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from these surfaces which are specially dangerous. Although adults are much less susceptible to the disease than children, there have been numrous instances in which they have contracted diphtheria by the accidental reception of a bit of infectious material directly into the fauces. This is especially liable to occur during the operation of tracheotomy; and several physicians have lost their lives in this way in their efforts to save those of their patients by aspirating through the tracheotomy tube. It seems extremely probable that the diphtheretic poison germ is capable of increase, independently of the sick, in damp, foul places, such as sewers, damp cellars, and especially under old houses in which the floors come near the surface of the ground, leaving a damp, ill-ventilated space. At all events, the disease often clings to such houses in spite of the application of the usual means of disinfection. There is no doubt as to the influence of bad hygienic conditions in maintaining the infection when the disease has been introduced, and it is possible that such conditions may, in certain cases, originate it.

Insufficient nourishment, the malarial poison and insanitary surroundings are predisposing causes to the disease. Those suffering from scarlet fever, measles and tuberculosis are also specially liable to be attacked. As in the case of scarlet fever, mild cases, which in the absence of others more pronounced it would be difficult to recognize, is due to the diphtheretic poison, may give rise to malignant diphtheria in more susceptible individuals, or in those whose vital resisting power is reduced by any of the causes inentioned.

Prophylaxis will demand complete non-intercourse with the sick, avoidance of infected localities, and care to exclude all persons and articles from such houses from contact with yourself or children. The disease is often spread by thoughtless persons who visit the sick-room and even kiss the infected patients, and then, without any precautions in the way of disinfection, fonale healthy children in other places, and perhaps transmit by a kiss the infectious material which has adhered to their lips. The possibility of transmission by pet animals is also to be borne in mind.

Tuberculosis.-Recent researches have demonstrated that tubercular consumption is an infectious disease, and that the sputa of those affected with it, injected into susceptible animals, reproduces in them the same disease. This sputim is therefore infectious material, and should be destroyed by burning, or by the use of chemical disinfectants. There would be little danger of infection from the moist masses of sputim, but in a dessicated condition this material is liable to reach the lungs of susceptible individuals and to induce the disease.

It is well known that there is a great difference in susceptibility to pulmonary consumption, and that in certain families this disease carries off one member after another, while it is unknown in other families. Those who have this hereditary disposition should pay especial attention to individual prophylaxis. They should avoid intimate association with consumptive persons, should live under the best hygienic conditions, in dry, well ventilated apartments, and should select an occupation which will keep them in the open air, rather than one which keeps them confined to the house. Above all, they should avoid the respiration of an atmosphere loaded with organic impurities, or with irritating inorganic particles-lust of various kinds. Out of door life on the high and dry plains in the center of the continent, or in the mountains, will, in most instances, enable them to overcome the predisposition, if commenced before infection and the resulting tubercular lesions have occurred.

Those who are engaged in occupations which require them to pass some hours each day in an atmosphere loaded with dust will do well to wear a respirator for filtering the suspended particles from the air; for it is demonstrated that, independently of hereditary predisposition the respiration of such an atmosphere predisposes tubercular diseases of the lungs.

Typhoid Fever,-In this disease, as in cholera, the infectious agent is contained in the alvine discharges of the sick. In the interest of self preservation as in that of the public good, every individual who has charge of cases should see that the evacuations from the bowels are thoroughly disinfected before they are thrown out.

The drinking of water contaminated with such infectious discharges is recognized as a very frequent mode of infection; and individual prophylaxis demands an intelligent consideration of the source from which a supply of drinking-water is obtained for personal or family use. If there is the least reason to suspect that this supply may be contaminated by typhoid material, or if it contains an undue amount of organic impurities, it should be rejected entirely, or boiled shortly before it is used.

Typhoid epidemics have in several instances been traced to using milk which had been contaminated by infected water, added to it directly, or used at the dairy to wash the vessels containg it. The remedy in this case is to verify the purity of the source of supply of all milk used for drinking, or to boil it immediately before use.

