the position of his cess-pool, dung piles, and house drains, the lay of the land and the dip of the geological strata, and then place it where he feels certain that no contamination from any of these sources can reach it; and the consequence of this disregard of a reasonable precaution is, that in more instances than any one.imagines, such contamination does gradually find its way into it, and deadly disease is the result. People in the country, therefore, while the majority of them are blessed with a purer water than any one in such a city as Philadelphia can obtain, do yet not infrequently use a vastly more impure water than any one in Philadelphia is obliged to drink. During the past year two serious epidemics of typhoid fever have been traced directly to impure water in Great Britain, one at Lewes, on the northern coast, the other at OverDarwen, a town in the Lancashire uplands. In both of these cases it was shown that the water probably contained the excreta of typhoid patients. In two most instructive cases, however, which recently occurred in this country, no such connection could be traced. I allude to the epidemic which prevailed, during the past winter, in St. Mary's Hall, a girls' school at Burlington, N. J., and that which spread such consternation among the guests at Lake Mahopac, the summer previous, an admirable account of which was read before the "Public Health Association" at its Philadelphia meeting by Gen. Viele.

The former case was carefully investigated by Dr. Le Conte, late Medical Inspector, U. S. A., and its origin in the drinking water developed beyond all manner of doubt. A detailed account of it from his pen appeared in the Medical Times, for May 29, 1875, from which I condense. The water supply was obtained from two cisterns, which were intended to contain only river-water, the school being upon the bank of the Delaware. A year after their construction, however, without the knowledge of the authorities, two plugs in the bottom of these cisterns were removed, and spring water was thus allowed to enter. Thus far no great harm was donebut eighteen months after this occurrence, privy vaults were dug outside of the building for the reception of the excreta, which up to that time were received in boxes and removed every few days. One of these vaults was sunk within twelve feet of the cisterns. Three years elapsed, during which the poisonous infiltrations from these vaults were slowly but surely making their way down to the springs which had now free ingress into the cisterns. At the end of that time, the mine exploded! Pupil after pupil was suddenly seized with alarming illness, deaths followed, and it became necessary to temporarily close the school, and send the scholars to their

homes. Now in this case, be it observed, Tyndall's second-hand theory, of the sole dependence of typhoid fever on contamination of food or water by typhoid excreta, finds no support. The ordinary drainage of the cess-pool without specific poison proved amply suf ficient to cause the disease, and in an aggravated form. Two remarkable facts are mentioned by Dr. Le Conte, which prove beyond question that this water was the materies morbi, and nothing else: first, That none of the servants were attacked. Why? Because they drank only tea and coffee, and the vitality of the poison was therefore destroyed by heat before they imbibed it: second, That of the seven pupils who were exclusive water-drinkers, the enormous proportion of six were seized with the disease.

Dr. Le Conte concludes his able exposé of the causation of this epidemic with the following recommendations to the authorities of such institutions, but which are equally applicable in the construction of private dwellings, and, if adopted, would certainly "in most cases prove effective."

"1. Before the plans of the building are fully matured, let an expert in sanitary studies be employed to give directions to the architect in all that relates to ventilation, drainage, and water supply.

"2. After the building is completed, no alterations should be made, affecting these three essentials of good hygienic condition, without the suggestion of a practised sanitarian.

"3. There should be stated inspections, say twice a year, of such institution, by some sanitarian of acknowledged merit, who, after close examination and the correction of any defect, would give a certificate, to be published in the circular or announcement of the school.

"4. On the outbreak of any zymotic disease in the institution, the advice of a sanitarian expert should at once be obtained, in order that means may be taken for its restriction, suppression, and prevention."

Dr. Thomas H. Bailey, of New York, furnishes in the Sanitarian for the present month, under the heading "Water Poisoning as a Cause of Disease," a detailed inquiry into the mode of origin of the second case, from which I make the following extracts:—

"Lake Mahopac is the largest and most beautiful of a chain of lakes which lie embosomed in the mountains of Putnam County in this State. It is about fifty miles north from this city (New York), being situated in what is known as the Croton Basin, or water-shed. It lies between the Hudson River and Harlem Railroad, and is furnished with a branch road from the latter. The surface of the lake is elevated some five hundred feet above the level

