres de la tarde quedando 
la bora de las doce reservada para el seno. 

Asi, sefiora, quince dias y entonces, (siempre, si no hay novedad, es claro), entonces 
agregiis una nueva mamadera a las doce. Es decir que vuestro beb6 tomard tres 
veces el seno y tres la mamadera. 

Dejad un nuevo intervale de quince dias y suprimid el seno a las seis de la tarde 
para darle una nueva mamadera. Qued&is asl alimentindolo con vuestros medios a 
las seis de la mafiana y a las nueve de la noche y d&ndole en las demds horas leche de 
vaca. 

Dejad paaar un nuevo periodo y suprimid la de la mafiana y tras otro t^rmino igual 
oe ittdep^idizto del todo. 

"^Peio a qu6 Doctor, un m^todo tan largo si yo he visto a madres que en veinte y 
cuatro horas ban destetado al beb^?'' 

Peor para ^llas y para el nifio. 

Os decla, Sefiora, Natiua no marcha a saltos y este es un caso probatorio de mis 
asertos. 

Gomprended, sefiora, que una madre que suprime de golpe la funci6n de bus 6rgano8 
lactantes se expone a terribles sufrimientos. Las verbis recurrir a purgantes en^rgicos 
a fin de conseguir se les retire la leche, ese n^tar divino que tanto necesitan sus hijos 
porque no me dig^ que no, sefiora. Si eetk, por algo estd, para algo sirve y no para ser 
desperdiciada. Ahora si fuera el caso de una madre que hubiera tenido la horrible 
desgracia de perder a su hi jo, ni consejo serfa que echara el purgante a los peiros, porque 
con ^1 no ver& disminuir ni una gota de su leche, y que levantara por un gran vendaje 
algodonado sus senos, lo que aliviarfa los dolores y le permitiifa poco a poco suprimir 
lasecreci^. 

Os decfa, ademds, peor para el nifio. Y es asi. ^ Si en esa 6poca crftica de la vida 
del beb^ una nana cualquiera lo ataca, a qu^ clase de alimentaci6n recurrirfa eea madre 
para su hijo? ^No sab^is que la leche matema ee el mejor remedio para un nifio 
enfermo? 

Y despu^ sefiora, i a qu^ p^petuar eea t^rible tragdia feuniliar que se desarrolla 
entre el deeeo del nifio y la obstinaci^ de la madre cuando se sui^ime bruscamente 
el seno, si siguiendo mi consejo el beb^ va a abandonar por olvido su fuente actual de 
delicias? No seamoe peores de lo que somoe, sefiora, y hagamos las cosas bien cuando 
podemoB. 

Vuestro beb^ consume en el memento que terminiis el deetete un poco m6a de un 
litro de leche por dia y como no debris sobrepasar esa cantidad ee necesario supHr las 
necesidadee crecientee de la alimentaci6n con otros manjares nutritivos que ayuden a 
laledie. 

Pero, por hoy basta, hablaremos otro dla de esas nuevas comidas que conseigaixin 
mantener y vigorizar las fuerzas de este precioeo beb^ en marclut. 



224 PROCEEDINGS SECOND PAN AMEBICAN SCIENTIFIO CONOBESS. 
YIOisnCA SEOUNDA YlBSTJi, 

iDMis eorUtnuar criando ri o$ senAs con novedadesf AlimerUaciAn progresiva — BM* 
da$ — Nada de alooholr^Los bombones y hs ccarameloa — PdigroB. 

Sefiora: ^Hab^s cuchicheado la pregunta y la he cazado al vueb? Si sefiora, ei; se 
puede seguir criando. ^ Y porque no? 

El nuevo beb^ que se va deeorroUando en la intimidad de los tejidos aomenta de 
15 a 20 gramos por dfa. Eee aumento lo conBeg:uii& robando elementos a vuestra 
sangre, la que para cubrir su dMcit no neceeitaii m&s que of deddiiB a aumentar un 
poco vuestra alimentaci6n. 

Lo de los peligroe para el nilio que atnaTnanUiw o para vos o para el nuevo, ee puio 
prejuicio que conviene destruir. Yo s6 que oe digo revolucionar& las ideas de cuantoe 
OS rodean. Vuestra mamita encabezaii la rebeli6n y a la menor indisposici6n del beb6 
me pretender^ demostrar que yo por mis consejos modemistas soy el culpable, aun- 
que la afeccidn que padece el beb6 sea una fiebre eruptiva. Pero no temo el ataque 
X>orquetengo convicci6n en mis afirmaciones ysi mucho me exigfs os dir6 exagerando: 
"sAcar del pecho al mayor para poner al reci^ nacido. " I Ahl sefiora, no est^ atin 
en el caso. Me alegro, pero ^sab^s por qu^? Porque hay verdadeia convenienda en 
espaciar los nacimientos a fin de que conBig6is criar y encaminar el uno antes de que 
Uegue el otio. 

Os decfa, sefiora, evacuada la consulta interpuesta, os decfa en mi charla anterior 
que la leche ya no bastard para seguir el avance victorioso de vuestio beb^ y que eia 
necesario recuirir a otros alimentos. 

Seguir^is para ello el m^todo que empledsteis para el destete. A las 12 cambiar6is 
la mamadera por una sopa de una harina cualquiera prepaiada en la leche que le 
tocaba absorber. 

En cuanto a harinas todas son buenas y mejores las vegetales, de avena, de anoz, de 
papas, de cebada, de lentejas, de malz, etc., las que usar^ altemando a fin de no 
cansar al beb^ y exciter su apetito. 

Quince dfas deepu^ le dar^is tres sopas, despu^ cuatro y nada mds. Mantened de 
leche solo las mamaderas de las 6 de la mafiana y de las 9 de la noche. 

Altemar^s la leche con caldo de legumbres que preparar^is hirviendo laigamente 
las l^;umbres de eetaci6n adicionadas de porotos, garbanzos, lentejas y papas. En 
seguida tamizadlas por un pafio y moderadamente salados servir&n de subetractum a 
las harinas que empl^ para hacer una buena sopa con que altemar con las de leche 
que le admimstr&is. 

Pasado algtin tiempo agregar^is una media yema de huevo a dos de las sopas diarias, 
perfectamente batidos en el caldo o en la leche. 

Y poco a poco Uegar^is, sefiora, a una alimentacidn mds amplia, una cdscara de pan, 
un poco de ensalada de verduras cocidas, unas pastas de Italia en la sopa, im pur6e de 
papas, habas o lentejas, im poco de pescado hervido si es fresco y no tiene eqpinas, 
una crema, im arroz con leche y frutas. ^V^is como voy ascendiendo? Lentamente, 
sefiora, ilegar^is a comidas mds s6Hdas: tallarines a la manteca, polio hervido, seso, 
sopas de fideos fines, budines, huevos pasados por agua, o fritos, jam6n cocido, frituras 
de papas, verduras de todas clases, etc. Llegar^is a darle came cuando alcance a una 
mayor edad, cinco afios por lo menos. 

En cuanto a frutas os aconsejo mantengdis con severidad su administracidn. Ellas 
no ser&n jamds nocivas cuando sean elegidas por vos misma (lo que me garantiza su 
estado de madurez y su limpieza) y cuando se coman como poetre despu^ del almuerzo 
y de la cena. 

Y en cuanto a bebidas, no voy aquf a iniciar una campafia antialcoh61ica, porque 
OS conozco inteligente y amorosa de vueetro hijo, pero os adveierto que m&B de una 
vez he visto nifios de dos afios que terminaban de almorzar y ostenti^an en su labio 



PUBLIC HEALTH AND MEDIOIl!^. 225 

saperior un x>ar de bigotes de vino. {Hay padres para todo, sefioral El agaa y la 
leche bastar&n como bebidas a fin de mantener la funci6n renal. 

Yneetat) beb^, sefiora, serd bien educado y no aaldrd de sua cinco comidas diarias, 
desayuno, almuerzo, merienda, cena y refrigerio noctumo. Admlto, sefiora, que en 
las doe grandes comidas se satisfaga plenamente, pero quiero aconsejaros contra el 
grave peligro de las pequefias comidas entre boras, fuera de las cinco citadas. ^Que 
el buen papito trae caramelos, bombones y masitas o frutas, con que saciar su glo- 
tonerfa x>er8onal? ^Que el amigo o la vecina ban comprada para el beb6 pastiUas o 
confites? Y ya me veo al divino cliente con una estdpida indigesti6n. 

No olvid^is, el estdmago es un 6rgano, no una m^uina industrial — ^por ende necesita 
deecansoB-— y adenUuB foment&is la gula del pequefio, el que no conseguiri la mia 
pequefia moneda sin que com al almac^n de la esquina a traducirla en comestibles 
de la peer calidad de acuerdo con su precio. 

Hago puee un Uamado a vuestra energfa de madre inteligente que sabri sobrepo- 
nerse a las debilidades de una bondad mal entendida, a fin de conseguir ver pronto 
hombre a este divino beb^ en marcha. 

YlQiaiMA TBBCBRA VI8ITA. 

Terruu triatea pero cuyo cofuycimiento es necesario — Afecciones ponhles — La vacunaciSn — 
Sus $egwridade9—La8 conimlHones—Su tratamiento inmediaU) — Las lombrice%—Su 
rrUtodo terapSutico, 

Sefiora, mi presentacidn de hoy serd severa. Es que debo hablaros de coeas serias, 
debo preveniros de los peligros posibles, de las complicacionee de la vida del beb^, 
y^v^is? Ya sin querer, vuestros ojos alarmados se ban dirigido al nifio y a mi como 
damando misericordia para vuestro hijo. 

N6, no es eso, sefiora. Gonocer donde est& el punto d^bil, donde la causa, donde 
el contagio probable, es aseguraros de que, si es necesario, los sabr6is mantener a 
distancia. En la vida, el conocimiento . . . 

^Decidme pronto, Doctor, qu^ puede pasarle a mi beb^7 

Os hablar^ largamente de ello y quedar^is tranquila. Primero, sefiora, es necesario 
vacunarlo. No os babia indicado antes esa necesidad porque no es ^poca de epidemia, 
pero ya es hora que pensemos seriamente en ello. No os alarm^is. En un minuto 
quedard vacunado con una preparaci6n freeca, suficientemente garantizada de otras 
inf ecc iones asociadas. Puede suceder, sefiora, que al tercer dia de la operaci6n vuestro 
beb^ tenga unos quintos de fiebre y una ligera incomodidad en el brazo y los ganglios 
de la axila se hagan pasajeramente dolorosos. Si en eeo quedan las cosas, os conten- 
tar6is con mudar las gasas as6pticas con que proteger6 el lugar de la inoculaci6n, si 
no, me llamar^is y acudir^ presuroso a vuestro llamado. 

Pero sabed, sefiora, que estas molestias que ocasionamos a mi cliente serin resarcidas 
con la absoluta seguridad de que la viruela no estigmatizard jamis el roetro divino del 
beb6 con esa serie de irregularidades indelebles que caracterizan a los que sobreviven 
a tan terrible enfermedad. 

Ya este mal alejado, pensemos en otro. Las convulsiones. 

iSon acaso posibles con el r^imen que bab^is ordenado a mi beb^? 

Deegraciadamente si, aunque poco probables, y digo si para colocarme dentro del 
terrene de la seguridad que he querido mantenerme con vos, que sois iuerte y valerosa. 

Sin embargo, como casi siempre el origen est& en el intestine y como el r^imen 
alimenticio adoptado mantiene la integridad de sus funciones, casi os podria afirmar 
que ser4n extremadamente raras en vuestro beb^. 

^Pero, si suceden, que debris hacer? Una cosa os exijo y es la tranquilidad. Nada 
de deeesperaciones embarazantes que en estos cases, obrar pronto es obrar bien. 
Inmediatamente un buen lavado intestinal, que limpiari el cabo inferior. Unos 



226 PBOCEEDINOS SECOND PAN AMEBIOAN SGIENTIFIO CONGRESS. 

buenoB buches de agua tibia que Uenaidn el estdmago y permitir&n su y6niito l&cil, un 
buen bafio caliente, y esperar al m6dico. 

^Cu&ntas coaafl, verdad? Verbis que sencillas. Una pera de caucho de laa m&a 
pequefLaa, con pico del mismo material, hervidla r&pidamente y cargadla con dos o 
tree cucharadas de glicerina. Introducidla en direcci6n al ombligo, sin que tiemble 
vuestra mano y vaciad eu contenido, y ya tenuis hecho el lavado. 

Inmediatamente le har^is absorber unos cuantos buches de agua tibia y con vuestros 
dedos o con una pluma de gallina que desinfectar^is por ebullici6n en agua, le har^is 
cosquillas en la garganta hasta provocar el v6mito. 

Con estas dos operaciones, habdis hecho cuanto podiais para limpiar el tube digestive. 

Ahora, sumergid vuestro beb^ en el agua, a 38 o 39 grades, poni^ndole contfnua- 
mente pafios de agua fria en la cabeza y dejadlo alii, media, una hora, no importa, 
hasta que lo vedis calmado. Entonces, m^s tranquila, esperad al m^ico que hard el 
res to. 

Una cosa, repito, es necesaria y es la tranquilidad. Os conozco bien y s^, sefiora, 
que con los pertrechos con que os he armado no temer^is ya a las terribles convul- 
siones, cuya sola menci6n hace palidecer a las madres y cuyo origen aunque 
miiltiple estd casi siempre en las vfas gastrointestinales. 

Y para no salir de ese terrene, hablemos ahora, de las lombrices: 

^Sab^, sefiora, que en un tiempo no remoto todas las afecciones de los nifios se le 
atribulan a las lombrices? 

Que un nifio era demasiado llor6n, que comia demasiado, que se restr^aba por 
demds las narices, que tenia retortijones intestinales, que tosia, todo era debido a 
lombrices. A tal grado se lleg6 en eetas afirmaciones que se form6 una corriente 
contraria que neg6 su existencia. La verdad estd, como siempre, en el t^rmino medio. 

In medio Veritas. Hay a menudo lombrices y ellas pueden ser la causa de deearreglos 
Intestinales o nerviosos. Pero de allf, a atribuir a tan modestos bichitos la causa 
eficiente de todos los males, hay un continente. 

Colocadas pues, en su verdadero terrene, veamos c6mo hacer para descubrirlas. 

El m^todo es verdaderamente fdcil y estd f undado en la observacidn de las mateiias. 
Si Tin dia, dos, dies, observdis lo que el nifio arroja, notardis, si tiene lombrices, unos 
pequefios bichitos blancos, tales como 'Vermicelli*' que se mueven rdpidamente o 
una gran lombriz semejante a la que se halla en las tierras bdmedas y que todos cono- 
cemos, con la (inica diferencia que la ariojada con las materias es blanca. 

^Qu6 hacer en estos casosO? 

Nada mds fdcil, Uamar al mddico. Desconfiad, sefiora, de los especfficos que oa 
oCrecen y que son capaces de curar desde una callosidad en un pie, hasta la calvicie. 
Desconfiad de la ''Santonina'' que a menudo las madres administran sin medida, 
ignorantes de sus grandes peligroe, y Uamad al mMico el que conserva adn en su 
recetario el vermifuge necesario para su destrucci6n. 

Ya no temer^is, pues, si os hablan de lombrices. Sab6is c6mo descubrirlas por 
ende, c6mo atacarlas, y sobre todo, sefiora, no olvid^ jamds, que la ciencia vela 
sobre la cabeza de este precioeo bebd en marcha. . . . 

VIO^IM A CUARTA VISrrA. 

ContinHa el tema trisu — Las heridas — Sus cuidados—De c6mo os podHs transformar en 
una ayudanu ikil—El aislamiento como medida general—El aiskaniento debe ser 

efectivo. 

Sefiora, contimiio alecciondndoos sobre los peligros posibles. Entended que os digo 
posibles, no probables y por ende convenceos ima vez por todas que elloe no tendrdn 
fatalmente que descaigarse sobre la cabeza de vuestro divine bebd. 

^Querdis que hablemos de heridas? Pues bien, sefiora, comencemos por ellas: 

^Frente a una herida qud debdis hacer? 



PUBLIC HEALTH AKD MEDIOIl^. 227 

Como siempre, lo primero es no alarmaros. Sale saogre, mucha sangre que impre- 
Siona por su cantidad y sobre todo por ser sangre. ^Vdis acaso a tomar vueetro pafiuelo 
o a recunir al viejo e inmundo procedimiento de la tela de arafia para aplacar la 
hemorragia? iVerdad que no, eefiora? 

Ante todo si no tenuis a mano gasa as^ptica y la farmacia se halla distante, sumeigld 
en agua hirviendo unas tiras hechas con eibanas o pafiales viejos y mlentras eso hierva 
lavaos friccionando fuertemente vuestras manoe, lavaos en seguida con alcohol y ya 
ad preparada emprended la cura. 

Deeinfectad cuidadosamente loe hordes de la herida con agua, jah6n y alcohol coioo 
hicisteifi con vuestras manos y tomando las gasas o los trapos que hab^ puesto a 
hervir limpiad de codguloe la herida. Tapadla en seguida con esas gasas o esos pafios, 
cubrid el todo con algod6n y vendad bien comprimido. 

Pod^ asl esperar tranquUamente a vuestro medico que no hard m6a que aprobar 
vuestra conducta y felicitaros por haber procedido de acuerdo con la ciencia. lQn6 
peligros puede tener una herida de vuestro beb^? 

La hemorragia que combatiscon la compresidn, la inf eccidn que prevents con la asepsia 
He ahf todo simplemente descrito porque la sencillez del tema no permitiria hacerlo de 
otro modo. 

Veamoe como debris proceder frente a una enfermedad. Ante todo deb^ aislar al 
pequefio, m&xime cuando segtin las profeclas de vuestro esposo; este es el principio 
de una laiga serie de preciosidades de la que serais capaz dada la muestra. 

Aislarlo por cualquier malestar ; no cuesta nada y os da planas garantlas de no espazcir 
la afecci6n. ^Sab^is acaso, sefiora, si esos tres quintos de fiebre que tiene el beb^ no 
son el principio de una enfermedad contagiosa? 

Aislad, pues, que vuestro medico dir& si hab^is hecho bien en adoptar tal medida. 

Al hablaroe de ese aislamiento quiero haceros preeente que ^1 debe ser efectivo, 
porque figuraos corriendo de un cuarto a otro y siendo vos misma la portadora del 
microbio. . . . ^Cu^ seria entonces [el aislamiento? Ninguno o muy deficiente. 
Entrad al cuarto del enfermo cubierta con un guarda polvo o con una de vuestras 
camisas de noche que al salir abandonarto y previo un cuidadoso lavado de manos os 
entregar^is tranquila a vuestras otras obligaciones. 

Cuidad vos misma de las tazas y cubiertoe, de las s&banas y fundas del enfermo. 

Todo lo que ha sido tocado por el beb^ debe restituirse a la comunidad previa 
desinfeccidn. 

Asf y s61o asi har^is un aislamiento efectivo el tinico que ser& beneficioso para la 
salud del hpgar. 

Y ya qup sab^is practicarlo pasaremos re vista a las multiples afecciones que lo han 
de menester y de las que conoci^ndolas me ayudar^is a luchar a fin de salvar a este 
divino beb6 en marcha. 

VIQ^SIMA QX7IMTA VISTTA. 

