phylaxis. The following notice was printed and posted in conspicuous places about the town:

NOTICE Owing to a severe epidemic of TYPHOID, everybody is required to boil all drinking water and to police all front yards, back yards, privies, pig-pens, etc.

Sprinkle lime freely around.

These precautions are absolutely necessary to prevent the spread of the disease, which is assuming alarming proportions. COUNTY BOARD OF HEALTH.

Every effort has been made by all the physicians to prevent the use of water for drinking purposes without previous boiling. Practical housekeeping difficulties stand in the way of a complete observance of this precaution in many of the houses, and verbal warnings have not been completely effective in preventing the use of unboiled water from some of the contaminated springs.

PREVENTIVE MEASURES RECOMMENDED.

At a conference held with the officials of the Union Mining Company, C. & P. Railroad, and the President and Secretary of the County Board of Heath, the following additional precautions were recommended in regard to the management of the water supply:

1. It was recommended that in addition to the posting of notices on springs which contained the Bacilli Coli Communis that such springs be sealed by means of a suitable superstructure, and that notices be posted thereon forbidding any interference with the seals placed upon them on pain of fine or imprisonment.

2. Any spring which it was impracticable to seal on account of mechanical difficulties to be rendered unfit for drinking purposes by the use of a harmless emetic, such as copper sulphate or alum. Similar notices being posted upon the springs also. The text of the notice to be similar to the following:

NOTICE This spring (or well) has been sealed by order of the Board of Health for Allegany county.

All persons are forbidden to molest the seal or covering placed on this spring on pain of fine or imprisonment.

CHARLES H. BRACE, M. D., Secretary.

At the request of the secretary a conference was held with the Board of Health and a plan of prophylaxis devised to follow three main lines:

1. The closure of all infected springs to be made effectual. 2. Covering the contents of all privies with a sufficient layer of earth, ashes, or lime.

3. Personal and domestic prophylaxis in the houses of the patients.

REGULATIONS.

OFFICE OF THE BOARD OF HEALTH OF ALLEGANY COUNTY.

MT. SAVAGE, MD., Aug. 1904.

NOTICE Owing to the presence of an epidemic of typhoid fever in the town of Mount Savage, the following regulations will be rigidly enforced:

1. Any person breaking open any well or spring sealed by the County Board of Health, or breaking any seal placed upon any pump, spring or well, or other water supply, or moving or destroying any of the printed notices posted by the County Board of Health, shall be prosecuted, and if convicted, will be dealt with according to law.

2. No person shall throw any stool or urine upon the ground under any circumstances, or into any drain, ditch, privy or latrine, until the same shall have been properly disinfected.

3. No stool or urine shall be kept in any premises in the town of Mount Savage unless the same shall be suitably covered. 4. All persons using earth closets, or privies, or latrines, in the town of Mount Savage, shall cover all stools and other evacuations with a layer of sand, earth or ashes as soon as passed.

By order of the

BOARD OF HEALTH FOR ALLEGANY COUNTY.

The general measures of prophylaxis to be accomplished were (a) the effective closing of polluted springs and wells; (b) the covering of the contents of all privy vaults by a sufficient layer of earth. The Union Mining Company to assign two gangs of a half dozen men with a cart, to attend to this duty, while all privies should be required to contain earth or ashes for sprinkling after each use of the vault.

It was recommended that four or six district nurses should be appointed to visit each typhoid patient two or three times daily, and to attend to all measures of domestic and personal prophylaxis, and to be personally responsible for the disinfection of the stools.

It was proposed by the County Board of Health to put some person in the town of Mount Savage with constabularly powers to render effective the regulations of the said board.

It was recommended to them that should this precaution prove necessary, a physician be placed in charge, to be given all proper powers and to have under his charge the four nurses and the gangs of men necessary to cover the contents of privy vaults and to perform all other necessary sanitary work.

It was further recommended that the duties of said physician and nurses and laborers under his care be definitely prescribed, e. g.

DUTIES OF PHYSICIAN IN CHARGE.

1. To inspect all privy vaults once daily and to see that the contents of the same are properly covered.

2. To inspect all sealed water supplies once daily, to see that the same are and remain effectually closed.

3. To supervise the work of policing gangs, and see that all necessary hygienic measures are taken.

DUTIES OF NURSES.

To prevent any contagion through the patient or his stools. To properly disinfect and keep the latter covered. To supervise the burial of the stools after efficient disinfection in a pit with quicklime.

DUTIES OF POLICING GANGS.

To report to the physician in charge daily with shovels and carts.

It was agreed by the company and the Board of Health of Allegany County that each should furnish two nurses for the purpose of domestic prophylaxis and the care of the sick

It was also agreed that the policing gangs should dig holes with a post-hole digger on the premises of each typhoid case, and that they should properly care for the closets and attend to all necessary policing.

It represented to the company

That the main source of infection was undoubtedly
destroyed.

That the efficient executions of these measures would pre-
vent any further epidemic sickness.

For a permanent supply a sufficient number of artesian
wells, or a supply of springs at a considerable distance,
were most practicable.

CONCLUSIONS.

The conditions of the earth closets in Mt. Savage and their situation on the side of the mountain constitute a serious menace to towns using water from the Potomac River or its north branch.

Complete but gradual subsidence of the epidemic may be looked for at Mt. Savage.

The very large percentage of non-immunes affected by the water from the brickyard spring and the very short period of incubation of 20 of the cases (one week) render it probable that this spring was polluted to a degree comparable only to a bouillon culture of the bacillus typhosis.

In the case of a nurse at the Charite Hospital who drank with suicidal intent a bouillon culture of the typhoid bacillus a similar short period of incubation was observed.