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spirit of the law. Pending a positive diagnosis, a suspicious case should be regarded as a probable case, and physician and health authorities should cooperate in its control for the protection of the public. The feeling is growing that in the past we have been too lenient with those who are either indifferent to the common welfare, or incompetent. “Malpractice ’’ is an ugly word; yet there is serious question whether the members of the family of a typhoid patient, contracting the disease through contact with him, have not a legal grievance against the attending physician, if he has failed to advise and offer protective inoculation. The responsibility of the health officer is equally great. In municipalities blessed with efficient and intelligent health officials, there is usually little cause for complaint regarding the attitude of the practising physicians. The health officer who cooperates receives cooperation. While inefficiency on the part of this official does not absolve the physician from his legal obligations, it is not surprising if the spirit of cooperation does not prevail where the health officer is habitually discourteous, and where, when cases are reported, nothing happens. . In practically every instance when a typhoid case is reported, the health officer, or a qualified representative, should visit the household and not only perform the routine duties incidental to the situation, but conduct a searching investigation to ascertain the source of the infection and prevent its becoming the source of other cases. From the study of a large number of report cards received from health officers, and at times from comparison of the data thus submitted with the actual facts obtained through subsequent investigation, it is apparent that in all too many instances investigations are superficial and the data submitted unreliable. Often the source of infection cannot be definitely determined until the date of onset is known and the probable date of infection estimated therefrom. Yet it is commonly found that the date given as that of onset is actually the date when the physician was called, or when the temperature reached its greatest height, rather than that of the actual beginning of the illness a week or two before. Sources of infection are recorded as “unknown,” “imported,” “flies,” or even “an open cesspool.” “Well water ’’ appears frequently, notwithstanding the fact that it is now generally known that wells are only sources of infection when they are receiving discharges from a typhoid case or carrier, in which event the investigation is not complete until the case or carrier has been located. Years of education will be required before typhoid fever will be eliminated as a national scourge. This education will proceed by leaps and bounds when the thousands of men now in the service of the country, who have learned that typhoid is prevented when there is mutual cooperation, have returned to their homes. They will have little sympathy with the ignorance and inefficiency which permits a preventable scourge to go uncontrolled.

Analysis of statistics relative to typhoid fever

For the seventh successive year there was a decline in the State's typhoid death rate and contrary to previous years this was despite a small increase in the rate for New York city.

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ANNUAL CASE AND DEATH RATES PER 100,000 POPULATION FOR TYPHOID FEVER, 1908–1917, FOR ENTIRE STATE, NEw York CITY AND REST OF STATE

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