Fin del mitmo tema — Sarampidn — Varicela — EsoarUUina — Tos oonviiUa — Difieria — 
Viruela — Paperaa — C6mo ayudar al r/Udioo — Es proceder sensato no abandonar al hebi 
y recurrir a la ciencia. — 

Sefiora: ^Os halldis preparada para continuar nuestro tema de tristezas? Si. 
Toca hoy a las enfermedades contagiosas. 

Os dir^, previamente, que en 6pocas de epidemia todos los cuidados son pocos para 
defender al beb6 del contagio. Aun contando con ^llos puede vuestro divino beb6 
caer enfermo sin que poddis descubrir d6nde estuvo la falta, d6nde la ranura en el 
circulo de cuidados con que le rode&is, que permiti6 la entrada del mal. 

Permitidme que, sin intemmipir nuestras charlas haga ligeras descripciones que 
06 servir&n de gula y que ser&n ratificadas por vuestro medico cuando lo llam^is. 

Sarampidn. — ^Enfermedad cuya incubaci6n es insidiosa, por ^llo de diffcil diagn<58- 
tico hasta el instante de la erupcidn. — Fiebre de invasion generalmente moderada, 
38 a 39 grados, ojos del niflo inyectados lagrimeantee, resfrlb de nariz, estomudos, tos 
68436— 17— VOL EC 16 



228 PBOOEEDINGS SECOND PAN AMEBICAK SCIENTIFIO C0NGBE8S. 

hueca y fuerte, a veces angina y ligera erupci6n en la garganta y velo del paladar que 
precede a la erupci6n de la piel, la que aparecerd en primer t^rmino en la cara al 
tercero o cuarto dla, para extenderse a todo el cuerpo al dla siguiente. Cuidados: 
encerrad al nifLo en su habitaci6n, la que calentar^ a 18 a 20 grades, temperatura 
que debe permanecer invariable, purgad al beb^, desinfectad su boca con agua b6rica, 
administradle lavados intestinalee y llamad al m^ce que se har& neceeario para pre- 
caverlo de posiblee y graves complicaciones. 

Varicela,—Afecci6n contagiosa, poco grave en general, se caracteriza luego que se 
produce la erupcidn, aparecen primeramente pequefias Tnanchan rojas, diseminadas en 
la cara y en todo el cuerpo y extremidades, en ndmero de quince o veinte, que se 
ir&n reprodudendo en los dlas sucesivos. En cada mancha se forma una ampoUa con 
liquido transparante el que se transforma a las veinticuatro horas en pus. 8e notan 
adem^, pdstulas en la garganta y paladar. 

Los cuidados necesarios se reducen a medidas de higiene y ciiando pase el periodo 
eruptive, bafios jabonosos que os ordenard, sefiora, vuestro m6dico a quien no deb^ 
olvidar de llamar. 

Esoarlatina. — ^He aquf algo m^ serio y que merecerd todos vuestroe cuidados por 
un laigo periodo. Es que en esta afecci6n la gravedad del mal o sus complicaciones 
puede prolongarse y ser en todo tiempo de resultados funestos. 

La inva8i6n es generalmente brutal, precedida por chuchos, v6mito6, dolor de 
cabeza y angina. La fiebre alta, en la mayorla de los cases alcanza a 40 o 41 grados, 
y aparece en las primeras veinticuatro horas la erupcidn acompafiada de picaz6n y 
desasoeiego. La garganta se llena a menudo de llagas y en 411as mora muchas veceo 
el bacilus de la dilteria. Llamad inmediatamente al medico qui6n instruiri segura- 
mente un tratamiento en^igico que servird para prevenir graves complicaciones. 
Desconfiad, sefiora, de las erupciones que vienen sin fiebre y que estamos tentados 
de clasificarlas como benignas. Entre ^Uas se esconden escarlatinas que no son claras 
porque no traen complete su cortejo de slntomas. 

To$ convmha. — Afecci6n muy contagiosa, cuyo primer sfntoma es la tos, sin ninguna 
caracterlstica en los primeros echo dlas; para hacerse en los periodos subsiguienteo 
por sacudidas, por accesos en que despu^ de seis, siete, diez expiracionee viene una 
inspiraci6n silbante. A menudo al niflo se le inyectan los ojos por efectoe de la bni- 
talidad de los accesos, o vomita por la misma causa. Tiene complicaciones, por ende 
08 aconsejo Uam^is al m^co que aunque por el memento se halla poco armado para 
la tos misma, puede imponeros el regimen conveniente para salvaros de las compli- 
caciones. 

Dt/lema.— Enfermedad grave, gravisima, mortal si os descuid&is un instante en 
llamar al medico. Aqul si se hace necesaria vuestra diligencia. Fiebre m&s o menos 
violenta, decaimiento general, lengua sucia y dolor de garganta. Observindosela 
notar^ una membrana blanca que cubre una o las dos amlgdalas. Pensad que esa 
membrana crece por instante, que puede llegar a la laringe, obstruirla, ahogar a 
vuestro beb6 en un ataque de crup, 

Llamad al m^co y prevenidle de vuestros temores, a fin de que no pierda tiempo 
y tenga en su visita todo lo necesario para darle el suero Salvador. 

Tendrla que hablaros ahora de la viruela, afecci6n grave, a menudo mortal; pero 
ya 08 habl^ de la vacunaci6n, que nos asegura el alejamiento de tan virulento mal. 

Es evidente, sefiora, que cada dla se desconoce m^ esa afecddn, por cuanto la 
vacuna la va relegando a los palses de baja civilizaci6n o a las gentes no creyentes o 
descuidadas. 

Los hechos, a despecho de los poco convencidos, demuestran hasta la evidencia que 
la viruela no ataca a los nifios vacunados y cuya vacuna les haya prendido, o si IO0 
ataca lo hace de una manera benigna y ^ilmente curable. 

V06, sefiora, que tenuis locura por vuestro beb6; que os horroriz&is ante la sola 
idea de que una mindscula cicatriz se grabe en el rostro terse del cliente, os hab^ 



PUBLIO HEALTH AND MEDIOIHE. 229 

mpresurado a vacunarlo y goziis de la tranquilidad de haberos prevenido contra el 
peligro que acecha. 

Y una palabra final, sobre las paperasy afeccidn tambi^n eminentemente contagiosa 
y que se caracteriza por un dolor por delante de la oreja, con tume£acci6n que baja 
hasta el borde del maxilar, e impedimentos para la masticacidn. Esa enfermedad 
trae aparejada graves complicadones que os obligar^ a recurrir al m^co a fin de 
que las prevenga u os dirija en su curaci6n. 

Y bien, sefiora; termino mi revista Itigubre, que os habrd impresionado. Todo 
600 puede tocarle a este precioso beb4, todo y m^. 

Pero no valen lamentos ni desesperaciones. 

La vida del nifio es una etema cueeta arriba sembrada de piedras sueltas que debris 
m su paso separar con cuidado, pero si una de ^llas se os pusiera irreparablemente en 
el camino, ee necesario que sepdis como salvada con ^xito. 

Tal ha sido mi misidn de hoy. Deciros, ''Sefiora, tal enfermedad es asi, poco mis 
o menos. " "Frente a 611a debris proceder de este mode y no de otro. " 

Y vuestra buena voluntad, la ciencia de vuestro m6dico y sobre todo el poder 
vital que trae acumulado desde su nacimiento y que como ^gel de la guarda, de la 
Leyenda Gristiana, acompafia al beb^, — os garantizar&n que aunque grandes fueran 
loe obstdculos, mayores son los recursos con que contamos. 

Poddis, entonces, Sefiora, entregaros plicidamente a vueetra misi6n, sin temores, 
dn aprensiones; el mundo es de este pequefio beb^ en marcha. 

TIOlftSIMA SBZTA YISITA. 

La marcha, — Cudndo d behi debt comeruar a oaminar. El mamje preparador. De la 
manemecnnodebeinidarieelaprendizaje. Mediosnaturalesporendebuenos, Elcastigo, 
Ignoranda o talvajumo. 

Sefiora: Los plazos fijados se cumplen religiosamente, es hora ya que vuestro 
beb^, fuerte, vigoroeo, active nos demuestre su poder. Me decls: "Doctor, cuando 
lo tengo entre mis manos se sostiene solo y hasta creo que ha ensayado pasitos. ** 

iEbo es una creencia o una seguridad? |Lo hab^is probado, verdad? |Ah Sefiora I 
cuidadosamente habfa obviado mi converBaci6n sobre la marcha a fin de no apresurar 
el memento solemne del primer paso. ^Porqu6? Sefiora es conveniente y es necesario 
retardar lo m^ posible el instante de independencia porque si comienca tarde lo 
har& mejor. Ya a los nueve meses habr^is notado que se para solo, que tiene fuerzas 
floficientes para inidar el aprendizaje, que se siente capaz de emprender la marcha 
y sin embargo os disteis cuenta de mi mutismo al respecto. 

Es que esperaba a que sus mfisculos se desarrollaran con el ejercicio de vigoroeo 
pataleo en el bafio y cuando lo mud&bais y me aseguraba como dentro de sus roUitoe 
de gordura se iban desarrollando progresivamente los mtisculos. Por eso, institul el 
maaaje. Os dije, ^lo record&is7: "despu^ del bafio deb^, con vuestras manos cu- 
faiertas de talco, hacer fricciones ligeras de las piemas y muslos del divino beb^ e in- 
tensificarlas progresivamente. Deb^ pellizcar entre vuestro pulgar e fndice, de un 
mode suave y acariciador como sois capaz de hacerlo, las masas musculares, de abajo- 
arrilm, es decir, del pie al muslo. Debris practicar enseguida movimientos de flexi6n 
y extension de los miembros, varias veces y sin esfuerzo. 

^Con qu6 fin os orden^ todo eso, sefiora? 

Ahora deb^ comprenderlo. Era necesario fortificar los mfisculos, los ligamentot 
a fin de que resistan el pesado organismo de vuestro beb^ sin necesidad de andadores, 
ni de sostenee de clase sJguna. 

^Ore^ que no not6 vuestra impaciencia? 

Todas las madres sois igualee. Cuando notiis que el l>eb6 mueve sus piemitas, se 
aacude o endurece afirmiis su capacidad pedestre. 

Y sin embargo no ee asf . 



230 PBOCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

£1 beb6 aprenderd a marchar como supo Uorar, mamar o reir, vale decir, que lo 
hard solo, con vuestra ayuda o sin 611a, pero a su debido tiempo. 

Para 611o iqu6 oe aconsejo, eefiora? 

Nada o muy poco. Dejad al beb^ en el suelo, sentado sobre una alfombra y vigilad 
que no saiga del espacio tapizado. Lo verbis, primero, caer hacia atr^ y volver a 
sentarse; en seguida, vol tear sobre s( mismo quedando alin el vientre piano sobre la 
aliombra. Este ejercicio repetido lo llevar& a encoger sus piemas y qnedar de rodillas 
apo3rado ademds en sus manitas, en cuatro patitas, gateando. 

Un buen dfa cuando ya lo not^ un diestro marchador, le acercar^ una silla de 
Viena y en su asiento colocareis el juguete que m&s agrade al cliente. Lo ver6ia 
entonces tomar apoyo en bus manos e irse elevando gradualmente hasta pararse en 
sus pies. R4pidamente tomard al chiche y al pretender darse vuelta caerA cu4n largo 
ee. Entonces, nada de aspavientos proque sabed sefiora que una cafda de tan pequefia 
altura sobre una alfombra no le producird jam^ una Ie8i6n seria. Refos y os asom- 
brar^is de ver como el valiente amigo corea vuestra risa y pretende repetir el acto. 
Y pronto, mucho m&s de lo que cre^, verbis al beb4 marchando presuroso como si 
muchas obligaciones fatigantee le absorbieran su contado tiempo. 

Un nifio que comienza a caminar, corre al igual que un aprediz de ciclista cuando 
empieza el pedaleo hace disparar a su miquina. 

Es que, sefiora, es m^ ^il mantener el equilibrio andando ligero. 

Nada de andadores ni de fajas de sost^n, pues tlenen el sezio inconveniente de 
comprimir el t6rax y hacen adaptar poaiciones viciosas al pequefilo y adem^, seflora, 
un beb6 que se convence que tiene un apoyo donde librarse de una caida no querri 
jamds desprenderse de 611a, tomard miedo a andar solo y costari el doble conseguir 
verlo en marcha. 

El m6todo que os aconsejo es muy sencillo. ^Por qu6? Porque es copiado de la 
Naturaleza y tiene pues el sello de lo mds prdctico y beneficioso. 

No olvid6is, sefiora, los cuidados que en estos momentos requieren las manos libres 
e inteligentes del pequeilo beb6. 

Nunca mis que ahora es que debris vigilarlo porque sus manos tomardn cuanto ob jeto 
e6t6 a su alcance y r&pidamente lo Uevardn a la boca. Vigilad, pues, y apartadle los 
objetos cortantes, los sucios, los que puedan ser un peligro en sus manos. Vuestra 
actividad estd en juego y vuestras energlas sufrirdn una ruda prueba. 

La arcilla estd blanda; es a vos a quien toca modelarla. El nifio forma en estos 
instantes su cardcter y se adapta tal como la arcilla. 

Ahora bien, si pretend6is el triunfo neceeitdlB energfa firme y persuadva; nada de 
gritos ni de castigos. 

Vuestras manos hardn menos que vuestra mirada. 

La obstinacidn del pequefio la verbis doblegarse ante vuestra constanda, y penaad 
en el cuadro horrible de una madre que castiga brutalmente a su hijo porque se Ueva 
a la boca un juguete I 

Si no fuera ignorancia se dirfa salvajismo. 

Por eso vos, sefiora, educada como lo hab^is sido entre mimos y halagos no senttrdis 
la tentaci6n jamis de levantar vuestra mano sobre este divino beb6 en marcha. 

VIOlftsIMA S^PTIMA VI8ITA. 

itliima vitita — Tendencias convenientu — Bxiena direccidn al ptincipio — DiscipUna 
de amor — Nada de gritoe — Constanda pertuasiva — El halago y el miedo — Las relado' 
nes con el mSdico — La riqueza moHvo de orguUo—La superioridad de los mayores — Los 
compafleros del bebS — El maestro — La madre Unica cons^era. 

Sefiora: Mi tiltima visita la dedicaromos a hablar del porvenir. 

iQu6 serd vuestro beb6? 

^M6dico, abogado, ingeniero, arquitecto u honrado comerciante couk) lo es su padre? 



PUBLIC HEALTH AND MEDICINE, 231 

He ahf una grave cuestidn que no os atrev^ a conf esar pero que ya la hab^is medi- 
tado en lo m&s hondo de vueetro cerebro. 

iVerdad? 

Hab^is hecho bien, sefiora, porque es a vos a quien toca decidir. 

lC6mo a mif , Doctor? 

Sf a vos, sefiora. No os dird que encarril^is brutalmente sus gustos hacia un fin 
determinado. No, porque cometeriais un grave error de resultados funestos para 
el porvenir de vuestro beb6; pero, es a vos, seilora, a quien toca observar donde estd 
la afici6n, donde estd el interns mayor de su inteligencia, hacia que punto se orientan 
BOB habilidades, cu&L es la senda que le ser4 m^ fdcil recorrer, y, armada de esos 
elementos proceder en consonancia. 

Depende de la buena direcci6n del principle, la formaci6n del cardcter que va a 
preeidir los actos de su vida entera. 

Os debris apresurar pues, en guiarlo hacia una buena iniciacidn, y asf como para 
loB cuidados f (sicos me vlsteis siempre partidario de dejar hacer a la Natundeza y so 
cooperar a su obra; en la parte moral, en cambio me encontrar^ en un terrene 
decisiones absolutas que os causardn admiraci6n. 

Primero y ante todo, el nifio debe ser disciplinado. No vayiis a creer que en tie 
per tal la disciplina del cuartel. Nada de eso, sine una mezcla de carifio, respeto 
y obediencia que serdn altamente beneficiosos a su marcha futura. 

Habituadlo a comprender que no valen llantos y rabietas para satisf acer sus caprichos 
y que a vuestra negativa no le queda otro camino que el silencio. 

Comprended, sefiora y amiga mia, que si cuando pequefio le permitis conseguir sus 
deeeos con llantos y gritos, cuando hombre, sentird pesar sobre sf amaigas contrarie- 
dades, pues en la vida, el ^xito estd muy lejos de ser obtenido por los que solo saben 
hacer geetos. 

Cuando vueetro nifio acostumbrado a conseguir sus satisfacciones personales im- 
poniendo sus caprichos obtenga la primera decepci6n, ^Ua ser& funesta porque va 
contra los hdbitos creados que forman su segunda natiiraleza. 

Pero tampoco os acostumbr^ a dar voces, cada vez que pretendiUs imponer vuestra 
voluntad, una negativa severa ahora que sus f acultades comprensivas no estdn todavia 
desarroUadas, una n^ativa explicada m£s adelante; pero nada de gritos, ni golpes. 

^Sabdis por qu6? £n cada hombre por m£s pequefio que ^1 sea existe el secrete 
placer de exacerbar a quien manda y vos, sefiora, foment^ ese mal instinto exhibiendo 
vuestros enojoe. 

No buaqu^ para imponer vuestra voluntad loe doe vulgares y pemidoflos medics 
del halago y del miedo. ^Sab^ a qu^ me refiero? 

Con solo deciroe dos frasee frecuentemente empleadas, os dar^ cuenta: "Beb6, 
fli te quedaii quieto te voy a comprar caramelos.'' "Beb^, si no te portas bien td va a 
comer el Cuco." 

He ahl, sefiora, propoaicionee que jam^ deben aparecer en vuestros labios. La 
primera porque transforma a vuestro beb^ en un ser interesado que no procederd 
jamds sin la esperanza de una remuneraci6n, serd honesto con paga, vale decir, no 
0er& jamds espiiitualmente honesto, y la segunda porque inculdds un sentimiento 
nodvo para su vida: el miedo, y porque iarjiiB un ser imaginario que obrard sobre el 
esplrita del beb^ como una etema pesadilla dolorosa. 

Con mayor raz6n atin os pido no supldis al Cuco de la s^^unda frase con el Doctor, 
porque si 4ete no es un ser imaginario es al menos un sujeto dtil y con quien conviene 
que vuestro beb^ conserve las mds amplias amistades, amistades que desaparecerin 
en el instante mismo que lo transformiis en un instrumento de terror. 

Por eso tambi^n, os pido no cometdis la torpeza de muchas madres que cuando el 
medico le dice al nifio ''Mu^trame la lengua,'^ se apresuran a agregar: ''Mu^etrasela 
querido, no te hard mal,'' y el nifio aleccionado de que es posible que el buen sefior 
que pretende hacer obs^rvadones en su lengua puede producirl^ un mal, se apreeurari 
a cecrar la boca, apretar los dientes y mmiar una rabieta. 



232 PHOOEEDINQS SEOOND PAN AMEBIOAN SOIEHTEPIO 00NQBB88. 

De todos estos detalles, nace esa comedia de llantos que se reproduce en cada viaita 
del medico a nifioe que han Eudo mal enBefiadoe. 

