Part 10

When a patient has recovered from diphtheria, thorough disinfection is a most important measure. Unfortunately, however, many persons consider it a hardship if articles which can not be disinfected are destroyed, and many will even use every endeavor to prevent the representatives of the Board of Health from carrying out their regulations. In this way the germ of the disease remains on the premises, and under suitable conditions again finds another victim in the household. To illustrate this, I recall an instance some years ago in which I was called in consultation to see a most malignant case of diphtheria. The little patient fortunately recovered, and the premises were thoroughly disinfected, the parents being anxious to avoid any repetition of the dreaded malady. Five months later, however, a younger child became ill, and was found to have diphtheria. In view of the vigorous efforts which had been made to disinfect the house thoroughly, and of the fact that the child could not have contracted it elsewhere, not having left its home for several weeks, the cause at first appeared a mystery. Careful inquiry, however, soon elicited a fact which clearly explained the case. The first patient had used a mouth-organ just before its illness, and when this was abandoned, the toy was carelessly thrown on the top of a bookcase, the nature of the child's illness at the time not being known. The second child, just before its illness, had accidentally found this toy and used it frequently. This experience explains the necessity of disinfection in all its details, and also illustrates the tenacious character of the germ which produces this disease.

Our knowledge of the specific cause of scarlet fever is not as complete as that of diphtheria, but we have much useful information which is of importance from a hygienic standpoint. As in diphtheria, the specific poison is probably produced in the throat of the patient, and may therefore be spread by the dried secretion from the mouth and throat. The most common means of contagion, however, is the skin, which peels off in the later stage of the disease, infection being produced by the inhalation into the nostrils of some of the diseased particles.

A predisposing factor which applies alike to diphtheria and all other throat affections is the abnormal condition of the nose and throat. When these important parts are in an unhealthy condition, where mouth breathing exists and other conditions inimical to normal health, the patient is more predisposed to all forms of maladies of this region, and the attack when developed is more apt to be of a serious character. The more ordinary forms of sore throat, such as tonsilitis, are frequently due to defects in the sanitary conditions and surroundings of the home. While modern sanitary plumbing, when properly constructed, adds much to the convenience of the household, it is a certain menace to all its members if, through improper construction or defective ventilation, decomposing matter collects in the waste pipes and vitiates the atmosphere of the rooms. Many recurrent cases of tonsilitis are due to this cause. Even the ordinary stationary washstands may be a source of danger, especially in the bedroom, unless thoroughly ventilated and care exercised that the traps are not filled with decomposing matter. A physician of large experience in this city is so imbued with the danger of this form of plumbing that he condemns it _in toto_. When well constructed and well ventilated, however, they can not be the source of danger in the household.

Tuberculosis, which is responsible for so enormous a mortality, frequently also affects the throat as well as the lungs. Although it usually originates within the chest, it sometimes finds its primary origin in the throat, and in a large percentage of cases the throat affection forms a complication of tuberculosis of the lungs. In spite of the numerous remedies which have been advocated for the cure of this disease, it must be admitted that our chief reliance is in proper nourishment and climatic effects, and that hygiene is the sheet-anchor which will eventually rescue us from this terrible foe of the human race.

Recent investigations tend to prove more and more that tuberculosis is inherited in but rare cases; that inheritance is simply a predisposing factor, and that the real cause is infection. As an illustration of this, all have seen instances in which there had been apparently no cases in a family for ten or fifteen years, when from some cause one case develops, and this is soon followed by other cases in the same family. Whatever rôle heredity may play in these cases, this simply shows that the first case produced the infectious material which found a suitable soil in the other members of the family and developed a similar disease. The inheritance theory has been the source of much injury by causing members of the afflicted family to submit to the apparently inevitable instead of instituting measures for its prevention. The infectious product in tuberculosis is not the breath, as is so frequently believed by the laity, but simply the expectoration which comes from the diseased lungs or throat. When this is allowed to come in contact with clothing or other material in the room, it becomes dry and loads the atmosphere with a dust which contains the infectious bacillus, which may cause a similar disease in a person predisposed by heredity or sickness to this affection.

The germ of tuberculosis is the seed, and the predisposed person the soil, and it requires a combination of both to develop the disease. To illustrate the necessity of suitable conditions for the development of plants--for it is now almost universally admitted that the germ of tuberculosis is a micro-organism which belongs to the vegetable kingdom--I remember some years ago, while in North Europe, seeing in a hothouse a plant which is here commonly known as the "four o'clock." The gardener in charge of the conservatory considered it a remarkable plant, but difficult to propagate, and stated that it was absolutely impossible to raise it out of doors. In this part of the world, however, we know that this plant grows so easily that once established in a garden it is difficult to keep it within limits. In both of the cases we have the same seed, the difference being only in the soil and the conditions favorable for its development. The absence of either the seed or the soil will absolutely prevent tuberculosis, and if the laws of hygiene are properly carried out, both in destroying the seed and in preventing the formation of a suitable soil, favorable effects will soon be shown.

