The Making of Arguments Part 22

We now come to what I will term Milton's hypothesis--the hypothesis that the present condition of things has endured for a comparatively short time; and, at the commencement of that time, came into existence within the course of six days. I doubt not that it may have excited some surprise in your minds that I should have spoken of this as Milton's hypothesis, rather than that I should have chosen the terms which are more customary, such as "the doctrine of creation," or the "Biblical doctrine," or "the doctrine of Moses," all of which denominations, as applied to the hypothesis to which I have just referred, are certainly much more familiar to you than the t.i.tle of the Miltonic hypothesis. But I have had what I cannot but think are very weighty reasons for taking the course which T have pursued. In the first place, I have discarded the t.i.tle of the doctrine of "creation," because my present business is not with the question why the objects which const.i.tute Nature came into existence, but when they came into existence, and in what order. This is as strictly a historical question as the question when the Angles and the Jutes invaded England, and whether they preceded or followed the Romans. But the question about creation is a philosophical problem, and one which cannot be solved, or even approached, by the historical method. What we want to learn is, whether the facts, so far as they are known, afford evidence that things arose in the way described-by Milton, or whether they do not; and, when that question is settled, it will be time enough to inquire into the causes of their origination.

In the second place, I have not spoken of this doctrine as the Biblical doctrine, It is quite true that persons as diverse in their general views as Milton the Protestant and the celebrated Jesuit Father Suarez, each put upon the first chapter of Genesis the interpretation embodied in Milton's poem. It is quite true that this interpretation is that which has been instilled into every one of us in our childhood; but I do not for one moment venture to say that it can properly be called the Biblical doctrine. It is not my business, and does not lie within my competency, to say what the Hebrew text does, and what it does not signify; moreover, were I to affirm that this is the Biblical doctrine, I should be met by the authority of many eminent scholars, to say nothing of men of science, who, at various times, have absolutely denied that any such doctrine is to be found in Genesis. If we are to listen to many expositors of no mean authority, we must believe that what seems so clearly defined in Genesis--as if very great pains had been taken that there should be no possibility of mistake--is not the meaning of the text at all. The account is divided into periods that we may make just as long or short as convenience requires. We are also to understand that it is consistent with the original text to believe that the most complex plants and animals may have been evolved by natural processes, lasting for millions of years, out of structureless rudiments. A person who is not a Hebrew scholar can only stand aside and admire the marvelous flexibility of a language which admits of such diverse interpretations.

But a.s.suredly, in the face of such contradictions of authority upon matters respecting which he is incompetent to form any judgment, he will abstain, as I do, from giving any opinion.

In the third place, I have carefully abstained from speaking of this as the Mosaic doctrine, because we are now a.s.sured upon the authority of the highest critics, and even of dignitaries of the Church, that there is no evidence that Moses wrote the Book of Genesis, or knew anything about it. You will understand that I give no judgment--it would be an impertinence upon my part to volunteer even a suggestion--upon such a subject. But, that being the state of opinion among the scholars and the clergy, it is well for the unlearned in Hebrew lore, and for the laity, to avoid entangling themselves in such a vexed question. Happily, Milton leaves us no excuse for doubting what he means, and I shall therefore be safe in speaking of the opinion in question as the Miltonic hypothesis.

Now we have to test that hypothesis. For my part, I have no prejudice one way or the other. If there is evidence in favor of this view, I am burdened by no theoretical difficulties in the way of accepting it: but there must be evidence. Scientific men get an awkward habit--no, I won't call it that, for it is a valuable habit--of believing nothing unless there is evidence for it; and they have a way of looking upon belief which is not based upon evidence, not only as illogical, but as immoral.

We will, if you please, test this view by the circ.u.mstantial evidence alone; for, from what I have said, you will understand that I do not propose to discuss the question of what testimonial evidence is to be adduced in favor of it. If those whose business it is to judge are not at one as to the authenticity of the only evidence of that kind which is offered, nor as to the facts to which it bears witness, the discussion of such evidence is superfluous.

But I may be permitted to regret this necessity of rejecting the testimonial evidence the less, because the examination of the circ.u.mstantial evidence leads to the conclusion, not only that it is incompetent to justify the hypothesis, but that, so far as it goes, it is contrary to the hypothesis.

