Mayor should have great power; but means should be provided for holding him strictly accountable for the exercise of the power. I very thoroughly believe in concentrating power in the hands of the executive, but the proposed charter does this to an extreme degree, and yet relieves him of responsibility for the way he exercises the power. It is to the last degree unwise to have the power over the finances left unchecked in the Mayor's hands. It is to the last degree unwise to make him a despot over the educational system of half the State of New York— for New York City contains half the population of the State. It is thoroughly unfortunate that no power should be lodged in the hands of the Governor whereby the Mayor can be called to account.

But, bad though the provisions of the charter are, the method of thrusting the charter upon the city is much worse. The change of wording in provision after provision is such as to make experts like those of the Bureau of Municipal Research wholly unable to tell just what is meant ; for instance, it seems clear that the charter gives the Mayor power to destroy any public record whenever he sees fit. Those responsible for the charter published a summary which was wholly misleading; and only the popular demand frightened them into making the whole charter public far enough in advance of action to give a chance for popular discussion. Practically, if the Legislature, which is to meet at Albany next month, does as Tammany expects, the organic law under which five millions of people are to live will be imposed upon them without allowing them to take any real part in framing it, without giving them any adequate opportunity to express their opinion upon its infinitely varied, and sometimes obscurely set forth, provisions. A more undemocratic method of procedure could not be imagined. The citizens of New York have not asked for this charter. There has not been the slightest popular demand nor agitation for it. Arizona and New Mexico contain together not much more than one-tenth of the population of New York; yet they have drafted their own Constitutions, through their own representatives, whose debates were widely reported, and whose actions were finally passed upon by the

people of the Territories concerned, and were then, and not till then, submitted to Congress. The people of the city of New York, ten times more numerous, are not given anything even approaching the opportunities thus given Arizona and New Mexico to fix for themselves the fundamental law under which they are to live. They have had no choice, direct or indirect, as to the men who have framed this charter, and they have been in no way consulted as to its provisions. Finally, they are to have nothing to say as to whether they will accept or reject the charter that has been framed for them. Every principle of home rule is violated. by such action, and it is to the last degree undemocratic and in violation of the fundamentals of popular government. Moreover, the proposed charter will give, by the action of outsiders, powers to one elective officer which that elective officer was not chosen to exercise, and at the same time will take from other elective officers powers which they were chosen to exercise. In 1999 certain men were elected to manage the municipal affairs of New York. All the men thus elected, except the Mayor, ran on the ticket opposed to that on which the victorious candidate for Mayor ran. All these men were elected to exercise certain well-defined functions, and were chosen to positions of certain well-defined powers. The election was the commission of the people of the city of New York to those officers to fulfill the functions and exercise the powers. Now, nearly two years after the election has taken place, a partisan Legislature steps in and says that the one officer who was elected on a partisan ticket—its own ticket, the Tammany ticket --shall have his powers greatly increased, and that the other officers elected on the other ticket

the non-partisan ticket-shall not exercise the functions intrusted to them, and shall have their powers greatly diminished, continuing in office, it is true, but not continuing to exercise the powers with which the voters intrusted them. The citizens of New York have a right to demand that they be permitted to exercise the same kind of intelligent control over the making of the organic law under which they are to live that is granted to the people of the new States.

HOLERA at New York."

"CH

Scarcely more than a decade ago these words, flashed over the wires from Atlantic to Pacific, would have sent a thrill of panic through the country. There could be no more impressive tribute to the recent swift advance of medical science and the increased efficiency of Quarantine and Health Departments than the well-justified calm with which press and public alike took the announcement that cholera had once more crossed from the Old World to the New. This was the more noteworthy because many persons still living remembered the great epidemics that swept the country in the middle of the last century, leaving the dead in thousands behind. Men still young had vividly in mind the cholera panic of 1892, when even the foreign mail bags were disinfected, and the inhabitants of Fire Island, armed with shotguns, attempted by force to prevent the landing of passengers from infected ships.

