might be of service in determining the presentation, but when it is remembered that in these cases presentation changes from time to time, thus decreasing the value of one examination. In women with fat abdominal walls, some good is derived from an X-ray examination, but even in these cases careful palpation usually yields satisfactory results.

In ectopic pregnancy there seems to be no advantage gained by their use. It would be very difficult to determine whether the fetus was outside or inside the uterine wall.

In twin pregnancy the author feels that there is a field for this method of examination, as it might be possible

to determine the presence of two vertebral columns or two fetal heads, thus making the diagnosis settled.

In feigned pregnancy the rays would be of value in showing the absence. of a fetus, providing the examination were made at a time when if there were a fetus it could be determined by this means. But palpation or palpation in conjunction with anaesthesia would be more simple and wholly reliable.

Walsham's experiments, which went to show that in the case of still birth the lungs were opaque to the ray, may delegate to this method medico-legal importance, but the older practice of floating the lungs in water is more simple and equally trustworthy.

general intelligence of the the people. Higher medical education and a suppression of quackery must precede a successful dissemination of facts among the laity regarding infectious diseases.

Sanitary Conditions.

Since the European invasion of cholera in 1830, the English towns which had been visited by this disease and those fearing similar scourges, in view of their sad experiences, were willing to institute sanitary reforms. Sewers, public water supplies, and a general sanitary condition of the home became the order of the day, and with it the birth of modern hygiene and sanitation. The example set forth by England was followed by all civilized peoples. Efforts at sanitation were demonstrated in the Crimean war, the civil war, and lastly in the Spanish-American and South African wars.

The United States were not slow in adopting sanitary measures and instituting laws governing public health. The invasion of cholera in 1832 and the epidemic of 1848-9, here as in Europe, aroused public interest in sanitary reform. Finally health boards sprang into existence, which adopted measures to deal with infectious diseases; and for the sanitary inspection of the food supply, schools, public institutions and tenements. Registration of vital statistics, supervision of burials, water supply, sewerage disposition, etc., followed.

Voluntary organizations such as the American Public Health Association, Section on State Medicine of the American Medical Association, the Climatological Association, and the American Sanitary Council, and numerous other organizations made impressions upon the public mind which have resulted in numerous sanitary reforms. Follow

ing the cholera epidemic in 1872-3, and the yellow fever epidemic in 1878, national and international quarantine systems sprang up which involved the inspection of vessels and their passengers, isolation of the sick, and the treatment and detention of suspected cases. These systems have been adequate to a certain degree in enabling us to keep these diseases from our shores. Water Supply.

No preventive measure in the field of medicine, not underestimating the brilliant achievements of Jenner and Lister, have been wrought with such magnificent results as have the efforts which have been put forth in the last half century to improve the water supply of the world. There is plenty of evidence showing that the introduction of sewers and public water systems in a number of cities has been accompanied by a decrease of almost fifty per cent in mortality. The good effects are plainly shown in the great decrease of typhoid fever, cholera, dysentery and tuberculosis. The vital statistics of Great Britain are sufficient proof of the great good derived from an adequate and pure water supply. The mortality rate at Salisbury has been reduced from 40 to 16 per thousand; at Dover from 28 to 14 per thousand; at Rugby from 24 to 10 per thousand; at Croydon, 28 to 15 per thousand; at Matlock, 18 to 9 per thousand. It is a common expression that every sewered city shows a lessened typhoid mortality subsequent to the introduction of sewers, and that the typhoid fatality is always higher in places supplied with privy pits and box privies than in localities where houses have sewer connections. The only explanation is, of course, that sewers carry away the infectious material which would otherwise contaminate the soil.

The number of towns in 1800 in the United States having a public water supply was only sixteen, supplying about 2.8 per cent of the existing population; in 1850 there were eighty-three public water works, supplying about ten per cent of the population; in 1897 there were 3,196, supplying about forty-one per cent of the census population. There is There is conclusive evidence,

here and abroad, pointing to the fact that there has been a great decrease in deaths from enteric and other diseases when a pure water supply was substituted for a contaminated one. For example, the typhoid fever death rate for Boston from 1846 to 1849 was still 17.4 per ten thousand; in 1890-2 it had fallen to 3.2 per ten thousand, the city in the meantime having expended $25,000,000 on its water supply. The typhoid fever death rate in Chicago in 1890-2 averaged 12.5 per ten thousand. After improving the water supply it fell at every step of its improvement, till last year it was only 1.9 per ten thousand, a total reduction of 84.8 per cent during the decade. London, Berlin, Vienna and Munich present similar statistics.

