of like physical condition. Her family history gave no taint of consumption. His father and sister died of that disease. Soon after marriage he sickened and died of consumption. His wife during the last seven months of his life nursed him incessantly. Soon after his death she sickened and died of the same disease. Dr. Hermann Weber gives details of thirty-nine wives who were contagioned by consumptive husbands.

Instances by the thousand like the preceding can be cited showing the communicability of this disease, and the importance of the adoption of all possible measures to avoid the contagion.

The records show that more women than men fall before this disease. The reason is, because they are more exposed. As in war, more men than women are killed, because the former are more exposed. The wife is the natural nurse of the sick husband, and ministers to his wants day and night for weeks, months-it may be years, with total disregard of self.

Per contra, if it be the wife who is ill, the husband, who is the bread winner, commits the invalid wife largely to the care of others, so that he is away from the house more or less, and thus escapes the close and constant exposure.

The contagium however, is no respecter of sex.

TUBERCULOSIS IN THE SCHOOL ROOM.

The following letter from an intelligent and experienced physician in Iowa is from a práctical standpoint and forcibly illustrates, as well as emphasizes, a source of danger too often overlooked:

J. F. Kennedy, M. D.:

Iowa, March 2, 1897.

DEAR DOCTOR-Permit me to invite your attention, and that of the State Board, to a matter that seems to have attracted no attention among physicians and educators. The only articles I have noticed in print were those over my own signature. I refer to the very dangerous habit of school teachers spitting on the floor in school rooms. It is not an uncommon practice in our country schools for teachers to habitually spit on the floor and then rub it down with the foot. I have known teachers to practice this daily who were then suffering from tuberculosis and died subsequently from its ravages. These persons (otherwise good teachers) did, of course, deposit millions of the tubercle bacilli upon the floor to dry and be inhaled by the pupils

Have we not all treated cases of consumption contracted, beyond a doubt, in the school room?

While the teacher will positively forbid the boys to chew tobacco and spit upon the floor, she will daily deposit her disease germs within easy

reach of the pupil's nose and mouth, and permit tuberculous pupils to do the same thing.

While the mention of this fact would astonish some of our legislators, it is certainly a matter of very serious import. Should not the State Board take the subject in hand?

I would suggest that no person be granted a certificate as teacher in our public schools who is not pronounced free from tuberculosis by a competent medical board; that it be made a penal offense for any one to spit on the floor of school room or church, and that disinfected spittoons be provided. If you can bring about such legislation your name will go down in history as a benefactor of the race. Yours truly,

M. D.

TYPHOID FEVER.

Typhoid fever, which was generally prevalent over the State during the first year of the biennial period, subsided very largely during the second year. The reason may be found in the increased rainfall, by which streams, wells, and sources of water supply were replenished, and the contamination thereof largely removed.

Typhoid fever is an endemic, infectious disease occurring in nearly all parts of the world. It occurs most frequently in persons under thirty years of age; oftener in males than females; and at all seasons of the year.

The microbe, or germ of the disease is communicated to the individual by the imbibition of water, milk, and other articles of food and drink. The bacillus finds lodgment in the intestinal canal, where it multiplies and produces the peculiar morbific effect.

The virus of the disease may be propagated among healthy

persons:

1. By percolation through the soil into wells that supply drinking water;

2. By issuing through defective sewers or drains into the air of the inhabited area;

3. By exhalations from ill-trapped water closets or privies which are the receptacles of the discharges of the sick and the resort of the healthy.

The micro-organism is found in the excreta of the patient,

and not in the air surrounding the patient; hence the air coming from contaminated cess-pools, water closets, etc., is more dangerous than that from the sick room.

Milk absorbs quickly the germs from the typhoid patient and can be easily contaminated by carrying the excrement through a room in which the milk is placed. Milk thus exposed is a prolific source of infection.

CAUSATION AND SPREAD OF TYPHOID FEVER.

From an elaborate report of Dr. George M. Grober, special medical sanitary inspector, upon his investigation of five hundred cases of typhoid fever, in the District of Columbia, in 1895, is taken the following conclusions as to the cause and spread of the disease:

All scientific physicians agree that typhoid fever is caused by an organized germ capable of reproducing itself within and without the body, instead of such hypothetical matter as miasms or contagia, whose nature has never been demonstrated to our senses. On no other theory, except the germ theory, can we explain the occurrence of typhoid fever epidemics spread through the water and milk supply. If we reject the germ theory, we will indeed be forced to the conclusion that fecal and putrescible matter when present in milk or water in infinitesimal dilutions is capable of producing the disease in question. "A poison may produce sickness and even cause death, but it cannot infect, because it cannot reproduce itself."

According to the advocates of the germ theory, a certain number of typhoid bacilli gain admission, we will say, into the intestinal tract, and, if the conditions are favorable, begin to proliferate. It has been estimated that a single germ by growth and subdivision is capable of producing over sixteen millions of similar germs in twenty-four hours. In consequence of their own life's process they produce a soluble poison which, when absorbed, gives rise to constitutional symptoms, and in addition also acts as a local irritant and causes the lesions in the alimentary canal, characterized usually in the first week by infiltration, in the second week by ulceration, and in the third week by separation of the sloughs.

The intensity of the local and general symptoms doubtless depends not only upon the dose of the fever-producing agent, but also upon the individual susceptibility, or rather the aptitude, of the organism to feel the effects of the poison evolved by the germs. In this way we get our mild, medium, severe, or irregular types of enteric fever, differing simply in degree but not in kind.