of the sea. Large springs situated beneath the surface furnish most of the water supply, its water-shed amounting to very little. The circumference is about eight miles, if the irregularities of the shore be followed. The natural outlet is at the western extremity, and furnishes, in connection with the outlet of another lake, a small auxiliary to the Croton River. Owing to the purity of water and air, the natural beauty of the place and surrounding country, together with its proximity to the metropolis, this place was long ago selected as a summer resort, and has ever received a liberal patronage. About the borders of the lake are numerous hotels, boardinghouses and villas. On a plateau at the eastern extremity of the lake stands the Gregory House, named after the original owner and proprietor, Mr. L. H. Gregory, under whose supervision the arrangements of sewerage and water supply were constructed. The water was conveyed from the lake to the hotel through earthenware pipes into a brick reservoir by gravitation; and as the ground in the rear of the hotel is lower than the surface of the lake, the water flows into a hydraulic ram, whence it is forced into the house. The construction of a large extension to the hotel necessitated the use of a small steam-engine, and for this purpose another reservoir, connected with the first one, was built under the house, to supply the water for the steam-engine. Subsequently to this (in 1871), a steam laundry was constructed, and the new engine did the work of the laundry and the pumping for the house; consequently the use of the smaller engine and its reservoir was discontinued. The connection, however, between the two reservoirs was not cut, and from this most stupid and criminal blunder originated much suffering and several fatal cases of typhoid fever." .. "No experi

ment could be devised to more fully and clearly demonstrate a fact than this accidental and unfortunate occurrence does. We find here an opportunity of putting all excremental complications entirely out of the question. Here, water contaminated with putrid matter and gases is found to produce certain characteristic symptoms, which, when the poison is ingested in sufficient quantities, are in a certain number of cases followed by intestinal lesions. Here cause and effect are clearly demonstrated. In the summer of 1870, the reservoir under the house being then in use, there is no cause for sickness, and the inmates of the Gregory House are free from any unusual sickness. In 1871 a change is made. The reservoir under the house is abandoned, and allowed to fill with impure water; the effect is, an epidemic of cholera morbus, followed by several cases of typhoid fever; the cause is found and remedied, and the diarrhoea and vomiting cease. During the summer of 1872

care is taken to keep the water pure, and no sickness occurs. In 1873, the reservoir is for a time neglected, and again the effects are made manifest, for a short time only, however, as the remedy is soon applied. Again, in 1874, the reservoir, through ignorance of its existence, is neglected, and the effects were produced as I have related, and the trouble was stopped when the reservoir was attended to."

The mind must be biased, indeed, which can avoid seeing the connection in both of these instances between the impure water supply and the occurrence of disease, the disuse of the impure water, and the cessation of the disease.

Coupling the revelations of these interesting cases with the gross carelessness already referred to as existing in the country in regard to the relative position of cess-pools and wells, is it strange that typhoid should be emphatically a disease of the country and of small towns, and should often assume there its deadliest type? Such being the facts with regard to one ascertained mode of propagation of this most serious affection, what is the duty of the physician when called to a case of it? Is it simply to devote his energies to the treatment of the patient? I assert, unhesitatingly, that, however assiduous and faithful his attentions, however great his skill, and however successful the result, should he confine his efforts to this alone, he is morally guilty of manslaughter, should the disease become fatally epidemic. His first duty should be, just so soon as he has a suspicion, even, of the probable nature of the disease, before leaving the house, to set on foot investigations as to its origin. And these investigations he should pursue untiringly, calling in the aid of experts, if himself unsuccessful, compelling the members of the family to aid in the search on the pain of losing his services, giving himself or them no rest until he has satisfied himself of either the absence or presence of a local source of pestilence, and, if the latter, has devised and instituted measures for its removal. Nothing short of this will relieve him of his responsi bility, in the eyes of the hygienist.

REPORT ON MENTAL DISORDERS.

BY JOHN CURWEN, M.D.

THAT the brain is the organ through which the manifestations of mind are made known is now generally admitted, and whatever tends to impair the integrity of that organ has a correspondingly injurious influence on the mental powers. It is true, cases are reported where great injury to the brain did not seem to act on the mental powers, but in nearly, if not quite, all these cases, if the observation had been continued for a length of time, some mental impairment would have been discovered. In what particular manner certain bodily disorders produce an impairment of the mental powers is a point on which neither physiology nor pathology has yet shed a clear and distinct light, but experience and observation bring before us certain facts which must be admitted even if they cannot be fully explained. To obtain a clear and distinct understanding of the nature and character of mental disorders, it must be constantly borne in mind that the various forms under which these disorders manifest themselves are not to be considered as so many unerring types to which every case must, of necessity, conform, but that each case has its peculiarities derived from the mental constitution of the individual who is the subject of the disorder. It is true, certain nosological distinctions are laid down in the books, but these, varying very much in different authors, characterize only certain genera under which the different species may be classed. No case of mental disorder can be rigidly defined in terms which will certainly apply in the detailed statement to every other which may be classified under the same general head, but each must be judged by itself, and the disordered condition must be traced out in its peculiar departure from the healthy action of the mental and moral powers. It has been too much the fashion to lay down certain metaphysical definitions to which it has been supposed each case can be made to conform, but while this may do very well for theorists, it is only confusing and distracting to the practitioner.

The disordered mental action can only be certainly discovered