The considerations upon which I base this conclusion are of the simplest possible character. The Miltonic hypothesis contains a.s.sertions of a very definite character relating to the succession of living forms. It is stated that plants, for example, made their appearance upon the third day, and not before. And you will understand that what the poet means by plants are such plants as now live, the ancestors, in the ordinary way of propagation of like by like, of the trees and shrubs which flourish in the present world. It must needs be so; for, if they were different, either the existing plants have been the result of a separate origination since that described by Milton, of which we have no record, nor any ground for supposition that such an occurrence has taken place; or else they have arisen by a process of evolution from the original stocks.

In the second place, it is clear that there was no animal life before the fifth day, and that, on the fifth day, aquatic animals and birds appeared. And. it is further clear that terrestrial living things, other than birds, made their appearance upon the sixth day, and not before.

Hence, it follows that, if, in the large ma.s.s of circ.u.mstantial evidence as to what really has happened in the past history of the globe, we find indications of the existence of terrestrial animals, other than birds, at a certain period, it is perfectly certain that all that has taken place since that time must be referred to the sixth day.

In the great Carboniferous formation,[69] whence America derives so vast a proportion of her actual and potential wealth, in the beds of coal which have been formed from the vegetation of that period, we find abundant evidence of the existence of terrestrial animals. They have been described, not only by European but by your own naturalists. There are to be found numerous insects allied to our c.o.c.kroaches. There are to be found spiders and scorpions of large size, the latter so similar to existing scorpions that it requires the practiced eye of the naturalist to distinguish them. Inasmuch as these animals can be proved to have been alive in the Carboniferous epoch, it is perfectly clear that, if the Miltonic account is to be accepted, the huge ma.s.s of rocks extending from the middle of the Paleozoic formations to the uppermost members of the series, must belong to the day which is termed by Milton the sixth.

But, further, it is expressly stated that aquatic animals took their origin upon the fifth day, and not before; hence, all formations in which remains of aquatic animals can be proved to exist, and which therefore testify that such animals lived at the time when these formations were in course of deposition, must have been deposited during or since the period which Milton speaks of as the fifth. But there is absolutely no fossiliferous formation in which the remains of aquatic animals are absent. The oldest fossils in the Silurian rocks[70] are exuviae of marine animals; and if the view which is entertained by Princ.i.p.al Dawson and Dr. Carpenter respecting the nature of the _eozoon_ be well founded, aquatic animals existed at a period as far antecedent to the deposition of the coal as the coal is from us; inasmuch as the _eozoon_ is met with in those Laurentian strata which lie at the bottom of the series of stratified rocks. Hence it follows, plainly enough, that the whole series of stratified rocks, if they are to be brought into harmony with Milton, must be referred to the fifth and sixth days, and that we cannot hope to find the slightest trace of the products of the earlier days in the geological record. When we consider these simple facts, we see how absolutely futile are the attempts that have been made to draw a parallel between the story told by so much of the crust of the earth as is known to us and the story which Milton tells. The whole series of fossiliferous stratified rocks must be referred to the last two days; and neither the Carboniferous, nor any other, formation can afford evidence of the work of the third day.

Not only is there this objection to any attempt to establish a harmony between the Miltonic account and the facts recorded in the fossiliferous rocks, but there is a further difficulty. According to the Miltonic account, the order in which animals should have made their appearance in the stratified rocks would be this: Fishes, including the great whales, and birds; after them, all varieties of terrestrial animals except birds.

Nothing could be further from the facts as we find them; we know of not the slightest evidence of the existence of birds before the Jura.s.sic, or perhaps the Tria.s.sic, formation;[71] while terrestrial animals, as we have just seen, occur in the Carboniferous rocks.

If there were any harmony between the Miltonic account and the circ.u.mstantial evidence, we ought to have abundant evidence of the existence of birds in the Carboniferous, the Devonian, and the Silurian rocks. I need hardly say that this is not the case, and that not a trace of birds makes its appearance until the Tar later period which I have mentioned.

And again, if it be true that all varieties of fishes and the great whales, and the like, made their appearance on the fifth day, we ought to find the remains of these animals in the older rocks--in those which were deposited before the Carboniferous epoch. Fishes we do find, in considerable number and variety; but the great whales are absent, and the fishes are not such as now live. Not one solitary species of fish now in existence is to be found in the Devonian or Silurian formations.

Hence we are introduced afresh to the dilemma which I have already placed before you: either the animals which came into existence on the fifth day were not such as those which are found at present, are not the direct and immediate ancestors of those which now exist; in which case either fresh creations of which nothing is said, or a process of evolution must have occurred; or else the whole story must be given up as not only devoid of any circ.u.mstantial evidence, but contrary to such evidence as exists.