Madres, que preguntan, al medico en preeencia de su hijo enfermo: ''^ Y c6mo hago 
doctor para administrarle el medicamento si no quiere tomarlo?" o que ponen en 
duda la obediencia de los hijos a sua drdenes, diciendo "all doctor, lo toma por que 
eetd Ud. delante y despu^?" V^is, Sefiora, con ^llo conaiguen avivar la perspicacia 
de BUS hijos que saben asf, que si ^Uos no quieren, van a salvarae poniendo obst^ulos 
o que es necesaria la presencia impositiva del Doctor para obedecer a sus mandates. 

VoB, s^uramente, no proceder^is asf, por cuanto espero que vueetra inteligenda 
comprensiva os habrd evidenciado los perjuicios que reportan tales procederes. 

Vuestra posici6n social, aunque descubierta por el nifio, no deberd ser jamis on 
motive de oigullo. Para 6II0 ee necesario, Sefiora, que busqu^is entre sus compafieros 
de colegio a un hijo estudioso, de laboriosos obreros, que serd su amigo, y hasta H os 
debeis inclinar para repartir vuestro carifio. 

Hacedle ver que la desigualdad de fortuna no es un m^rito y que 61 es, cuando mds, 
igual a su amigo inferior a 61, si aquel tiene condicionee intelectuales superiores. 

Demostradle que el dnico prestigio entre los hombres lo da el talento y que para 
conseguir ese prestigio no bastan las dotes naturales sine que ee necesario su perfec- 
cionamiento por la labor diaria. 

Hacedle comprender que el dinero no es el fin de la vida, que hay algo mis grande, 
mds noble, y que vale mds que la riqueza material, pero no por eso dej6is que lo 
malgaste en nimiedadee pemiciosas e instituid el ahorro deede la primera edad. 
Con 6II0 se acostiunbrard vuestro beb6 a ser econ6mico, empleard su dinero como un 
medio de producirse satisfacciones honestas y de un orden superior. 

Alejar^is los peHgros realee que rodean al beb6 tales como los del ju^^, los objetoe 
cortantes y las caldas pero no vaydis a cometer el error de infundirle miedo. Este 
sentimiento es mds de educaci6n que innate. Pensad que si cada vez que lo dejdis 
solo agregdis "No temas, ehl, que ya vuelvo," el beb6 razonard asl: "Mi madre dice 
que no tema, en ^once8 algo me puede suceder'' y es claro que a la segunda vez que 
tent^is la experiencia romper tfen llanto y os seguird. 

Es necesario que el nifio comprenda la superioridad de sus m&i73res para lo cual us 
evidente que no os debris mostrar jamds en vuestros instantes de debiUdad. 

Por ello OS digo, sefiora, no mintdis jamds al nifio. Si una vez comprueba que no le 
hab^is dicho la verdad dudard de vos para siempre, y esa duda se traducird en deeobe- 
diencia. 

Las pequefias querellas dom6sticas tampoco deben ser preeenciadas y vuestra vida 
debe ser de etema annonla para 61. S6, sefiora, que hasta ahora se prolonga la luna de 
miel de vuestros amores. Sabed que la deseo etema, pero si alguna nube oscurece el 
cielo de vuestra dicha, el beb6 nada deberd saber. 

Ese respeto mutuo, ese carifio constante, esa igualdad de opinionee y de procederee 
que hacen la paz del hogar, deben quedar en evidencia para vuestro beb6, que al 
notaros de acuerdo se sentird tentado a plegarse a la mayorfa, y modelard sus acciones 
a vuestros deseos. 

En las conversaciones que entabldis poned siempro el sello de vuestra superioridad 
y no mantengdis jamds una duda. Cuando la pregunta ee del g6nero de 6sas que no 
querela responder, amparaos en una supueeta ignorancia y no aliment6is su suspicacia, 
diciendo: "jAhl pillin, eso no se pregunta:", por qu6 isab6is entonces qu6 hard 
vuestro beb67 Inquirird hasta satisfacer su curiosidad animada por vuestra respuesta, 
mientras que vuestra ignorancia confesada lo dejard conforme y con la convicci6n de 
que cuando vos no lo sab^is, 61 tambi6n puede ignorarlo. 

El nifio debe ser para vos como un pdjaro en la jaula. Con amplia Ubertad para 
sus pequefios vueloe pero defendido por los bairotee de vuestro carifio que aunque 
diaminuyan su independencia lo amparan y protegen contra el abuse de la vida 7 
BUS contagios pemiciosos. 



PX7BLI0 HEALTH AND MEDIOINB. 238 

For eeo debris elegir sua compafieroe y cuando ^ vaya al colegio, que seid lo mis 
tarde poeible, debris cooperar a la acci6n del maestro a quien conmderar^iB un amigo 
y para quien prodigar^is en todoe loe instantee y con conociniiento del niiio vueetras 
alabanzas y agradecimientos. Tal proceder influird en la mente del educando quien 
sentird amor y respeto por su profeflor, amor y respeto que se traducii&n en una mayor 
dedicaci6n y provecho en sue estudios. 

Pasaron los tiempos en que se afirmaba ''la letra con sangre entra''; se abolieron los 
Idtigos y las palmetas y el reinado del caiifio hace de nuestros profeaores seres dignos 
de veneraci6n para quienes no basta el agradecimiento de nueetra vida entera. 

Ensefiadle pues a amar al maestro que en ello vuestro beb6 pagahl un poco del 
enorme saciificio que importa la brega diaria por su instruccidn. 

Y continuad la acci6n del profesor en vuestracasa. ^Sab^is c6mo7 Interes&ndoos 
Yos tambi^n en bus estudios, haci^dole notar sus progresos, sosteni^dolo en los 
mementos de desaliento, demostr&ndole que todo se consigue, pero que es menester 
luchar. 

Ese aprendizaje demoetrativo de que no hay nada ficil en la vida, lo ensefiahl a ser 
pertinaz y constante y le ahorrar6 enormes decepciones. Frente al fracaso se dir&: 
"no he trabajado bastante'^ y no se entregaii a la desesperaci6n de los seres d^biles 
que se creen siempre vfctimas del error o de la injusticia de los hombres. 

Habladle a menudo al ofdo de vuestro carifio y de vuestra amistad a fin de que 
sienta en vos su mejor confidente y os permita vuestro consejo en todos los actos de su 
vlda infantil. 

Y llegado el memento de su independencia total cuando sintdis que aquel ser 
bien querido ya ha formado las alas que le permitir&n escalar libremente las alturas, 
OS sentir^ r^ocijada de haber procedido segtin mis consejos, porque habr^is cons- 
titufdo un ser fuerte de cuerpo, sano de alma, conformado con la esencia de vuestra 
bondad y con la pujanza de vueetros sentimientoe de madre. 



PUEMCULTURA. 

Por P. RUEDA, 
Jtft de la Sala de CHnica Midica del Hospital de Niffos, Rowrio de Santa Fe, Argentina 

El nifio enfermo exige un cuidado mde prolijo si es posible, que el adiUto, pues mientras 
hie tiene el recurso de la queja, aquel recompensa con el carifio mds sincero y el md$ 
prof undo olvido hasta las f altos de cuidado que podemos hacerU svfrir, 

Es hoy dfa de intima satisfacci6n, porque puedo realizar en la forma que aspiraba 
im proyecto que me ha ocupado m^ de ima vez; la Ensefianza Prdctica de la Pueri- 
cultura — que por primeravezse implanta en el pais' — a una entidad social tan 
respetable como lo constituye el noble gremio del magisterio. 

No es mi idea precisamente aumentar la densidad de vuestros conocimientoe, 
pues ello estd m^ que garantizado por la vasta erudlci6n del personal docente de 
vuestra casa, mi finalidad es contribuir dentro de mi modesta esfera a la 8oluci6n de 
un verdadero problema social, de ima cuesti6n de la mayor trascendencia en nuestro 
pais — como en muchos otroe — de un asunto, dirfa, tan viejo como la historia y que 
sin embargo espera reeolverse todavla. Me refiero como ya lo sab^ vosotras al tema 
de actualidad etemamente palpitante: La protecci6n del nifio. 

Compleja y diflcil es la aplicaci6n del remedio a mal tan viejo, si no se estudia 
con m6todo la cuesti6n, explorando minucioeamente su origen, sus causas y sus 
modalidades; como seria imposible curar una difteria, por ejemplo si el encaigado 

> Primer corso prtfctloo de puerlcultura dictado en la Rep<&blica Argentina, inldado en seDtiembre d« 
1915 por el autor. Dedleado a 4* afio de la Ssonela Normal da liatftroa. 



234 PEOCEBDINGS SECOND PAN AMEBICAN SCIENTIPIO CONGEESS. 

de tratar la dolenda desconociera el mal. £1 problema se aclara empero y el ^to 
se f acilita, cuando el terapeuta poeee pleno dondnio de la enf ermedad y el medicamento 
que debe aplicar. Pretendo yo si no se me apura ofrecer la completa curacidn del 
enfermo. 

Desde luego, pienao que loe libros ban becho ya eu tiempo, agradezcdmoeleB su 
enaefianza y sin dejarles del todo, reconozcamoe que su sola acci6n no es suficiente. 
En efecto, la vieja difuai6n impreea no ha podido reeolver la cuestidn, como lo prueban 
por una parte la excedva mortalidad infantil y por otra la neceddad en que se ban 
visto las nadones m^ eivilizadas de seguir nueva via. La enaefianza de loe libroe 
ee incapaz de corregir el nud, por vanas razones; pero bastard enumerar la siguiente: 
porque mucba gente que sufre no sabe leer y muchos de los que saben no leen. 

Las conferencias tedricas muy dtiles son signo evidente del esfuerzo que bace la 
sociedad para llegar al fin deseado; es esto un buen slntoma porque nos muestra que 
el pueblo empieza a preocuparse de veras, constituye pues un gran progreso hacia el 
perfeccionsjniento. 

Pero ee indiacutible que la tinica forma razonabley v&lida ee la ensefianza esencial- 
mente pr^tica. Es tiempo ya que la acci6n se inicie, que los hechos reemplacen 
a las teorfas, para que se infiltre en el hogar el pleno dominio de los sanoe e indiq>en8a- 
bles consejos. 

Ensefiar baciendo, enaefiar mirando, ensefiar palpando y sintiendo en todas las 
formas posiblea a conocer el alma y el cuerpo del nifio para interpretar mejor sus 
necesidades y sufrimientos y alejarle un tanto del mal que le acecba, es como baremoa 
obra dtil, mediante el concurso inestimable de nuestra feliz intervencidn en esta 
cdtedra. 

Hadendo pr^tica, ae impreaionard vuestro eeplritu con aenaadonee diveraas: txiatea 
y doloroaaa laa mia, matizadaa a vecea de alegrea ra^goa, cual la mirada riauefia y 
picareeca de un bebe robuato y aano. En esta forma, lo eepero, coeecbaremoe 6pimo8 
frutoa. 

Impreeionando la exquiaita aensibilidad de la mujer, ae marcar&n buellaa profundaa 
en el coraz6n y aobre todo en el cerebro que puedan guiar laa pr^ticaa cientfficas, ora 
ejerdtando en came propia, ya predicando con criterio firme para aUviar mucbaa vecea 
laa amarguraa del bogar ajeno. 

Sin deaecbar por complete el libro impreeo, pienao que al le^ en eate libro viviente: 
que llora, rfe y aufre, que ofrece au frdgil cuerpedto bambriento a vecea, y a vecea 
lastimado por acbaquea m^ cruelea, al leer eata p&gina aentida y palpitante en la 
fuente original y pura de laa neceaidadea aocialea, aprenderda de la manera m^ 
pat^tica, a reflexionar con provecho y a reeolver con 6xito algunoa problemaa que con 
barta frecuencia ae preaentan en loa bogarea. Procederemoa aaf con laa ventajas de la 
prevision aobre loa lamentoa de la deeeaperanza. 

iCuando veaia eae nifio que llega anbelante, pilido y anaioao torturado deapiadada- 
mente por interne mal, ain aliento para lanzar, ni un d6bil quejido, til time recurao 
que le queda para implorar el auxilio, llegado en una palabra en eatado fisico miaerable; 
cuando veaia repito eae nifio tan pr6ximo a la muerte, capaz todavia de recuperar la 
aalud de que parecia irremiaiblemente privado, cuando auaculteia laa mil circuna- 
tanciaa que como una conaigna fatal le acechan; babrda llegado a comprender la 
magnitud d d problema y la urgencia de reaol verlo 1 Mia atin, ai penetr&ia (ntimamente 
la prdctica boapitalaria, podrda comprobar la nefoata acd6n que la ig^orancia ba 
provocado en el vulnerable organiamo del nifio; podrda comprobar tambi^n con que 
frecuencia, felizmente, la victima tan gravemente atacada reacdona a preacripdones 
de la m&B pura 16gica. 

Reunid todas eaas impredones, considerad todas eeas contingenciaa y oe aaom- 
brar^ia con juato motive de la inexplicable apatfa con que ae ba mirado dempre eata 
faae de la bigiene infantil, aaf comprenderda mejor la juatida de mi entuaiaamo por 
eata verdadera lucba, la neceddad impreacindible de difundir los conodmientoe de 
pueiicultura en loa bogarea, implantando el tinico siatema eficaz para au enaefianza. 



PUBLIC HEALTH AND MEDIOINB. 236 

Con este prop<5eito decia yo en un pioyecto elevado a la Direcci6n de Ensefianza 
Primaria y Especial, en el alio 1912, solid tando la creaci6n de cdtedras de puericultura: 

''Podrfa objetaree a primera vista que es este asunto del resorte exclusive de la 
medicina, no dudo empero que si eeta ciencia estd encargada de profundizar, de espe- 
dalizar por asf decir su estudio, de la puericultura, necesita a su vez, como auxiliar 
poderoso la preparaci6n del pueblo, la difusidn de conocimientoe en la sociedad, fonnar 
d ambiente, en una palabra, para conseg:uir una penetraci6n ^Ldl y obtener el resultado 
que al coeechar sus fnitos constituiri el engrandecimiento de la patria." 

Es la maestra por su doble cardcter, particularmente en el ejerdcio de su nobilisimo 
ministerio, en contacto fntimo con la masa social, quien desarrollard un gran papel en 
la impregnacidn de cuestiones tan vitales para el progreeo de nuestro pueblo; es la 
maestra, el factor poderoso que contribuird con su pr^dica constante y tenaz a la 
realizadi^ de la gran obia, que en 6poca no lejana nos pennitird mostnur nuestra patria 
como un modelo en el concierto universal de las naciones. Ser& solamente por su 
inestimable concurso que lograremos alcanzar la perfecd6n obtenida en la actualidad 
por los suecos que ban hecho descender la mortalidad infantil a una cifra verdadera- 
mente ideal, vale decir, al 4 por dento (40 por 1,000) de la natalidad. 

Es un pals joven, en iormBci6n como el nuestro, son mdltiples las preocupadones 
que solidtan intensa y urgentemente la atend6n del estadista, necesitan por ello — 
tanto las instituciones, como los problemas vitales, como el que me ocupa — el esfuerzo 
individual, la tenaddad del luchador in&tigable, para que hecho came en el espfritu 
del pueblo, pueda merecer el apoyo eficaz y decisive del Gobiemo. 

Emprendamos pues la tarea y cuando hayamos aimado esfuerzoe, orientado ten- 
dendas, marcado rumbos definitives, madiuado en una palabra el problema, confiemos 
en que la acd6n ofidal se plasmard en forma f&cil y estable. 

iQae bagaje de conocimientoe lleva, hoy por hoy, al nuevo hogar la futura madre, 
por lo que a la higiene infantil se refiere? 

^Como inidar^ el cuidado de su primer hijo? 

Ser& fatalmente inevitable la acd6n peijudidal de su intervenddn en los menores 
actos, es entonces que empieza, todavla no siempre, a apreciar la neceddad del 
eetudio de estos conocimientoe y el im)vecho que su f^cil dominio le prestarfa, impi- 
diendo la aplicaci6n tan difundida de las m^ detestablee pr^U^ticas a que irremisi- 
blemente tiene que conducirla la ignorancia de los preceptos dentfficos. 

Puedo afirmar satisfecho que con la perseverante visita de vosotras a este hospital 
supiimiremos una serie no escasa de sufrimientoe y dol(H:es a m^ de un niilo. 

Es de esta manera que cumpliremos la sabia miJTima de Emerson, es asf como 
protegeremos al niilo, fuerza latente que enderra tanta esperanza. 

Es practicando ampliamente que podr6is formaros un criterio nUis liberal y eeca- 
pards con seguridad de caer en la rutina, tambi^n comprenderds que a voces puede 
uno distanciarse im discrete trecho de la vfa que marcan los rumbos generales y asf 
por tiltimo aprenderds a reflexionar m^ detenidamente sobre las mil cuestiones que 
tan diversas ofrece la vida diaria. 

Guidemoe pues dentfficamente a los nifios, los continuadores de nuestras obras, de 
esa masa espiritual en formacidn saldr^ los artifices que perfecdonen nuestros cono- 
cimientoe, eUoe aliviar&n muchos males que todavla pueden atacamos. 

La nifiez proveer^ los heroes de la acci6n y el pensamiento. 

La nifiez resarcird con creces el mfnimo esfuezo que deearroUemos en su proteccidn. 

Nifiez sangre de nuestra sangre, prolongaddn interrumpida de nuestra ezistenda 
que al iluminar su camino en la vida no hacemos nUis que condudmos a nosotroe 



236 PBOOEEDINGS SECOND PAN AMEBIOAN SCIENTIFIC CONGBESS. 

LA NOYOCAlNA GLiCERO-YODADA. 

Por JUAN D. SUSINI, 
ExrJtft Interino del Servicio Odontoldgico del Departamento de Polida de Buenm Airee, 

introducct6n. 

Se puede soetener, con justicia, que estin a nueetro alcance una variedad de anea- 
t^icoe locales, que con mayor o menor 6xito vienen preetando grandee servidoe y 
llenando una alta misi^n en dentistica operatoria. 

Estas subetancias agregadas a la t^cnica de las inyeccionee, hacen que las opera- 
ciones en cirugla dental sean casi indoloras o indoloras por completo en la mayorfa 
de los casos. 

£1 perfeccionamiento credente de la anestesia en esta tiltima d^cada, hace que 
nuestro trabajo sea complementado por el padente que ya no llega a la clinica con 
el temor y la excitad6n de antaiio, resignado a sufrir un dolor realmente grande, 
que ni la habilidad del operador ni la rapidez de la intervenci6n podlan evitar. 
Felizmente, hoy estos inconvenientes se hallan descartadoe en gran parte por la acci6n 
segura de los anest^icos, y el enfermo, ayudado al grade de ilu8traci6n general de 
la 6poca presente, se nos presenta casi siempre en un estado de dnimo m&s bien sereno 
confiado en su acci6n comprobada, salvo ese temor instintivo al dolor, aumentado 
muchas voces por observar de cerca nuestros preparatives e instrumentos, y otras, 
raras por suerte, por consejos sin fundamento de ciertas personas pesimistas en cues- 
tiones de medicina. 

En poder de tan preciosos elementos, nos ha colocado en condidones de actuar con 
seguridad adn en los casos que antes eran de una dificultad absoluta. Y esa acd6n 
segura, por demils comprobada en la pr&ctica cientlfica, va abriendo cada dla nuevos 
horizontes en dentistica operatoria, o mejor dicho, en el campo de la cirugla en 
general. 

