few facts, however, may be commented on. In the first place, it is noticeable that most of the large European cities have spared no legitimate pains nor expense to secure uncontaminated supplies if possible. That when this has been impossible or impracticable for physical or financial reasons, they have spared neither pains nor expense to reduce the danger entailed from the use of such water as they could obtain. A comparative exhibit of the relative purity of untreated waters from different sources, as indicated by the typhoid fever death rates, seems to show, as our judgment would suggest, that the purest are those from springs and ground water in unpopulated districts whose sources are beyond the possibility of pollution: that the next in purity are the waters collected from large surface-gathering grounds, either in natural or artificial lakes, whose water sheds are protected against pollution as much as possible; that next come supplies from running streams where there may be a pollution at a distant point, the effect of which is modified by dilution and sedimentation, and that the most impure water supplies are those obtained from rivers or lakes whose waters are subject to pollution with the wastes of cities near the point where they are abstracted for use.

But the most gratifying and important lesson is, that these statistics show that it is possible to take waters of the poorest quality and by intelligent treatment make them safe for use. These are not laboratory experiments made under theoretically perfect conditions. They are results actually obtained, often under adverse conditions, with large plants, in large cities, in different lands, among different peoples and under different climatic conditions.

It is well known that during the months of August, September and October typhoid fever prevails the most generally. The climatic condition of the preceding Summer has a notable effect upon the disease. This was demonstrated to a marked degree in the Autumn of 1892, when the disease was unusually prevalent over the entire country, the death rate being also very high, as a consequence of the preceding dry, hot Summer, when wells, rivers, lakes and streams were very low.

TYPHOID FEVER IN THE COUNTRY.

There are in the rural districts many cases of typhoid fever every year. A very probable source is in typhoid stools which have not been thoroughly disinfected, and deeply buried, but thrown upon the frozen earth in Winter, and in the following Spring washed into sources of water supply.

Blythe, in his Manual of Public Health (page 508), says: A constant series of cases of typhoid fever occurring regularly in the Autumn among children would indicate the infection of the soil; for, as is well known, children sit about upon the ground, continually have earth-soiled hands, and in this way contami. nate their food."

LABORATORY DIAGNOSIS OF TYPHOID.*

While the method of making the Widal test for typhoid fever has been found to be necessarily more complicated than was at first supposed, nothing has been found to disprove its great value. As the discovery of the bacilli of tuberculosis has materially changed our views of consumption and, by rendering its recognition possible in its incipiency, placed it among the curable diseases, so the Widal reaction in typhoid fever shows a greater diversity in the manifestations of this disease than was formerly recognized. Cases are now classed as typhoid which in the absence of this test would not be so regarded. That typhoid fever can now be recognized when the clinical symptoms are insufficient to establish a diagnosis is a fact the value of which can hardly be overestimated, for it is the mild class of cases that are potent factors in the perpetuation and spread of the disease. While the early diagnosis of a case that would subsequently prove severe is of value to the physician in directing his treatment, the positive diagnosis of a mild case is of equal importance, as such restrictions can then be placed upon the patient as to prevent contamination which might give rise to other and more severe cases.

Every case of typhoid has its origin in some previous case which, through the media of food or drink, has brought about infection. It is therefore evident that any means which enables the physician to reach a positive diagnosis in a greater number of cases will at the same time be the means effectual in reducing the number of cases. We now have in the serum reaction a method of establishing a diagnosis in both mild and severe cases. Few physicians, however, are prepared to make the test, but as the quantity of blood required is small, and not impaired by drying, the examinations can be made and reports furnished by distant laboratories.

In collecting blood for this purpose the following simple directions are to be complied with: Cleanse the tip of patient's finger and puncture lightly with a sterilized needle, allow a few, five to ten, drops of blood to fall separately on an ordinary piece of glazed writing paper, allow to dry without heat, fold and mail in an ordinary letter. No trace of antiseptic material of any kind should be on finger or needle in procuring the blood.

Without entering into a detailed discussion of the laboratory technique, the examination may be briefly described as follows: *By Eli Grimes, M. D., Bacteriologist of the State Board of Health.

To a drop of dried blood is added a drop of bouillon and the two thoroughly mixed; a drop of this mixture is placed on a cover glass and a drop of bouillon culture of typhoid bacilli added. This is now examined as a hanging drop in a moist air cell under the miscroscope. If the bacilli show no cessation of motion nor agglutination the case is probably non-typhoid, and if another specimen be examined with the same result typhoid fever can safely be excluded from the diagnosis. But when the bacilli exhibit a marked decrease of motion with agglutination, the examination must be continued, as typhoid is strongly indicated but not established. The further examination now consists in making a series of dilutions of the blood and culture, and determining the highest dilution that will give a marked reaction. At the same time a parallel series of dilutions and examinations are made, using blood, similarly prepared and previously tested, obtained from a patient known to have typhoid fever. The object of this last named series of tests is to determine the sensitiveness of the bacilli used, and to obtain comparative results. In some instances blood of non-typhoid individuals give the reaction when in concentrated solution, but not when dilute. It is therefore necessary to exclude these cases by determining the degree of dilution which gives the observed reaction. By means of a Hemo-chronometer the amount of blood in solution is estimated with a sufficient degree of accuracy for this purpose. The reaction is most marked in blood taken when the temperature of the patient is the lowest. This is an important fact to keep in mind in procuring a specimen for examination.