We have learned a good deal since then, and so have the doctors. We have seen the surgeons of the United States Marine Hospital Service go into Panama, where yellow fever had taken its annual toll of death for centuries, and stamp out the disease as one would tread the smoldering flame out of a burning rag. We know the relation between yellow fever and mosquitoes, and that where there are no mosquitoes there will be no yellow fever, or malaria either, for that matter. have learned that the first step necessary to combat successfully the bubonic plague is to exterminate rats and their fleas, which spread infection. We know the relation of the house-fly to typhoid fever, and, armed with this knowledge, the surgeons and sanitary officers of the Division of

We

Maneuver kept the army recently living under canvas in Texas in a superb condition of health that proved how cruelly unnecessary were the thousands of deaths from typhoid in our camps during the Spanish-American War.

In their successful war on all these diseases the medical men have learned more and more surely the truth of the old adage that an ounce of prevention is worth many a pound of cure. Once they have discovered the real source of infection, they have had little difficulty in preventing its spread. ing its spread. And they are learning all the time. This year Dr. Alvah H. Doty, Health Officer of the Port of New York, has given proof positive of the cholera carrier's dangerous ability to elude the safeguards of quarantine methods and regulations hitherto considered ample and effective. How quickly this knowledge was put to practical use could be seen at the Quarantine station of New York Harbor the other day. A threatened cholera epidemic along the Atlantic coast had been checked and every possible source of infection stamped out. Incoming ships from infected ports were moving slowly but steadily through a new routine of quarantine regulations especially adapted to detect the presence of cholera carriers. All went as smoothly as though the system had been in effect for years instead of weeks. Three big liners, under suspicion since they had taken on passengers at Naples, lay at anchor in the Narrows, flying between foremast and funnel the warning yellow flag, the international signal that a vessel is still held in quarantine. Up at the bacteriological laboratories a large staff, reinforced by experts drawn from the United States Marine Hospital Service and the State and city Health Departments, worked in

relays, day and night, examining under powerful microscopes cultures taken from every person on the suspected vessels. The experts were hunting through their lenses for the deadly little bacillus, shaped like a comma, that has in its infinitesimal form all the potentiality of thousands of deaths and a devastating epidemic. Right here on the gleaming glass slides under these microscopes is the final line of cholera coast defense.

Let one of those thousands of cultures show the little comma-shaped bacillus, and the quiet words of the expert, "Here it is," send a liner's passengers down to the detention barracks of Hoffman Island until all who are infected have been stricken or all danger has passed.

All was order and system that day at Quarantine among these men who were defending the Nation's health, but these conditions had not come without preparation. Long before the general public even suspected the danger of cholera the Quarantine lines were closing in everincreasing watchfulness along the Atlantic

coast.

Dr. Doty was expecting cholera on incoming ships from the Mediterranean this year, and he was prepared for it. Two or three sporadic cases had developed on vessels en route from southern Europe last autumn. In no case, however, did the infection succeed in passing Quarantine. Officers of the United States Marine Hospital Service abroad had watched the march of cholera across Europe in 1910 and the resultant invasion of Italy. The efforts of the Italian Government officials to conceal the real seriousness of the situation did not deceive these trained observers, and they forwarded confidential reports of the progress of the epidemic to this country.

While the bacteriological experts hunted their quarry in the laboratories and the liners swung at anchor awaiting the result, Dr. Doty sat in his study down at Quarantine and told how he had planned his campaign against the cholera carrier. The fight had been won then, and the danger of an epidemic was past. He might well have spoken with some little pride of the achievement, but he seemed to look upon the whole business in the most matter-of-fact way, as if fighting

cholera were nothing at all out of the ordinary, but all in the day's work.

"I knew what we were in for," he said, quietly, "and we were ready. Previous to last year there was a general feeling that cholera was a disease that demonstrated itself within five days of infection. Therefore, as a means of combating cholera, we depended on a five-day detention of persons suspected of infection or coming from an infected district. We held them for five days, and, if no cases developed, we let them go, on the theory that there was no danger of further infection. This was our theory, as is indicated in the regulations of the United States Government and local Quarantine and Health Departments.