Preetando siempre preferente atend6n al estudio de la anestesia local, elemento 
precioso que complementa de una manera eficiente nuestras intervenciones, he eetu- 
diado detenidamente la acd6n, ventajas e inconvenientes de las prindpales subs- 
tancias en pr&ctica actualmente, y despu^ de muchas observaciones dlnicas, he 
utilizado una combinaci6n que por sus cualidades especiales, ha Uenado por completo 
nds aspiradones de hallar una fdrmula que en los casos de extracd6n del 6igano 
dentario a causa de periostitis alveolo-dentaria, a la par que se obtenga con ella la 
anestesia local, posea una acd6n antis^ptica, a fin de ayudar de este mode al trata- 
miento post-operatorio. • 

Los casos cUnicos ^ constatados que acompafian este trabajo demueetran un resultado 
altamente satisfactorio, que me ha decidido hacer esta comunicaci6n. 

CONSIDERAaONES OBNBRALB8. 

La periostitis alveolo^entaria, puede ser originada por causa diversas: traumatismos, 
aparatos de ortodoncia, cambios bruacoe de temperatura en la boca, dep6sitos de 
tdrtaro, restos de ruberdam o hilos de seda en el cuello de los dientes, absorcidn de 
substancias medicamentosas (cdusticos, desinfectantes), mechas de a]god6n abando- 
nadas en los canales, descomposid6n parcial o total de la pulpa, y en una palabra, toda 
infecci6n o irritaddn que ataque al periostio alveolo-dentario. 

De m4s estd dedr que con los medios que hoy posee la odontologla, existen siempre 
muchas probabilidades de un tratamiento conservador; pero cuando la complicaci6n 
peridstica es rebelde a todo tratamiento poniendo al 6rgano dentario en la imposibilidad 

> La aplicaddn de mi fdnxmla fa6 heoha a un gran ntUnero de enlennos, oon excelentes resultados. Sdk> 
aoompafio algnnos casos detaUados, que he oonsiderado de verdadero interns clinico. (£1 Editor: Se 
somete un oaso al fin oomo ilustraddn del trabajo.) 



PUBLIC HEALTH AND MEDICINE. 237 

de seguir desempefiando sua fundones fidoldgicaa y comprometiendo el estado general 
del padente, la extracddn eeUl indicada, m^bdme trat&ndoee de rafces. 

La extracd6n en tales casos trae gran alivio al paciente. Y se explica, ella es de- 
congestionante, y la distensidn de las extremidades nerviosas por los vasoe dilatados, 
desaparece. Esa decongestidn en uni6n de la acci6n aneet^ica, hacen que el padente 
se encuentre en pocos mementos en un estado de alivio complete y se retire tranquilo, 
contrastando con el estado en que se hallaba mementos antes. 

Pero, generalmente, este alivio es moment&neo y el dolor aparece de nuevo per- 
sistiendo por horas y muchas voces algtin dfa. Por lo regular, los buches antis^pticoe 
y analg^cos no actdan como debieran en eetos casos obligando a una medicaci6n 
interna. En otros, m^ delicados, donde el proceso se ha abandonado, el dolor re- 
crudece, entra un malestar general que es favoreddo por la falta de alimentaddn, 
insomnio, etc., aparece la fiebre y nos encontramos en presenda de una infecddn grave 
en la regidn donde se ha hecho la extracci6n. 

lOuil es la caiisa efidente de esta persistenda del dolor en la ma3roria de los casos, 
y de la nueva infecd6n en otros? 

^C^mo es posible suponer, admitiendo que el padente haya seguido las prescrip- 
dones del case, que sea tan probable una nueva infecd6n, hall&ndose la herida bajo 
una acd6n antis^ptica regularmente continuada poniendo barrera a la invasidn 
microbiana? 

La decongesti6n produce un alivio caai inmediato. Pero debemos tener presente 
que existe una infecd6n del periostio y que la hemorragia que produce la extraccidn 
no la hace desaparecer. Con el diente quitamos la causa de la infecd6n, pero ^sta 
adn queda en el alveole. 

La extracci6n produce una herida grande, y esta herida abierta favorece el avance de 
la invasidn microbiana, que en organismos debilitados, ya por la misma afecd6n, por 
una enfermedad general o una di&tesis, la hacen inminente, mdxime ai se dene en 
cuenta la septicidad del medio bucal. 

La acci6n fagodtaria del oiganismo, es de nuevo llamada a contrarrestar la nueva 
infecd6n, y esa nueva reacci6n inflamatoria, ayudada al estado general de la region, 
produce al paciente ese dolor continuado de mayor o menor intensidad de acuerdo con 
el grade de la inflamad6n. 

De manera que lo indicado serfa poner la herida en condiciones tales, que la reinfec- 
d6n no pudiera realizarse inmediatamente; y que, complementado luego con los 
buches antis^pticos, est^ a cubierto de nuevas infecciones. 

En una palabra: preparar el terrene antes de produdr la herida; escudar ese tejido 
debilitado all! donde mementos despu^ estard en condiciones de ser vulnerable. 

El tratamiento preventive de poner tintura de yodo en el alveole despu^ de la 
extracd6n, como desinlectante y revulsivo, no Uena el fin que se destina. Porque 
hay que tener presente que la tintura de yodo actda mal en un terrene htimedo. La 
hemorragia, mucha o poca que sea, impide se deposite como debiera en el tejido, y 
que, unido a la saliva y a los buches que hace el paciente despu^s de la extracd6n, 
obstaculiza su acd6n a tal punto que su efecto desinlectante es fnfimo. Y si adem^ 
de esto se agrega el tiempo que pasa desde la extracci6n hasta el memento que el 
paciente se halle en posesidn del antis^ptico prescrito, vemos que transcurre un 
tiempo bastante apreciable que es bien aprovechado por los microrganismos que 
acttian sobre un punto debilitado. 

Y ^sto siempre en el supuesto de personas aseadas que siguen las indicadones de no 
tocarse la herida, no fumar, etc. 

En consecuencia, he crefdo que es indispensable unir al aneet^co, una substancia 
que sin neutralizar su acd6n, ayude al tratamiento post-operatorio, que despu^ de 
la extracci6n pueda defeMerse de un nuevo ataque exterior, y en una palabra, como 
lo he dicho antes, que prepare el terrene antes de producirse la herida. 



238 PKOCEEDINGS SECOND PAN AMERICAN SCIENTIFIO CONGBEBS. 

Eso me ha inducido a agregar a la novocaiiia, la tintiua de yodo y la glicerma, qu e 
he denominado '* NoYocafna-gHcero-yodada, " solucidn que a la par de ser aneetMca, 
ee revulaiva, desmfectante y ligeramente c&ustica, y que Uena ese fin, como prueban 
las observaciones clfnicas que acompafio. 

La inyeccidii se hace in situ * procurando que ella se d^Kwte con preferenda en 
la regi6n afectada. La tintura de yodo durante el tiempo que pasa antes que el 
anest^co actde, va esteiilizando el medio, cujra acci6n ee facilitada gradas a la cons- 
tituci6n anat6mica del diploe, de modo que, cuando la aneetesia se ha producido, el 
terrene se halla en condicionee de resistir a una nueva infecci6n despu^ de la 
extracci6n, pues gran parte del medio estd ligeramente cauterizado. 

La reyul8i6n produce decongestidn de loe vasoe del periostio, y en consecuencia 
menoe dolor, por cuanto la irritaci6n de las extremidades nerviosas por loe vasos dila- 
tados desaparece, y por tanto ayuda la acci6n del anest^sico. 

La esterilizaci6n que produce antes de la extracci6n, igualmente favorece, por 
cuanto la initaci6n microbiana igualmente disminuye. Y por tiltimo, la cauteriza- 
ci6n pone al tejido en condicionee favorablee de no infectarse de^u^e de producirse 
la herida, que complementado con los buches desinfectantes, hacen un ambiente 
impropio para los microorganismos impidi^ndoles romper el equilibrio. 

Y si atin asf se produjera una nueva inCeccidn, ella siempre serd sin importancia, y 
el organismo estari en condiciones de contrarrestarla en una forma r&pida y segura. 

De ahi, entonces, que la inyeccidn a la par de ser anest^ca, simplifica y forma 
parte del tratamiento al mismo tiempo que proporciona una seguridad del resultado. 

En una palabra, la adici6n de la tintura de yodo en la f6rmula, favorece la acci6n 
del anest^co, actda como discrete hemostdtico, calma el dolor, poet-operatorio, 
dificulta una nueva infecci6n, facilita la cicatrizacidn y es un tratamiento preventivo 
que importa una seguridad para el tratamiento general. 

Y con eeta nueva pr&ctica, la conciencia profesional estari en un grade tal de segu- 
ridad de su tratamiento, que le obliga a convencerse de que una complicaci6n no sea 
probable, por haber tratado de esterilizar el medio, atin en personas despreocupadas, 
en los refractarios a los medicamentoe, en loe deeaseadoe, y en principal modo, en loe 
enfermoe de las clfnicas pdblicas. 

NOVOCAfNA OliCERO-TODADA. 

Esta soluci6n, como su tltulo lo expresa, se halla compuesta de novocafna, tintura 
de yodo y glicerina, y por consiguiente, como ya he indicado, es una soluci6n anes- 
t^co-revuMvo-desinfectante y ligeramente c&ustica y hemost4tica. 

Los componentee entre si no neutralizan las cualidades que aisladamente poseen 
cada uno de ellos, y su combinaci6n forma un Ifquido trasparente de color amazillooro. 

Quiz&B podrla suponerse que esta soluci6n fuera dolorosa por el alcohol de la tintura 
de iodo y por la misma acci6n c&ustica del yodo, pero los cases observadoe me hacen 
llegar a la conclusi6n que no sdio no es dolorosa sino que el poder de la novocafna no 
ha disminuldo. Quiz&s su poder anest^co sea sensiblemente menor por hallarse en 
di9oluci6n a las doe substancias, cuyo tftulo de la solucidn de la novocafna, es por 
tanto menor del inicial, pero atin cuando pueda existir esta diminuci6n del poder 
anest^co, su acci6n es completa y suficiente para el fin que se destina la novocafna- 
gllcero-yodada. 

Como se ve, los componentes son bien conoddos y estudiados, y tal vez parecerfa 
de m^ una de6cripd6n de ellas recordando bus cualidades e indicadones, pero ran 
embargo, he crefdo del case recordarlas de paso y someramente por ocupar en terapia 
un lugar preferente. Novocafna ee un cloridrato de paramino-benzoil-etil-amino- 
etanol, ha sido descubierta por Einhom en 1904, es uno de los anest^sicos m&a impor- 
tantes que hoy se posee, y lo demueetra de una manera concluyente el gran campo 

1 Sin embargo, on varios oasos, la inyeoddn la he heoho subperi<38tioa, gingiyal, con bueo resultado. 



PUBLIC HEALTH AND MEDICINE. 239 

que logr6 abrirae en cirugla, que en un lapeo de tiempo relativamente corto, las 
experiendas clfnicas ban demoetrado bu bondad a tal grade de dejar en un orden 
secundario no a61o a otros anest^eicos, sine basta a la miBma cocaina. Su poca toxi- 
cidad, BU Mcil eeterilizaci6n Bin que bub cualidadeB Be alteren, su poder anest^Bico 
comprobado, que para algunoB quiz^ Bea igual al de la cocafna, unidaB a bub eBcasas 
contraindicacioneB, Bon condicionee por ei solaB elocuentee. 

Por eBO Be ba viBto en breve tiempo Ber el aneetMco preferido, no b61o en dentiBtica 
operatoria, Bino tambi^ en cirugla general, donde basta citar aparte de los resultados 
tan balagQefioB en la raquinovocainizaci6n en los hospitales de Buenos Aires,' y los 
importantes trabajos de Sonnenburg (de Berlin), del Prof. Reclus de la Facultad de 
Paris, de Barker (de Londres), de Pringle (de Glasgow), de Eummell (de Hambuigo), 
etc., y por dltimo la opinidn del Prof. Reynier emitida en la Facultad de Medidna de 
Paris, en que expresa bub condiciones de esta manera: "La he comparado con otros 
anest^sicos tales como la cocaina, la eetovaina, la nirvanina y la eucaina. Esta 
comparaci6n ha side favorable para la novoca^ia, puee reune, en efecto, las cuali- 
dades que, segdn Braun, debe poseer un buen anest6sico.'" 

En dentistica, su ubo es general; su eficada y buenas cualidades la hacen indicada 
en todos los cases. 

Peraonalmente he tenido oportunidad de observar bub buenoe resultados en nuestra 
facultad de medidna por nuestro maestro, Dr. Nicasio Etchepareborda en las inyec- 
dones dipl6icas. La aneetesia se produce dentro de un promedio de 6 minutes m^ 
o menos' cuya durad6n es en algunos cases basta 20 minutos, oper&ndose completa- 
mente sin dolor y sin observarse en los muchos caaos he presenciado en la clinica, 
intervenidoB por mi maestro, ningdn case de sfncope ni fracaso. 

Igualmente, en el curso de mi distinguido maestro Dr. Le6n Pereira, se utiliza en 
las extracdones la novocaina como anest^co local, con excelentes resultados. 

Respecto del yodo (tintura) su use es universal en medidna y toda ponderaddn que 
se haga de este metaloide seria de mds. 

Miquel ha demostrado de una manera concluyente su valor como desinfectante; es 
revulsive, ciustico y antipdtrido. Su acci6n es en superfide y no en profundidad. 

Como desinfectante en drugfa mayor y eepedalmente en cinigia, se ha comprobado • 
SUB cualidades del todo inmejorables. 

El tftulo de la soluddn de la tintura de yodo usada en la combinad6n, es la del 
Codex Argentine o sea 1/12. 

En cuanto a las inyecdones de yodo, el organismo las soporta muy bien, dentro 
de la dosii de la solud6n que use. Segdn las experiendas de B^Him, un hombre de 
70 kilogramos puede soportar sin acddentes la inyecd6n en la sangre de 1} a 2 gramos 
de yodo libre. Si bien se ban registrado fracases en operadones que se ban querido 
tratar con inyecdones de yodo, se debe tener presente que las cantidades inyectadas 
eran muy grandes. Ya se observaron 36 cases de muerte a consecuencia de estas 

1 Enrique P. Bagnatl. Contribuddn al estudio de la raquinovocainizaoiOn en cinigla. Dr. Leopoldo 
Bard (1S07-8); Dr. Jo66 Aroe en 1909 (Congreso de Mcdicina de Rio Janeiro); Dr. Emilio Dlax Arano (tesis 
1913) haoe una estadistica de las anestesias realizadas en el Hospital Italiano dcsde 1904 hasta 1913, en donde 
se ve que hasta 1904 elcloroformo se usaba como anest^sicoen una proporcldn de 92.83 por cicnto del total de 
las interrenciones, j la raqulnovocainixacidn en el primer semestre de 1913 Uevaba un percent^ 67.87 por 
oiento, mientras que la raquinovooainizacidn en 1907 era sdlo de t^.06 por ciento. Por Ultimo el Dr. C. C. 
Bagnatl (tesis 1913) en su estadistica deolara que en 4,200 operadones practicadas desde 1911 a 1913 en el 
Hospital Italiano, en 2,400 se usd como anest^co la novocaina; y tennina mauilestando que "entre las 
4,200 intervenoiones las hay desde la mis pequefia hasta la mis alta drugla. " 

Eusebio Albina (revista C. E. Medidna y C. M. Argentine, agosto, 1914), en su trab^Jo titulado la noro- 
calna en la cirugla del cuello, mendona entre otros cases, uno operado por el Dr. I'ahr a en el Hospital San 
Roque, y se trataba de un sujeto que tenia im tumor de los ganglios de la cadena carotldea dereoha. Di^a 
persona, de 63 afios de edad, era un "arterio-esderoso, con insufidenda a<$rtica mal compensada, puet 
aoababa de aalir de un ataque asistdlioo." La anestesia tvA hecha looatanente con novocaina, con ez- 
oelento resultado. 

I E. P. Baganti. Contrlbuddn al estudio de la raquinovocainlsaddn en drugla. 

■ Caaos en que me fu6 indicada la observaddn por mi prolesor (1912). 



240 PEOCEEDINGS SECOND PAN AMEBICAN SCEBNTiriC CONGRESS. 

inyecciones, dice Nothnagel y Bossbach, y en el mayor ndmero de eotoe acddentes 
deben ser atribuf doe a las inyecciones hechas de una manera imprudente. ^ Y refiri^n- 
dpse al case de Rose, adn no bien aclarado, continda diciendo, que es bien dilfcil 
atribuir el fracaso dnicamente a la acci6n del yodo si se admite con Boinet que 200 
gramoe de yodo pueden ser inyectados sin peligro en los quistes del ovario, es decir, 
en el organismo. 

De manera que la cantidad de yodo que se usa en la solucidn anestMca que presento 
no puede producir ningtin accidente consecutivo local o general. 

Olicerina, — He agregado esta substancia a la fdrmula, como un suavisantea fin de 
evitar un pequefio ardor que he observado despu^ de la desaparicidn de la accidn 
anest^ca de la novocafna y que considero es debida & la acddn ciustica de la tintuia 
de iodo. La adicl6n de la gHcerina para este fin es excelente, corrigiendo ese defecto 
y aportando adem^ a la f6rmula sus cualidades andpdtridas y ligeramente desinf ec- 
tantes. 

Como se sabe, la gUcerina como cuerpo neutro que es, no modifica en absoluto la 
acci6n de los otros dos componentee, que, por el contrario, tieiide a favorecer su re- 
sultado. 

Sttio de la inyeccidn.— Ella debe ser con preferencia dipl6ica, pero sin embargo, 
la be hecho subperi^stica y gingival, con buenos resultados. 

La inyecci6n debe ser lenta, lo que da lugar a que puede actuar progresivamente 
con escaso dolor, pues si se hace con rapidez podrfa resultar dolorosa. 

Antes de la trepanacidn de la tabla 6sea, si fuera dipldica, para la de8infecci6n de 
la mucosa y anestesia, como tambi^n si fuera subperidstica o gingival, he usado la solu- 
ci6n clorof6rmica de yodo como lo aconseja Chassevant, por ser inalterable.' 

Se seca bien la encfa y luego se embroca el punto a trepanar. 

Este procedimiento f u6 aconsejado igualmente por el Dr. Texo, quien manifeetaba 
que con 61 se evitarf a arrastrar elementos s^pticos con la aguja. Con este agente, dice, 
cuimtos procesoe infiamatorios y dolores post-operatorios se evitarlan, atribuldos a 
otras inocentes causas.'' ' 

Fdrmula, — ^La f6rmula de la non>ooaina'glicero-iodaday es la siguiente: 

Sol. Novocaina al 2 ^ gr. 60. 

GUcerina neutra pura Ogr. 50. 

Tintura de yodo A de gota. 

(Para una ampoUa.) 

En esta proporcidn resulta una soluci6n completamente If mpida de color amarillo-oro. 
Si se aumentara la cantidad del yodo, aunque en pequefia cantidad, la solucidn se 
enturbia y se precipita. La f6rmula citada es estable y no se altera. 

CONCLU8I6n. 

