The epidemic of 1793 in Philadelphia, so graphically described by Matthew Carey, was, according to Osler, the most serious that has ever prevailed in any city of the Middle States. Although the population of the city was only 40,000, during the months of August, September, October, and November the mortality, as given by Carey, was 4041, of whom 3435 died in the months of September and October. During the following ten years epidemics of a lesser degree occurred along the coast of the United States, and in 1853 the disease raged throughout the Southern States, there being a mortality in New Orleans alone of nearly 8000. In the epidemic of 1878 in the Southern States the mortality was nearly 16,000. South America was invaded for the first time in 1740, and since 1849 the disease has been endemic in Brazil. Peru and the Argentine Republic have also received severe visitations of yellow fever since 1854. In Cuba the disease is epidemic during June, July, and August, and it appears with such certainty that the Revolutionists at the present time count more on the agency of yellow fever in the destruction of the unacclimated Spanish soldiers than on their own efforts.

Leprosy is distinctly a malady of Oriental origin, and existed in prehistoric times in Egypt and Judea. It was supposed to have been brought into Europe by a Roman army commanded by Pompey, after an expedition into Palestine. Leprosy was mentioned by several authors in the Christian era. France was invaded about the second century, and from that time on to the Crusades the disease gradually increased. At this epoch, the number of lepers or ladres becoming so large, they were obliged to confine themselves to certain portions of the country, and they took for their patron St. Lazare, and small hospitals were built and dedicated to this saint. Under Louis VIII 2000 of these hospitals were counted, and later, according to Dupony, there were 19,000 in the French kingdom. Various laws and regulations were made to prevent the spread of the contagion. In 1540 it was said that there were as many as 660 lepers in one hospital in Paris.

No mention is made in the Hippocratic writings of elephantiasis graecorum, which was really a type of leprosy, and is now considered synonymous with it. According to Rayer, some writers insist that the affection then existed under the name of the Phoenician disease. Before the time of Celsus, the poet Lucretius first speaks of elephantiasis graecorum, and assigns Egypt as the country where it occurs. Celsus gives the principal characteristics, and adds that the disease is scarcely known in Italy, but is very common in certain other countries. Galen supplies us with several particular but imperfect cases—histories of elephantiasis graecorum, with a view to demonstrate the value of the flesh of the viper, and in another review he adds that the disease is common in Alexandria. Aretaeus has left a very accurate picture of the symptoms of elephantiasis graecorum; and Pliny recapitulates the principal features and tells us that the disease is indigenous in Egypt. The opinion of the contagiousness of elephantiasis graecorum which we find announced in Herodotus and Galen is more strongly insisted upon by Caelius Aurelianus who recommends isolation of those affected. Paulus aegenita discusses the disease. The Arabian writers have described elephantiasis graecorum under the name of juzam, which their translators have rendered by the word lepra. Later, Hensler, Fernel Pare, Vesalius, Horstius, Forestus, and others have discussed it.

The statistics of leprosy in Europe pale before the numbers affected in the East. The extent of its former ravages is unknown, but it is estimated that at the present day there are over 250,000 lepers in India, and the number in China is possibly beyond computation. According to Morrow, in 1889 in the Sandwich Islands there were 1100 lepers in the settlement at Molokai. Berger states that there were 100 cases at Key West; and Blanc found 40 cases at New Orleans. Cases of leprosy are not infrequently found among the Chinese on the Pacific coast, and an occasional case is seen in the large cities of this country. At the present day in Europe, where leprosy was once so well known, it is never found except in Norway and the far East.

Possibly few diseases have caused so much misery and suffering as leprosy. The banishment from all friends and relatives, the confiscation of property and seclusion from the world, coupled with poverty and brutality of treatment,—all emphasize its physical horror a thousandfold. As to the leper himself, no more graphic description can be given than that printed in The Ninteenth Century, August, 1884: "But leprosy! Were I to describe it no one would follow me. More cruel than the clumsy torturing weapons of old, it distorts, and scars, and hacks, and maims, and destroys its victim inch by inch, feature by feature, member by member, joint by joint, sense by sense, leaving him to cumber the earth and tell the horrid tale of a living death, till there is nothing left of him. Eyes, voice, nose, toes, fingers, feet, hands, one after the other are slowly deformed and rot away, until at the end of ten, fifteen, twenty years, it may be, the wretched leper, afflicted in every sense himself, and hateful to the sight, smell, hearing, and touch of others, dies, despised and the most abject of men."