I placed before you in a few words, some little time ago, a statement of the sum and substance of Milton's hypothesis. Let me now try to state as briefly, the effect of the circ.u.mstantial evidence bearing upon the past history of the earth which is furnished, without the possibility of mistake, with no chance of error as to its chief features, by the stratified rocks. What we find is, that the great series of formations represents a period of time of which our human chronologies hardly afford us a unit of measure. I will not pretend to say how we ought to estimate this time, in millions or in billions of years. For my purpose, the determination of its absolute duration is wholly unessential. But that the time was enormous there can be no question.

It results from the simplest methods of interpretation, that leaving out of view certain patches of metamorphosed rocks, and certain volcanic products, all that is now dry land has once been at the bottom of the waters. It is perfectly certain that, at a comparatively recent period of the world's history--the Cretaceous epoch--none of the great physical features which at present mark the surface of the globe existed. It is certain that the Rocky Mountains were not. It is certain that the Himalaya Mountains were not. It is certain that the Alps and the Pyrenees had no existence. The evidence is of the plainest possible character, and is simply this:--We find raised up on the flanks of these mountains, elevated by the forces of upheaval which have given rise to them, ma.s.ses of Cretaceous rock which formed the bottom of the sea before those mountains existed. It is therefore clear that the elevatory forces which gave rise to the mountains operated subsequently to the Cretaceous epoch; and that the mountains themselves are largely made up of the materials deposited in the sea which once occupied their place.

As we go back in time, we meet with constant alternations of sea and land, of estuary and open ocean; and, in correspondence with these alternations, we observe the changes in the fauna and flora to which I have referred.

But the inspection of these changes gives us no right to believe that there has been any discontinuity in natural processes. There is no trace of general cataclysms, of universal deluges, or sudden destructions of a whole fauna or flora. The appearances which were formerly interpreted in that way have all been shown to be delusive, as our knowledge has increased and as the blanks which formerly appeared to exist between the different formations have been filled up. That there is no absolute break between formation and formation, that there has been no sudden disappearance of all the forms of life and replacement of them by others, but that changes have gone on slowly and gradually, that one type has died out and another has taken its place, and that thus, by insensible degrees, one fauna has been replaced by another, are conclusions strengthened by constantly increasing evidence. So that within the whole of the immense period indicated by the fossiliferous stratified rocks, there is a.s.suredly not the slightest proof of any break in the uniformity of Nature's operations, no indication that events have followed other than a clear and orderly sequence.

That, I say, is the natural and obvious teaching of the circ.u.mstantial evidence contained in the stratified rocks. I leave you to consider how far, by any ingenuity of interpretation, by any stretching of the meaning of language, it can be brought into harmony with the Miltonic hypothesis.

There remains the third hypothesis, that of which I have spoken as the hypothesis of evolution; and I purpose that, in lectures to come, we should discuss it as carefully as we have considered the other two hypotheses. I need not say that it is quite hopeless to look for testimonial evidence of evolution. The very nature of the case precludes the possibility of such evidence, for the human race can no more be expected to testify to its own origin, than a child can be tendered as a witness of its own birth. Our sole inquiry is, what foundation circ.u.mstantial evidence lends to the hypothesis, or whether it lends none, or whether it controverts the hypothesis. I shall deal with the matter entirely as a question of history. I shall not indulge in the discussion of any speculative probabilities. I shall not attempt to show that Nature is unintelligible unless we adopt some such hypothesis. For anything I know about the matter, it may be the way of Nature to be unintelligible; she is often puzzling, and I have no reason to suppose that she is bound to fit herself to our notions.

I shall place before you three kinds of evidence entirely based upon what is known of the forms of animal life which are contained in the series of stratified rocks. I shall endeavor to show you that there is one kind of evidence which is neutral, which neither helps evolution nor is inconsistent with it. I shall then bring forward a second kind of evidence which indicates a strong probability in favor of evolution, but does not prove it; and, lastly, I shall adduce a third kind of evidence which, being as complete as any evidence which we can hope to obtain upon such a subject, and being wholly and strikingly in favor of evolution, may fairly be called demonstrative evidence of its occurrence.