Comohedicho, lainyecci6ndebeserinsitu, y por esoespreferible que sea intra, o sea 
jMuu que actde alll donde la af ecci6n est6 localizada o procurando que abarque gran 
parte de ese medio (gingival o Bubperi<5stica). 

El yodo es revulsive; de manera que la congestidn sanguinea va deeaparedendo por 
su acci6n, lo que trae por consecuencia una dimlnucidn de dolor, por cuanto la disten- 
si6n de las extremidades nerviosas por los vasos dilatados, es menor; conjuntamente 
a su acci6n revulsiva, es desinfectante poderoso y cdustico, de manera que comienza 
a esterilizar el medio cauterizdndolo levemente, teniendo presente la cantidad em- 
pleada en la 8oluci6n. 

1 Nothnagel y Rossbaoh: Mati^ m4dicale et th^rapeotlque, p. 262. 

• Monde mMical, No. 300, p. 957 

* La odontologfa. No. 4, p. 280. 



PUBLIC HEALTH AND MEDICINE. 241 

De modo que por de pronto ataca las causae de la inflamaci6n. mientras se eepera la 
actuacidn del anest^co, cuya acci6n favorece grandemente, pues precisamente a(m 
ellas las causae que por lo regular le impiden actuar como debiera. 

Esta acci6n revulsiva, o en una palabra, vaso-constrictora, es durable. Ouando la 
anestesia se produce y se procede a la extraccidn del 6rgano dentario, la hemorragia 
ee poca generalmente. 

La isquemia se mandene despu^ por largo rate. 

A primera vista podrlase suponer que esta propiedad sea debida dnicamente al 
anest^co, pero te6ricamente se comprende y prdcticamente lo he comprobado, que 
gran parte de esta acci6n es debida al yodo, que si bien al principio su ef ecto es ocultado 
por el anest^co, la falta de ese dolor post-operatorio caracteristico, cuando la anestesia 
ha desaparecido y la hemorragia inwignificante casi siempre, prueban de una manera 
evidente su importante acci6n complementadora al anest^co y al tratamiento conse- 
cutivo de la periostitis. 

La glicerina favorece la acci6n conjunta de una manera apredable asegurando el 
resultado de la formula. 

Si se observa el alveole y encfa de un diente, unas boras despu^ de extraldo, vemos 
que se hallan en un estado que indica hallarse en camino de cicatrizaci6n. Esta 
obeervacidn la he hecho en todos los cases intervenidos, en algunos de ellos con colec- 
ci6n purulenta, y en la mayorfa personas especificas, cardio-renales, enfermos del 
hfgado, etc. 

£1 complementar el tratamiento poniendo tintura de yodo en el alveolo despu^s de 
la extracci6n y la prescripci6n de buches antis^pticos y analg^sicos, son precauciones 
indispensables para coadyuvar al tratamiento. Sin embargo, en muchos cases he 
prescindido de esto, en personas desaseadas (como lo son gran parte de las que he 
tratado teniendo presente su condici6n social y el ambiente en que se hallan), unoa 
por experiencia y otros porque estaba convencido de que no seguirfan las indicaciones, 
la cicatrizaci6n fu^ completa y sin inconvenientes, tinicamente mds lenta y el dolor 
deBapareci6 menos r&pidamente que con los buches arriba citados. 

Por consiguiente, la soluci6n cuya f6rmula me permito presentar, llena el fin que 
me he propuesto, de tener seguridad y abreviar el tratamiento poniendo al paciente 
dentro de lo posible, al abrigo de complicaciones que a causa de la eztracci6n puedan 
ocunir, muchas veces debida a ignorancia, males consejos, pobreza, falta de comodi- 
dad o una infecci6n a que se halla expuesta toda herida abierta con el agravante que 
ya tuvo una por la perioetitiB y que es probable otra, no s61o por ser un punto debili- 
tado no por falta de higiene, sine por el medio ambiente en que se encuentra localizada. 

La e6terilizaci6n se hace en forma completa gradas a la diBpoeici6n anat6mica del 
dfploe, y si bien el Ifquido inyectado podri ir mds all4 del sitio deseado, no importa 
una dificultad y resulta m^ bien una precauci6n que felizmente noe focilita su consti- 
tuci6n aerolar. Pero aparte de esto, la inyecci6n nunca podri abarcar una regidn 
muy extensa dada la cantidad inyectada (1 gramo), pero sufidente para toda pre- 
vi8i6n. 

En cuanto a la cantidad de tintura de yodo utilizada en la aDluci6n anestMca que 
aconsejo, es muy sufidente para eeterilizar ese medio en una forma completa y si 
tenemos presente que Miquel con s61o gr. 25 e0terili26 un litro de caldo de cultivOy 
no hay duda alguna que una cantidad propordonal, esterilizaii bien y completamente 
un centimetre cdbico, si asf se me permite calcular el espado del medio a esterilizar 
en una periostitis alveolo dentaria. 

Con eeto termino este breve trabajo, y contintio extendiendo mis obs^vadonea 
en otros cases de medicina general, los que, si bien inidados, la blta de tiempo me 
impide incluir en el presente. 

Y con esta pr&ctica, no dudo se podri sostener una ves mis el tan ladonal afcmsmo 
que dice: Vcii md$ prevmir que cimv irrflmMthda. 



242 PROCEEDINGS SECOND PAN AMBBIOAN SCIENTIPIO CONGBESS. 

POUCU DS BUMMOS AlBKS, CAPITAL FBDKBAL— DlViai6N SAXIDAD. 

E 1 que soaoribe Jefe de la DiyisUSn Sanldad del Departaxnento de Policfa de la Capital, autoriia al Dentista 
Doa Juan D. Sosiai para que haga las aplioadones de la sohiddn ** Novoeoina-gUeero-podadti" en el Conmlto- 
rlo Odoatoldgloo de este DepartatneDto, a fin de que el personal de esta ofloina oompruebe la eficada del 
medioamento, que ha sido, por otra parte, debldamente anallsado en la Seooldn Qulmlca de esta Division. 

BuxNOS Amis, Oetubre de 1914, 

(Finnado) F. C. Babbasa. 

OBaSBYAadM Tebckra. 

Feoha: Ootubre de 1914. 

Nombre: M. R. 

Edad:26afi08. 

Ocupaddn: Agente de poUda. 

Aparlencla general: Hombre bien formado; buen desarrollo esqueldtico y muscular. 

Anteoedentes hereditarios j personales: Sin importanda. 

Estado de la boca: En buenas eondidones. 

Diagndstioo: Periostitis alveolo-dentaria produdda por raSoes de la segnnda molar inferior irquierda. 

Tratamiento: Extraoddn previa anestesia oon novocalna-gUbero-yodada. 

Inyeoddn: Gingival. 

Cantidad de anestteloo empleado: 2 oenttmetros cdbioos. 

Tiempo en que se produjo la anesteda: Un poco mAs de un mlnuto. 

Duraddn de la anestesia: Dos mJmitos y medio. 

Resultado: Satisfiaotorio. Aousd poco dolor a pesar de ser una extraoddn laboriosa. No hubo mareos nl 
malestar. Se retira bien del consultorio. 

Revisado: A los tres dias. Durante ese plazo tuvo un poco de dolor, pero un dolor muy soportable. 
En la fedia de la revisaddn, casi ha desapareddo. Herida en vlas de dcatrixaddn oompleta. 

Comprobado: 

(Finnado) Juuo Tkllo, 

Dentitta id Departamento, 



LOS DISPENSARIOS PARA LACTANTES (GOTAS DE LEOHE) COMO MEDIO 
PARA DISMmum LA MORTALEDAD INFANTIL. 

Por JULIO A. BAUZA. 
Director del ConsuUorio Oota de Leche No, 1, de Montevideo Uruguay. 

El criterio cad andniine de los que estudiaD los medios piicUcos para diBminuir 
la mortalidad infantil, conaidera a loe Dispensarioe para Lactantee (Gotaade Leche) como 
un baluarte que lamodemadvilizacidn oponealcrecimientode lamortalidad infantilde 
los dos primeros alios, cuya tendencia a progresar en algunos pafses y ciudades ha dado la 
voz de alarma, por cuanto, por su contribuci6n a la mortalidad general ha resultado la 
existencia de ciudades con crecimiento n^gativo casi nulo (Paris) o negative (Santiago, 
Valparaiso). 

£1 movimiento empiendido en todos los paises de civilizaci^n superior en defensa 
del nifio ha dado resultados indiscutibles en los tiltimos 10 afios, habidndose produddo 
caai universalmente un descenso en la mortalidad en el primer afio, que llega en 
algunos paises hasta caai un 50 por ciento. 

£1 Uruguay no podia quedar resagado en este sentldo y gracias al apoyo prestado 
por el superior Oobiemo, pudo la Asistencia Pdblica, abrir el primer Consultorio Gota 
de Leche a principios del afio.1908 en la dudad de Montevideo. Hasta fin del a£k> 1913, 
se habfan asistido en este Consultorio 7,000 nifios diferentes, habi^dose distribuido 
600,000 litres de leche y gastado 77,000 oro (ddlares). Desde 1914, siete Consultoiios 
dirigido cada uno de eUos por un m6dico especialista se hallan repartidos en dlstintaw 
zonas de la ciudad, correspondiendo a un consultorio por cada 50,000 habitantes. 
Aun cuando la mortalidad infantil en el Uruguay no es muy elevada en Montevideo, 
11.5 por ciento naddos vivos, no debe olvidarse que teniendo en cuenta que la alimen- 
taci6n natural es la mds dilundida, representa esa cifra un coeficiente bastante elevado 
y que podr4 ser reduddo a 7 u 8 por ciento en un porvenir no lejano. 



PUBLIC HEALTH AKD MBDIOINB. 248 

Es indudable que los DupenBarios para Lactantee, cuando eslin Men diiigidos, y 
cuando se emplean todos los medioe de propaganda poaiblee, conlerendas, concuraoa 
con premioe en dinero etc., contribuyen poderosamente a difundir la conveni e n ci a 
de la lactancia natural y a prevenir loe peligroe de la alimentacion artificial. 

La mejor demostracidn de c6mo con pocos recursoe pueden con8Qg:uirBe buenoe resulta- 
doe, U tenemos en el hecho de que si se compara el ndmero de nifioe ingresados 
alimentados a pecho en 1908 y en 1914 en la Gota de Leche No. 1 a mi cargo, ee 
observa que se ha triplicado la proporcidn de los nifios nutridos ezclusivamente por 
seno matemo en el afio 1914, en reladdn a 1908. Este resultado lo atribuyo al esti- 
mulo que representan los concursos mensuales para nifios a pecho, los que inducen 
a las madres pobres a inscribir a sus pequefios en el Gonsultorio desde los primeros 
meses, consigui^ndose asf dirigir y prolongar en lo posible la lactancia natural, 
suBtituyendo el m^co a la madre en la direcci6n de la criansa del nifio. 

£s indispensable para conseguir un buen resultado, que al Dispensario para lac- 
tantes posea tambi^n la secci6n Crota de Leche, es dedr que est^ en condidones de 
sumimstrar diariamente leche esterilizada o leches espedales, para comfdetar la 
alimentacidn a pecho o para sustituirla en los cases en que esta no sea posible. 

£s naturalmente ventajoso que sea siempre el mismo mMico, el que atienda a las 
madres y haga las prescripciones para cada case; de esta manera se gana mis f&dl- 
mente la confianza de las madres, que ven en el m^co que atiende siemi»e a su 
hijo, a la persona mis indicada para dirigir su crecimiento o para meJOTarlo en case 
de enlermedad. 

^Son pdddinicas las Crotas de Leche? Es indudable que originindose buen niimero 
de enlermedades, por defectos de alimentaci6n en cantidad o en calidad, y siendo 
igualmente dertos trastomos digestivos del nifio secundarios a otra enlermedad para 
intestinal, nadie estd m^ indicado que el mMico del Dispensario para indicar el- 
gdnero de alimentaci6n m^ conveniente en cada case; por consiguiente los Dispen- 
sarios para lactantes, deben ser consideiBdos como verdaderas pdidfnicas. 

ConsideriUidolo asf , se comprenderi f ddlmente que la promiscuidad de nifios sanos 
y enfermos en un mismo local no est4 libre de inconvenientes. La traamislAn de 
enlermedades cantagiosas, mientras madres y nifios est&n en la sala de eepera no sdlo 
es posible, sine que es muy probable. ^Gdmo podrfa salvane este inamTenienteT 
Lo mia ^pticHco a nuestro mode de ver, es sefialar dias ditoentes en la semana para 
nifios sanos y para enfermos. Esteprocedimiento, quehacepocosehapuestoenpiic- 
tica en el consultorio a mi cargo, si bien adolece de algdn inccmveniente, habitda 
a las madres a la diadplina, y ofrece ventajas indiscutibles en locales cuy 
instalaci6n no es completamente adecuada. Por lo juronto se eliminan de los dias 
destinados a nifios sanos los enfermos con tos convulsa, sarampi6n, varicela, aaf 
como la mayor parte de los enfermos agudos. Las madres que deeen oonsultar para 
enfennos en los dias de los sanos, son objeto de un interrogatorio minudoso y son 
aisladas en case de sospecharse una enfermedad contagiosa. 

En los dias destinados a nifios enfermos, las madres son interrogadas sobre el objeto 
de la visita y aisladas en una piesa especial, si bus nifios tienen alguna enfermedad 
tnamirible. 

Como consecuenda de las consideradones presentee, se comprenderi que es necesa- 
ria una instalad6n as^ptica y f&dlmente desinfectable, como una polidinica de un 
hospital de nifios. Una enfermera competente deber& intenogar a las madres a la 
entrada, antes de pasar a la sala de pesadas y a la de esp^ra; en los cases en que el- 
nifio presente sintomas de una enfermedad trasmisible resolveri su aialamiento y 
en case de duda requeriri la opinidn del medico. La sala de aiwlamiento deber4 
estar dividida en varies ''box," separados por tabiques vidrieras. 

Consideramos innecesario insistir sobre la necesidad de que estos establedmientos 
estto dotados de cale&cci6n en todas bus secdones, para evitar el efecto pemidoso 
del frio, espedalmente en la pesada y en la consulta. 
68486— 17— VOL ix 17 



244 P&OOSEDINGS SECOND PAN AMBBIGAN SOIEHTIFIO 00NQBBS8. 

No meiDos .titil serfa igualmente la instalacidn de una Becci6n de bafioB para nifioe 
7 madies, <dado que muchas madres no cumplen con eeta regla higi^nica por no dis. 
poner de lina instaladdn adecuada. Aun cuando no ee tan frecuente su ihobservancia 
en lo8 nifio8, aerfa yentajoeo una instalaci6n para elloe. 

Tambi^n aerfa de mima neceeidad la in8talaci6n de una pequefia fuente, que Buminis- 
tre agua pant beber a las madree que lo deeeen, lo que pasa muy frecuentemente en 
lo8 dfas caluroeo6 del verano. El agua debe poder beberse al suigir del 8urtid<Mr en 
foima de napa directamente sin requerir ledpiente'de ninguna daee. 

OOOINA DB LBCHB8. 

W La codna paia la elab<»raci6n y e0tmlizaci6n de la leche ee la Becci6n mis impor. 
tante del Consultorio; ella reemplaea al seno matemo y ee 8upei€uo dedr que cons- 
tituye el cofasdn del dispensario, ya que es la encais^da de nutrir a centenares de 
nifioe. En Hontevideo la codna central de leches se halla instalada en el Ckmsultorio 
N^ 1, y en ella se i»epaian las leches paia los siete ccmsultorioe. Su instalad^n 
oomprende varias secdones. 

1^. ManipuladAn de la leche cruda. 

El local que le esti destinado pos^ apaiatos para filtrad6n de la leche, enfriamiento 
a 4 o 6 gcs^os mediante una m^uina enfriadora en la que se utilisa una mesda 
frigofffica de hielo y sal y una llenadora autom&tica que puede llenar simult&neamente 
doce botellas hasta de un litro. El derre ee por medio de discos de cart6n parafinado. 
Esta seccidn fundona solo en yerano, pues no se considera necesario usarla todo el afio. 

2^. Preparacidn de leches espeddles. 

En eeta secddn se hace la preparad6n de la leche esterillzada, Baube];re, Sopa de 
Malta, Leche Descremada, Pegninizada etc., que se emplean en la allmentaci6n de los 
nifios chicos o enfermos. Oomprende: 1^, una cocina a vapor, con dos recipientes de 
10 y 20 litres de capaddad respectlvamente y que sirve para preparar sopa de malta; 
2®, un aparato mezclador, paia preparar las distintas dlludones y en comunicackSn 
con un llenador automitico de frascos; 3^, un autoclave, en el cual se colocan los 
irascos despu^B de llenos para ser esterilizados a 104 o 106^ por 16 minutes; 4^, de una 
batea en la que los irascos son enfnadoe despu^ de una esterilisaci^, por agua, puL 
verizada por medio de un aparato especial; 5^, de una desnatadora, utilizada para 
obtener la leche descremada, que ha de usarse sola o que ha de empleane para la 
obtencldn del Babeuire, dej&ndola agiiar y agreg^dole 12 gramos de harina y 40 de 
asticar por litro. 

3^. Limpiexa defrascoB y houlku, 

Los frascos son lavados con agua caliente y soda, y despu^ sometidos a la acci^ de 
cepiUos intemos y eztemos; finaJiaindose con enjuagados pcnr un chono de agua fria. 
La mAquinalavadaraesmovida por unpequefio electromotor. La persona que trabaf a 
en esta secddn no interviene para nada, en la preparaddn de las leches. 

4^. Oenerador de vapor. 

Con dicho generador se suministra vapor de agua para el autoclave y cocina, aai- 
mlsmo agua caliente pan la limpiesa de frascos y Utiles. 

Finalmente, se dispone tambito de un pequefio laboratorio en el cual se hace el 
andlisis diario de la leche redbida para reconocer su pureza. Sirve tambito paia e! 
examen qulmico, hematokSgico y bacteriol^co de los casos de la policUnica. 

LA LBOHB. 

Para que todo el engranaje fundone arauSnicamente, es necesario que todo el 
personal cumpla su obligacidn con la mayor escrupulosidad, cosa que se ha con^ 
seguido deepu^ de varies afios de iM:^tica. Ahora bien, para que el resultado se ponga 
de manifieeto, en lo ref erente a la salud de los nifioe que toman el alimento preparado 



PUBLIC HEALTH AND MEDIOINB. 24£P 

en la cocina de leches, es indupenBable que la materia prima, es decir, al leche, sea de- 
calidad Irreprochable. Este es el gran problema, de diifcil solaci6n, que adn no ha 
side resuelto en el OonsuHorio Gota de Leche N^ 1, a mi caigo. 

£a imposible, que una leche que contiene millones de g^rmenes por cent cub., na 
sea peijudicial psia los nifios d^biles o convalecientes, aun cuando sea hervida o esteri- 
lisada antes de ser utiliaada. 

