to discontinue the contamination, and reinspecton of the premises showed that both privies had been moved. No. 418. An inspection of premises located at Frenchtown showed that contaminating materials were discharged from a house drain on said premises directly into one of the tributaries of the Delaware river. A notice was served upon the owner to discontinue the contamination, and as reinspection of the premises showed that the notice had not been complied with, the matter was referred to the attorney-general for such action as the law provides. No. 419. An inspection of premises located at Frenchtown showed that a privy was placed directly over a tributary of the Delaware river. A notice was served upon the owner to discontinue the contamination, and as reinspection showed that the notice had not been complied with, the matter was referred to the attorney-general for such action as the law provides. No. 420. An inspection of premises located at Frenchtown showed that a privy was so situated on the bank of a tributary of the Delaware river that contaminating materials were discharged directly into the stream. A notice was served upon the owner to discontinue the contamination, and reinspection of the premises showed that a tight vault had been constructed. No. 429. An inspection of premises located at Belvidere showed that a privy was placed directly over Pequest creek, one of the tributaries of the Delaware river. A notice was served upon the owner to discontinue the contamination, and as reinspection showed that the notice had not been complied with, the matter was referred to the attorney-general for such action as the law provides. No. 430. An inspection of premises located at Belvidere showed that a pig pen was placed upon the bank of Pequest creek, and that stable manure was placed within two feet of the creek. A notice was served upon the owner to discontinue the contamination, and reinspection of the premises showed that the notice had been complied with. No. 431. An inspection of premises located at Belvidere showed that a slaughter-house was situated on the bank of Pequest creek, and that contaminating materials from the floors of the slaughter-house and from a pig pen were discharged directly into the stream. A notice was served upon the owner to discontinue the contamination of the stream at this point, and upon reinspection it was found that the buildings had been destroyed by fire. No. 432. An inspection of premises located at Belvidere showed that a privy was placed directly over Pequest creek. A notice was served upon the owner to discontinue the contamination, and reinspection of the premises showed that the privy had been moved. No. 433. An inspection of premises located at Belvidere showed that a privy was placed directly over Pequest creek. A notice to discontinue the contamination, was served upon the owner, and as reinspection showed that the notice had not been complied with the matter was referred to the attorney-general for such action as the law provides. No. 434. An inspection of premises located at Belvidere showed that a privy was placed directly over Pequest creek. A notice to discontinue the contamination was served upon the owner, and as reinspection showed that the notice had not been complied with, the matter was referred to the attorney-general for such action as the law provides. No. 435. An inspection of premises located at Belvidere showed that a privy was placed directly over Pequest creek. A notice was served upon the owner to discontinue the contamination, and reinspection of the premises showed that the privy had been moved. No. 436. An inspection of premises located at Belvidere showed that a privy was placed directly over Pequest creek. A notice was served upon the owner to discontinue the contamination, and reinspection of the premises showed that the privy had been moved. No. 437. An inspection of premises located at Belvidere showed that a privy was placed directly over Pequest creek. A notice was served upon the owner to discontinue the contamination, and a reinspection of the premises showed that the privy had been moved. No. 438. An inspection of premises located at Belvidere showed that a privy was placed directly over Pequest creek. A notice was served upon the owner to discontinue the contamination, and reinspection of the premises showed that the privy had been moved. No. 439. An inspection of premises located at Belvidere showed that two privies were placed directly over Pequest creek. A notice was served upon the owner to discontinue the contamination, and as a reinspection showed that the notice had not been complied with the matter was referred to the attorney-general for such action as the law provides. No. 440. An inspection of premises located at Lambertville showed that a privy was placed within three feet of Swan creek, and that contaminating materials were discharged directly into the stream. A notice was served upon the owner to discontinue the contamination of the stream at this point, and reinspection of the premises showed that the notice had been complied with. No. 441. An inspection of premises located at Lambertville showed that two privies were so situated that contaminating materials were discharged directly into Swan creek. A notice was served upon the owner to discontinue the contamination, and reinspection of the