M32 
 
THE HOUSE-FLY AT THE BAR 
 INDICTMENT 
 
 GUILTY OR NOT GUILTY? 
 
 EVIDENCE : IN THE MATTER OF THE PEOPLE 
 
 against 
 
 THE COMMON HOUSE FLY 
 
 APRIL, 1909 
 
 THE MERCHANTS' ASSOCIATION OF NEW YORK 
 
^sV iV S - 
 
 THE MERCHANTS’ ASSOCIATION OF NEW YORK 
 
 OFFICERS 
 
 HENRY R. TOWNE, President 
 
 GUSTAV H. SCHWAB, ist Vice-Pres. GUSTAV VINTSCHGER, Treasurer 
 
 WM. A. MARBLE, 2d Vice-Pres. S. C. MEAD, Secretary 
 
 ROBERT C. OGDEN, 3d Vice-Pres. FREDERICK B. DeBERARD, Statistician 
 
 JOHN W. GRIGGS, Counsel 
 
 DIRECTORS 
 
 Nathan Bijuh 32 Nassau St 
 
 Frank R. Chambers Rogers, Peet & Co., Broadway and 13th St 
 
 J. Hampden Dougherty 27 William St 
 
 Harry Dowie De Winter & Co., 334 Greenwich St 
 
 Thomas H. Downing R. F. Downing & Co., 24 State St 
 
 Prof. Joseph French Johnson, Dean, School of Commerce, Finance and Accounts, New 
 
 York University 32 Waverley Place 
 
 Walter C. Kerr Pres. Westinghouse, Church, Kerr & Co., 10 Bridge St. 
 
 James H. Killough J. H. Killough & Co., 157 West St. 
 
 Charles R. Lamb J. & R. Lamb, 23 Sixth Ave. 
 
 Wm. H. McCord Post & McCord, 44, East 23d St 
 
 J. Crawford McCreery The James McCreery Realty Corp., 112 W. 42d St 
 
 Wm. a. Marble Vice-Pres. R. & G. Corset Co., 395 Broadway 
 
 Marcus M. Marks David Marks & Sons, 687 Broadway 
 
 Daniel P. Morse President Morse & Rogers, 134 Duane St 
 
 Robt. C. Ogden 125 E. 56th St 
 
 Albert Plaut Lehn & Fink, 120 William St 
 
 Edwin H. Sayre R. C. Williams & Co., 56 Hudson St 
 
 Gustav H. Schwab Oelrichs & Co., s Broadway 
 
 Henry R. Towne President Yale & Towne Mfg. Co., 9 Murray St 
 
 George Fred'k Vietor Vietor & Achelis, 66 Leonard St 
 
 Gustav Vintschger President Markt & Co., Ltd., 194 West St 
 
 Silas D. Webb President China & Japan Trading Co., 32 Burling Slip 
 
 Clarence Whitman Clarence Whitman & Co., 39 Leonard St 
 
 F. W. Woolworth President Guardian Trust Co., 170 Broadway 
 
COMMITTEE ON 
 
 POLLUTION OF THE WATERS OF NEW YORK 
 
 EDWARD HATCH, Jr., Chairman 
 J. PIERPONT MORGAN JOHN Y. CULVER, C. E. 
 
 ALBERT VANDER VEER, M. D. DANIEL D. JACKSON, S. B. 
 
Digitized by the Internet Archive 
 in 2016 with funding from 
 
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 https://archive.org/details/houseflyatbarindOOunse 
 
THE HOUSE-FLY AT THE BAR 
 
BY WAY OF EXPLANATION 
 
 I N DECEMBER, 1907, this Association published the report made to it 
 by Daniel D. Jackson on the '‘Pollution of New York Harbor as a 
 Menace to Health by the Dissemination of Intestinal Diseases 
 Through the Agency of the Common House-Fly,” in which he proved 
 beyond a doubt that raw sewage discharged into large or small bodies of 
 water, even if such water was not used for drinking purposes, furnished feed- 
 ing grounds for flies, from which they gathered and spread the germs of typhoid 
 fever and other intestinal diseases. 
 
 In cities whose sewers empty into lakes, tidal waters or slow-moving 
 streams, deposits of filth are certain to collect on the banks or beaches, and house- 
 flies are as certain to seek them out and to carry the disease germs from the 
 sewage-polluted water-front inland to the homes of the inhabitants. Thus it 
 will be seen that water-front conditions, similar to those which afflict New York, 
 are to be found in many other cities, and that they, too, must grapple with the 
 problem of protecting the health of their inhabitants from the closely associated 
 pests of flies and untreated sewage. 
 
