Concluded.

I

Na letter from Jerusalem under date of October 17, William C. Groeniger, former Director of the Division of Plumbing in the State Department of Health, now a captain in the American Red Cross Commission attached to the British expeditionary forces in Palestine, writes as follows to James E. Bauman, Deputy Commissioner of Health:

"Have written you several letters and sent you several postals from different parts of the world through which we traveled on the way over here, but the tin fishes most likely have got them, as well as any you have written. Letters from you 'Mafish', which means in Arabic 'There is none.' So I am going to try again and trust this reaches you in good time.

"We traveled 15,000 miles in ninety days, reaching here about June 15. I have been on the jump ever since, working day and night, Sundays and week days. We are installing sanitary equipment, debugging, de-lousing and fighting the Anopheles and other brands of mosquitoes, flies, fleas and other numerous pests. We have fitted up two hospitals, a dispensary (including children's hospital), a laboratory which would make Van Buskirk open his eyes, a laundry, a hospice (which houses sixty of our officers and has seven general toilet rooms, seven bath rooms, with hot and cold running water), two industrial establishments which furnish employment for six hundred women engaged in weaving and making garments for the

refugees, two orphanages (with the third under way) and several refugee hotels. We have irrigated several small plots, fitted up our administration building, organized a blacksmith shop, plumbing and pipefitting shop and carpenter shop, and have plans for a machine shop and a general garage that will house the greater portion of our thirty ambulances, trucks and touring cars. In addition to this we have built several sterilizers, put several flour mills into operation and cleaned and repaired many large cisterns that hold as much as 30,000 gallons of water. Almost every foot of ground in Jerusalem is catchment area for some cistern; cisterns 50 x 70 x 25 are very common. In the Russian compound, where most of our activities are centered, there are twenty such cisterns. All of the buildings that we have taken over had to be limewashed and fumigated and in many instances we have gassed the 'b.-b.'s,' which seems to be the quickest and best way of exterminating the bugs, sandflies and hard-back fleas.

"Malaria fever, some typhus, relapsing fever, trachoma and tuberculosis are prevalent. Several of our unit are now in Tiberius fighting an outbreak of cholera. The typhus season is rapidly approaching. The average native-particularly among the refugees-is lousy.

"Our transportation department has moved thousands of sick and wounded Turkish and German prisoners and a great number of Tommies. Most of the Turks are

in a bad way. One of our large White trucks picked up ninety-two that had fallen by the roadside. Some of these poor devils died after reaching the hospitals.

"On the thirteenth day of September your humble servant was made director of engineering service, including sanitary, mechanical, electrical, building construction and transportation, and was also elected to the executive council which has control of the various activities. Some job, but I am gradually effecting an efficient

machine that will do the work. Our greatest handicap has been in securing skilled native mechanics. However, my previous practical experience has stood me well in hand and I have been able to teach them the modern methods of America.

I

"A few weeks ago we were very close to the lines and could hear the roar of the guns and see the flashes at night. Since then, however, the world has been thrilled with Allenby's wonderful accomplishment and the line has been moved 150 miles northward. was privileged to pass through No Man's Land shortly after the of fensive began and got as far north as Nabulus. 'Jericho Jane,' one of the large enemy guns, was silenced and there are many interesting - stories to be told of the great victory, which seems almost impossible if you have seen the country through which the troops had to

pass.

"The great work being done by our boys on the Western front is very much appreciated in this part of the world, and has added much to the morale of the troops here. Everybody here believes that the war will be over shortly. Here's hoping!"

