bers; or a stool showing an entire absence of bacilli may be followed by one having an abundance. There may even be an intermission of months or longer, and yet a person may continue to be a carrier for years, and during all this time he is a menace to those with whom he comes into intimate contact. The germs are harbored in both the bowel contents and the urine, and hence it is quite easy to soil the hands and through these the food or utensils in which it is served. "The danger of a carrier to his associates and to the general public will depend upon his occupation and his habits of general cleanliness. Of 51 chronic bacilli carriers reported in the literature, 33 were known to have been the cause of disease in others. Of these 13 were dairy workers, 10 were cooks, 7 were housewives and 3 were laundresses. Hence those carriers who have anything to do with the production and handling of food, especially food which is eaten uncooked, are most dangerous. It is important to note also that about 90% of all typhoid bacilli carriers are women, who, in most families, prepare the food for the table." (Gardner & Simmons, Prac. San.)

The common housefly has come to be considered a very frequent cause of fever cases. This insect is omnipresent, its reproductive powers immense, and hence its numbers are unlimited. It breeds in manure heaps and other filth, revels in garbage cans, privy vaults and other foulness, and comes fresh from its nasty revels to the kitchens and tables of the people. The germs of typhoid fever have been found on the feet and legs of these pests. How easy, then, to infect the family milk, meat or other food, especially of careless cooks and housewives, and how innocently and unconsciously may one take into his stomach the poison that lays him on a bed of lingering illness or puts him beneath the green sod of the church-yard. Only a little fly, but an insect most potent for mischief.

Last September the writer visited a village of about 225 population in which 23 cases, just one-tenth of the people, had been attacked with typhoid fever within a few weeks. There was no common water supply, each family having its own pump. There was no common source of milk supply, many having their own cows. There was but a single privy vault in the village, but the old fashioned country accommodation, a little house set on the ground, open in the rear and without excavation, was found on every lot. The weather was warm, the close of a warm summer, and flies were abundant. In the absence of a common water or milk supply the simplest explanation of this outbreak was certainly the open privy and the fly. One case that may have been imported was sufficient to start the fly on its mission of destruction. Flies, filth, fingers, food, fever; and farewell to many bright young lives. This too often is the sad sequence.

The profession is coming to recognize that while this disease is not contagious as is smallpox or scarlet fever, yet we may and

do have many "contact cases." This means that a person in attendance on the sick or vis..ing the typhoid patient may, by kissing, shaking hands, coming into contact with bed or body clothing, drinking out of vessels that the patient may have used, get the infection into his system, with a resulting attack of the disease. The United States Public Health Service, whose surgeons are expert in investigation of this disease, attach much importance to this mode of infection.

Infected water, ice, oysters, raw fruits and vegetables, infected milk and milk products, infection by flies and human carriers, and infection by contact with patients are the common methods in which typhoid fever is conveyed; water, milk, flies, contact and human carriers being the chief of these. Our aim, therefore, should be to apply constantly the knowledge we possess for the purpose of reducing the number of typhoid cases to the minimum, if we may not totally eradicate this grave disease.

Firstly, it is an absolute necessity to secure a pure water supply. In the cities this is a matter for municipal and not individual action, and usually it is necessary to install a filtration plant. In the country each family must have its own spring or well. In either case the source of water supply must be located at a distance from manure heaps, privy vaults, and the house. drains, and when possible above rather than below these, so that the surface and underground drainage will be away from and not toward the sources from which the water is drawn. The spring should have a curbing around it and a covering over it. The well should have a cement or tongued and grooved board covering so that no filth from the surrounding earth or the feet of those using the well can get into the water. Many persons are extremely careless as to their well covering, and no doubt the water often becomes infected by such carelessness. If any doubt exists as to the quality of the water it should be boiled pending an investigation, which can now be made without cost at the State Hygienic Laboratory at Morgantown.