THE TRANSMISSION OF YELLOW FEVER BY MOSQUITOES

GEORGE M. STERNBERG, M.D., L.L.D, SURGEON-GENERAL U.S. ARMY[72]

This article is a scientific demonstration of a new fact. It shows clearly the processes of scientific reasoning based on the methods known to Logic as the Methods of Agreement and Difference. The theory that the germs of the disease are carried by mosquitoes seems first to have suggested itself to Dr. Sternberg and to Dr. Finlay through noticing a similarity of phenomena in many cases under different conditions. Yet, however plausible, the theory, neither of them could declare that he had discovered the fact until the experiments carried on under rigorous precautions had been tried. By these experiments all other causes were ruled out of consideration.

The discoveries which have been made in the past twenty-five years with reference to the etiology[73] of infectious diseases const.i.tute the greatest achievement of scientific medicine and afford a substantial basis for the application of intelligent measures of prophylaxis.[74] We know the specific cause ("germ") of typhoid fever, of pulmonary consumption, of cholera, of diphtheria, of erysipelas, of croupous pneumonia, of the malarial fevers, and of various other infectious diseases of man and of the domestic animals, but, up to the present time, all efforts to discover the germ of yellow fever have been without success. The present writer, as a member of the Havana Yellow Fever Commission, in 1879, made the first systematic attempt to solve the unsettled questions relating to yellow fever etiology by modern methods of research.

Naturally the first and most important question to engage my attention was that relating to the specific infectious agent, or "germ," which there was every reason to believe must be found in the bodies of infected individuals. Was this germ present in the blood, as in the case of relapsing fever; or was it to be found in the organs and tissues which upon post-mortem examination give evidence of pathological changes, as in typhoid fever, pneumonia, and diphtheria; or was it to be found in the alimentary ca.n.a.l, as in cholera and dysentery?

The clinical history of the disease indicated a general blood infection. As my equipment included the best microscopical apparatus made, I had strong hopes that in properly stained preparations of blood taken from the circulation of yellow fever patients my Zeiss 1-18 oil immersion objective would reveal to me the germ I was in search of. But I was doomed to disappointment. Repeated examinations of blood from patients in every stage of the disease failed to demonstrate the presence of microorganisms of any kind. My subsequent investigations in Havana, Vera Cruz, and Rio de Janeiro, made in 1887, 1888, and 1889, were equally unsuccessful. And numerous competent microscopists of various nations have since searched in vain for this elusive germ.

Another method of attacking this problem consists in introducing blood from yellow fever patients or recent cadavers into various "culture media" for the purpose of cultivating any germ that might be present.

Extended researches of this kind also gave a negative result, which in my final report I stated as follows:

The specific cause of yellow fever has not yet been demonstrated.

It is demonstrated that microorganisms, capable of development in the culture media usually employed by the bacteriologists, are only found in the blood and tissues of yellow fever cadavers in exceptional cases, when cultures are made very soon after death.

Since this report was made, various investigators have attacked the question of yellow fever etiology, and one of them has made very positive claims to the discovery of the specific germ. I refer to the Italian bacteriologist, Sanarelli. His researches were made in Brazil, and, singularly enough, he found in the blood of the first case examined by him a bacillus. It was present in large numbers, but this case proved to be unique, for neither Sanarelli nor any one else has since; found it in such abundance. It has been found in small numbers in the blood and tissues of yellow fever cadavers in a certain number of the cases examined. But carefully conducted researches by competent bacteriologists have failed to demonstrate its presence in a considerable proportion of the cases, and the recent researches of Reed, Carroll, and Agramonte, to which I shall shortly refer, demonstrate conclusively that the bacillus of Sanarelli has nothing to do with the etiology of yellow fever.

So far as I am aware, Dr. Carlos Finlay, of Havana, Cuba, was the first to suggest the transmission of yellow fever by mosquitoes. In a communication made to the Academy of Sciences of Havana, in October, 1881, he gave an account of his first attempts to demonstrate the truth of his theory. In a paper contributed to _The Edinburgh Medical Journal_ in 1894, Dr. Finlay gives a summary of his experimental inoculations up to that date as follows:

A summary account of the experiments performed by myself (and some also by my friend, Dr. Delgado), during the last twelve years, will enable the reader to judge for himself. The experiment has consisted in first applying a captive mosquito to a yellow fever patient, allowing it to introduce its lance and to fill itself with blood; next, after the lapse of two or more days, applying the same mosquito to the skin of a person who is considered susceptible to yellow fever: and, finally, observing the effects, not only during the first two weeks, but during periods of several years, so as to appreciate the amount of immunity that should follow.

