1883 and 1884. At Ilford in 1882-3, due to infected milk supply and subsequently spread by sewage effluvia from cesspools and defective. drains.

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In 1884, at St. Albans, January, 2; February, 2; March, 4; April, o; May, 93; June, 38; total for May and June, 131 infected; 23 deaths during May, June, and July. Simultaneous outbreak of typhoid fever during June and July at St. Albans and London among the consumers of milk coming from a farm near St. Albans." Absence of evidence that the milk at the farm had become infected in

any of the commonly-believed ways. Some reason for believing that this farm milk which had given rise to a serious outbreak of typhoid in St. Pancras in 1883, had retained, though to a slight degree, power of infecting its customers in the interval between the two outbreaks.

In 1884, at York, 315 infected; 54 deaths. Not due to water contamination. Milk supply exculpated. The outbreak was apparently due to exhalations from the sewers after an exceptionally dry, hot summer. Sewers unventilated; their outfalls covered by, and admitting backflow from, the River Ouse. Sink pipes generally disconnected from the drains.

:

In 1885, at Faldingworth and Barlings (Lincolnshire). Faldingworth small outbreak of typhoid traceable to pump well water polluted by washings from a fever case imported from Newark. Filthy ditch sewers. Barlings: outbreak of typhoid traceable to pollution of the village water supply by sewage. House drainage defective. Vault closets in dangerous proximity to dwellings. Chief supply of water obtained by imperfect filtering of the sewage-polluted village brook.

In 1885, at Hebden Bridge. Outbreak of typhoid, affecting chiefly cottagers using excremental polluted water from the "Birchcliffe stone cisterns." Bad house drainage. Old open middens in dangerous relation to dwellings and open water courses. Springs used for domestic purposes in almost all cases open to pollution.

In 1885, at Kidderminster, 35 in second half of 1885. Cases existing in places where defective house drains existed — vide 1884. In 1885, at Lower Sheringham (Norfolk). Severe outbreak of typhoid under circumstances pointing to contamination of milk supply. Origin of infection uncertain. Water supply from land drainage and rivulet in danger of pollution. Drainage defective. Nuisances from privy pits, net tanning, whelk boiling, and from ponded sewage, ordure, and fish offal.

In 1885, at Market Weighton (Yorks). "Prevalence of enteric

fever." Due to drinking water from surface wells in a porous soil, contaminated by soakage from defective sewers, cesspools, etc. Accumulation of excrement.

In 1885, at Newark. "Typhoid prevalent in 1884." An old and closely built town. Sewers mostly unventilated. Sewage discharged unpurified into the Trent. Company's water supply derived from gravel bed in the neighborhood of this river. Shallow wells also in use liable to contamination. House drains with loose iron traps, permitting escape of drain air into and near houses. Offensive midden privies. Refuse accumulations.

In 1886, at Swanage (Dorset). "Outbreak of enteric fever." First case in January; assumed an epidemic form from July to September. Water supply largely from impure wells. Drainage system consists almost entirely of square rubble sewers, many of them joining a highly polluted and almost stagnant brook. Large uncemented privy pits on and in permeable sedimentary rocks dipping steeply toward the town. No public scavenging beyond street sweeping. The epidemic associated at its commencement with the use of milk from a dairy situated on the polluted brook and without water supply on the premises.

In 1887, at Eastry Rural Sanitary District (Kent). "Mortality from typhoid sixteen per cent higher than elsewhere in England or Wales." Water supplies of most of the villages subject to pollution. Cesspits and privy pits in close proximity to dwellings and wells, polluting both air and water. No proper means of sewerage. Refuse and excrement accumulations.

In 1887, at Margate. "Increasing mortality from enteric fever." Deposit of sewage and excrement in deep cesspools and cesspits sunk into the chalk. Pollution of air and soil by excremental accumulations. Water supply pumped from a well in the chalk, beside a populous neighborhood. Water of bad quality and exposed to contamination by soakage of sea water and from cesspools. Water-closets getting water directly from mains.

"A

In 1887, at Mountain Ash (Glamorganshire), 518 infected. sudden and severe epidemic of typhoid, 518 cases occurring between July and October, 1887." The specific poison was distributed by water delivered through one particular water main. Of the 396 houses supplied from this main below a certain point of its course 57 per cent were invaded by fever. Near this point (where evidence of specific contamination commenced) defects in the main were discovered, which would lead during intermissions of water supply to insuction of

air, and probably of liquid, from old drains. Earlier history shows that since the water main in question was laid in 1855, an endemic prevalence of typhoid has existed in the district supplied by it. Analysis of the water showed that a sample taken before the nightly intermission of service was pure; that taken from the same tap after intermission gave evidence of animal contamination and of the appearance of low forms of life. Sanitary conditions in other respects fair. In 1888, at Buckingham. A sudden outbreak of typhoid in January and February, confined at first to a poor suburb of the town, and especially affecting persons drinking water from a particular spout," the water conduit to this spout exposed to pollution from a leaky drain which had received specifically infected excreta from a previous case of typhoid. Scattered cases later on referable probably to infection derived from defective drains and foul closets. Water generally from wells exposed to risk of pollution by leakage from cesspools, drains, etc. Sewers and house drains very defective, allowing deposit, leakage, and entrance of drain air to houses. Old privies with large deep vaults; foul hopper closets.

