and one additional granule, to twenty-four teaspoonfuls of water -a teaspoonful every fifteen minutes, every half-hour or hour, until the symptoms are relieved. Strychnine hypophosphite or brucine should be given daily.

This treatment will relieve rapidly, pleasantly, and safely. Given early, it will "jugulate" every case.

In diathetic cases the foregoing treatment, may need some extension, by giving colchicine, grain 1-250, arbutin, grain 1-6, lithium benzoate, grain 1-6, one of each every hour or two, to increase elimination.

In asthenic or tuberculous subjects, a tonic form of treatment is indicated. Iodoform or calcium iodized (Calcidin), for the alterative effect of iodine, is very helpful. Give also iron phosphate, grain 1-6, strychnine arsenate, grain 1-134, or the triple arsenates of iron, quinine and strychnine, with nuclein, three tablets every three hours, to increase metabolism and nutrition, and to "take up the slack."

The diet at first should be restricted, and later very nutritious and easily assimilated. Alcohol in any form is unnecessary and positively injurious. The coal-tar derivatives are not indicated or particularly useful. The usual cough mixtures do more harm than good, very often containing antagonistic drugs, and upsetting the stomach digestion by the syrup they contain.

The indications should be met by single remedies, directed against the underlying conditions present. In this regard, the use of active, reliable preparations given dosimetrically, that is, in "small dosage mathematically divided," is essential to rapid, definite, uniform results. With the active principles given in this manner, there is no possibility of uncertain results, provided that the indications for the chosen remedy are present, and the remedy given in sufficient dosage to produce results, stopping short of overaction.

Chicago, Illinois.

Public Health and Hygiene.

...

IN CHARGE OF...

J. J. CASSIDY, M.D., AND E. H. ADAMS, M.D.

REPORT NO. 1 OF THE COMMITTEE ON EPIDEMICS TO THE ONTARIO PROVINCIAL BOARD OF HEALTH.

Mr. Chairman and Gentlemen,-Your Committee on Epidemics wish to draw your attention to the fact, which is being more emphasized each month, that there exists an almost entire disregard for those sections of the Public Health Act which require that each and every case of typhoid fever (enteric) should be notified.

The sections of the Act relating to the notification of this disease are as follows:

"86. Whenever any householder knows that any person within his family or household has the smallpox, diphtheria, scarlet fever, cholera or typhoid fever, he shall (subject in case of refusal or neglect to the penalties provided by subsection 2 of section 115), within twenty-four hours, give notice thereof to the local Board of Health, or the medical health officer, or by a communication addressed to him and duly mailed within the above time specified, and in case there is no M. H. O., then to the Secretary of the local Board of Health, either at his office or by communication as aforesaid. R.S.O. 1887, c. 205, s. 77.”

"89. Whenever any physician knows that any person whom he is called on to visit is infected with smallpox, scarlet fever, diphtheria, typhoid or cholera, such physician shall (subject in case of refusal or neglect to the penalties provided by sub-section 2 of section 115) within twenty-four hours give notice thereof to the local Board of Health or medical health officer of the municipality in which such diseased person is and in such manner as is directed by rules 2 and 3 of section 17 of schedule B, R.S.O. 1887, c. 205, s. 80."

It is, therefore, quite evident that the Public Health Act re quires both the householder and physician in charge of a case of typhoid fever, to notify the local health authorities of each case within twenty-four hours, and for this purpose it is the duty of each local Board of Health, either through its health officer or

secretary, to provide each medical practitioner in its municipality with blank forms, upon which to report any case. (Rule 1, sec. 17, schedule B, R.S.O.)

To remove misapprehension respecting the outcome of the notification of typhoid fever, should any such exist in the minds of members of local boards of health or medical practitioners, your Committee deem it advisable to state that while the Ontario Health Act requires the householder and attending physician to report a case of typhoid fever, the local Board of Health is not required to placard the house in which a person sick with this disease is lying. According to rule 4, section 17, schedule B, R.S.O., placarding is required for scarlet fever, diphtheria, smallpox, cholera, or whooping cough, but is not considered necessary for typhoid fever. Primary notification of typhoid fever by the householder and attending physician to the local Board of Health, and secondary notification by the latter to the Provincial Board of Health are required for the following reasons:

First. That inquiries may be instituted at an early date to discover the cause of the disease, such inquiries relating chiefly to the character of the water and milk supplies used by the infected person.

Second. That preventive measures may be adopted.

Third. That trustworthy statistical facts giving information as to the prevalence of the disease, its type, mortality, etc., may be recorded.