Hygiene in regard to patients demands simply that the infectious character of the expectoration be destroyed. The vessels for this purpose should contain some disinfecting solution, should be cleaned regularly, and handkerchiefs, towels, or other material with which the expectoration has come in contact should be sterilized by being placed for at least half an hour in boiling water. This is necessary not only for those in the same room with the patient, but also for the patient, as it is quite possible that a former expectoration may produce reinfection of the patient himself.

Another method of contracting tuberculosis is by means of animals, such as cows, used for food and milking, which are known to be subject to this disease. It has been shown in some localities that one cow out of every twenty-five was affected with tubercular disease. This suggests the importance of having competent veterinarians to examine not only the meat which is sold, but also the cows used for milking purposes. Where there is the slightest doubt as to the nature of the meat or milk, the former should be thoroughly cooked and the latter sterilized before using.

In this connection it would be well to refer to the subject of spitting in street cars and in public places. While this nuisance is the subject of danger to every one in the street cars, especially in winter, when the windows are closed and a large amount of impurities is inhaled, it is more particularly so to ladies, whose skirts, in spite of every care, are soiled by the filthy expectoration, thus making them subject not only to the inhalation in the car, but also to carrying the infectious material to their homes.

The danger of this condition is not merely speculative. It has been bacteriologically demonstrated that the organisms of various contagious diseases thus find a lodging place in our cars and public places, and experiments on animals, in which the inoculation has developed diseases, have shown that these organisms retain their vitality in these places and may propagate disease under favorable conditions.

A factor in the spread of diseases of the throat and mouth that should not be overlooked is kissing. Unfortunately, this matter has usually been treated with much levity, and where a sanitarian is bold enough to condemn the habit he is frequently made the subject of all forms of ridicule in the public press.

The tender lining of the lips, mouth, and throat, and its large blood supply, make it peculiarly susceptible to contagion, and I have no doubt that the habit of kissing is responsible for many cases of infection. Last year I noticed a lady coming from a house from which a diphtheria flag was flying, who walked to the corner to take the street car, when a nurse with a small child approached. The lady without hesitation stooped down and kissed the little child. As it is well known that a healthy person may transmit a disease without incurring the disease himself, this lady voluntarily risked the danger of inflicting this disease upon the innocent child. It is not an uncommon thing for nurses to kiss the children under their charge, and here in New Orleans even the colored nurses sometimes practice this habit, occasionally with the permission of the parents. In fact, a fashionable lady on one occasion told me, when I remonstrated with her about this, that she feared to hurt the feelings of the old nurse, who had been a valuable servant in the family for many years.

How often this habit is productive of evil results is of course only speculation. I recall, however, an instance in which two small children of one family developed a specific disease which originated in the mouth and affected the whole system. Examination proved this to have been caused by a nurse, a white woman, who had been in the habit of kissing the children. If women will voluntarily incur risks by using kissing as a form of salutation in all stages of acquaintanceship, I would at least request that the innocent children be spared the possible consequences.

The subject of the hygiene of the ear is so intimately connected with conditions influencing the nose and throat, which have already been explained, that but few words are needed to cover this part of my subject. In general, the best care of the ear is to leave it alone. Ear scoops are injurious; the ear should be cleaned simply on the outside, and nothing, as a rule, should be inserted into the external canal. I have seen many cases of abscess and the most severe inflammation due to endeavors to clean the ear with the omnipresent hairpin and other objects used for this purpose. The use of cotton in the ear in general is to be condemned. It produces an artificial condition in the outer canal of the ear which reduces its physical resistance and makes it more liable to injury from exposure. The ear is sometimes injured by the entrance of cold water. This happens occasionally during ordinary bathing, but more frequently in outdoor bathing and in swimming. In surf bathing, where the water is thrown up with considerable force, it is much more liable to enter the external orifice of the ear, and severe inflammation may originate from this cause.

Salt water has been claimed to be more injurious than fresh, but my personal experience leads me to believe that it is more a question of temperature than of the quality of the water. Some years ago a large reservoir was built by an educational institute near this city, the water, which was quite cold even in summer, being supplied by an artesian well. The tank was used for bathing purposes, but earache soon became so frequent among the boys that the use of the reservoir for this purpose had to be entirely abandoned. In ordinary bathing, the entrance of water into the ear can easily be avoided. In swimming or surf bathing it is advisable to use a pledget of lamb's wool to close the opening of the ears. Ordinary cotton soon becomes saturated and is of no use in this connection, but the wool, which is slightly oily, forms an excellent protection in these cases.