premises showed that tight vaults had been constructed and the notice complied with. Report on Outbreak of Typhoid Fever in the State Hospital, Trenton. BY HENRY MITCHELL, M.D., SECRETARY. The State Hospital for the Insane, located about two and onehalf miles from the City Hall, but just within the boundary limits of the city of Trenton, was established in 1847, and until last spring no case of typhoid fever had developed on the hospital premises. The site was originally selected because of the spring which was located there, and this spring furnished all of the water used in the institution until about the year 1896, when three wells were drilled to increase the supply of water. Water was pumped from the spring and from the wells into a standpipe, and distributing mains and branches conveyed it to all of the various buildings on the hospital premises. Because the persons who were first attacked with typhoid fever were located in a wing of the main building nearest to the spring, and because the pipe supplying water to that wing also carried the water from the spring to the standpipe, a theory was considered early in the course of the inquiry which was made to trace the source of the infection, that the spring water was the medium through which the disease was being conveyed, but when the epidemic ceased, and all of the facts relating to the outbreak were on record, it was found that the disease did not attack persons who were not, either directly or indirectly, in contact with the sick or convalescent fever patients. The water which was obtained from the spring reached the standpipe without doubt, and it was there thoroughly mixed with the water pumped from the wells, and all of the buildings were connected with the mains through which the standpipe water was distributed, but no case of typhoid fever occurred in the annex, in which 400 inmates were confined. The deductions drawn from these facts and from negative investigations directed to the food supply are stated in the reports which follow, copies of all of which were forwarded to the managers of the hospital. To the Board of Health of the State of New Jersey: GENTLEMEN-Recent inquiries show that new cases of typhoid fever have continued to occur among the inmates of the State Hospital, Trenton, at the average rate of about one each day, up to and including August 13th, and among the conditions which at present favor the spread of the disease in the institution the following have been noted: 1. Convalescents freely mingle with the other inmates in the wards and dining-rooms, and through this agency infection and reinfection of dishes, doorknobs, chair-backs, &c., is constantly occurring. 2. Insane inmates are still retained in service in the kitchens and diningrooms, and therefore there can be no assurance that orders and instructions requiring sterilization of spoons, forks, cups, &c., will be faithfully carried out. In view of these facts it is recommended that measures be at once taken to separate all convalescents from other inmates, and to immediately discontinue to permit any patient in the institution to assist in the kitchens or diningrooms, or to have access to any portion of the building where the food is prepared or where the dishes are washed. Very respectfully, August 16th, 1907. HENRY MITCHELL, Secretary. To the Board of Health of the State of New Jersey: GENTLEMEN-During a visit to the State Hospital, Trenton, made this day, it was learned that no new case of typhoid fever has occurred in the institution since August 13th, a period of nine days. In the course of an inspection of the central kitchen, the kitchen in the west wing and the kitchen in the annex, certain defects in location, construction, arrangement, lighting, ventilation and management were observed, and attention is particularly called to the following conditions: The central kitchen is located in the basement of the main building. The ceilings are low, the window space is small, one cell-like room containing two steam kettles has no window, artificial light being depended upon entirely. The sinks are made of wood and are worn out, the floors are constructed of wood, the refrigerator is worn out. The west kitchen is better located and better lighted than the one just described and it is conducted in a more cleanly manner, but in its location and construction it is not well adapted to the cleanly preparation of food. The kitchen in the annex is superior in construction to those above referred to, but it also is defective in certain particulars (wooden floors and sinks). The dishes, spoons, forks, &c., used by the insane inmates are washed by the inmates in wooden sinks in the dining-rooms. No reliance can be placed upon the faithfulness of these persons, and there is good reason to believe that the dish-washing performed by them cannot be depended upon to remove infective substances from the dining-room utensils. Accumulations of dirt from the hands of the patients and attendants were found to be encrusted upon the doors of the kitchens and dining-rooms, and appearances indicate that these surfaces are never washed. Upon inquiry information was given by Mr. Fleitchman showing that neither the warden nor the medical officers of the hospital have accepted responsibility for cleanliness in the dining-rooms, and consequently there has been gross neglect in this |