the corresponding period of 1910 the writer estimates from the report of deaths and from the data collected by Kelley and Wilber1 that between 150 and 200 cases of typhoid fever occurred among persons who contracted the infection and developed the disease in North Yakima. It is unfortunate that complete statistics are not available for the purpose of pointing out accurately the very marked reduction in the rate of prevalence of typhoid fever in North Yakima for 1911. The results of the campaign, however, even when estimated most conservatively, are very striking.

North Yakima has demonstrated the effectiveness of reasonable and practicable measures for the prevention of typhoid fever, and has furnished for every community in the world where this preventable disease is highly prevalent an example most worthy of emulation.

CONCLUSIONS.

1. The high rate of prevalence of typhoid fever in North Yakima in the summer and fall of the years 1908, 1909, and 1910 was due for the most part to the local dissemination of human excreta from insanitary privies, privy vaults, cesspools, septic tanks, and bedsides of the sick to the mouths of persons by fingers, flies, foods, and water.

2. Exogenous infection introduced into the city through the public water supply, milk supply, and fruit and vegetable supply very probably has contributed from time to time to the prevalence of the disease, but the high rate of prevalence of typhoid fever in North Yakima year after year has been caused chiefly by infection of distinctly endogenous character.

3. The outbreak of typhoid fever in North Yakima in May-June, 1911, was caused beyond reasonable doubt by infection in water pumped either wilfully or by accident from the Cascade Lumber Co.'s mill pond into the city water mains.

4. The prevalence of typhoid fever in North Yakima for the summer and early fall of 1911 was reduced by about 90 per cent as compared with the rate for the corresponding period in previous years by the carrying out of reasonable measures directed especially toward the correction of insanitary local conditions.

5. The results of the campaign against typhoid fever in North Yakima in the summer of 1911 are striking and indicate that the high annual prevalence of typhoid fever in the towns and rural districts generally of Yakima County is amenable to very marked reduction by the application of simple measures for the correction of insanitary local conditions.

1 Studies in Typhoid Fever by the Washington State Board of Health during 1909-10, pp. 23-24 and 40.

RECOMMENDATIONS.

1. Abolish every insanitary privy, privy vault, cesspool, and septic tank in the city and replace those in the nonsewered areas with sanitary privies.

2. Exercise rigid official supervision over all privies to make sure that they are maintained at all times in sanitary condition.

3. Provide a municipal service for the proper disposal of privy

contents.

4. Rigidly enforce laws and regulations requiring every habitation within the publicly sewered and watered areas to be properly connected with the sewerage system.

5. Extend the public water system and the water-carriage sewerage system as rapidly as possible to reach all sections of the city.

6. Enact an ordinance prohibiting the occupancy of any new or any vacated building until after a permit to occupy has been granted by the health department, the health department to issue such permit only after due inspection and determination that the prospective residence is provided with proper sanitary devices.

7. Rigidly enforce ordinances prohibiting the maintenance on premises of such nuisances as collections of stable manure and garbage not kept in fly-proof containers.

8. Make every day clean-up day for all streets, alleys, and back yards in the city.

9. Have exercised under official supervision at the bedsides of all patients suffering from or suspected to be suffering from typhoid fever rigid precautionary measures to prevent spread of the infection.

10. Safeguard the public water supply by the following measures: (a) Sanitary patrol of the watershed to prevent pollution of the water with human excreta.

(b) A change of location of the intake so that the water will be received from the river at a point upstream from the mouth of the Tieton River.

(c) An extension of the closed conduit so that the water will be protected from pollution throughout its course from the river to the mains in the city.

(d) Replacement of the old reservoir on Nob Hill, if there be need for a reservoir, with a reservoir constructed either of cement or of other material impervious to water.

11. Pass and strictly enforce an ordinance requiring the purification of the public water supply to such a degree that the water will not contain at any time more than 100 bacteria to the cubic centimeter, nor an average for 10 days of more than 1 colon bacillus to 200

cubic centimeters. The measures for purifying the water suggested for consideration are:

(a) Adequate treatment with hypochlorite of lime.

(b) Filtration.

12. Enact an ordinance prohibiting the sale or the offering for sale in the city of any water which may be shown by bacteriological examination not to be within the standard of purity defined in recommendation 11 for the public water supply.

13. Abolish the shallow wells in the city as rapidly as the extension of the public water supply makes practicable, and in the meanwhile prevent, so far as practicable, the use of water from dangerously polluted wells or springs.

14. Rigidly enforce the ordinance passed in May of 1911 for the safeguarding of the milk supply.

15. Enact an ordinance prohibiting the sale or the offering for sale in the city of any milk or green garden truck obtained from farms not provided with either sanitary privies or sanitary waterclosets.

16. Enforce, as rigidly as is practicable, measures directed toward the prevention of contamination of any foods or beverages whatsoever in North Yakima by fingers or flies soiled with human excreta.

17. Maintain the strength of the health department so that the city government can perform with reasonable adequacy its duty for the preservation of the health and lives of the people of North Yakima.