Between the 30th of June, 1881, and the 2d of December, 1893, eighty-eight persons have been so inoculated. All were white adults, uniting the conditions which justify the a.s.sumption that they were susceptible to yellow fever. Only three were women. The chronological distribution of the inoculations was as follows: seven in 1881, ten in 1883, nine in 1885, three in 1886, twelve in 1887, nine in 1888, seven in 1889, ten in 1890, eight in 1891, three in 1892, and ten in 1893.

The yellow fever patients upon whom the mosquitoes were contaminated were, almost in every instance, well-marked cases of the alb.u.minuric or melanoalb.u.minuric forms, in the second, third, fourth, fifth, or sixth day of the disease. In some of the susceptible subjects, the inoculation was repeated when the source of the contamination appeared uncertain.

Among the eighty-seven who have been under observation, the following results have been recorded:

Within a term of days, varying between five and twenty-five after the inoculation, _one_ presented a mild alb.u.minuric attack, and _thirteen, only_ "acclimation fevers."

While Finlay's theory appeared to be plausible and to explain many of the facts relating to the etiology of yellow fever, his experimental inoculations not only failed to give it substantial support, but the negative results, as reported, by himself, seemed to be opposed to the view that yellow fever is transmitted by the mosquito. It is true that he reports one case which "presented a mild alb.u.minuric attack" which we may accept as an attack of yellow fever. But in view of the fact that this case occurred in the city of Havana, where yellow fever is endemic, and of the eighty-six negative results from similar inoculations, the inference seemed justified that in this case the disease was contracted in some other way than as a result of the so-called "mosquito inoculation." The thirteen cases in which only "acclimation fevers"

occurred "within a term of days varying between five and twenty-five after the inoculation" appeared to me to have no value as giving support to Finlay's theory; first, because these "acclimation fevers" could not be identified as mild cases of yellow fever; second, because the ordinary method of incubation in yellow fever, is less than five days; and, third, because these individuals, having recently arrived in Havana, were liable to attacks of yellow fever, or of "acclimation fever" as a result of their residence in this city and quite independently of Dr. Finlay's mosquito inoculations. For these reasons Dr. Finlay's experiments failed to convince the medical profession generally of the truth of his theory relating to the transmission of yellow fever, and this important question remained in doubt and a subject of controversy. One party regarded the disease as personally contagious and supposed it to be communicated directly from the sick to the well, as in the case of other contagious diseases, such as smallpox, scarlet fever, etc. Opposed to this theory was the fact that in innumerable instances nonimmune persons had been known to care for yellow-fever patients as nurses, or physicians, without contracting the disease; also the fact that the epidemic extension of the disease depends upon external conditions relating to temperature, alt.i.tude, rainfall, etc. It was a well-established fact that the disease is arrested by cold weather and does not prevail in northern lat.i.tudes or at considerable alt.i.tudes. But diseases which are directly transmitted from man to man by personal contact have no such limitations. The alternate theory took account of the above-mentioned facts and a.s.sumed that the disease was indirectly transmitted from sick to well, as is the case in typhoid fever and cholera, and that its germ was capable of development external to the human body when conditions were favorable.

These conditions were believed to be a certain elevation of the temperature, the presence of moisture and suitable; organic pabulum (filth) for the development of the germ. The two first-mentioned conditions were known to be essential, the third was a subject of controversy.

Yellow fever epidemics do not occur in the winter months in the temperate zone and they do not occur in arid regions. As epidemics have frequently prevailed in seacoast cities known to be in an insanitary condition, it has been generally a.s.sumed that the presence of decomposing organic material is favorable for the development of an epidemic and that, like typhoid fever and cholera, yellow fever is a "filth disease." Opposed to this view, however, is the fact that epidemics have frequently occurred in localities (e.g. at military posts) where no local insanitary conditions were to be found. Moreover, there are marked differences in regard to the transmission of the recognized filth diseases--typhoid fever and cholera--and yellow fever.

The first-mentioned diseases are largely propagated by means of a contaminated water supply, whereas there is no evidence that yellow fever is ever communicated in this way. Typhoid fever and cholera prevail in all parts of the world and may prevail at any season of the year, although cholera, as a rule, is a disease of the summer months. On the other hand, yellow fever has a very restricted area of prevalence and is essentially a disease of seaboard cities and of warm climates.