HOG CHOLERA AND TYPHOID FEVER.

The following communication was addressed by Dr. Wright to Dr. J. I. Gibson, State Veterinary Surgeon, and was read by Dr. Gibson before the Board at its meeting held May, 1896.

The Secretary of the Board laid the facts before the meeting of the Iowa State Veterinary Association later, and suggested, as other cases somewhat similar had been reported, that in his opinion there were abundant reasons to believe that water polluted with the excreta of hogs having cholera might produce

typhoid fever or some similar affection in the human subject if the water was drank without being properly sterilized.

Dr. Peters, of Nebraska, thought there was a marked difference between the germs of hog cholera and those of typhoid fever. Whether that is so or not, decency and safety dictate that such water should under no circumstances be used for potable or domestic purposes:

I was called Sunday evening, April 19, 1896, to visit the family of J. C., near Vail, Crawford county. Dr. Glynn, of Vail, had first seen them on the morning of that day.

The father had felt quite sick for more than a week. He was confined to bed on and after the 15th. Had no medicine until the 19th. From the 16th to the 18th four daughters became sick, and were obliged to remain in bed at home. Another daughter, who teaches school in Sac county, having been at home a week, on returning to Sac county, was taken sick at the same time as the others.

Dr. Glynn's record showed the temperature ranging from one hundred and one degrees to one hundred and three degrees Fahrenheit, and pulse about ninety to one hundred, at the morning visit on the 19th. I found in the evening of the same day, temperatures from one hundred and three degrees to one hundred and five degrees Fahrenheit; pulse from one hundred to one hundred and twenty.

The daughters at home ranged in age from fifteen to eight years. The daughter in Sac county is eighteen years old.

All had tenderness over the stomach, but not over the lower abdomen; some nausea; marked headache; stiffness and soreness at the back of the neck; chilly sensations, and markedly red tongue. Two had looseness of the bowels with very foul odor in the discharges. The others afterward developed a fetid diarrhoea.

One grown daughter, and the mother, and a small brother five years old were quite well, and have continued so. Inquiry as to the habits showed nothing unusual eaten or done. But the mother, the daughter and small son were in the habit of drinking tea and coffee-no water. The others all drank water freely. Their well is situated in the lowest point in the hog-yard. Quite a steep and high hill extends from the house to the hogyard. Last Fall the hogs had cholera - so called. I have seen a good deal of this so-called cholera in that neighborhood. Its symptoms are first, loss of appetite, then constipation, drowsiness, diarrhoea, increasing and fetid, apathy, hemorrhage of bowels, extreme emaciation, death.

This hog cholera is very common in Crawford county, and the wells are often at some low place in the hog-lot. Typhoid fever is quite uncommon, and less so in the country than in the towns. In the last two years there has been a large number of cases, but none at all before within a mile of this farm.

The Woodbridge treatment was used thoroughly with three daughters at home. One of them became permanently free from fever after the fourteenth day She had at first a temperature of one hundred and five degrees Fahrenheit, and pulse one hundred and eight. She had severe diarrhoea. All had free bleeding at the nose, and became quite tympanitic after the

first week. Two other girls who took the Woodbridge treatment, became free from fever-one after the twenty-first day, the other after the twenty-fourth day. The father and other daughter at home were much worse than the others, the father being slightly delirious. They began the Woodbridge treatment about the fourteenth day, under which they seemed to improve, the father for three days, the daughter continuously. On the nineteenth day the father had a sudden, severe relapse, and died on the twenty-second day.

The girl who was the sickest developed severely the bronchitis peculiar to typhoid fever. Sibilant rales, and afterward moist rales were quite easily heard all over both lungs. She expectorated freely.

Dr Johnson diagnosed typhoid fever as affecting the daughter in Sac county.

The water in the well above described, when added to sugar, and set in a warm place developed the odor of rancid butter. Ordinarily it smells and tastes like the best water.

Vail, Iowa.

W. F. WRIGHT.

SMALL POX

During the biennial period there have been but three outbreaks of small-pox within the State.

July 26, 1895, a case was officially reported from Douglas township, in Clay county. The subject was a male adult who had come from Etnaville, Ohio, arriving July 16th, where he had been exposed to the disease, and was supposed to have been quarantined there. Quarantine was at once established, and the remainder of the family who had been exposed, consisting of one adult male, one adult female, and a babe, were vaccinated. On the 28th of July the male adult developed variola, followed by the female August 8th, and the babe August 24th. All recovered except the babe, who died September 4th, from pneumonia, caused by taking cold. Quarantine was released September 18th. The attending physician states that the disease was greatly modified by the vaccination. The original subject claimed to have been vaccinated thirty years prior.

AT DAVENPORT.

In June, 1895, Dr. Cantwell, health officer for the city of Davenport, reported a suspected case of small-pox, the subject being an adult male person. He was immediately sent to the isolation hospital, and restrictive measures at once applied.