solely upon the efficiency of sand filtration. London may be cited as the chief example of this class, the Thames water, after extensive sand filtration, forming the principal supply; and in this case the area above the intakes is far from being uninhabited or uncultivated. Indeed, if one is to judge the merits of the two methods solely by a comparison of the prevalence of communicable diseases, like typhoid, or the death rate of those towns which represent both, his verdict must be in favor of the latter method. The typhoid case rate of London, for example, is remarkably low, being seventy-two, as compared with an average of 115 per 100,000 per annum for 219 towns in England, and there is no evidence to show that it has suffered to any appreciable extent from drinking the water drawn from a tainted area. The water supply of Hamburg is another instance of river water, after filtration on scientific principles, being chemically and bacteriologically as pure as it is practicable to obtain, and it must be conceded that those towns which drink river water, and depend upon the efficiency of filtration for its quality, are, generally speaking, the most immune from enteric fever. The conclusion from this evidence is, that bacterial purification in sand filtration, if carried out under skilled supervision, is effective in reducing pathogenic organisms, although it does not absolutely prevent their passage into the filtered water. Much depends upon the efficiency of the filter, which, unless properly constructed and worked, may be productive of more harm than good; several epidemics have been traced to the use of filtered water which had been polluted before filtration, showing that the filters had failed to remove the impurities, and that it is unsafe to rely upon them alone; and cases are not unknown where water has been grossly contaminated by being passed through filters. The health of towns and cities like London and Hamburg is largely dependent upon the thoroughness and efficiency with which the filtering of the water is carried out. If through carelessness or accident the water were allowed to pass unfiltered, or the filtering media of one filter-bed were allowed to become cultivation areas for pathogenic organisms, the result would soon be apparent in an epidemic-a condition of affairs which is not ideal. It seems to me that, to prevent all possibility of pollution to our water supplies at their source, it is necessary for water boards or authorities-whose imperative duty it surely is to ensure this-to have full control over the watershed areas from which their supplies are obtained, and, where possible, to divert or stop up all pub lic roads and footpaths. Where this is impracticable, to make provision for the drainage from public roads to be carried below the storage reservoirs or intakes, to clear all human dwellings off the catchment areas, and, as far as possible, prevent the incursion of tramps and others over them, and while utilizing them as pasture lands to prevent, by fencing, the access of cattle to the feeders or streams, and to take precautions against decaying vegetable matter being carried during floods into the storage reservoirs. This constitutes the first line of defence, and, if perfectly maintained, there will be absolutely no need for further precautions. But, unfortunately, it is difficult, and increasingly becoming so, if not altogether impossible, even while possessing full control over the catchment areas, to prevent a certain amount of trespass by people who, as in the case of the Maidstone epidemic, may be the means of polluting an otherwise wholesome source of supply. Recourse must, therefore, be also had to a second line of defence, that is, efficient filtration, not as we usually see it carried out in this country, but conducted on scientific principles, under competent supervision and systematic and frequent inspection. To some this will doubtless appear altogether unnecessary, although in imperial affairs the wisdom displayed in providing a second line of defence, in view of the possibility of the temporary or complete failure of the first line, is seldom questioned, and surely the protection of the first necessity of life is as important as that of national prestige. At all events, it is the policy that is being carried out by the Bury and District Water Board, to which I am the responsible adviser, and also by important water authorities like Liverpool, Birmingham, Leeds, and others; and as the danger of relying exclusively on one or other of the systems is apprehended, the more enlightened policy of adopting and efficiently maintaining both will be proportionately and increasingly pursued. THE ALLEGED INJURIOUS EFFECTS OF PRESERV- Report of United States Deputy Consul-General Hanauer, Frankfort, Germany, October 3, 1903. Protests against the action of police authorities in seizing or forbidding the sale of American dried fruits because they contain an admixture of sulphuric acid are made in the annual reports of many chambers of commerce throughout Germany. The chambers claim that not a single case has occurred where injury resulted from said admixture. On the contrary, it is said it helps to preserve the fruits, which are a popular article of food. The Chamber of Commerce of Mannheim, in conjunction with many other chambers of commerce, addressed the imperial sanitary bureau at Berlin on the subject of "American dried fruits" and the police orders inhibiting their sale. The chamber refutes the allegation that the use of sulphuric acid as a preserving means is injurious, and petitions the sanitary bureau to fix the amount of acid allowable in the preservation of these fruits, which are a necessary article of consumption. The report of the Mannheim Chamber of Commerce speaks also of the scarcity of the meat supply and the greatly lessened consumption of beef and pork, owing to their high prices forcing the working classes to eat horse flesh. The report of the chamber of commerce for the State and city of Hamburg says on the subject of the restrictions on the importation of meats that they are Agrarian