6 
to contain typhoid bacilli. The facts and conclusions of that work 
are fully discussed in the text. 
Upon our request, Dr. L. O. Howard, Chief of the Bureau of 
Entomology, Department of Agriculture, made a study of fly abun- 
dance in relation to the prevalence of typhoid fever in the District 
of Columbia. But little connection between the germ of typhoid 
fever and the fly as its disseminator could be made out. 
The prevalence of typhoid fever in the District of Columbia showed 
but slight differences between the two years 1907 and 1908. Our 
studies showed that about 50 per cent of the cases during the typhoid 
seasons of these two years were definitely attributable to importa- 
tion, contact with previous cases in the febrile stage of the disease, 
and to infected milk. 
The evidence strongly suggests that more cases were due to per- 
sonal contact and to infected milk than were traceable to these 
factors. 
The city water supply during the typhoid seasons of these two 
years was, according to bacteriological standards, of good sanitary 
quality, and it does not seem probable that such water could have 
been directly responsible for more than an insignificant part of the 
infection. We believe, therefore, that in order to cause a further 
and a marked reduction in the prevalence of typhoid fever in Wash- 
ington it will be necessary to carry out measures to prevent the 
conveyance of infection by milk and by personal contact. Our 
studies indicate that if the market milk supplied the city were pas- 
teurized under official supervision, and an efficient campaign made 
to diminish contact infection, there would result a very great diminu- 
tion in the amount of typhoid fever in the District of Columbia. 
It is beginning to be realized generally that the solution of the 
typhoid-fever problem and the final suppression of the disease 
depend upon accurate knowledge gained by special studies of the 
disease in endemic areas rather than by the necessarily hurried 
studies of acute outbreaks. For a full appreciation of the typhoid- 
fever problem in Washington it is necessary to have comparable 
data from other cities. It is therefore gratifying to note that care- 
ful and valuable studies of this particular problem are being made 
in at least three other large American cities — Richmond, Va., Pitts- 
burg, Pa., and Baltimore, Md. 
Levy and Freeman® have contributed a particularly valuable 
report on typhoid fever at Richmond, Va. 
In Pittsburg the typhoid situation is being studied by a typhoid- 
fever commission composed of Drs. J. F. Edwards, W. T. Sedgwick, 
« Levy, Ernest C., and Freeman, Allen W. : Certain conclusions concerning typhoid 
fever in the South, as deduced from a study of typhoid fever in Richmond, Va. Old 
Dominion Journ. Med. and Surg., vol. 7, Nov., 1908. 