In the Bulletin of the Provincial Board of Health of Ontario. for February, 1904, the following question is asked: Are typhoid fever cases reported? Replying to this question the Bulletin states that the returns of typhoid fever by householders and physicians received during 1903 by the Provincial Board of Health amounted to only 1,012 cases. An extract is also taken from the statistics of typhoid fever given in the Annual Report of Dr. Chamberlain upon the hospitals of Ontario, for 1903, which shows that 1,231 males and 687 females were treated for typhoid fever in the Ontario hospitals during the year.

Do the hospitals notify their cases of typhoid fever?

The figures just quoted show conclusively that they do not notify them. Now admitting that an hospital is an excellent. place in which to treat typhoid fever, a place which will not easily become a centre for the diffusion of that disease, the following facts also remain to be considered:

From the standpoint of hygiene, the medical health officer of a municipality should learn the nature of the local conditions which occasioned an attack of typhoid fever in a person living in his municipality, in order to exercise his preventive powers as promptly as possible.

A patient with typhoid fever is treated in some private house or in an hospital, either of which may be situated in the municipality in which the patient contracted the disease, or in another municipality of this Province. Should the patient be treated in a private house of the municipality in which the disease was contracted a report from the householder and one from the attending physician will answer. If in an hospital of the municipality, one from the medical superintendent would answer. If the patient is being treated in another municipality, similar reports would be called for; and in addition the medical health officer of the municipality in which the patient is domiciled, who should be advised in the notification that the patient was not residing in his municipality at the time when he contracted typhoid fever, would also report to the medical health officer of the municipality in which the patient was residing when he contracted typhoid fever. Notification of this nature would draw expert attention to the local conditions or circumstances which had occasioned the disease in question, and the medical health officer of the municipality where the disease had occurred being informed of the possible source of the trouble would be placed in a position to exercise proper measures of prevention. There can be little doubt, therefore, that public health would benefit very much if such a system of notification were made obligatory, as the majority, if not all, of the cases of typhoid fever which occur in Ontario would be known, not only to the physicians or hospital superintendents who may have medical charge of them, but also to the medical health officers of the municipalities to which they respectively belong.

It is reasonable to think that if superintendents of hospitals who have charge every year of a large number, perhaps the majority, of the typhoid fever cases in Ontario, were bound by law to notify these cases, in the way mentioned above, private medical practitioners would not be so likely to neglect their duty in this particular, but would learn to imitate so excellent an example.

Such a system of notification would inevitably lead to the extinguishment of unsuspected local conditions which regularly produce typhoid fever, and the irrelevancies which now exist between morbidity and mortality statistics of typhoid fever in Ontario would soon disappear.

Your Committee would therefore advise that the facts and figures embodied in this report should receive your careful consideration, and that any conclusions you may form relating to this matter should be drafted in the form of a circular and mailed as soon as possible to the Medical Health Officers, Local Boards of Health, Medical Superintendents of Hospitals, Asylums, etc., and to all the medical practitioners of this Province.

Your Committee would also advise that in the circular here referred to attention should be drawn to the fact that samples of drinking water are examined free at the Provincial Laboratory, and that persons desirous of having such examinations made should apply to Dr. J. A. Amyot, bacteriologist of the Board, for properly sterilized bottles, in which the samples of water should be placed. Emphasis might also be given to the fact that physicians may forward samples of suspected blood to the laboratory in order to have the Widal test made.

It may be feared that the reporting of cases by medical superintendents of hospitals may cause re-duplication, it being possible that physicians, who have seen cases before they were admitted to the hospitals, may already have reported. The attention of medical health officers would need to be drawn to this possibility, with the request that they look over the names and addresses of the persons reported to them to avoid re-duplication.

Your

Your Committee also desire to draw your attention to a leaflet prepared by them and containing personal and general precautions suitable to prevent the spread of consumption. Committee ask your endorsation of this leaflet, and if it is satisfactory, request your permission to print copies for distribution throughout this Province. The following is the text of the leaflet:

Personal Precautions Against Consumption.

1. Consumption is contracted by taking into the system, chiefly through inhalation, the germ or microbe of the disease.

2. This germ is contained in the sputum or spit of the consumptive, and the minute droplets which he sprays into the air in coughing or sneezing. The germ may be inhaled directly through the air. When the sputum and droplets become dry they mingle with the dust, and being inhaled with it, introduce the germ into the body; or the germ may be inhaled directly through the air.

3. The consumptive person, therefore, must not expectorate about the house or on the floor of any public building, cab, street car, railway carriage, or other conveyance, nor on the street or other public place.

4. The consumptive must not expectorate anywhere except in a spittoon kept for the purpose, which spittoon should contain water to which a disinfectant has been added-preferably a 5 per cent. solution of carbolic acid, which is prepared by dissolving one ounce of carbolic acid in one imperial pint of hot water.

5. When absent from his own room the consumptive should use a small wide-mouthed bottle with a carefully fitting cap (pocket spittoon), the contents of which when emptied should be