the water on the premises was discontinued, and this was brought about only by calling the attention of the State Board of Health to the condition of affairs.

Diphtheria.—Fifteen cases, none fatal. One case was contracted in Massachusetts.

3

SS-Sink-spouts.

The following summary of reported causes of typhoid fever is exceedingly interesting. It shows to what an extent filth in some form, or other causes which are largely avoidable, enter into the question of typhoid fever production. Such opinions are also given by the medical profession in every country of the civilized world. Typhoid fever destroys more lives than cholera, or yellow fever, or small-pox, or any other pestilential disease, and no

country escapes its ravages. How to avoid it is forcibly suggested, indirectly, in a knowledge of its causes. The following table would seem to indicate that there is a growing belief that the disease is dependent upon a specific germ, or poison. This is undoubtedly true; and the sooner such a theory is recognized by the practitioner, the sooner will scientific principles be applied to prevent its ravages. Indeed, it is believed that the particular germ has already been discovered. It was first described by Eberth, and has been studied and investigated by Goffky, who regards it as the specific organism of the disease. He found the bacilli in the blood drawn from the spleen of a typhoid fever patient during life. Goffky found them in the kidneys, liver, spleen, and mesenteric glands. Culture experiments have, however, proved negative. The English authors, to a large extent, believe in a specific germ, and that the germs after leaving the body often reach the water supply and thus produce the disease; also, that the dried germs, or poison, may reach the air passages and in this manner infect the individual.

Whatever the form or nature of the germ, or poison, that produces the disease, we know that certain conditions, classed as unsanitary, are necessary to the propagation of the disease. This conclusion has been reached through observation in individual cases, as well as the history of epidemics of the disease.

It will be seen in the above table that polluted water stands greatly in excess of all other reported causes. The reported cases are almost without exception attributed to contaminated wells. In some instances other factors are mentioned in connection with polluted water.

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Under the head of "filth" are classed "bad surroundings,' unsanitary conditions," etc.

Good authorities assert that typhoid fever is the scourge of the farmer. The conditions which are most favorable to its development are most frequently found at farmhouses and in villages. Cities as a rule have a good water supply, or at least a supply not polluted by filthy drainage. Sewers, while they may perhaps, as often constructed, cause other diseases, have undoubtedly contributed to lessen typhoid fever.

Spontaneous cases of the disease often appear in sparsely settled localities, so often that many physicians have no doubt that certain conditions develop de novo the particular poison that produces the disease. The Massachusetts State Board of Health, after giving considerable study to the subject, came to the conclusion that typhoid fever might be produced in three

* Seventy-eight had not observed a case during the year.

ways: 1. By foul water; 2. By foul air; 3. By emanations from the earth, occurring most frequently in the autumn and in seasons of drought.

Dr. Cabell, in a paper read before the American Medical Association in 1877, protested against the idea that a prior case was necessary to the existence of typhoid. Dr. Pinckney Thompson, the able president of the Kentucky State Board of Health, says: "As I study the literature of the etiology of typhoid fever, coupled with an experience in the practice of medicine for thirty years, I am forced to the conclusion that typhoid fever does originate from other causes than the contagion of a previous case.”

With a knowledge of such facts as we already possess, there is much that can be done to prevent the disease, although it is not probable that it will ever be eradicated.

Diphtheria, one of the scourges of the young, is believed by the medical profession to be as closely allied to bad sanitary conditions as typhoid fever, while it has one element in its propagation very much more marked, contagion.

Newmarket-CHARLES A. MORSE, M. D.

Diphtheria. Since Oct. 1, 1885, there have been 91 cases of diphtheria in this town, 20 cases proving fatal. The average age of the fatal cases was 6 years; one case, a young lady, being 17 years and 9 months old. Taking into account the severity of the epidemic, I think that a good per cent of our cases have recovered. We have not been able fully to ascertain as yet the cause. At first we thought it came from one of the school buildings, but upon close examination we came to the conclusion that that was not the fact, and we are still in doubt. Our sewerage is not of the best; but no one is to blame but the townspeople, as they won't appropriate money to do it, and it cannot be done for nothing. We have done the best that we could to keep the disease confined to certain limits, and have practiced isolation as far as we could, and we have been ably assisted by the board of health.

*Secured too late to be inserted in the regular alphabetical order.

The following table is interesting in showing a partially classified arrangement of the reported causes of diphtheria for the past four years:

The table presents only an approximate statement of causes, since in many instances several conditions are reported in an individual experience, while the classification is made under one head. For instance, if we find given as a cause polluted water and bad drainage," we classify it under one head, — polluted water. The entries in the table include all answers given as to the cause; several did not answer the question. The evidence is, however, all that a rational mind needs to reach the conclusion that bad sanitary conditions are intimately associated with the disease. The element of contagion should be more generally recognized than it has been heretefore. Many lives have been