(1) 855 primary cases of typhoid fever in households in Birmingham were investigated.

(2) In 124 or 14·5% of these cases a history of mussel eating within four weeks of the onset of the disease was obtained.

(3) In 17 instances the histories were conclusive of mussel infection.

(4) The curve of mussel-typhoid cases arranged in their weeks of commencement tallies closely with the importation of mussels into Birmingham.

(5) Mussel infection is one of the causes contributing to the autumnal rise of enteric fever.

(6) Some of the sources from which mussels are sent to the Birmingham market are known to be exposed to dangerous sewage contamination.

(7) 65 samples of mussels obtained on entering the Birmingham market from 22 different known sources were analysed bacteriologically.

(8) The results in terms of (a) the total number of organisms, (b) the number of glucose-fermenters, (c) the number of spores of Bacillus enteritidis sporogenes, and (d) the number of Streptococci shew that pollution to a dangerous degree of a large proportion of mussels placed on the market for human consumption exists.

(9) 14 experiments were carried out in relation to mussels subjected to mussels subjected to moist heat at 100°C.

(10) These shew that the ordinary method of cooking to mussels does not remove the risk of typhiod infection and that mussels may be heated in a steam steriliser at 100° C. continuously for as long as four and a half hours without sterilisation.

(11) Legisaltion is necessary to prohibit the gathering of mussels for human consumption from mussel beds exposed to sewage contamination.

Unexpected contamination of several jars of a culture-medium was traced to some red rubber stoppers which had been washed and boiled and then kept for some days in 1:1000 potassium mercuric iodide solution, which was exposed to aerial contamination. An examination of this solution showed that it had very greatly diminished antiseptic properties. Not only did a mixture of equal volumes of the solution and broth support the growth of Staphylococcus but living organisms were actually present in it. These observations were repeated with a second solution of pure mercuric iodide and potassium iodide and other samples of red rubber, and their confirmation led to the investigation of the action of several kinds of rubber upon potassium mercuric iodide solutions.

The United States has been fortunate in never having had any extensive epidemics of plague. With the exception of a few cases, not over a dozen, that are directly chargeable to the infection of the indigenous rodents (ground squirrels), the disease has been confined to the two largest and most important cities on the Pacific Coast, San Francisco and Seattle. In each city the disease has yielded promptly to vigorous sanitary measures carried out by the public health arm of the Federal Government. Under the political organization of the Government, direct control of measures for the suppression of a disease is taken by the central sanitary authority only when a request is made by the local authorities, but it has been the experience that local authorities are prompt to make requests for assistance whenever any serious epidemic appears.

The following observations upon the Natural History of Epidemic Diarrhoea were made in Mansfield during the summer and autumn of 1908. The fact that at the time the writer was engaged in preparing a paper—to which the present paper is to some extent complementary—upon the epidemiological relations of season and disease, lent special interest to the enquiries regularly made from the Health Department of this town into the circumstances attending fatal attacks of diarrhoea. Early in the season a more than usually extensive enquiry was made into one of these fatal attacks in an area where an outbreak of diarrhoea appeared to be spreading outwards from a group of old privy-middens. To test how far the condemnation of the latter was justifiable another area was taken on the other side of the town, where the houses were newly built and provided exclusively with water-closets; and records, collected by house-to-house visitation, were obtained of all cases of epidemic diarrhoea, whether non-fatal or otherwise, occurring in these localities. The enquiries thus begun were afterwards extended so as to embrace two fairly large districts, a chance of doing this being provided by the opportune postponement of the addition to the department of certain work of inspection which had been impending at the beginning of the summer. These districts were several times revisited and scattered observations were also made throughout the other parts of the town. During 1909, while there was no opportunity of making extended observations, there were valuable opportunities during the course of the routine inspections of the summer of testing and re-testing the principal results obtained during 1908.