In 1893, 41 per cent of our population lived in towns having public water supply, and only 28.7 per cent in sewered towns. It is evident from this data that the municipal authorities failed to recognize the fact that public water supply and a sewer system must go hand in hand. The neglect of the latter means sure pollution of soil and rivers, in the train of which follows certain disaster.

The Marine Hospital reports show that cholera, typhoid fever and dysentery are more prevalent in those towns situated along the great rivers of this country, it being at once apparent that such a condition is due to the pol

It

lution of the streams, one city being a source of another's contamination. is estimated that no fewer than 35,000 deaths occurred last year from typhoid fever alone. The average duration of this disease is thirty days. If we calculate that on an average $1.00 per day is expended for care, treatment and loss of work, and that the value of a human life is $5,000, we have a total loss in the United States of $105,000,000 per annum from one of the socalled preventible diseases.

Congress appropriated $40,000 to exterminate the gypsy moth, but Mr. Barthold's bill for the appointment of a commission to look after river pollution was defeated. Such is the attitude of legislation towards this subject. The pollution of a stream by an individual or community when said stream is a source of water supply for the same or another community, is an outrage and should be legally considered as such

Irrigation provides a means for sewage disposal, but when for any reason this can not be instituted, chemical means should be used to render sewage inert. At the present time over one hundred communities have established means to rid themselves of sewage, there being eighty irrigation plants, and about twenty localities employing chemical means.

While the public water supply has been a great boon in the reduction of mortality, still, in many cases, the source of this supply is decidedly unsafe. The waters are often rendered impure and dangerous to life by drainage from cultivated fields where the rains wash the fertilizers into the streams, and often, too, pollution from shops and factories complicate the situation. The advice furnished by the city to boil the water effects in reality. no purification of it, as it is too often

so carelessly done that the dangerous. germs remain undisturbed. The domestic filter is an article only too often. a dangerous device, well adapted to the breeding and dissemination of discase. The soluble poisons pass through and bacteria collect in the filter, multiply and are the source of continuous infection. The efficacy of hard and mineral waters is often exaggerated, while indeed they even contribute as a cause for premature old age and decav. The inorganic minerals in the water are absorbed and deposited in the tissues, causing sclerosis and loss of elasticity. The purest spring waters and the most popular ones are those which come nearest, in analysis, to distilled water. The only absolutely pure water for drinking and culinary purposes is the latter; it is the greatest solvent and rids the body of excreta more thoroughly and tends to longevity.

Food and Food Legislation.

From the cradle to the grave the question "What to eat" faces humanity. It is the striking fact that onetenth of all infants do not live a month, and that one-third do not reach the age of three months. This is due, in a large part, to digestive disorders growing out of improper food. It is a scientific truth that breast feeding is superior to artificial feeding, but the former must be suspended in many cases and resort had to the latter. Cow's milk, plain or modified, has been the most popular substitute, but it is often unsatisfactory and indeed positively dangerous. The consideration of the methods by which cow's milk becomes unfit for use and contaminated, involve (1) Diseases affecting the cow, her food and surroundings; (2) contamination of the milk while it is prepared for shipment at the dairy, and

while being transported and delivered to the consumer; (3) after the milk is in the hands of the consumer. To avoid such contamination it is necessary to secure intelligent supervision over the entire milk industry, with due attention to its source and the methods in vogue in its delivery. In view of the immensity of this traffic, its supervision becomes an important obligation. It is said that 1,250,000 quarts of milk are consumed in New York city daily. That would mean milk from 155,000 cows, and the employment of 35,000 milkmen.. It can be readily appreciated from these figures that the liability of milk infection is very great. In regard to diseases affecting the cow, tuberculosis is the most important. In this connection comes up the question of the communicability of bovine tuberculosis to human beings, which will have to be left at the present time unanswered. Digestive troubles often affect the cattle. during periods of drouth when they are forced to feed upon weeds and plants owing to the scarcity of grass. It is very well known that such conditions in the health of cattle affect the dairy products. Not only should the food of cows be of the best, but the condition of the stables, which are often disastrously unhygienic, should be carefully inspected. Contamination by the hands of milkmen need only be mentioned. Scarlet fever, diphtheria and typhoid fever occur by means of milk so contaminated, or result from the addition of impure water. The various preservatives, borax, salicylates and paraldyhide, are pernicious.

The multiplication of bacteria in milk is stupendously rapid. In very good milk fresh from the cow there are usually 3,000 or 4,000 bacteria per cubic centimeter, while milk such as