The water of wells located within the limits of the city or village should not, as a rule, be used for drinking purposes, for the soil is almost certain to be polluted; and it often occurs that the contents of privy vaults and cesspools pass into the same porous stratum of sand or gravel from which the well water is obtained, or that surface drainage finds its way into shallow wells. It will be necessary also to regard with suspicion the water of small streams and ponds which are so situated that they may receive the drainage from collections of filth upon their margin.

Next to impure water we must place impure air as a factor in the etiology of typhoid fever. There is good reason to believe that the germs of the disease may be carried by the foul gasses which are given off from sewers, privies, etc., when these become infected, and that the disease may be induced by the respiration

of such a contaminated atmosphere. At all events, the breathing of a vitiated atmosphere, and insanitary surroundings generally, constitute predisposing causes which should be avoided.

In typhoid fever, as in yellow fever and cholera, depressing mental emotions, such as grief, despondency, or fear, and physical exhaustion from excessive fatigue, insufficient food, etc., are predisposing causes which may induce an attack in the presence of the infectious agent.

Concluding Remarks.-This chapter might be greatly extended, but having passed in review the principal measures of individual prophylaxis against those infectious diseases which are most fatal, we shall not dwell upon precautions to be taken in other contagious diseases, such as measles and whooping cough. These precautions will not differ from those already recommended in the case of small-pox and scarlet fever. So, to, in regard to the infectious skin diseases. These are communicated by personal con: tact, and rarely occur except among those who neglect personal cleanliness, as well as other sanitary laws. Soap and water will generally suffice for individual prophylaxis. By avoiding filthy persons, as well as filthy places, the danger of contracting these and certain other unmentionable infectious diseases will be reduced to a minimum.

SUPPLEMENTAL REPORT.

To His ExcellENCY, E. W. Wilson,

Governor of West Virginia: SIR:-In compliance with the act establishing a State Board of Health, I beg leave to present this brief report in addition to that forwarded to you about the first of November. The time, since then, more particularly covered by this report, has been more than usually free from sickness. Scarcely a report of any sickness of serious character having been received. During the early autumn yellow fever prevailed very extensively in the extreme southern States, which caused no little uneasiness to many of our people, especially among those living along our navigable rivers and other lines of travel. The danger, however, was more imaginary than real, as the lateness of the season and our geographical position made it exceedingly improbable that the disease would extend to our State. The State Board at no time deemed it necessary to establish quarantine against the infected districts. The wisdom of this course time has fully demonstrated and the State has been saved what would have been a useless expense. The hardship of some of the quarantines of our sister States, has, I fear, had the effect of making people sensitive upon that subject.

Reports received from the health officers of many of the States • clearly indicates an extensive prevalence of smallpox. This much dreaded disease, notwithstanding the efforts made for its suppression by health boards and State authorities, appears to be steadily on the increase, all of which is the result of indifference to proper preventive measures. Vaccination, the only known and sure prophylactic against this slayer of thousands, is grossly neglected by our people, and only resorted to in times of epidemic prevalence. Continued immunity can hardly be expected when every line of transit entering our State comes from a district more or less infected.

In this connection, it appears to be clearly the duty of our Legislature, at its coming session, to make some provision for supplying the people with pure vaccine virus. At present we are at the mercy of private establishments in other States, who rarely fail to take advantage of our being non-residents.

The mode of doing this in the past, by our Legislature, that of appointing vaccine agents in different parts of the State, at a nominal salary, is a waste of money and utterly void of good results, as not one of them ever was known to have a supply of virus on hand when needed. What the people want is an establishment under State control, for the cultivation of pure bovine virus, where it can be had at small cost and of assured purity. One case of smallpox would cost more to the State than the production of virus enough to vaccinate half our population.

Very respectfully,

N. D. BAKER, Secretary.

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