A mild infection may give rise to abdominal catarrh, with symptoms of catarrhal jaundice, and temperature not exceeding one hundred degrees. Many of such cases have been observed, in which there was enlargement of the spleen, with the characteristic eruption.

Again, there are cases, though quite infrequent in the United States, which have been described as the abortive form, in which somewhere between the seventh and fourteenth day, as Jaccoud expresses it, "the

sickness takes a sudden turn and runs a course similar, as regards enteric fever, to that which varioloid runs as regards variola." Griesinger reports a case where the duration did not exceed five days.

Such cases can only be explained by assuming that the intestinal lesions undergo resolution, and that we simply have to deal with the primary fever and not with the secondary or septic fever due to the ulcerations and formation of sloughs.

CHANNELS OF INVASION AND MODES OF DISSEMINATION.

The invasion of the microbe most likely takes place through the alimentary tract, as evidenced by the primary intestinal lesion and the frequent dissemination of the disease through the water and milk supply. The possibility of transmission of the virus through the air should not be excluded, for, as in tuberculosis so in this disease, the infectious material may have become dried and pulverized and with particles of dust gain access to food or into the mouth, there to be swallowed or inhaled.

The principal source of transmission of the microbe, however, is through the water supply, infected milk and food, and there is much reason for believing that in such cases the virus proceeded from the dejecta of typhoid patients which gained access to the water supply directly or through the soil, or the wash water from patients and infected clothing and bedding, or found its way into vegetables and fruits, which are eaten raw, through the medium of fertilizers or washing them in infected water.

The agency of flies and other insects in carrying the germs from box privies and other receptacles for typhoid stools to the food supply cannot be ignored.

MILK INFECTIONS.

Dr. Busey and myself have tabulated one hundred and thirty epidemics of typhoid fever from all parts of the world, which were traced to contaminated milk.

In one hundred and nine instances there is evidence of the disease having prevailed at the farm or dairy.

In fifty-four the poison reached the milk by soakage of the germs into the well water with which the utensils were washed: in fourteen of these the intentional dilution with polluted water is admitted.

In six instances the infection is attributed to the cows wading in sewagepolluted water. In three instances the infection was spread in ice cream prepared in infected premises. In twenty-one instances the dairy employés also acted as nurses. In six instances the patients while suffering from a mild attack of enteric fever or during the first week or ten days of their illness continued at work, and those who are familiar with the personal habits of the average dairy boy will have no difficulty in surmising the manner of direct digital infection. In one instance the milk tins were washed with the same dish cloth used among the fever patients.

WATER-BORNE EPIDEMICS.

We have the experience of Plymouth to show that the excreta of a single typhoid patient washed into a stream caused over one thousand cases of this fever. A study of the epidemic at Cumberland, Md., 1889-'90, indicates that typhoid fever was not present until the discharges from a case living

on one of the little runs which empties into the Potomac about two hundred feet above the pumping station found their way into the city water supply, Such instances could be recited by the hundreds.

INFECTED SELTZER WATER.

Helwig reports an outbreak at Mayence in 1884, which was traced to the use of artificial seltzer water, the water having been obtained from a well polluted with typhoid dejecta.

INFECTED WELLS.

Breumer presents the medical history of a farm, showing for twenty-four years the occurrence of typhoid fever, sometimes amounting to an epidemic. During a similar outbreak in 1886 he examined the drinking water, which, though clear and odorless, contained twenty thousand germs per teaspoonful, among others fecal or intestinal bacteria.

An outbreak of typhoid fever at Hirschfelden in 1885 was limited to persons using the water from a well in the vicinity of which the mother of a typhoid patient had been washing the soiled linen and bedding of her son.

INFECTED CLOTHING.

Gelau reports an epidemic which renders it probable that the disease may be communicated by means of infected clothing. A German army regiment, with an average mean strength of three hundred and fifty-three men, between the years of 18 3 and 1884, furnished not less than one hundred and forty-six cases of typhoid fever. The water supply was above suspicion, and disinfection of the quarters and even abandonment of the barracks failed to check the disease. This finally led to the suspicion that the clothing might be the source of infection, especially as the garments were promiscuously worn. Examination revealed the presence of fecal spots in a number of pantaloons. The clothing was disinfected, after which only three mild cases appeared, and these were confined to the men engaged in the disinfection.

INFECTED HANDS.

There are of course a number of instances on record in which the disease was contracted by washerwomen, nurses, and persons engaged in the removal of night soil containing typhoid stools, and the most probable explanation is that in the majority of these cases the virus was conveyed to the mouth by means of infected fingers.

Professor Finkler, of Bonn, a very competent observer, believes that the disease may be communicated by intimate contact, living in the same room, or breathing the same air, and accounts in this way for a number of outbreaks in his section. In 1886 a woman who had been called to one hamlet to nurse her children returned to her home, was taken sick with typhoid fever and communicated the disease to her nurse, and subsequently fifty other cases developed which could not be traced to soil pollution or infected water supply. From this locality three children were admitted to the hospital at Bonn; here four persons were attacked who had come in direct contact, and five washerwomen who had come into indirect contact, i. e., through the clothing and linen of the patients. I have found similar instances in my present investigation, but it is practically impossible to say