£s indudable que si no excluoivamente, por lo menos en gran parte es esta la causa 
de la ezcesiva mortalidad Inlantil en los mesee de verano. La leche se recibe en la 
Qota de Leche N® 1, despu^s de 12 o 14 horas de ordefiada; los tarros de leche que 
lUgan a la dudad, deben permanecer varias hons caldeados por el sol de verano 
hasta la Uegada del tren que los ha de conducir aMontevideo. A pesur de la i»opa- 
ganda que se ha hecho, no se ha conseguido atin emplear vagones Irigorfficos. No debe 
extrafiarse por tanto que ciertos dias llegue la leche tan alterada que no pueda sec 
ntUisada psia la alimentacidn de los nifios. 

Como se comprender6, este hecho, aun cuando no se produce frecuentemente;. 
trastoma prctfundamente el fnrestigio de la Institud^ y desorienta a las madres que nor 
siben qu6 alimentaciAn deben emplear . 

Opino qi|e en estos casos, serfa preferible, durante los meses de verano, suprimir el 
reparto de leche a los Dispcoisariosyentregar a las madres gratis, o a precios reducidos, 
bomos por la cantidad de leche necesaiia para adquirirla en las vaquerfas o lecherfas 
higiAnirai debidamente controladas. 

CUNA TBMPORARIA. 

Desde que Marbeau fund6 en Paris el afio 1844 la primera Casa Ouna hasta la 6poca 
actual, su ntlmero ha ido aumentando r&pidamente, hasta el punto de contarse por 
centenares en Francia, Alemania, Italia, Estados Unidos, B^lgica, etc. Su existencia 
esU Justificada por la necesidad imperiosa de trabajar, de las madres que no poseen 
recursos suficientes, sea por enfermedades o fallecimiento del marido, por abandono o 
por insufidencia de salario, etc. En una palabra, su necesidad estd justificada por la 
miseria. No siempre la madre puede obtener trabajo, de realizar en su habitaci6n al 
lado de su hijo. Muchas voces tendri que procurkrselo fuera de ella, en f&bricas o 
talleres, o como criada. En estos casos, ^qu6 se hace del nifio?; o Men la madre la 
deposita en el Asilo de Nifios, y las mis de las voces lo olvida, o bien si no tiene alguna 
persona de la famiUa que pueda cuidar de 61, lo entregard a una mujer a quien deber6 
abonar la casi totalidad de su jomal para que lo cuide y alimente: el resultado ea 
depUnrable en la Inmensa mayoria de los casos. 

Ahora bien, si la madre se^ que su hijo puede ser alimentado y cuidado bajo el 
control mMico en el Consultorio Gota de Leche, su elecd^n no ser& dudosa: lo pre* 
teiii por las ventajas de todo orden que le ofrece. Si el nifio esti a pecho, 6ste no le 
aeri supiimido. El medico se edonui para que la madre siga amamantando a so 
hijo, y eventualmente se podr& consQguir vaya a medio dfa a darle el seno, ofredte- 
doaele a ser posible, como en ciertas Gunas de Norte AmMca la comida de medio dia. 
Duante la permanencia del nifio en la Cuna b61o necesitard dos biberones de leche y 
una comida ligera, si se trata de nifios m^ crecidos. 

No ban faltado tampoco en este caso, criterios que se oponen a la instalaci6n de las 
Cimafl. Se ha dicho en i»imer t^rmino que favorecen al desarrollo de enfermedades 
oontagiosas. ^Ssto puede ser cierto, para los casos en los que la admiai6n se hace sin 
contrcd: no es el caso cuando el medico examina diariamente a los nifios a su entrada, 
Impidiendo el ingreso de los contagiosos. Una enf^mera competente puede, sin 
inconveniente, reemplasar al m^co a la hora de ingreso. Adem^ entendemoe que 
la Cuna debe disponer de una secd^n de bafios, en la cual todo nifio al ingreear es* 
bafiado y sos ropas son reemplasadas por las que ha de llevar mientras est^ en ella; 
I>%asenos ahofa si no esti en mayor peligro de adquirir alguna enf^medad contagiosa 
en la prosmicuidad del inquilinato, que en un local que posea las condidones mencio- 



246 PBOCEEDINGS SECOND PAN AMERICAN SCIENTiriC C0N0BB8S. 

nadas. Se ha dicho tambi^n que la separacidii aunque sea temporaria durante laa 
horas del dla, de la madre para con su hijo, afloja IO0 vlnculos matemales. No es este 
nuestro modo de pensar. La madre veri todoe los dias a su hijo al retirarlo y apre- 
ciar& sus progresos, su crecimiento y su intellgencia; a medida que el tiempo trascuira 
aumentar&n los lazos de cariflo que la vinculan a su hijo: su abandono en el aailo es 
poco menos que imposible. 

Otra ventaja ezistirfa en la anezidn de una "Cuna'' a la Gota de Leche. Los dfas 
de fiesta en los que la madre puede conservar a su pequefio todd el dia a su lado, red- 
birfa la leche preparada a la que el niiio est4 habituado: se evitaria asf que el nifio 
saiga de la Cuna sano, un s6bado, e ingreee enfermo el lunes sigui^ite, hedio com- 
probado en muchas Cunas y que esteriliza a voces la labor de toda la semana. 

Otra objeci6n que se hace frecuentemente, es su costo relativamente elevado. 
Hasta se ha pretendido que serfa mis conveniente abonar un jomal a la madre, y 
^vitar asf el ingreso del nifio. Si bien esta objeci6n puede tener cierto valor, y aon 
cuando es cierto que las Cunas pueden resultar costosas en Europa, 1 fr. 50 a 2 fnincos 
per nifio y por dia, debe tenerse en cuenta, que por ellas la madre aprende a querer y 
A cuidar bien a su hijo, atendiendo los consejos de la enfermera. 

CUB8O8 DB pirBRiox7i;rnRA.. 

Son de importancia cada vez mayor para la instrucci6n popular que las madres 
adquieren dia por dla, los cursos de pueiicultura instalados con tanto ^to en Estadoe 
XJnidos, Franda, Alemania y otros pafses. 

Laignorancia y los prejuicios de las madres son las causas de gran n6mero de 
^nfermedades del nifio. Este es un hecho que no necesita demostraci6n. No cabe 
ningnna duda de que como consecuencia de ello, la mortalidad in&tntil es mfm 
elevada de lo que serfa, si la instrucci6n de la masa popular fuese mis avanzada de 
lo que es en realidad. La casi totalidad de las madres de la clase social inferior, 
atribuyen la mayor parte de las enfennedades del nifio a la saHda de los dientes. La 
bronquitis, lo mismo que la gastro-enteritis, son alribuidos a que el nifio esti echando 
los dientes y antes de que el medico las interrogue, se apresuran a decir que vienen a 
consultar porque el nifio esti enfermo a consecuencia de la denticidn; y como conse- 
cuencia de ello, la madre no consulta sine cuando ve que su nifio esti coifenno graye- 
mente. En muchos cases, la intervenddn m^dica se electda tardfamente con re- 
sultados desfavorables a veces^ o conslgui^ndose la mejorfa despu^ de mudio tiempo 
y fatiga de parte de la madre, qui^i se la hubiese ahonado si hubiera practicado 
la mixima, de que es mejor y mis ec6nomico prevenir que curar. 

En el Uruguay, la alimentaci6n artifidal esti poco extendida. Su poblacidn de 
origen espafid e italiano en su gran mayoifa, tiene los hibitos de sus antepasados. 
La lactanda natural es la regla, o por lo menos la lactaada mixta. La lactaada 
artifidal en los primeros meses es relativamente rara; a pesar de Mo, la mortalidad 
infantil en el primer afio es alrededor de 11 por 100 nadmientos, dfra relativamente 
elevada si conaideramos, como hemes dicho, que la alimentad6n natural o mixta 
<!onstituye la regla. Las gastro-enteritis son sumamente frecuentes en d verano, 
hasta d punto de constituir mis de un tercio de la mortalidad total dd primer afio. 
Las causas deben buscarse en la falta de reglamentaddn de las tetadas, que general* 
mente son muy frecuentes, y en d hibito de dar al pequefio toda dase dealimentos 
s61idos e indigestos, hibito general en la mujer dd pueblo. De aquf que las gastro- 
enteritis que son relativamente raias en la dase acomodada, sean muy frecuentes en 
la clase pobre, asf como tambi^n otras enfennedades debidas a la ignoranda y a los 
males cuidados, como por ejemplo: las bronco-neumonfas, la tos convulsa y las infec- 
dones umbilicales. Estos hechos demuestran hasta la evidenda la necesidad de que 
un Consultorio Gota de Leche tenga otganisados cursos de puericultura para las ma* 
dres del presente y dd futuro, en los cuales se les instruya de todo lo rd^ente a la 
higiene, cuidados y alimentaci6n dd nifio. Estos cursos cuya duraci6n mfnima debe 



PUBLIO HEALTH AND MBDIOINE. 247 

Mr de 0010 1116060, do0 V6C60 por 0einana, 0er(an tedrico prictico0, utiluindo0d el mate- 
rial del Coii0iiltorio y de la Giina. 

8a irecaentaddn con aoidnidad y on examen final darfa lugar a la obtenddn de on 
c6rtificado de aptitud60, que podrla 0ervir, a la que lo obtuvi60e, para alcansar una 
buena plaza como nifiefa o cuidadora. La alimentaddn natural, la higiene del nifia 
y de 0U habitaci6n, la preparaci6n de alimentoe 60pecial60, 9ti como IO0 primeroe cui- 
dadoe para el nifio enfenno, coimtituirfan otro0 tanto0 capf tulo0 oobre IO0 cual60 0e 
in0i0tirfa 60p6cialmente. 

De todo lo que acabamoo de decir, 00 deduce 0in mayor eofuerso, que ya no 60tamo0 
en IO0 ti6mpo0 en IO0 que un pediatra d]0tinguido afirmaba que para implantar en 
una ciudad "La Qota de Leche," 0^0 00 nece0itaba un mMko abnegado y un aparato 
Sozhlet. L06 di0pen0uio0 para lactant60 modemo0 necentan, oi 00 deeea obtener el 
TOJTimum de reeultado, una iiuitalacidn eopecial que haga poflible la realuaci6n de 
todao la0 ideaa expu60ta0 en eete trnbajo. Montevideo que cuenta con la A0i0teiicia 
Pdblica Nacional 061idamente Qiganisada, no debe demorar mSm la inataladdn de una 
inatitucidn en la forma que dejo relatada. 



a ESRO ESSENCIAL DE PESSOA NA LEI BRAZILEIRA DO CASAMENTO 

CIVIL. 

For RODRIGUES D0RL4, 

Fn]^ie$9or de Meiieina FukHca da Faeuldade de Direiio e eaikedratikOy em diipambU, da 

FdetUdade de Medidna da Bakia. 

O casamento civil 6 uma in8titui9ao relativamente nova no Brazil: veio com a 
Republica, e foi promulgada com o Decreto 181 de 24 de Janeiro de 1890, pelo Governs 
Provi0O]io, alterando profundamente 00 co6tume0 e 00 habitoo, e contrariando at 
cren^aa de um pdvo, na sua grande maioria catholico e superBticioso, que 06 admitte o- 
caoamento perfeito como sacramento, e garantida a unifto firme e perpetua doa conjugee 
pela ben9ao oacerdotal. Nfto foram poucos 00 de0a8tre0 havidoo no0 primeiroo annoo da 
ezecu9fto da lei, entre pe00d«0 de pouca instruc9ao que fugiam is garantiaa legaea do> 
canmento, contrahindo a unifto conjugal aomente diante do altar. Illegitimidade doe 
filho0 perante o Estado, perdaa de heranyaa, foram as consequencias doa actoa impon- 
deradoa do0 que aasim procederam, e t^m procedido, at^ que um gr6o mais adiantado- 
de in0truc9So e civilisa^So fa^a perder as abusOes, e 00 oacerdotea de todas as religiCeo, 
syotematicamente, nfto celebrem o casamento reUgiooo 0em que lhe0 0eja apresentado> 
documento probatorio da precedencia do casamento civil. ' '0 govenio maisdespotico e 
meticuloso, a legiala^fto mais obedecida e rigorosa," diz Tarde, ''60 1100, comprehendldo* 
por I0OO 60000 mil e um habitoo recebido0, quer tradicionaeo, quer novo0, que regulam 
a conducta privada, nfto de cima e abstractamente como a lei, mas de muito perto » 
no inen<Hr detalhe, e que comprehendem todaa as neceasidadea artificiaes, traducgfto 
livre daa nec608idad60 naturaeo, todoo 00 gostoo e 00 deflgo0to0, todas as particularidadee 
de costumeo e de maneiras proprias a um paiz e a um tempo." E muito mais impe- 
liooa 6 easa legislagfto do uso so ella so misturam sentimentoo religio0O0. 

Cautelooo o govemo revolucionario, receiando certamente nfto abalar em maior 
extenafto 00 habitoo e oe co0tume0 de p6vo, podendo chegar a conaequencias grave^ 
mente compromettedoraa da aasocia^fto conjugal, nfto creou o dlvorcio, como uma 
conaequencia natural, logica e juridica do contracto a que ficou excluaivamente 
redusido o caaamento, em que peze ao receio de juriatas actuae0, que, no dizer do feete- 
jado juri0conaulto bnudleiro. Dr. Clovi0 Bevilaqua, nfto podendo manter hoje, no- 
direito definitivamente 0eculariaado, ease exotiamo do aacramento, dlzem que 6 acto, 
comie ae contracto nfto fdaoe igualmente um acto juridico. Contracto 6q>ecial, continda 
o aotor do * D ireito da familia, " por ae constituir mediante um accordo de intereasea, uma 



^48 PB00EEDIKG8 SEOOND PAN AMEBIOAK 80IEKTIFIC O0NQBES8. 

coincidenda de vontade, ou oomo dizia lord Robertson, a mab importante de todas 
as transacgOes humanaB, base da constituigfto da sociedade civilaada, ou como 
dia Mathew Woods, o mals sagrado dos la^os, a mais profunda das responsabilidades, 
incluindo a mais inflexivel das obnga^Oes (Divorce). 

Nada impede que esse contracto seja sanctificado pela ceremonia religiosa, que 
^atiaCae e tianquilisa a consciencia dos crentes. 

casamento pode, porto, ser annuUado, e entre as causas de nullidade figura o 
■erro esseneial de peuda, 

A lei do casamento civil assim dispOe: 

Abt. 71. Tambem ser& annullavel o casamento quando um dos conjuges houyer 
consentido nolle por erro essencial em que estivesse a respeito da pessda do outio. 

Abt. 72. Oonaiderapse eno essencial sobre a pessda do outro conjuge: 

{ 1^. A ignorancia do seu estado. 

|2^ A Ignorancia de crime inafian^avelenfioprescriptOyCommettido por elle antes 
•do casamento. 

1 3^. A ignorancia de defeito physico irremediavel e anteric»r, como a impotencia 
e qualquer moleetia incuravel ou transmissivel, por contagio ou heran^a. 

A annulla^ do casamento por erro essencial sobre a pessda s6 poder& ser pedida 
pelo conjuge, victima do engano ou d61o, dentio de dois annos da data do casamento. 

O que se deve entender, ou, antes, entende a lei por ettado do conjuge, cujaigno- 
Tancia possa dar logar d grave consequenda da nullidade do casamento? 

A pressa com que foram mganisadas as leis do govemo piovisorio da Bepublica den 
iugar, a]gumas vezes, ao emprego de phrases ou termoe ambiguos, como o i^Mmtado, 
o que nfto deve existir num systema de legisla^ bem oiganisado, sem as neoe»> 
earias restricgGes ou a predsfto do sentido em que devem ser ent^idos os voca> 
bulos. E$tado quer dizer, lezicologicamente, situa^fto ou mode de ser de uma pessda 
ou coisa, e nesse case pode a palavra ser entendida de maneiras differentes. "A 
applicavel, por exemplo, d situa^So economica de uma pessda, dla o Dr. Glovis Bevi- 
laqua, e 6 repugnante a todos os principles que se proponha a annulla^ de um 
•casamento sob tal fundamento; e, lembrando essa fei9So do termo, accresenta o notavel 
jurisconsulto que apenas salienta "a inconsistencia do vocabulo," que elle ainda 
•denomina "vago e elastico, vacillante e equivoco." 

Pode termo ser comprehendldo como exprimindo a situa^fto do individuo em 
rela^ d sociedade, d familia e ds leis, e tambem d religjAo. O jnojecto de Godigo 
■Civil, organisado pelo Dr. Goelbo Rodrigues, fas a restric^fto do estado civU $ religioBo, 
e neste case trata-se de saber se o individuo 6 solteiro, viuvo ou casado, se gosa de 
plena capacldade ou soffre de alguma interdic^fto, ou se pertence d religifto que repelle 
■a do outio conjuge. 

Nfto tendo side a lei do casamento civil ieita pelo Gongresso, de cuja discussSo se 
pudesse tirar elementos para a interpreta^fto de phrases ou vocabulos incertos, ao ler 
e paragrapho apreciado, a primeira ideia que surge ao espirito 6 a da referencia ao estado 
•de viigindade da mulher, o que estd excluido pela disposigfto do projecto Ooelho 
Rodrigues, e ainda pela Interpreta^fto do Dr. Glovis Bevilacqua. Todavia, este sen- 
tido 6 perfeitamente plausivel, pois a integridade da hymen 6 essencial ao casamento, 
<:omp testemunha da moralidade e dos costumes da mulher, pois de outros signaes se 
|>ode repetir o gracejo bocacciano, citado por Ziino: 

Bocca baciata non perde ventura 
Ansi rinnova come fa la luna. 

Os hebreus chamavam d donzella alma, cUnutra, segundo Galmet, e tal era entre 
'elles o valor da viigindade no casamento que a sua ausencia podia ser um motivo de 
repudio, e um crime a imputagfto ftdsa de desvirginamento, desde que o pae da mulher 
•demonstrasse essa falsidade: et ecce haee $unt iignit wrgmUatit fikae meae: expandetu 
tcestinuruum coram senwnlnu civitatis. Deuteronomio, Gap. XXII, 17. A viigindade 



PUBUO HEALTH AKD MBDIOINB. * 249 

ultrajada sempre encontrou vingan^a nas leis. TSo predosa 6 conAidenuJ)^ easa con- 
di^So da mulher, que o Chrigtianiaino erigiu o culto da Vligem. Juato 6 que perca 
08 ieu8 effeitoe, como se no houvera, o caBamento em que o deaviigmamento foi 
doloaamente occulto ao homem confiante, poia aeria um eacandalo ena co^^fto eata- 
tuida no contracto, como profeasa o dlieito eccleaiaatico que a ledua a inlpedimento 
impediente, e nfto dirimente. 

O prqjecto do Codigo Oivil do Dr. Clovla Bevilacqua, modificado pela^commiaBfto 
eq[>6cial da Camara doe Deputadoe, em 1902, comprehendeu o deaviiginamento anterior 
ao caaamento e ignorado pelo marido, como eno esBencial de peasda, quer no projecto 
primitivo, quer no segundo, que deu melhor diapoaigfto a eate caao particular, e nolle 
ae 16: i 

Abt. 280. Tambem 8er4 annullavel o caaamento quando um doa conj^gee houver 
conaentido nolle, por erro easendal, em que eativease aobre a peesda do o^Hro. 