Syphilis.—Heretofore the best evidence has seemed to prove that syphilis had its origin in 1494, during the siege of Naples by Charles VIII of France; but in later days many investigators, prominent among them Buret, have stated that there is distinct evidence of the existence of syphilis in prehistoric times. Buret finds evidence of traces of syphilis among the Chinese five thousand years ago, among the Egyptians at the time of the Pharaohs, among the Hebrews and Hindoos in biblic times, and among the Greeks and Romans after Christ. Some American writers claim to have found evidences of syphilitic disease in the skulls and other bones of the prehistoric Indian mounds, thus giving further evidence to the advocates of the American origin of syphilis. The Spaniards claimed that, returning from America in 1493, Columbus brought with him syphilis. Friend says: "One thing is remarkable; the Spaniards, upon their first expedition to America, brought home from thence this contagious disorder, and soon after carried another affection thither, the small-pox, of which the Indian Prince Montezuma died." The first descriptions of syphilis are given under the name of morbus gallicus, while the French in return called it morbus neapolitanus or mal d'Italie. The name of syphilis was said to have been first given to it by a physician of Verona, in a poem describing the disease. Inspired by heroic epics Fracastor places before us the divinities of paganism, and supposes that a shepherd, whom he called Syphilus, had addressed words offensive to Apollo, and had deserted his altars. To punish him the God sent him a disease of the genitals, which the inhabitants of the country called the disease of Syphilus.

"Syphilidemque ab eo labem dixere coloni."

Buret traces the origin of the word syphilis from sun, with, and filia, love, the companion of love; which means in plain language that the pox is a disease transmitted more especially by venereal relations. The first great epidemic of syphilis occurred between 1493 and 1496, and attacked all ranks, neither the Church nor the Crown being spared. The ravages of this disease were increased by the treatment with mercury which soon afterward was found in proper doses to be a specific in this disease. It is possible that the terrible manifestations of syphilis of which we read in the older writers were in a great measure due to the enormous doses of mercury. At the present day syphilis is universally prevalent. In his excellent monograph Sturgis estimated in New York, in 1873, that one out of 18 suffered from it; and White of Philadelphia pronounces the opinion that "not less than 50,000 people in that city are affected with syphilis." According to Rohe, on this basis Gihon estimates the number of syphilitics in the United States at one time as 2,000,000.

To-day no disease, except possibly tuberculosis, is a greater agency in augmenting the general mortality and furthering sickness than syphilis. Its hereditary features, the numerous ways in which it may be communicated outside of the performance of the sexual act, and the careful way in which it is kept from the sanitary authorities render it a scourge which, at the present day, we seem to have no method of successfully repressing.

Modern Mortality from Infectious Diseases.—As to the direct influence on the mortality of the most common infectious diseases of the present day, tuberculosis, universally prevalent, is invariably in the lead. No race or geographic situation is exempt from it. Osler mentions that in the Blood Indian Reserve of the Canadian Northwest Territories, during six years, among a population of about 2000 there were 127 deaths from pulmonary consumption. This enormous death-rate, it is to be remembered, occurred in a tribe occupying one of the finest climates of the world, among the foothills of the Rocky Mountains, a region in which consumption is extremely rare among the white population, and in which cases of tuberculosis from the Eastern provinces do remarkably well. Mayo-Smith quotes a table illustrating the annual deaths (based on the returns from 1887 to 1891) from certain infectious diseases per 10,000 European inhabitants. The figures for each disease give a rough measure of its prevalence in different countries. The large figures as to small-pox show the absence in Italy and "Hieronymi Fracastorii," Veronae, 1530. Statistics and Sociology, New York, 1885.

Austria of vaccination; diphtheria seems to be very fatal in Germany and Austria; Italy has a large rate for typhoid fever, and the same is true of the other fevers; France, Germany, and Austria show a very large rate for tuberculosis, while Italy has a small rate.

DEATHS FROM CERTAIN DISEASES PER 10,000 INHABITANTS.

Small- Scarlet Diphtheria Typhoid Tuber- COUNTRY. pox. Measles. fever fever. culosis

Italy, . . . . . 3.86 6.17 2.99 6.08 7.49 13.61 France (cities). 2.3 5.18 3.1 6.66 5.32 33. England, . . . . 0.11 4.68 2.31 1.74 1.9 16.09 Ireland, . . . . 0.01 2.01 1.22 0.76 2.33 21.15 Germany (cities). 0.04 2.8 2.15 10.21 2.11 31.29 Prussia, . . . . 0.03 3.2 2.46 14.17 2.26 28.06 Austria, . . . . 4.43 5.36 5.57 13.2 5.42 37.2 Switzerland, . . 0.06 1.53 1.22 3.53 1.47 21.07 Belgium, . . . . 1.52 6.2 1.62 5.77 3.83 19.87 Holland, . . . . 0.02 3.93 0.38 1.45 2.5 19.21 Sweden, . . . . . 0.01 2.3 3.69 3.89 2.22 0.

Based upon the Tenth Census Reports, we figure that of every 10,000 inhabitants of the United States the number of deaths for the census year from similar diseases was as follows:—

Rural. Cities.

Measles, . . . . . . . 1.62 1.54 Scarlet Fever, . . . . 2.84 5.54 Diphtheria, . . . . . 7.53 8. Croup, . . . . . . . . 3.51 4.08 Typhoid Fever, . . . . 4.75 3.46 Tuberculosis, . . . . 16.29 28.55

The general average of deaths from small-pox was about 0.14.

THE END