The Health Department's Duty

To conserve the public health is the duty of every health department in the land. No matter how many physicians there may be in a community, there must be some. one, or some department, vested. with legal authority to act in matters pertaining to the health of the masses. The wisdom of placing such authority in the hands of competent persons is shown every day. One frequently reads of some serious epidemic in congested communities, and were it not for legal authority vested in health boards, the ravages from disease would be much greater. It is the duty of the physician to diagnose diseases, and if they be of a communicable nature, the law imposes. upon him the duty of reporting such to the health authorities, who, by virtue of their office, make regulations governing the isolation of such persons, who, if allowed to roam about at will, would become

C

HLORINE in the treatment

of public water supplies occupies a very important position. It has its proper field of usefulness and its limitations which must be recognized. It is particularly applicable to the treatment of a clear, sparkling water which is only mildly contaminated, such as a ground water supply, or the effluent from a filter plant. When properly applied in such cases, chlorine may be counted upon to accomplish complete safety of the water without producing any deleterious effects.

It is frequently necessary to apply chlorine or one of its compounds to a public water supply which is not of satisfactory physical quality. The use of chlorine in such instances is only a temporary expedient to be employed pending the provision of some other form of treatment such as filtration. However, chlorine serves a very useful purpose, even under these conditions. Due to the unfavorable quality of the water treated, the efficiency of the chlorine may not be perfect, larger quantities may be required and at times objectionable tastes may be produced, but on the whole, the treatment will accomplish a marked degree of improvement in the

cured. To accomplish this reduction of typhoid fever and this consequent saving of life, it may be necessary at times to treat the water to an extent to produce tastes, particularly when chlorination is the only form of treatment used. No thoughtful person will question the superiority of the treated water, which has been made safe for drinking purposes, over the untreated supply, which is capable of causing typhoid fever, even admitting that the treatment has introduced an unpleasant taste in the water.

When the treatment of a municipal water supply by the application of chlorine is undertaken, it is not at all unusual to encounter popular protest against this procedure. The wave of objection is kept in motion usually by agitators who are not informed as to the nature, objects and results of this method of treatment, or even the necessity of correcting the contamination of the public water supply of their community. Arguments thus presented, illogical as they may be, often result in general complaints against the alleged evil effects of the treatment, even before the treatment is actually started, so prone is the average mind to accept without question misstatements of this nature.

Persons inclined to complain against real or imaginary effects of the chlorination treatment of water will do well to pause and weigh the resulting beneficial effects before they assert the worthlessness of the treatment and protest against its use.

The control of communicable disease depends primarily upon the local health officer, because the prevention of outbreaks depends upon the prompt control of the early cases. No centralized authority can do more than aid in the suppression of an outbreak already started.

As with everything else there are two things necessary to successful accomplishment knowledge and

intelligent action. The health officer must know the sources of infection, the possible modes of transmission and, above all, he must know the relative frequency with which the different factors operate. While it is interesting to know that typhoid may be transmitted by blankets soiled with typhoid excreta, it is of less importance than the knowledge that typhoid is very frequently transmitted by the soiled fingers of typhoid carriers and of those caring for typhoid patients. Though smallpox may be transmitted by the clothing of a prior case, it is more important to know that in the vast majority of instances there has been indirect contact with a case. The practical application of such knowledge is that one should not be satisfied with the explanation based on an improbability until the probabilities have been excluded.

With the exception of a few diseases, most of which are rare in

this State, the common sources of the communicable diseases are human beings. They may be classified as recognized cases, cases in the early stages of the disease, the mild, the atypical and the concealed cases which are still sick (so called "missed" cases), convalescent cases, both recognized and missed, and the carriers. The relative frequency with which these sources are concerned in the spread of communicable disease varies with the disease under consideration and varies also with the measures of control applied and the diagnostic acumen of the medical profession.

Until twenty years ago it is probable that the principal source of typhoid was the recognized case, as the stool and urine of such cases were not disinfected as a routine measure and their contagious character was generally unrecognized and disregarded. Today it would be difficult to say whether the recognized case, the unrecognized case, or the carrier is the most frequent source of typhoid. Apparently the last two are the most frequent causes of explosive outbreaks, the former the most frequent as the origin of contact typhoid. However, this conclusion may be due to failure to detect carriers as sources of many of our "sporadic" cases. For example, a case of typhoid, Mrs. B., occurred