Abt. 281. Gonaidera-ae erro eaaencial aobre a peeada do outio conjuge: 

1®. A ignorancia de aeu eatado civil ou religioao; 

2^. A ignorancia de crime inafin^vel e nfto preacripto, commettido antee do 
caaamento; 

3®. A ignorancia de defeito phyaico irremediavel e anterior, como a iillpotencia, e 
qualquer moleatia grave, incuravel ou tranamiaaivel; 

4?. O deaviiginamento da mulher, ai o marido nfto tinha conhedmento^deaae facto. 

Aa nullidadea contidaa noa trea primeiroa numeroa deate artigo podem aar requeridaa 
dentro de doifl annoa, a datar do dia do caaamento, ou da data da lei, ae tiver aido anterior ; 
prudentemente, porem, foi marcado para o ultimo caao o praao de des diaa, que aegundo 
Toulmouche, Ziino, e outroa, conatitue o maior lapao de tempo para q^e a perida 
medico-legal poaaa deacobrir aa dcatrisea doa retalhoa da hymen, e determinar a epocha 
do defUmunento, evitando por eaae mode poeaiveia explora^Oea e abuaoa. 

Releva aqui obaervar: Em um paiz, cuja conatitui^fto preacreve a liberdade de con- 
aciencia, em que a egreja eeti aeparada do Eatado, em que eate nada tem que ver com 
aacran^aa religioeaa de cada qual, como ae pode admittir figure na lei que aeja annul- 
lavel o caaamento civil, em virtude do eatado religioao de um doa conjugea, quando 
a celebra^ do contracto, ou do acto, ae quiaerem, obedeceu a todaa aa exigenciaa e 
fonnatidadea da lei? 

Nfto vi raaOea que juatLfiquem eaaa excreacencia do projecto, nem o aeu autor aa deu. 

Parece-me de neceaaidade que a lei, como erro eaaencial de peaada, fiseaae a eapeci- 
fica^ da identidade, evitando por eaae mode a repetigfto da fraude de Labfto, aubati- 
toindo aaua filha Rachel, eabelta e formoaa, dada em caaamento a aeu oobrinho Jacob, 
p<Hr lia, menoa bella e nfto requeatada. 

O grande juriaconaulto brazileiio Teixeira de Freitaa, no aeu Eabo^o de Codigo Civil, 
admittin como enro eaaencial: 

"Quando veraar aobre a peaada, iato 6, quando um doa contrahentee acrediton ter 
caaado com uma certa peeada, entretanto que o caaamento foi oelebrado com peeada 
diveraa." 

A eate propoeito, na Comnuaafto da Camara doa Deputadoa, que reviu o projecto 
Clovia Bevilaqua, o Dr. Aniaio de Abreu, da referida comnuaafto, propos a a^guinte 
emenda que nfto foi aliia acceita, permanecendo a diapoaigfto do projector 

''Ignorancia do aeu eatado civil e religioao, ou de aua identidade peeaoal, ou da 
integiidade phyaica da nubente, ae fte eata aolteira" comprehendendo, portanto, 
neeae numero, a queatfto da virgindade. 

O aegundo caao de nullidade de caaamento por ignorancia de crime ioaffian^avel de 
um doa conjugea 6 obvia; nenhum contracto pode aer valido neaaaa.condi^Oea, eape- 
dalmente o que prende para uma vida em commum, para a bda ou mi fortuna, na 
maior intimidade, duaa creaturaa, uma daa quaea ae apreaenta um monatro aoa olhoa 
daoutra. 



250 PROOEEDINGS SECOND PAN AMEBICAN SGIENTIFIO C0NQBBS8. 

terceiro caso de erro essencial de pesBoa ^ constituido por "defdto phydco ine- 
mediavel e anterior como a impotencia, e qualquer molestia incuravel ou transmifidvel 
por contagio ou heranya." 

A impotencia nem sempre se mamfesta por um defeito physico; ella pode ser func- 
cional, por falta de erecgfto, que 6 um acto reflexo, cuja determina^ parte do centro 
nervoso especifico, collocado na por^fto lombar da medulla. 

E como deve ser aqui comprehendida a impotencia? 

Distinguem-se em medicina legal duas formas da enfermidade — a impotencia para 
exercer o acto conjugal, impotencia coeundi, e a impotencia de gerar ou de conceber, 
generandi out concipiendi. Ambas as f^rmas podem-se apresentar no homem, ou na 
mulhor. 

A primeira f6rma da impotencia, no homem, pode existir com a apparencia normal 
das partes genitaes, vidadas apenas na sua funcdonalidade ao ponto de gerar a inap- 
tidfto absoluta, quor em consequencia de uma doen^a da medulla espinhal no nivel, 
ou adma do centro especifico, quor por estados psychopaticos que annuUem oe estimu- 
loB partidos do cerebro, ou por grios de degenera0U>, que comprehendem a natura 
frigida do direito canonico — **frigiditas est membrif qwxm vis optime coftformatif flaeei' 
ditoi quaedam et inexdtdbilis mollities*^ (G^parri). Esta f6rma da impotencia pode 
resultar tambem da ausencia ou defeito do membro viril, impotencia instrumental, 
prpveniente, no primeiro caso, de uma amputagfto cirurgica, ou accidental, como um 
caso do meu conhecimento, em que a voracidade de um peixe arrancou a um menino 
t<^os OS orgftos genitaes extemos; ou no segundo, originar-se de um defeito congenito, 
coipo a epi ou a hypospadia, e o hermophrodismo, 

Na mulher a impotencia coeundi pode igualmente ser congenita ou adquirida, a 
saber: estreitamento exagerado da bacia, nfto dando ao afastamento dos ramos do 
pubis ^ amplitude necessaria para permittir a intromissSo do orgfto viril, uma oblitera^So 
da vagina, reduzida a cordllo fibroso, a abertura da vagina no inteetino, ou conformik- 
90es viciosas do orificio vulvo-vaginal e do canal, por lesOes ou processes morbidos 
gipaves, e cicatrizes consecutivas, adquiridas antes do casamento, ou um estado de 
hyperesthesia exceesiva (vaginismo doloroso). 

A fdrma de impotencia de gerar resulta da aiisencia de cellulas nemospermicas 
(eepermatozoarios) no liquldo seminal, ou de affeccdee que impecam a forma^to 
deese liquido, como a epididimite blenorrhagica chronica e dupla, e o teeticulo 
tuberculoso ou syphilitico. Na mulher a impotencia concipiendi di-se por ausendm 
de utero e ovaries, pela obtura^ do orificio ou do canal do collo por versOes ou 
flexGes. 

Nfto havendo a lei feito dlstincgfto entre as f6rmas da impotencia, qualquer della 
pode servir de fundamento d nullidade de casamento? 

No tempo do imperio, quando havia religifto do Estado, e somente o casamento 
religioBo, reconhecido e garantido pela lei, as questdes de nullidade de casamento per- 
tenciam ao fdro ecclesiastico, e se faziam de accordo com os preceitos do direito 
canonico. artigo 158 da ''Consolida^fto das Leis Civis" reza: 

"As questOes de divorcio ou sobre nullidade do matrimonio, ou sobre separa^fto 
temporaria ou perpetua dos conjuges, pertencem ao Juiz Ecclesiastico. A respeito 
dellas nenhuma ingerencia pode ter a jurisdic^ secular.^' 

O direito ecclesiastico s6 encarava, e encara, como causa de nullidade de casamento, 
OS impedimentos dirimentes, e a respeito do impedimento por impotencia, diz Thomas 
Bellacosa. — Theologiae moralis rudimenta. — Tertia editio: 

" Impotentia est inhabilitas ad copulam habendam. Impotentia dirimit matrimo- 
nium an sit antecedens et perpetua, sive sit absoluta, sive sit respectiva." 

E em nota acrescenta o autor: "Hunc si quis est habilis ad coeundum et impoe 
ad generandum potest contrahere; sterilitas enim non est impedimentum." 

D'aqui se v6 que, perante a egreja catholica, s6 a impotencia de exercer o acto 
sexual, constitue motivo de nullidade do casamento, com exclusfto da impotencia de 



PUBUO HBALTH AKD MBDIOINE. 251 

r ou de conceber, comquanto o fim do casamento seja a procrea^fto ou a perpetua0k> 
daespecie. 

O artigo 56 da lei do caflamento civil diz: ''Sfto effeitoe do casamento: { 1^. Con- 
fltitoir familia legitima e legitimar filhoe havidoe de um doe contrahentes com o outro^ 
flalvo se um deetes ao tempo do nascimento ou da concep^So doe mesmos filhos estiver 
caaado com outra peasda." 

Em rigor, parece que todos as fdnnaa de impotencia poderiam ser allegadas, coma 
motivo de nullidade do contracto matrimonial, pois constituir familia, formar familia,. 
tern como objectivo a procreagfto, a perpetua^So da especie. casamento 6 conse- 
gttintemente a legitima9fto desse objectivo, a que precede natundmente a satisfacgfto 
doe imuseres sexuaee; repugna, porem, aoe noesoe ueoe, tradi9So e costumes, essa 
interpretacfto, comquanto sejamos um paiz novo, Carente de populagfto, que nfto pode 
dar uniGes eeteris. Seria, porem, um escandalo para A nossa sociedade se um doa 
cofnjugee, apto d procreagfto, tentasse a nullidade do casamento, allegando ser o outro 
esteiil, ccHnquanto perfeitamente apto ao acto sexual. Poderiamos a este respeito diser 
coin Prof. Brouardel em relag&o d legisla^ franceza, comparada com a allemil, da 
qual "deduz-ee que a unifto matrimonial tcim um s6 fim, procrear filhos; quando este fim 
nfib^attingido, aquelle esposo que possueainda faculdades procreadoras pode procurar 
utilisal-as em circumstandas mais favoraveis. Em Franca, continua o autor dtado^ 
legislador se coUocou em outro ponto de vista: um dos fins do casamento pode ser ter 
filhos, mas um pacto muito mais solemne liga os conjuges de mode indissoluvel, o» 
mie'para seguirem juntos a bda ou a mi fortuna.'* 

Fda compara^ da legisla^fto auotriaca e allemft com a brazileira, chega-se i» 
mesinas conclusOes do professor da Faculdade de Medicina de Paris. A palavra 
familia, cuja constitui^fto legitima 6 principal effeito do casamento, tem tido com a 
teinpo iftccep9Ges juridicas diversas, ora comprehendendo toda a descendencia de um 
trpnco commum, ora o conjuncto mais limitado de parentes e pessdas vinciiladas aa 
gnij^. '*No direito modemo, diz o jurisconsulto brazileiro Dr. Clovis Bevilacqua; 
frunilia 6 o conjuncto de pessoas ligadas pelo vinculo da consanguinidade, cuja efficada 
0e estende, ora mais Itfga, ora mais restrictamente segundo as varias legisla^Oes. 
Outras vezes designam-se por familia somente os conjuges e a respectiva familia. ''^ 
Portanto, se algum erro de intelligencia me nSo oblitera a comprcdiensfto, a familia. 
estd constituida pelos conjuges, mesmo antes da prole, ou quando esta nfto appare^a. 

Ji o direito ecclesiastico definia o casamento: Nuptiae sunt conjunctio maris et 
feminae consortium omnis vitae, divini et humani juris communicatio. Tr. 1 . D. 23, 2. 

O art. 60 do Godigo Civil austriaco diz: "Uma impotencia completa e incuravd i 
consummayfto do dever conjugal, produzida durante o casamento dd igualmente direita 
ao divorcio." 

O art. 696 do Codigo prussiano reproduz pelas meemas palavras a mesma doutrina, 
da qual se segue directamente que, se depois do casamento sobrevior a impotencia a 
um dos conjuges, pode ter lugar o divcndo pelo motivo de que cessou a faculdade de- 
procrear, e, conseguintemente, essa impotencia nfto serd somente a impotencia coeundi, 
mas tambem a de fecundar ou conceber, pois alii o que se quer obter com o casamento 
6 a prole. 

A nossa legisla^, acompanhando a doutrina do direito canonico, exige que a im- 
potencia seja anterior ao casamento. Por conseguinte, desde que a enfermidade 
aobrevenha ao contracto, nfto pode ser admittida como motivo de sua nullidade. 
No ''Dirdto da familia,'' do Dr. Clovis Bevilacqua, 3a edigfto, 1906, ds paginas 162^ 
e&ooDtra-se a seguinte nota: 

"Quando fallamos de impotencia, que consiste na inaptidfto para gerar, referimo-noa- 
maSt directamente ao homem (impatentia coeundi); comtudo, ainda que mais ram- 
mente, ella se encontra na mulher sob outra fd^fto {impoUrUia condpiendi). No dtado- 
Hvio, cujas opinidee afto, com justissima razfto, gruidemente acatadas pelos nosM* 
cultores da sdencia do diieito, aiBda se 16, ds paginas 8 :'* Os lactoros da constitui^fto da. 



252 PBOOEEDINOS SEOOKP PAN AMEBIOAN 80IEKTIFI0 C0KGBB88. 

fomilia bSo: em primeiio lugar o instincto geneaicOi o amor, que approxima 06 dob 
«exo6; em segundo lugar os cuidados exigidos para a cooBerva^fto da prole, que tomam 
maiB duradoura a aasociac^ do homem e da mulher, e que determinam o surto de 
emo9de8 novas, a philoprogenie e o amor filial, entre procreadores e procreados, 
emo90eB eaaaa que tendem todas a consolidar a aasocia^ familial." 

De tudo o que venho examinando, parece-me poder-ae logicamente concluir que, 
«ntre nde, a impoasibilidada de procrear conaidera-ee uma conaequencia da impotenda 
^»eutuj»— aquella que pode motivar diasolugao do vinculo matrimonial.^ 

Entre os defeitoe que podem acarretar a impotenda est^ o hermaphrodiamo, ou a 
Teunifto, no mesmo individuo, de oigftos aexuaee, glandulaa, ou canaea excretorea e 
oigftoB da copula, aem a poasibliidade da auto-fecunda^fto, como no hermaphrodiamo 
vegetal, e em alguna animaea infeiiormente collocadoe na eacala. 

XiA a aexta aemana da vida intrauterina o aexo de embryfto 6 indeciso, iato 4, nHo ae 
•encontra differen^a de estructura e oiganiza^&o entre o que ha de aer homem, ou 
jnulher. A natureaa noe aeua indecifraveia e myaterioaoe proceeaoa de aperfeipoamento, 
naa eapecificagOea e aeparaySo daa f unc^Oea, nem aempre caminha pladda e aegurm, 
encontrando ia veaee trope^oe que Ihe deaviam a orienta^fto e perturbam a marcfaa do 
trabalho in&tigavel. Ou pela heran^a, que 6 uma grande for^a de fixa^So naa eapedea 
novaa, podendo no entretanto fiwer recordar fdrmaa antigaa, qualidadea abandonadaa, 
levivendo oigfkw quaai extinctoe; ou por um abalo no deaenvolvimento do embryfto, 
que 6 uma reproduc^fto da hiatoria ancestral, tomando os indicios primitivos da hi- 
aexualidade, demonstrada por Waldeyer, impulao evolutivo em direc^&o paraldla; 
•como quer que aeja, quaesquer que posaam aer as influencias perturbadoras da mardia 
normal do desenvdvimento, a criatura humana nfto ae acha ao abrigo desae desgarro da 
natureza, que redunda ia mais daa vesea em tenivd castigo a aeu portador innocente. 

hermaphrodiamo apresenta gtioB differentes, e na maioria dos cases, pode ser 
uma causa de impotenda eoeundif e consequentemente imia causa de nullidade de 
casamento, ae o outro conjuge ae nfto conformar com a situa^ embara^osa que a aocte 
the deparou. 

(hios menos adiantados desse defdto, o faJso hermaphrodiamo- como a epiwpadia 
•ou a hyi>08padia, pode accarretar a impotenda, ae nfto 6 remediavd cinugicamente, 
•como at6 certo ponto me pareceu o caao por mim observado, ha um anno, do qual dd 
conhecimento i Sodedade de Medidna Legal da Bahia, e que aqui reproduao. 

Resta finalmente, o erro essencial de pesaoa que conaiste na ignoranda de moleada 
incuravd ou tranamissivd por heran^a. 

Hoje, que a tendencia 6 melhorar a raga humana, i semelhan^a do que ae pratica 
com 06 diversoa animaea, formando-se uma adencia nova— a Eugenia — para conaeguir 
•esse dedderatum, nfto ae poderia admittir um contracto, em que a fraude de uma daa 
partes, nfto s6 obrigaase a outra aos riscos de uma molestia que Ihe fosse contaminar 
a existenda, como tambem estragar a prole com a infecgSo grave. 

Medidas serias deviam mesmo ser tomadas antes do casamento, para que nSo foasem 
levadas para o Idto conjugal molestias que, como a syphilis e outras infecyCes venereas^ 
podem causar a degenerescenda da ra^a, contaminar a mulher, e tomal-a esteril e 
•enferma a vida intdra. Todavia jd 6 um progresso a dispodgfto da Id. 

0A8O DB HtPOSPADIAS, BmUIAKIK) HBRMAPH&ODI8MO.' 

De passagem pela villa de S. Paulo, no aertio do Estado de Seigipe, a 4 de Jandfo 
4este anno, fdnne mostiado um menino, que me diasefam, na linguagem popular, a^r 
macho e femea. Logo foi grande a minha curioddade em examinal-o, nfto me aendo 
^ntfto poesivd faael-o, aenSo, muito superfidalmente, eatando o menino de p6, e 
ainda c^erecendo todaa as reaistendas poadveis, chorando muito, com receio de uma 

1 Bsta ildnoHa foi remettida ao Ccngrano Sdantifloo Pan Amflrioano antes da ser approvado pelo Coo- 
i wo o Codlgo CItO BraiOeiro. 
• ObMrraoio apctMatada 4 8ooi«lada da Madlolna Legal a (Mnlnolo^ 




8 

Bi 
I 




s 

I 



S 



PUBLIC HEALTH AKD HBDIOINS. 253 

operagfto, ou pelo vexame que Ihe caiuava a observagfio do defeito, de que era portador 
e que servia de chac6ta aoe outros meninoe. Effectivamente, oe oigfios sexuaee 
eztemoe tmham a apparencia de uma vulva com clitoriB grandemente deeenvolvido e 
adiente. 

Consegui, nfio sem difficuldade, que em principio de Fevereiro o pae o trouxesBe a 
Ancajd, onde pude examinal-o melhor, e obter as duas photographias que, sob oe 
num^os 1 e 2, junto a esta rapida descripQfto. 

F. 0. de M. tem 7 annoe completes, de cdr morena, com mistura de caboclo, e 
apresenta regular desenvolvimento. pranto em que estava, quando foi photo- 
graphado, deixa ver as costollas salientoe do lado direito, parecendo magrem. 

O pae, de estatura regular, ou talves baixa, de boa complei9fto, tem 26 annoa de 
idade, e um mais do que sua mulher, acabodada e menos robusta do que o marido. 

Beferin*me este que o menino tem, pelo lado matemo, um prime com defeito 
semelhante, e que 6 casado e tem filhoe. O defeito desto deve ser bastante menor, 
pois F., chegando i idade adulta, nao poderi fecundar, nem mesmo exercer a copula 
vaginal. 