The "running ear" is a diseased condition which should not be tampered with by the inexperienced, but which should not be neglected. The old idea that the child will outgrow it, or that it is a secretion of the head which if interfered with would prove dangerous, has been fruitful of many cases of deafness and even more serious complications.

Another condition to which I would call your attention is the incipient development of deafness in children. Where the capacity of hearing is quickly lowered from the normal to fifty per cent, it is so striking that the patient is much distressed and even confused. But when this change takes place insidiously from day to day, it is frequently not observed by either the patient or those around him until it has greatly advanced. Children thus affected hear only with difficulty and by straining certain small muscles of the ear, which soon become fatigued, and the child becomes listless and inattentive. I have seen numerous cases in which children have been severely punished for inattention, when this was due to defective hearing. Watchfulness and early attention in these cases will frequently prevent the more serious forms of deafness.

THE PHYSICAL GEOGRAPHY OF THE WEST INDIES.

BY F. L. OSWALD.

I.--THE FAUNA OF THE ANTILLES: MAMMALS.

The study of the geographical distribution of plants and animals has revealed facts almost as enigmatical as the origin of life itself. Water barriers, as broad as that of the Atlantic, have not prevented the spontaneous spread of some species, while others limit their habitat to narrowly circumscribed though not geographically isolated regions.

Tapirs are found both in the Amazon Valley and on the Malay Peninsula; the brook trout of southern New Zealand are identical with those of the Austrian Alps. Oaks and _Ericacea_ (heather plants) cover northern Europe from the mouth of the Seine to the sources of the Ural; then suddenly cease, and are not found anywhere in the vast Siberian territories, with a north-to-south range rivaling that of all British North America.

But still more remarkable is the zoölogical contrast of such close-neighborhood countries as Africa and Madagascar, or Central America and the West Indian archipelago. The Madagascar virgin woods harbor no lions, leopards, hyenas, or baboons, but boast not less than thirty-five species of mammals unknown to the African continent, and twenty-six found nowhere else in the world.

Of a dozen different kinds of deer, abundant in North America as well as in Asia and Europe, not a single species has found its way to the West Indies. The fine mountain meadows of Hayti have originated no antelopes, no wild sheep or wild goats.

In the Cuban sierras, towering to a height of 8,300 feet, there are no hill foxes. There are caverns--subterranean labyrinths with countless ramifications, some of them--but no cave bears or badgers, no marmots or weasels even, nor one of the numerous weasel-like creatures clambering about the rock clefts of Mexico. The magnificent coast forests of the Antilles produce wild-growing nuts enough to freight a thousand schooners every year, but--almost incredible to say--the explorers of sixteen generations have failed to discover a single species of squirrels.

The Old-World tribes of our tree-climbing relatives are so totally different from those of the American tropics that Humboldt's traveling companion, Bonplant, renounced the theory of a unitary center of creation (or evolution), and maintained that South America must have made a separate though unsuccessful attempt to rise from lemurs to manlike apes and men. Of such as they are, Brazil alone has forty-eight species of monkeys, and Venezuela at least thirty. How shall we account for the fact that not one of the large West Indian islands betrays a vestige of an effort in the same direction?

More monkey-inviting forests than those of southern Hayti can not be found in the tropics, but not even a marmoset or squirrel-monkey accepted the invitation. In an infinite series of centuries not one pair of quadrumana availed itself of the chance to cross a sea gap, though at several points the mainland approaches western Cuba within less than two hundred miles--about half the distance that separates southern Asia from Borneo, where fourhanders of all sizes and colors compete for the products of the wilderness, and, according to Sir Philip Maitland, the "native women avoid the coast jungles for fear of meeting Mr. Darwin's grandfather."

The first Spanish explorers of the Antilles were, in fact, so amazed at the apparently complete absence of quadrupeds that their only explanation was a conjecture that the beasts of the forest must have been exterminated by order of some native potentate, perhaps the great Kubla Khan, whose possessions they supposed to extend _eastward_ from Lake Aral to the Atlantic. The chronicle of Diego Columbus says positively that San Domingo and San Juan Bautista (Porto Rico) were void of mammals, but afterward modifies that statement by mentioning a species of rodent, the _hutia_, or bush rat, that annoyed the colonists of Fort Isabel, and caused them to make an appropriation for importing a cargo of cats.

Bush rats and moles were, up to the end of the sixteenth century, the only known indigenous quadrupeds of the entire West Indian archipelago, for the "Carib dogs," which Valverde saw in Jamaica, were believed to have been brought from the mainland by a horde of man-hunting savages.