measures, instituted for the purpose of forcing high prices for domestic meat, and are not justifiable on sanitary grounds. It mentions particularly “corned beef," against which nothing can be alleged as being hurtful to consumers, and it quotes the opinions of experts to show that the small amount of boracic acid used for the preserving of the meat is not injurious and is actually indispensable. The chamber instituted inquiries among the Hamburg shipowners, who said that since foreign canned meats have been used on their vessels the health of the crews has been much improved, but after trial it was found that the canned meat put up in Germany is inferior to the foreign article. The report further expresses the hope that the Federal Government will soon realize the fact that by keeping out cheap foreign meat a serious injury is done to the working classes of Germany and that such injury must create intense feeling and strengthen the Social-Democratic party.-Consular Reports, January, 1904. DISINFECTING APPARATUS.—A new apparatus, of French origin, is based upon the evaporation of formic aldehyde. The solution of formic aldehyde is boiled in a vessel heated by spirit or other lamp, the escaping vapors being led through a tube made flexible, so that it can be passed through the keyhole of the door of the room to be disinfected. A gauge shows the level of the liquid, and scales are provided to show the amount of liquid to be evaporated to disinfect the room properly. OTHER SOURCES OF TYPHOID INFECTION THAN WATER, AND HOW TO GUARD By SEALE HARRIS, M.D., of Union Springs, Ala. I am very glad, indeed, that our president, in assigning my theme as one of the "regular reporters" for this meeting of the State Medical Association, selected that of "Other Sources of Typhoid Infection Than Through the Medium of Drinking Water, and How to Guard Against Them," because from my observation, and from the recent researches made in large epidemics of typhoid fever, I am convinced that the medical profession greatly exaggerates the part that drinking water plays in the dissemination of that disease. The subject is, therefore, a "congenial" one to me. Sanitarians, in writing learned theses on the etiology of typhoid, are wont to make such statements as the following: "Show me a city's mortality statistics from typhoid, and I will tell you the character of its water supply," and "from any given case of typhoid fever the cause can, and should be, discovered"; but the fact remains that in very many epidemics, and in more of sporadic cases, the cause is frequently from other sources than drinking water, or it is not discovered at all. Recent investigations seem to show that, except in the cities, the germs of typhoid are disseminated more in other ways than through the medium of drinking water. I do not mean to deny that typhoid fever is largely a water-borne disease, but in this article I am not expected to discuss its spread through drinking water-all of us know too much about that side of the question-though in considering the other sources of typhoid infection, I shall mention some methods of conveying the disease where polluted water is indirectly the cause, though the infection is not taken into the system in drinking water. The great epidemics of typhoid fever that visited the concentration camps of the United States Volunteer Army during the Spanish-American War, in 1898, were carefully studied by a board of army surgeons, consisting of Majors Walter Reed, Vic *Transactions of the Medical Association of the State of Alabama, 1903. tor C. Vaughan and Edward O. Shakespeare. In 92 regiments investigated there was a total number of 107,973 men; 20,738, or nearly 20 per cent., developed typhoid fever; and of these, there were 1,580 deaths-a mortality rate of 7 per cent. of those who contracted the disease. This board examined the records of all these cases, they visited all the cities where the camps were located, they investigated carefully the source and quality of the water supplies of all the camps, also their food supplies, and the methods of disposing of their excreta-in fact, they investigated everything bearing upon the cause and spread of typhoid fever among our soldiers, more of whom suffered and died from typhoid fever than from Spanish bullets. All the members of this board were sanitarians of renown and great experience, and having been given every possible facility for making investigations, their conclusions are of great value and have almost revolutionized our ideas regarding the origin and spread of typhoid fever. Their report, which was published by the Government, and which may be obtained free by application to the SurgeonGeneral of the army, is one of the most valuable contributions to the literature of typhoid fever that has been published in years. Their report presents so forcibly some of the facts which I desire to bring out that I shall quote freely from it. Among the general conclusions of this board are the following statements: "Infected water was not an important factor in the spread of typhoid fever in the national encampments in 1898." "It may be stated in a general way that the number of cases of typhoid fever in the different camps varied directly with the methods of disposing of the excretions." According to these distinguished authorities on typhoid, the most active agents in the dissemination of the disease in over 20,000 cases were: Flies, personal contact and dust, though they thought that in some of the camps the drinking water was infected. There are many sources of typhoid infection other than through the medium of drinking water, the more important of which I shall discuss under separate headings. Milk.-Infected milk is a fruitful source of typhoid fever. Eberth's bacillus will thrive and multiply in milk without affecting its taste or appearance. It will live for days even in sour buttermilk, and fresh milk is an excellent culture medium for the germ. Some have thought that the germ can be ingested by the cow in drinking water and be excreted in the milk without destroying its vitality. However, this is hardly probable, unless |