A photographia numero 1 apresenta o menino de p^, tondo os orgftos sexuaee extemoe 
a apparencia dos de peesda do sexo feminino, cnjos grandes labios sfto muitoa&wtadoa 
na parte anteriw, pela salienda de um simulado e volumoso clitoris, e respectivo pre- 
pucio. Fasendo deitar o menino, e conservando as cdxas approximadas e dobradaa 
sobre a. bacia, contintia a aparencia feminina doe orgftoe sexuaee, em virtude de ter o 
escroto, na parte m^dia, um profundo sulco, adaptando-se uma a outra as duas metadea 
ou lobulos na parte posterior, como se foesem dois verdadeiros grandes labios, de cnja 
parte anteriw exhuberava o volumoso clitoris. 

Afastadas as cdxas, como na photographia numero 2, separam-ee os dois lobulos do 
eactoto, nfto existindo vestigio algum de orificio vaginal, no fundo do sulco, onde a 
pelle^liaa. 

Naa partea salientes e livres dos fingidoe labios, a pelle tem a apparencia franiida 
da pelle escrotal. 

Examinando os lobos do escr6to, separadamente, verifiquei em cada um dellea 
um pequeno corpo ovoide, como uma pequena oliva, correndo dentio de uma bolsa, 
oa quaea eram e\identemente testiculos. 

A saliencia que se v6 na parte superior do sulco (photographia n? 2), de 8 e meio 
centimetros de ccnnprimento, tem a confOTma^fto de um penis, com a ^ande toda 
descoberta, e cujo coUo pode-se distinguir na photographia. Esse penis 6 totalmente 
adherenteao sulco pda parte inferior ouuretral,etoma a f^madeumarco. Aglande 
6 in^MrfuIada, comquanto se note em sua extremidade uma dei»essfto ligeira, alongada, 
em aeguimento ao freio, para diante, e onde devera ser o meato urinario. 

Na rais do penis se deacobre, elevando um pouco a glande, um pequeno orificio, 
em fdnna de fenda antero-poaterior, que 6 o meato urinario, e por onde o menino fas 
a eyacua^k) da bexiga. 

A ere^fio tender^ a accentuar a curvadura do penis, e, em virtude de sua adherenda 
total, scffi impossivel a intromissfto desse membro na vagina em acto de ajuntamento 
sexual, s6 podendo o paciente obter o praser genital por manobras outras, sendo 
perdida a ejacula^fto. 

Por esta descrip^ se poderd deduzir a situa^&o physica e moral desse menino, 
quando chegar d idade adulta. Pareceu-me, no entretento, que uma opera^fto 
drurgica, consistindo no desbridamento do penis, despregando-o do sulco inters 
escrotal, poderia de algum mode permittir a copula a aginal, sendo assim ranediada 
at^ certo ponto a impotencia eoeundi^ persistindo, porto, a de fecundar, pela situa^io 
da deeembocadura do canal uretral. 

As inf onna^Oes sobre os habitos do menino pouco adiantaram; disse-me a mAe que 
elle dava preferenda, ou parecia dar, a brinquedos proprios de meninas. Essaa 
infonna90ea, porem, nfto eram filhas de observa^Ao intelligente, e pareceu-me que 



254 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

esta queetSo foi despertada no eepirito da mulher pela minha indaga^So. Os brin- 
quedofl das crean^as estfto sempre de accordo mais com o meio em que 83o criadaa. 
Neste caso 6 preciso attender d esquivan^a do menino em rela^fto aoe de sua idade, 
em consequencia do defeito que 6 moti^ o de zombaria doe companheiroe, e por iaso- 
toma o menino mais retrahido e cazeiro. 

Sem entrar, por eecusadas neste meio, em considerables anatomicas e de (vdem 
moral, sobre o defeito com que a natureza, nos sens de8\ ios, marcou penosamente o> 
pequeno F., concluimoe: 

1? — Que F. 6 um hypospadico, com apparencias, apenas, do sexo feminine, ou de ma 
false hermaphrodismo, e victima de impotencia coeundi atqtu generandi. 

2? — Que F. estd comprehendido, se algum dia pretender contrahir casamento, no- 
art. 72, f 3, da lei do casamento ci il, salr o se a operate cirurgica suggerida viet 
remediar o defeito, desde que as nossas leis nfto fazem da impotencia de gerar motiva 
de impedimento ou nullidade do casamento. '>- 

3? — Caso a cirurgia possa remediar o caso de mode que a copula carnal seja poesivel, 
permanecerd a impotencia de fecundar, pela posi^So do orificio da uretra, nfio se 
fazendo a ejacula^Ho dentro da \i^na. 



MliTODOS MODERNOS PARA LA PREVENadN DE LA MORTAUDAD 

INFANTIL. 

Por ARTURO L. GUERRA, 

Miembro de la Washington Diet kitchen Association. 

Al escribir este trabajo no intento discutir Ios tecnicismos relacionados con el 
cuidado y alimentaci6n de Ios nifiuM, sine m^ bien dar un lureve reeumen del trabajo 
que se esti Uevando a cabo en esta Naci6n, con el objeto de resguardar la salud de loe 
niiios, reduciendo por estos medios la mortalidad infantil. 

Para dar una idea de la energia con que Ios Estadoe Unidos est4n tratando el pie- 
blema, b^tame decir que en algunas secciones de Manhattan se publican libros en siete 
idiomas sobre el cuidado de Ios niiloe y se reparten gratis a las madres con el objeto 
de que sus esfuerzos al aprender a salvar las vidas de sus hijos puedan ser reducidoa & 
lo mfnimo . Los Estados de Louisiana y Texas ban equipado canros de exhibicidn que 
Yiajan por lugares rurales y por medio de demostraciones pricticas si^nbran por 
doquier Ios principles fundamentales de la higiene infantil. El Departamento de 
Niiios estableci6 un Centre de Salud Infantil en la Exposici6n Panam^Pacifieo, 
donde grandes auditories observaron Ios miles de niflos que alll fueron examinadoe 
y tratados, no b61o haci^doles un gran bien, sine tambi^n educando las masM en 
general. Sin discutir m^ lo que la Naci6n estd haciendo, vuelvo a mi prop6sito, que 
es el de hablar de lo que la Asociaci6n ''Diet Kitchen " de Washington, por medio de 
Ios Centres de Salud Infantil, lleva a cabo con el objeto de prevenir la mortalidad 
infantil en esta ciudad. 

Anterior a 1905 estas instituciones eran casi desconocidas, y el sistema que al presente 
se sigue, se deeanroll6 durante Ios dltimos cinco afioe. Hoy hay en Wdahington cinco 
Centros de Salud Infantil, localizados en las secciones mis populosas de la ciudad, 
con objeto de que est^n al alcance de las multidudes de madres y niiios que habitan 
estos distritos. 

Cada eetacidn se compone de un sal6n, amplio, limpio y bien ventilado, donde te 
examina a Ios niflos, y otra sala de espera en donde Ios desnudan y pesan. Una o doe 
enfermeras asisten a Ios pacientes, y un cuorpo de doctoree atiende las conferencias, 
las cuales tienen lugar tres veces por semana. 



PUBUC HEALTH AND MEDICINE. 255 

Lo6 remiltadofl que se obtuvieron de este trabajo fueron halagadoree deode el prin- 
cipio, a juzgar por la eetadlstica de estos afloe: el tanto por ciento de defuncionefl de 
menoree de un afio con reepecto al ntimero de nacimientoe fu6 anualmente como sigue: 
de 1906 a 1910, 16.18; en 1911, 13.61; en 1912, 12.83; en 1913, 11.99; en 1914, 10.02. 
Eeta reducci6n mueetra lo que se puede lograr con un continue y sistemdtico Mai 
por instruir a las madres y conservar la salud de los nifios. Las estaciones de la ' * gota 
de leche'' eran antes lugares adonde acudlan las madres, porque alK podian obtener 
leche a un precio muy bajo. Hoy eetas instituciones modemas ban variado de cate- 
goria; no siendo ya estaciones de lecbe, sine mis bien Oentros de Salud Inlantil, 
donde las madres reciben instarucci6n en los principios de la higiene y sua nifios son 
atendidos por m^icos competentes. Su objeto no es el fomentar los alimentos arti- 
ficiales; los centres saben e inculcan en las madres el hecho de que la leche humana es 
el alimento ideal para el nifio de pecho y s61o recurren a la alimentaci6n artificial 
cuando las circunstancias absolutamente los obligan a ello. Frecuentemente se logra 
inducir a las madres a que vuelvan a dar de mamar a sus nifios despu^ de haberlos 
destetado y haberse limitado a alimentarlos con mamadera. Los Centres de Salud 
In&ntil llevan a efecto dos clases de conferencias, las prenatales, para mujeres 
«n cinta, y las postnatales para sus hijos. Las primeras son de suma importancia. 
En ellas se ensefia no solamente la higiene durante el embarazo, sine tambi^n el cuidado 
de los nifios al nacer; adenUus se les presta atencidn ^ultativa prepar^dolas fisica- 
mente para el gran acto de la matem idad . Para mostrar lo necesario que es el cuidado 
prenatal citar6 como ejemplo una de las estadisticas copiladas por Williams. Entre 
705 fetos muertos cuyas causas ^1 investig6, 186 murieron de sifilis, y tiene rasones para 
creer que el 40 por ciento del resto murieron por la misma causa. Como esta en- 
fennedad es, hasta cierto punto, curable bajo un r^imen debido, esta alta mortalidad 
daberia haber side mucho menor. Mor^ nos dice que el 42 por ciento de los mifioa 
que mueren anualmente no completan el primer mes de vida, y siete d^imos de ellea 
mueren como resultado de condiciones anteriores a su nacimiento. Si estas mujeres 
hubieran side vistas o puestas bajo tratamiento mMico, ^serfa posible estimar cu^tos 
de estos nifios hubi^ramos podido salvar? 

En la ciudad de Washington las dehmdones ocasionadas por partes prematuros 
auben a 35.54 por mil de nacimientoe. Esta propoici6n es 50 por ciento mayor que 
la de los muertos a consecuencias de deeiMenes ditoicos que fueron reg^strados 
durante el mismo perfodo. Los Centros de Salud con sus medidas priMsticas y su 
generoso inters, son un gran ftustor actualmente e influihm mas a<in en el future 
an la redueci6n de la mortalidad infantil cauaada por los partes prematuros o 
cualquiera otca condici6n evitable o curable, existente antes del nacimiento. 

La importancia de este problema se eeti comprendiendo ri^idamente en todaa 
partes y actualmente, 38 Departamentos de Salud, de ciudades y 247 agendas par- 
ticulares han emprendido el trabajo prenatal en 110 lugares de los Estados Unidoa. 
Los m^todos empleados en los Centros de Salud de W&shlngton concuerdan por 
f^gla general con los empleados por las miwinaH instituciones en todos los lugares de 
los Estados Unidos. 

Las madres tienen conocimiento de estos centros por medio de alguna amiga, cuyo 
hijo est& aaistiendo a las conferencias y recibiendo vidbles beneficios; otras voces 
las madres empiezan a in^ estigar, despu^ de haber leido algun articulo, acerca de 
lo que a menudo se publica en los peri(3dicos y en los cuales, se habla del gran bien 
que hacen al ptiblico estas instituciones. La Sociedad de Enfermeras Instructoras fre- 
cuentemente tiene notidas de estas madres, ya sea por medio de algtin padente 
o de la Asociaci^n de Caridades. Una de las enfermeras vinta a la madre y general- 
mente logra convencerla de que para el bien del nifio, no podrfa hacer mejor cosa 
que llevarlo semanalmente a las conferencias. Los doctores frecuentemente sirvan 
da agantes para aumentar la concurrenda a los centros, pues ellos saben bien que 



256 PROCEEDINGS SECOND PAK AMBBICAN BCIEKTIFIC C0NGBE88. 

^0toe son lo6 lugares por excelencia donde las madres, faltas de recimos, pueden ser 
educadas y al mismo tiempo recibir ateiici6n facultativa para ellas y para sus ntfioe. 
Otro hctoir que ayuda a atraer la ateiici6n de las madres hacia los centres, conaiste 
en las exhibiciones que de evz en cuando se dan en teatros, iglesias y Centrot 
de Salud. Estas exhibiciones no b61o educan a las madres, aino que las persuaden 
de que el asistir a las conferencias vale bien su tiempo y trabajo, puee su aaistenciA 
a ellas no puede resultar sino en favor de sus pequefiuelos. 

Cuando las madres asisten a las conferencias prenatalee la enfermera las instruye 
cdmo deben vestirse; la clase de trabajoe que deben evitar; cuinto deben donnir, y 
en general las hacen comprender que U salud del futuro hijo depende en gran parte 
del estado de salud de ellas. Despdee de ^eto el m^co las examina cmnpletamente 
y guarda relaci6n exacta de lo que se refiere a su condici6n previa y la presente y 
de los resultados del examen ffsico: dimensionee de la pelvis, reeultado del examen 
de la orina, pre8i6n de la sangre y reacci6n de Wasserman. Durante los tUtimos 
meses se hacen exianenee abdomioales y vaginalee cuando es neceeario. Estas 
pacientes se reciben cada dos semanas, obsOTvdndolas, de esta manera, cuidadosamente 
durante la gestaci6n. La mira de los Centros de Salud ee que las madres empiecen 
a asistir a las conferencias al comensar el embaiaao, para asf poder obeervar y diiigir 
cada case desde su <»igen. En las conferencias las madres reciben adecuadas y 
cmnpletas direcciones sobre c6mo deben tratar y cuidar a bus futuroe hijoe. Se instru- 
yen en la manera de alimentarlos, vestirlos, bafiarlos, y en el departamento llamado 
"sewing circle" aprenden a haceries ropa. 

Como es evidente, eatos esfuenoe evitan muchas muertes. Frecuentemente es 
posiblexyrevenirabortosymalpartos; las presentacionespeligrosBSse pueden corregiry 
al educar a la madre se consigue aumentar las probabilidades de salud y vida para it 
nifio.* Dos ventajas mis se obtienen tambi^n de las conferencias prenatales: la pre* 
venci6n de la ceguera, y el matricular op^tunamente a la madre en los Centros de 
Salud. 

Uno de los deberes de la enfermera es investigar las condiciones de la casa en que vive 
la madre, y si dichas condiciones son tales que impidan el parto allf , se le recomiendan 
los nombres de algunos buenos hoepitales donde la mujer recibiri toda la atencidn y 
cuidado debidos. Cuando el parto occure en casa las aaisten m^icoe competentes 
que han hecho estudios especiales de obstetricia y a quienes siempre puede Uamtodes 
por tel^ono. Despu^ del parto, durante la convidecencia son asistidas por una de 
las enfermeras del Distiito. 

Cuando la madre sale del hospital, una enfermera del Distiito y otra del Centio de 
Salud, la viaitan y hacen que siga las Instrucdones que le fueron dadas antes que 
naciera el nifio. Despu^ asiste a las confeiencias una vez por semana y allf vuehre 
a recibir instrucci6n sobre el cuidado de su hijo. 

UNA OONFBBBNCIA BN UN CBNTBO DB SALUD INFANTIL. 

Cuando la madre por primera vez trae al nifk) a los centros, sus nombres son regis- 
trados en los libros de la Institucidn. La enfermera desnuda al nifio en la sala de 
espera y lo pesa. En una tarjeta de tamaflo apropiado se registra la edad del nifio en 
semanas, y debajo de esta, su peso. Esto ee hace semanalmente. Cuando gana en 
peso, ^ste se marca con tinta negra, y con roja cUando el peso es menor que el de laves 
anterior. Las madres temen mucho estas dltimas marcas porque son para ellas una 
sefial de peligro que inmediatamente estimula sus energfas para encontrar la causa, 
lo cual las hace segulr las instrucciones del doctor con mis cuidado y perfecci6n. 

Despu^ de pesar al nifio la madre lo lleva al consultorio donde el m^ico tcmia 
cuidadosamente la historia de Ice dos. Las condiciones horeditarias se estudian en 
detalle, asf como las circunatancias presentee durante el nadmiento, lugar del parto, 



PUBUO HBALTH AHO) HBDIOIHB. 257 

estado y peso del niiio al nacer, y cualquiera otro detalle que pueda influir de un 
mode secnmdario. Al terminar esta inveBtigaci6n se desnuda al niflo y se le examina 
completamente, anotando con cuidado cualquier fonnacI6n defectuosa, eintomas de 
raquitismo o de enfermedades cong^nitas. Ouando se termina este examen si el 
nlfio se estd lactando debidamente, se le dan completas instrucciones a la madre con 
ielaci6n al tiempo que debe estar el nlfio en el pecho, y se le explica como conservarA 
mejor su salud si se le da de mamar solamente cada tres o cuatro boras con reguTaiidad . 
Tambi^ se la Infonna sobre lo necesario que es darle agua varias voces al dla, as! 
como respecto al ndmero de boras que debe dormir. El doctor aconseja luego a la 
madre con relaci6n a sf misma, advirtidndole el mejor alimento posible, el debido 
ejerdcio y que duenna las mis boras que pueda. 

Ouando el nifio no puede lactar de la madre por alguna raz6n que realmente lo 
impide, el doctor bace lo posible por encontrar la fdrmula de lecbe que est6 indicada. 
En tales cases se siguen las slgulentes reglas: se usa lecbe en estado natural y la madre 
la modifica en casa, agregando simplemente cierta cantidad de agua pura, o agua de 
cebada, y uno de los asdcares, generalmente el de malta. La salud de algunos nifios 
progresa mejor cuando reciben el alimento cada cuatro boras, otros en cambio lo 
requieren cada tres. Sm embargo, la cantidad total de lecbe que reciben en las 24 
boras es la misma, lo tinico que yarfa es la cantidad de agua que se usa. Cuando se 
completa la f6rmula la madre recibe instrucciones escritas que explican c6mo debe 
preparar esta lecbe, pues ella prepara diariamente por la mafiana la cantidad total que 
el nifio deberd consumir durante el dfa« La enfermera encaigada del Centre de 
Salud siempre prepara la lecbe la prlmera yes cuando cada madre recibe su 
fdrmula, para ensefiarla a medir y mezclar las simples substancias que forman la dieta 
de su bijo. A la primera oportunidad la enfermera visita la casa para cerciorarBe de 
que todo marcba debidamente, y para ver si la madre estd Uevando a cabo las ins- 
trucciones que reclbi6 en la conferencia. 

Los deberes de la enfermera de los Centres de Salud son de suma importancia. 
Aparte de lo que bace durante las conferencias, es su deber el visitar a cada nueva 
madre el dfa que es admitida a las conferencias y escribir un informe complete acerca 
de la condlci6n social de la famllia y la situaci^n de la casa; si est& ubicada en una 
secci6n limpia y sana de la ciudad, o en una atestada de gente y malsana, donde los 
nifios crecen diffcilmente sin calor y faltos de sol. Da parte tambi^n de la salud 
aparente, educaci6n e inteligencia de los miembros de la familia, especialmente de la 
madre; de los recursos de los padres y por lo tanto de las comodidades que se pueden 
ofrecer a su nifio y de las condiciones bigi^nicas del bogar. ^Hay limpieza, recibe la 
luz del sol, se puede calentar debidamente en el inviemo? La enfennera rinde los 
informes sobre estos asuntos con el objeto de que el trabajo sociol6gico y medico de las 
conferencias pueda Uevarse a cabo mejor. 

£1 objeto primitive de los Centres de