Evidently neither of the theories referred to accounts for all of the observed facts with reference to the endemic prevalence and epidemic extension of the disease under consideration.

Having for years given much thought to this subject, I became some time since impressed with the view that probably in yellow fever, as in the malarial fevers, there is an "intermediate host." I therefore suggested to Dr. Reed, president of the board appointed upon my recommendation for the study of this disease in the island of Cuba, that he should give special attention to the possibility of transmission by some insect, although the experiments of Finlay seemed to show that this insect was not a mosquito of the genus _Culex_, such as he had used in his inoculation experiments. I also urged that efforts should be made to ascertain definitely whether the disease can be communicated from man to man by blood inoculations. Evidently if this is the case the blood must contain the living infectious agent upon which the propagation of the disease depends, notwithstanding the fact that all attempts to demonstrate the presence of such a germ in the blood, by means of microscope and culture methods, have proved unavailing. I had previously demonstrated by repeated experiments that inoculations of yellow fever blood into lower animals--dogs, rabbits, guinea pigs--give a negative result, but this negative result might well be because these animals were not susceptible to the disease and could not be accepted as showing that the germ of yellow fever was not present in the blood. A single inoculation experiment on man had been made in my presence in the city of Vera Cruz, in 1887, by Dr. Daniel Ruiz, who was in charge of the civil hospital in that city. But this experiment was inconclusive for the reason that the patient from whom the blood was obtained was in the eighth day of the disease, and it was quite possible that the specific germ might have been present at an earlier period and that after a certain number of days the natural resources of the body are sufficient to effect its destruction, or in some way to cause its disappearance from the circulation.

This was the status of the question of yellow fever etiology when Dr.

Reed and his a.s.sociates commenced their investigations in Cuba during the summer of 1900. In a "Preliminary Note," read at the meeting of the American Public Health a.s.sociation, October 22, 1900, the board gave a report of three cases of yellow fever which they believed to be direct results of mosquito inoculations. Two of these were members of the board, viz., Dr. Jesse W. Lazear and Dr. James Carroll, who voluntarily submitted themselves to the experiment. Dr. Carroll suffered a severe attack of the disease and recovered, but Dr. Lazear fell a victim to his enthusiasm and died in the cause of science and humanity. His death occurred on September 25, after an illness of six days' duration. About the same time nine other individuals who volunteered for the experiment were bitten by infected mosquitoes--i.e. by mosquitoes which had previously been allowed to fill themselves with blood from yellow fever cases--and in these cases the result was negative. In considering the experimental evidence thus far obtained, the attention of the members of the board was attracted by the fact that in the nine inoculations with a negative result "the time elapsing between the biting of the mosquito and the inoculation of the healthy subject varied in seven cases from two to eight days, and in the remaining two from ten to thirteen days, whereas in two of the three successful cases the mosquito had been kept for twelve days or longer." In the third case, that of Dr. Lazear, the facts are stated in the report of the board as follows:

Case 3. Dr. Jesse W. Lazear, Acting a.s.sistant Surgeon U.S. Army, a member of this board, was bitten on August 16, 1900 (Case 3, Table III) by a mosquito (_Culex fasciatus_), which ten days previously had been contaminated by biting a very mild case of yellow fever (fifth day). No appreciable disturbance of health followed this inoculation.

On September 13, 1900 (forenoon), Dr. Lazear, while on a visit to Las Animas Hospital, and while collecting blood from yellow fever patients for study, was bitten by a _Culex_ mosquito (variety undetermined). As Dr. Lazear had been previously bitten by a contaminated insect without after effects, he deliberately allowed this particular mosquito, which had settled on the back of his hand, to remain until it had satisfied its hunger.

On the evening of September 18, five days after the bite, Dr. Lazear complained of feeling "out of sorts," and had a chill at 8 P.M.

On September 19, twelve o'clock noon, his temperature was 102.4, pulse 112; his eyes were injected and his face suffused; at 3 P.M. temperature was 103.4, pulse 104; 6 P.M., temperature 103.8 and pulse 106; alb.u.min appeared in the urine. Jaundice appeared on the third day. The subsequent history of this case was one of progressive and fatal yellow fever, the death of our much-lamented colleague having occurred on the evening of September 25, 1900.

Evidently in this case the evidence is not satisfactory as to the fatal attack being the result of the bite by a mosquito "while on a visit to Las Animas Hospital," although Dr. Lazear himself was thoroughly convinced that this was the direct cause of his attack.