66

• But in the last four or five years we have learned that in nearly all diseases we are dealing with two classes never before fully appreciated: first, the mild and irregular type; and, second, the carrier. We have learned a great deal more about the danger of carriers in many infectious diseases in the last few years. You will recall the case of Typhoid Mary,' which attracted considerable attention in New York a year or so ago.

We know now that when cases of infectious disease get past Quarantine the infection is not carried in clothing or baggage or cargo. It is nearly always the mild or irregular case or the carrier that brings the infection. Twelve or fourteen years ago I began to use the clinical thermometer to detect these mild or irregular cases here at Quarantine when yellow fever was suspected. This proved most effective against yellow fever, but it is of no use as a guard against cholera. Cholera patients develop a high temperature only in the last stages of the disease."

As Dr. Doty told of his growing belief that there was still much to be learned about the sources of cholera infection his face lighted up with enthusiasm, and he laughed as he told of the old crude quarantine methods, the disinfecting of mailbags and cargoes, and the terror that the very word cholera once carried.

"It was almost as bad as the old ways of fighting yellow fever, before we knew about mosquito infection," he said.

"I caught my first cholera carrier on a

vessel arriving here from Naples last year. The possibility of such a type had always interested me intensely. I believe that Professor Calmette had already described a case of cholera carrier occurring during the epidemic at Hamburg in 1892. A young man, supposed to have been infected in that city, traveled for two or three weeks, and then suddenly developed the disease.

"When the vessel which I suspected arrived from Naples last autumn, after a voyage of fourteen days, the ship surgeon's certificate declared no deaths, no infectious disease or suspicious cases, and no case of intestinal illness. Our examination of the passengers and crew showed all apparently well. We were requiring at that time from all ships coming from cholera-infected ports a list of all cases where some of the passengers or crew applied to the ship's surgeon for any sort of treatment whatever. On this vessel six men had sought treatment for minor ailments. None was any longer under treatment, and all appeared practically well. I decided, however, to detain these six men at Hoffman Island for observation. Three days later one of the six was in a state of collapse, and died of cholera within twenty-four hours. Bacteriological examination, confirmed by exhaustive tests, gave positive evidence that it was a case of cholera.

"There we had a plain case of a cholera carrier. The man had come on a voyage of fourteen days from the infected port, and did not develop the disease until three days after his arrival here. That was enough to put us on our guard, and we have had unmistakable confirmation in a number of similar cases this year. The importance of this discovery in regard to cholera carriers can hardly be overestimated. We know now why cholera has evaded the Quarantine barriers in the past and how to prevent it in the future."

Dr. Doty does not claim the credit for the discovery of the cholera carrier. He says that he has simply confirmed in practice what medical men have long suspected. But theory and practice differ in a very important sense when the defense of a nation's health is concerned, and when Dr. Doty was once convinced that

his theory was correct he moved without hesitation to give it practical effect.

"The remedy was plain," he said, "and we have taken the necessary steps to enforce it. By authority of the Secretary of the Treasury all persons arriving from infected districts must remain at Quarantine until specimens from their intestinal tracts have been submitted to bacteriological examination. This necessitates a great deal of hard work and a big staff of experts, and we are obliged to hold all vessels from infected ports for from two to three days. But it is well worth the trouble. It makes the detection of cholera carriers practically certain. The system is now in force at Quarantine, and we will continue it as long as necessary."

Dr. Doty was asked if this system of bacteriological examination gives an absolute assurance that no cholera infection can pass Quarantine.

"There

"Not absolute," he replied. is no system of quarantine regulations, even the most modern and scientific, which will guarantee one hundred per cent safety. But it is practically effective. Any case which did evade us would be promptly isolated upon development, and all sources of infection extirpated. The chance, however, of a case of cholera evading bacteriological examination is extremely remote. This is the only way it could occur: We know that a carrier may expend his potentiality as a source of infection. We have had cases in which the carrier has not developed the disease for forty-five to fifty days after infection, and he may never develop the disease in an acute form, but recover completely. he måy have infected another person and later have recovered himself so that he will not show the bacillus upon the bacteriological examination. The other person whom he has infected may not have passed the period of incubation, and will likewise fail to show the bacillus upon examination. You will see that that is a very remote contingency."