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In 1888, at Flint. Fourteen cases of typhoid fever in seven houses, between August 11th and 20th; subsequently general over the town. Water supply intermittent and discolored when turned on in the morning. Method of excrement disposal in infected locality such as to cause fæcal fouling of air and soil.

In 1888, at Keynsham Rural Sanitary District (Somerset and Gloucester). "Recurring prevalence of epidemic typhoid." Conveyed in the bodies of persons attacked from one part of district to another. Spread of the disease by specific excremental pollution of water. No proper sewerage provision. Cesspit privies in vogue. Water supplies exposed to dangerous pollution.

In 1887 and 1888, at Mytholmroyd (Yorks), 66 infected in 1887; IO deaths. In 1888, 29 infected; 5 deaths. Prevalence of unwholesome condition of water supply, drainage, and excrement disposal. River Calder highly polluted with sewage and excremental matters, in fact little better than an open sewer. Twenty-two of the fifty-five houses attacked are situated in the immediate vicinity of this river, inhaling the effluvia arising therefrom. The local sources of water supply are from small streams descending the hillside. Washings from meadows and manured lands, and excremental filth pollute these streams. The water is conveyed in pipes from a spring on the hillThis spring water is reinforced by sewage from a manure heap.

side.

No system of sewage exists. Bad scavenging. Midden privies flowing over, etc.

In 1887-8, at New Brighton (Cheshire), 21 infected during 1887-8. "Typhoid fever prevalent.” The fever prevalence had no relation to the water supply, nor to the milk supply. Faulty sewer ventilation. Drains are commonly carried beneath the floors of dwellings, without any special precautions. Gullies having unbroken communication with the drain, and so with the sewer, often exist in cellars. "The appearance of typhoid, at New Brighton has been found so constantly associated with specially grave defects of drainage, as to create a strong suspicion that this condition has been the cause of the mischief."

In 1887-8, at New Clee and Gt. Grimsby, 260 infected; 52 deaths. General water supply good. Some of the households drew their water supply from local wells, which were subject to risk of specific contamination. Some cases were due to the use of a box privy, into which the infected discharges of an earlier case had been thrown. More frequently, however, such discharges were thrown into the yard drain-inlets and catch-pits, and so infection of some of the smaller and defective drains occurred. Unventilated public sewers, along with faults of private drainage, led to ventilation of sewer air into private dwellings. "The pollution of wells by excremental matters must be considered to have played a part in the epidemic."

In 1888, at Stourbridge Rural Sanitary District (Staffordshire). "A severe outbreak of enteric fever in third quarter of 1888 in Pensnett and Bromley." Affected specially young adult males employed at ironworks, their chief beverage being ginger beer, made often at home from the water of polluted wells not wholly boiled. No sewerage; slop water nuisances prevalent; privies with wet open ash-pits; pigkeeping nuisances; wells exposed to pollution from these sources. In 1888, at Standish-with-Langtree (Lancashire). "Prevalence of enteric fever." Ventilation of sewers obstructed. Midden privies drained into sewers causing nuisance. Water supply from local sources, one of them exposed to excremental pollution; incidence of fever chiefly in families using this supply, but spread of disease due also to privy defects. No system of scavenging. Prevalence of nuisances from undrained yards and from pig-keeping.

DIPHTHERIA.

The mortality returns made to the registrar of vital statistics as well as the monthly returns made to this Board, show that diphtheria is a disease that every year destroys the lives of many children in New Hampshire. The fearful results of this horrible malady, in the magnitude that it prevails, are, in the light of modern sanitary science, uncalled for, and indicate mismanagement of the disease with respect to isolation and disinfection. It is a pretty well settled fact that diphtheria is a germ disease; that the germ is easily transported, and propagated, under suitable conditions; that unless the conditions are favorable the germ loses its vitality and becomes harmless. It is therefore an infectious and contagious disease. Evidences of direct infection from an existing case are common. Because persons exposed to the disease do not always contract it, is no proof to the contrary. We have seen the disease spread from person to person and from family to family with fearful and terrible consequences, simply because reasonable and proper measures were not taken to prevent it. That it can be restricted and prevented has been often demonstrated whenever sanitary and restrictive measures have been thoroughly attended to and enforced.

Nothing favors the ravages of this disease so much as filth, in some form or other; and with neglected sink-drains, foul privies, undrained cellars, wet sites, unventilated rooms without sunlight, polluted drinking water, and many other unsanitary surroundings, a liability to an outbreak is greatly increased, and treatment of the disease under such circumstances is often of little avail in saving life. Therefore, first of all, every family should see that the premises are clean and free from such conditions as invite its appearance to the household.

There is some doubt that bad sanitary conditions develop this disease de novo, but there is no doubt that filth is a condition par excellence for the culture and propagation of the infection. Unsanitary environments also weaken the powers of resistance against this and other diseases.