Pure water on a farm almost insures freedom from typhoid infection, but to make the purity of the milk doubly sure the cows should be milked in a clean place, should be brushed before milking so that no impurity may drop into the bucket, the cows' udders should be cleansed, and the milker should be personally clean, especially his hands, and should wear clean outer garments. The milk should be reduced to a low temperature to prevent the multiplication of germs from which milk is never entirely free, and it should be at all times handled by cleanly persons only. Special care should be exercised that no flies gain access to it, for we can never know when infection may be carried by this insect, nowly commonly called "the typhoid fly." And this leads us to impress the importance of having garbage cans at all times securely covered, filth of every sort reduced to

the minimum, and manure heaps cleared away at frequent intervals, since they are the favorite breeding places of flies. On another page in this bulletin the use of borax on manure heaps is advised by the United States Agricultural Department, which has found this valuable in preventing the breeding of flies. In this connection we urge in the strongest possible terms

the replacing of the present privy system by some form of sanitary privy. The one here pictured has been recommended by the United States Public Health Ser'vice. It can be erected or changed from the old form by the farmer himself at a trifling cost, and, if properly managed, will positively prevent flies from carrying infection from this source, as they cannot gain access to the excreta. There are two essentials. One is that the seats be covered by a lid so constructed that it will fall forward when the seat is unoccupied. The other is that a galvanized iron bucket be placed on a firm foundation under each seat, and that they be closed in by a falling hinged door in the rear so as to make the inclosure fly-tight. At intervals the buckets are to be emptied and the contents buried. This can be done by running a furrow and covering it with a plow or shovel.

Human carriers, when found, must be quarantined and treated by a competent physician until freed from the germs of typhoid fever. No such persons should be permitted to engage in cooking or serving food, and especially must they be prevented from taking any part in dairy work, since the danger of milk infection from this source is very great. Dr. Ravenel of Wisconsin has recently reported a typhoid carrier who conveyed typhoid fever to 21 persons, many of them relatives, before a microscopic examination proved him to be a carrier. Such cases are not rare. "Typhoid Mary" of New York caused 26 cases in seven families in which she was a cook.

Contact cases can be easily and certainly avoided by simply

avoiding contact with typhoid patients. There is too much visiting in cases of sickness. Most patients will get along much better without visitors, making a better and more rapid convalescence. In the event of visiting, however, which we can scarcely entirely stop, the visitor should avoid coming into contact with the patient, the bed, drinking vessels, or anything that has been handled or used by the patient. The necessary attendants should use the utmost caution as to cleanliness, and should especially wash their hands thoroughly immediately before eating. By observing these precautions there is little danger of contact cases arising.

This leads us to the most important point in the control of typhoid fever. With our present views on the subject, were the body discharges of all typhoid patients thoroughly disinfected at the bedside, the disease would in time cease to exist. Water carries the poison because it has become infected by these excreta. Milk carries the poison because it has been infected by the hands or water or other thing that has previously become infected by these excreta. Disinfection of excreta means dead germs and dead germs cannot convey infection. Kill the germs at the bedside, therefore, as soon as possible, and you strike the disease at its most vulnerable point, and greatly diminish the probability of its spreading, with the result that, were systematic and thorough disinfection practiced in every case, typhoid fever would ultimately be extinguished.

How shall this disinfection be done? The process is fortunately both easy and economical.

We have a number of efficient disinfectants, among which I

may name:

1.

Carbolic acid. This should be used in a 5% solution.

2. Tricresol, which is to be used in a 2% solution.

3. Chloride of lime, which must be fresh. Dissolve 6 ounces in a gallon of water. In a stoppered bottle this will retain its strength for some days.

4. Quick lime, in the form of milk of lime or common white wash. To be particular, add two quarts of broken lime to 3 pints of water. This produces hydrate of lime, which will retain its strength for some time if kept dry. Add a pint of this to a gallon of water to form milk of lime, which will retain its strength for several days.

Of any of the above add as large a quantity as the amount of excreta to be disinfected, thoroughly mixing. Cover the vessel immediately and let stand at least an hour before emptying. In this way all danger of spreading the disease by the excreta will be removed.

It is important that disinfection should be practiced from the commencement of typhoid fever, but it is not possible for even the most experienced physician to determine the nature of every