But natural history has kept step with the advance of other sciences, and the list of undoubtedly aboriginal mammals on the four main islands of the Antilles is now known to comprise more than twenty species. That at least fifteen of them escaped the attention of the Spanish creoles is as strange as the fact that the Castilian cattle barons of Upper California did not suspect the existence of precious metals, though nearly the whole bonanza region of the San Joaquin Valley had been settled before the beginning of the seventeenth century. But the conquerors of the Philippines even overlooked a variety of elephants that roams the coast jungles of Mindanao.

Eight species of those West Indian _incognito_ mammals, it is true, are creatures of a kind which the Spanish zoölogists of Valverde's time would probably have classed with birds--bats, namely, including the curious _Vespertilio molossus_, or mastiff bat, and several varieties of the owl-faced _Chilonycteris_, that takes wing in the gloom preceding a thunderstorm, as well as in the morning and evening twilight, and flits up and down the coast rivers with screams that can be heard as plainly as the screech of a paroquet. The _Vespertilio scandens_ of eastern San Domingo has a peculiar habit of flitting from tree to tree, and clambering about in quest of insects, almost with the agility of a flying squirrel. There are times when the moonlit woods near Cape Rafael seem to be all alive with the restless little creatures; that keep up a clicking chirp, and every now and then gather in swarms to contest a tempting find, or to settle some probate court litigation. San Domingo also harbors one species of those prototypes of the harpies, the fruit-eating bats. It passes the daylight hours in hollow trees, but becomes nervous toward sunset and apt to betray its hiding place by an impatient twitter--probably a collocution of angry comments on the length of time between meals. The moment the twilight deepens into gloom the chatterers flop out to fall on the next mango orchard and eat away like mortgage brokers. They do not get fat--champion gluttons rarely do--but attain a weight of six ounces, and the Haytian darkey would get even with them after a manner of their own if their prerogatives were not protected by the intensity of their musky odor. The above-mentioned _hutia_ rat appears to have immigrated from some part of the world where the shortness of the summer justified the accumulation of large reserve stores of food, and under the influence of a hereditary hoarding instinct it now passes its existence constructing and filling a series of subterranean granaries. Besides, the females build nurseries, and all these burrows are connected by tunnels that enable their constructors to pass the rainy season under shelter. They gather nuts, _belotas_ (a sort of sweet acorns), and all kinds of cereals, and with their _penchant_ for appropriating roundish wooden objects on general principles would probably give a Connecticut nutmeg peddler the benefit of the doubt.

They also pilfer raisins, and a colony of such tithe collectors is a formidable nuisance, for the _hutia_ is a giant of its tribe, and attains a length of sixteen inches, exclusive of the tail. It is found in Cuba, Hayti, Jamaica, Porto Rico, Antigua, Trinidad, the Isle of Pines, Martinique, and two or three of the southern Bahama Islands, and there may have been a time when it had the archipelago all to itself. The Lucayans had a tradition that their ancestors found it on their arrival from the mainland, and in some coast regions of eastern Cuba it may still be seen basking in the sunlight--

"Sole sitting on the shore of old romance,"

and wondering if there are any larger mammals on this planet.

Its next West Indian congener is the Jamaica rice rat, and there are at least ten species of mice, all clearly distinct from any Old-World rodent, though it is barely possible that some of them may have stolen a ride on Spanish trading vessels from Central America.

Water-moles burrow in the banks of several Cuban rivers, and two genera of aquatic mammals have solved the problem of survival: the bayou porpoise and the manatee, both known to the creoles of the early colonial era, and vaguely even to the first discoverers, since Columbus himself alludes to a "sort of mermaids (_sirenas_) that half rose from the water and scanned the boat's crew with curious eyes."

Naturally the manatee is, indeed, by no means a timid creature, but bitter experience has changed its habits since the time when the down-town sportsmen of Santiago used to start in sailboats for the outer estuary and return before night with a week's supply of manatee meat. The best remaining hunting grounds are the reed shallows of Samana Bay (San Domingo) and the deltas of the Hayti swamp rivers. Old specimens are generally as wary as the Prybilof fur seal that dive out of sight at the first glimpse of a sail; still, their slit-eyed youngsters are taken alive often enough, to be kept as public pets in many town ponds, where they learn to come to a whistle and waddle ashore for a handful of cabbage leaves.

Fish otters have been caught in the lagoons of Puerto Principe (central Cuba) and near Cape Tiburon, on the south coast of San Domingo, the traveler Gerstaecker saw a kind of "bushy-tailed dormouse, too small to be called a squirrel."