 So much interest was aroused by the publication of this report that the 
 Association’s Committee on Water Pollution has been encouraged to pursue its 
 investigations of the habits of this pest, which Dr. L. O. Howard, Chief Ento- 
 mologist of the Department of Agriculture, has re-christened the “typhoid fly” 
 — and to assemble the testimony of the health officers and other expert sanitarians 
 of the country as to the dangers arising from this cause and the means which 
 may be taken to combat them. 
 
 With this end in view the Chairman of the Committee addressed the fol- 
 lowing letter to health officers, physicians and other authorities throughout the 
 United States and Canada: 
 
 Dear Sir: 
 
 Will you be so kind as to inform us whether your department has been 
 making any investigations with regard to transmission of typhoid and other germ 
 diseases through the medium of flies ? 
 
 You are probably acquainted with the report made by Dr. Jackson, of this 
 committee, on the dangerous activity of the common house-fly, and will under- 
 stand our desire to have the benefit of your observations on the very important 
 subject of disease transmission by flies. 
 
 Incidentally, we shall be glad to know what is your opinion as to the trans- 
 mission of typhoid bacilli through impure milk and polluted water supply. We 
 ask this question because some authorities have recently made the statement that 
 
 5 
 
typhoid infection from these causes is insignificant as compared with that through 
 the medium of flies. 
 
 We are gathering this information from all parts of the United States, 
 and shall be pleased to send you a memorandum of the result wh^ completed. 
 
 Yours truly, 
 
 Edward Hatch, Jr., Chairman. 
 
 The result of the correspondence which ensued is embodied in the pages 
 which follow. It is believed that the perusal of these letters and the extracts 
 from the scientific monographs here presented will serve to convince those who 
 may have hitherto given little thought to the subject that the common house-fly 
 is one of the most dangerous pests in the world, and to stir all who read this 
 little book to take an active part in the campaign for the extermination of flies by 
 the removal of conditions which breed them. 
 
 Edward Hatch, Jr., Chairman. 
 
 J. PiERPONT Morgan. 
 
 John Y. Culver, C. E. 
 
 Albert Vander Veer, M. D. 
 
 Daniel D. Jackson, S. B. 
 
 Committee on Pollution of State Waters, 
 The Merchants' Association of New 
 York. 
 
 6 
 
WHAT HEALTH AUTHORITIES SAY ABOUT 
 
 THE HOUSE-FLY. 
 
 Extracts from Letters Discussing its Agency in Spreading 
 Typhoid Fever and Other Intestinal Diseases Received 
 by the Committee on Water Pollution from All 
 Parts of the Country. 
 
 While health authorities naturally hold varying views as to the relative 
 influence of flies, polluted water and impure milk in the transmission of typhoid 
 fever, there is practically no dispute of the assertion that flies do carry and dis- 
 seminate the germs of the disease. The great importance attached to their agency 
 as spreaders of typhoid and other germs by the majority of the correspondents 
 who have answered the inquiries of the Committee is sufficient warrant for the 
 publication of the letters which are here quoted. 
 
 FROM DR. G. W. COLER, HEALTH OFFICER, ROCHESTER, N. Y. 
 
 My Annual Report for 1906 contains the following reference to the 
 house-fly : 
 
 ‘‘They not only become nuisances, but they are to a large extent carriers 
 of disease. They fly from the polluted places in which they breed to the faces, 
 mouths and noses of sleeping infants, and from thence to men, women and 
 children. By these means they became the undoubted carriers of disease. Were 
 it possible to cause all the manure piles to be properly cared for by covers and 
 screens, it would not only rid the city of a pest, but prevent, to a considerable 
 extent, the carrying of disease. In the near future one of the new departments 
 of the newer medical science will busy itself with the removing of the manure 
 heap, the house-fly, and other insect pests.” 
 
 Rochester, N. Y., Nov. 7, 1908. 
 
 FROM J. N. HURTY, SECRETARY OF THE INDIANA STATE BOARD 
 
 OF HEALTH. 
 