Now

These regulations, under the system now in vogue at Quarantine, apply only to the steerage passengers and the crews of vessels. Cabin passengers of suspected or infected ships are customarily released, unless, in Dr. Doty's opinion, the emergency requires their detention. He has,

of course, ample authority to detain cabin passengers if necessary. The practice of releasing cabin passengers has been found entirely safe, and in the past two years that it has been followed no spread of infectious disease has been traced to this cause. Dr. Doty gives several good reasons for following this course. Cabin passengers are not as likely as steerage travelers to come from infected localities, or to develop infectious diseases. They are practically isolated on shipboard from the quarters of the steerage passengers, among whom most of the cases develop. There is nothing very dangerous in single cases of infectious diseases passing Quarantine providing they are promptly isolated and the proper precautions taken when the disease develops. Steerage passengers are not likely, to consult a physician until their symptoms have taken a serious turn and there has been abundant opportunity for the infection of others in the crowded quarters in which persons who travel by steerage are likely to live. On the other hand, cabin passengers are far more apt to consult a physician at the first symptoms, and their isolation in time to prevent the spread of infection is a comparatively easy matter.

The fumigation of baggage and cargoes Dr. Doty regards as equally useless and unnecessary.

How effective the measures taken at the port of New York have been in safeguarding the Nation from the possibility of a disastrous epidemic of cholera the history of the recent cases brought to this country from the Mediterranean plainly show. Since this spring some thirty-odd cases have either developed on this side of the ocean or have been removed from ships for treatment. There have been no new cases recently, and ships coming from infected ports have practically ceased bringing steerage passengers on account of the expense involved to the companies by the rigid enforcement of the new Quarantine regulations. Five cases, probably all carriers, succeeded in passing the Quarantine barrier. One woman, after detention and release from a ship arriving from the Mediterranean, developed cholera in Brooklyn. There was a similar case of a man who died in Auburn, New York, although this was not bacteriologically not bacteriologically

who kept a sailor's lodging-place died in Boston. No source of infection could be traced with certainty. A sailor coming from Boston was taken ill in a lodginghouse in lower Manhattan, New York City, and after his removal to Bellevue Hospital it was found that he was suffering from cholera. An employee at Hoffman Island in New York Harbor, where the cholera cases were taken for treatment, developed the disease at his home on Staten Island. In not one of these instances did a secondary case occur--sufficient proof of the vigilance and prompt precautions taken by the attending physicians and health officers.

A record of this sort would appear to justify the statement made by Dr. Doty when he said:

"There is no disease now known with which modern medical science and sanitation cannot successfully deal. There may be sporadic cases of cholera in the future in this country as long as there remain so many infected areas in the world, but there is not the slightest danger of a serious epidemic while our Health and Quarantine Departments remain in their present efficient condition."

Thus the cholera came to the Eastern sea-gates of the Nation and was checked, held, and repulsed. There were anxious days for Health and Quarantine officers all along the Atlantic coast, but few people will ever know just how hard Dr. Doty worked, and how many hours out of the twenty-four he was on duty until he had the situation well in hand. And it is only fair to him to say that he has fought his successful fight against cholera under a difficult handicap. Last year a lawyer forwarded complaints to Governor Hughes based upon the affidavits of certain immigrants detained at Quarantine, charging unsanitary and improper conditions at the Quarantine stations at Hoffman and Swinburne Islands. Governor Hughes sent the complaints to Dr. Doty, asking a report. Dr. Doty investigated, and answered that there was no basis for the charges. Governor Hughes was apparently satisfied with Dr. Doty's report, for he took no further action in the matter. When Governor Dix was inaugurated, the same lawyer sent the