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Scientific Memoirs by

italicised the reference to specific pollution, and we need only-refer to Dr. Horton-
Smith's Goulstonian Lectures (1900) for ample evidence of the danger and pre-
valence of undetected sources of such pollution, in ambulatory cases and in
convalescents both as regards the solid and liquid excreta.

     Dr. Robertson, the experienced M. O. H. of one of the chief endemic
Typhoid areas in England, has stated his deliberate opinion, that of 20,000 cases
investigated, about 10 per cent. were due to direct infection (as in nursing);
water and milk-borne infection may account for 10 per cent., while 80 per cent
have a dust and filth-borne origin with its nidus in the soil. (British Medical
Journal of August, 1898.)

     Again the figures submitted by Dr. Boobyer (M. O. H., Nottingham) as
regards the relative incidence of typhoid fever on communities served by privy-
middens, by the pail system and by water-closets, have a very definite bearing
on the subject of our means of removal and disposal. The incidence over ten
years was shown to be relatively as follows:—

which affords striking evidence of the importance of complete and rapid removal.

     Lastly, it will suffice to invite attention to the address delivered by Sir
R. Thorne-Thorne, late Principal Medical Officer to the Local Government Board,
before the Midland Medical Society (1897) wherein he discusses the prevalence
of endemic typhoid in certain rural areas in England, and draws the inference
of the paramount influence of defective measures of the removal and disposal of
excreta in inducing local soil pollution, and, among the first methods of prevention,
advocates the provision of an impervious covering to the polluted site.

     Haffkine has pointed out, in reference to a connexion of enteric fever with the
soil, that the virus may pervade the infected locality for years, and may, in spite
of improvement in the water-supply, cause a continuous incidence of the disease
for which occasionally nothing short of complete evacuation of the locality is an
effective remedy. It is not suggested that there is any mysterious connexion bet-
ween the disease and the soil; the whole danger lies in the defilement, though that
may be influenced in extent or duration by local geological formation, as
contended by Sir C. Cameron in the case of Dublin.*Haffkine further says that
while cholera infection seems to be almost exclusively confined to the water-supply,
in the case of enteric the improvement of the water seems to leave intact a large
number of other sources of danger to which attention has not been sufficiently
directed. It is recognised that enteric fever is not, by any means, solely a water-
borne disease.

* See British Medical Journal, July 1st, 1899, and June 3rd, 1899.