 We have records of several instances where typhoid fever was unques- 
 tionably transmitted by flies. The last instance was at the Wehrnely Orphans^ 
 Home, near Richmond, Ind. Sewage disposal at this Home is by the use of a 
 dilapidated outhouse, or vault. The house is not fly-proof, and it was un- 
 doubtedly through flies that the typhoid epidemic was started. A man who had 
 recently lost his wife came to the Home, bringing his child to be taken care of 
 there. He was sick at the time and returned to die two weeks afterward, with 
 typhoid fever. Within eighteen days after his visit typhoid fever broke out in 
 the Home, one death and fourteen cases resulting. He used the outhouse, and 
 there was no possibility of drainage getting into the well. Flies must have car- 
 ried the infection. That typhoid fever may be transmitted through impure milk 
 
 7 
 
and polluted water supply is beyond question. However, my observations lead 
 me to believe that very rarely is the infection carried by impure milk, but quite 
 frequoitly in polluted water. Much of our data leads me to believe that it is 
 more frequently carried by flies than in other ways. 
 
 Indianapolis, Ind., Nov. 2, 1908. 
 
 THE SECRETARY OF THE KANSAS HEALTH BOARD, DR. S. J. 
 
 CRUMBINE, SAYS: 
 
 A year ago this department undertook to make an investigation of the 
 cause of typhoid fever that prevailed to an alarming extent in quite a number of 
 the smaller towns in the western part of this State. The investigation was made 
 by Prof. W. C. Hoad, civil and sanitary engineer for the State Board of Health, 
 and the writer. Among the five towns thus visited it was determined that in no 
 case was the typhoid epidemic due to the city water supply. In three of the 
 cities visited we came to the conclusion that the disease was spread by flies. 
 In each town the cases seemed to be in groups in certain portions of the city. That 
 is to say, an initial case would start, and then, immediately surrounding this 
 case, other cases would come down with the disease. There was no common milk 
 or water supply in these three small towns, the first case being usually an im- 
 ported one into the town from some other point, and then came the spread of the 
 infection by the common house-fly. We invariably found a filthy condition of 
 sterilization of the discharges and open privy vaults to which the fly had ready 
 access, many of the houses using no screens whatever. Thus it was reasonable 
 to conclude that the medium of dissemination was that of the fly. It was noted 
 that the disease continued until the death of the fly by the advent of cold weather. 
 This condition has prevailed in a number of the western towns in the State during 
 the past year, and in the absence of the common milk and water supply, there 
 seems to be no other conclusion than that the disease is spread through the infec- 
 tion of food by the fly and by personal contact between the sick and the well. 
 
 Topeka, Kan., Nov. 9, 1908. 
 
 THE “TYPHOID FLY” IN THE GREEN MOUNTAINS. 
 
 Several cases of typhoid infection through the agency of flies are reported 
 by Dr. Henry D. Holton, of Brattleboro, Vt., Secretary of the Vermont State 
 Board of Health : For several years one or more persons living on a large farm, 
 which received its water supply from mountain springs, had typhoid fever in the 
 autumn — new farm hands generally being the sufferers. No pollution of the 
 water supply was discovered, but investigation showed that the farm privy was 
 unscreened and swarming with flies, which had free access to the house and its 
 food supplies. After the old closet was abandoned for more modern arrange- 
 ments, and the house supplied with screens, no cases of typhoid occurred in the 
 neighborhood. The daughter of another farmer in a section in which there had 
 been no typhoid fever for many years came home when she developed a mild case 
 of the disease. Two other children were stricken, and one died. Water condi- 
 tions were found to be unobjectionable, but it was learned that the discharges 
 from the patients had been thrown into a meadow opposite the house, which had 
 no screens. Flies swarmed upon the table at meal time. “To my mind,'’ says 
 Dr. Holton, “undoubtedly the disease was communicated by the flies, all other 
 sources of infection being excluded.” 
 
 8 
 
MOST OF ATLANTA'S TYPHOID FROM FLIES. 
 
 This department has made some investigations of the flies in this city; 
 and in every instance we found the feet of the flies carrying colon organisms, and 
 we have been endeavoring to have an ordinance passed by which to eliminate the 
 common house-fly. We have been convinced for some time that the greater part 
 of our typhoid fever comes more from the activity of the common house-fly than 
 from any other source. Our records in the health office show that typhoid fever 
 comes and goes with the house-fly, while other conditions appear to be the same. 
 
 Claude M. Smith, M. D., 
 
 Atlanta, Ga., Nov. 5, 1908. Director of Laboratory of Hygiene. 
 
 TESTIMONY FROM LOUISIANA. 
 
 There can be no doubt that under certain conditions the house-fly is a 
 greater element of danger than either the supply of impure milk or polluted 
 water, or both. In large cities where the entire population is totally dependent 
 for its milk supply upon the cunning and unscrupulous milkman, the danger from 
 the adulteration of the product with impure water can scarcely be overestimated, 
 and probably surpasses that due to the house-fly. I feel assured that when you 
 have gathered your information from so many sources all over the country, as 
 you propose doing, the result of your work will be most valuable as a matter of 
 record. 
 
 J. A. Estopinal, 
 
 Baton Rouge, La., Nov. 6, 1908. Secretary State Board of Health. 
 
 SECRETARY HUGH L. TAYLOR, OF THE COLORADO STATE 
 BOARD OF HEALTH, SAYS: 
 
 In the city of Denver we had a very sad as well as plain demonstration 
 of the transmission of typhoid fever by flies and milk. Early in August of this 
 year the wife of a dairyman was taken with typhoid fever, remaining at home 
 about three weeks before her removal to the hospital, August 28th. During the 
 first two weeks in September we received reports of numerous cases of typhoid 
 fever in the northern portion of Denver, and upon investigation found that all 
 of these cases had been securing their milk from this dairy. An inspection of 
 the dairy was then made, and in addition to learning of the illness of the dairy- 
 man’s wife, we also found the dairyman himself suffering with a mild case of 
 typhoid fever, but still up and delivering milk. The water supply of this dairy 
 was fairly good. However, we found that the stools of both the wife and husband 
 nad been deposited in an open privy vault located thirty-five feet from the milk- 
 house, which was unscreened and open to flies. The gelatine culture exposed 
 for thirty minutes in the rear of the privy vault and in the milk-house among 
 the milk-cans gave numerous colonies of typhoid bacilli, as well as colon bacilli 
 and the ordinary germ life. The source of infection in the dairyman’s wife’s case 
 is unknown, but I am positive that in all the cases that occurred on this milk route 
 the infection was due to bacilli carried from this vault by flies and deposited upon 
 the milk-cans, separator and utensils in the milk-house, thereby contaminating the 
 milk. This dairyman supplied milk to 143 customers. Fifty-five cases of typhoid 
 fever occurred, and six deaths resulted therefrom. 
 
 This epidemic was given wide publicity by our local papers and has been 
 a vivid object-lesson to the people of Denver. Our Board for some time has 
 
 9 
 
been endeavoring to educate the public and the merchants to the fact that a great 
 many cases of tuberculosis, typhoid fever and kindred diseases are undoubtedly 
 transmitted through the medium of flies. We have been pounding away all sum- 
 mer endeavoring to stop the exposure of foods and vegetables in unscreened con- 
 dition in front of stores, and while we have not been completely successful, we 
 have made a good start and through the public press we have carried on a cam- 
 paign of education. 
 
 In closing I will say that I quite agree with the opinion of those authorities 
 who maintain that the fly is one of the most common disseminators of typhoid 
 infection. I think that one of the most important works for health authorities 
 and sanitarians at present is to educate the public to the danger from flies. 
 
 Denver, Nov. 7, 1908. 
 
 FROM H. M. BRACKEN, EXECUTIVE OFFICER, MINNESOTA 
 STATE BOARD OF HEALTH. 
 
 Several years ago, during the collection of troops for the Spanish-Ameri- 
 can War, an epidemic of typhoid fever broke out in one of the camps in this 
 State, and in that instance the study was carefully carried on until the final con- 
 clusion was reached that the general infection was through flies. This report 
 was sent in to the Surgeon-General of the Army at Washington. We fully recog- 
 nize this possibility, as shown by our regulation relating to the construction of 
 cesspools and vaults. Regulation 123 reads as follows: “All human excreta 
 
 in cities and villages shall be deposited in sewers, cesspools or vaults. The cess- 
 pools or vaults must be made water-tight, and fly-proof.’’ 
 
 St. Paul, Minn., Nov. ii, 1908. 
 
 FLY-BORNE TYPHOID IN SOUTH DAKOTA. 
 
 I have just investigated a specific case in which a small epidemic of typhoid 
 fever was undoubtedly caused from infection being carried by the common 
 house-fly. The case was something like this: In a town of 1,500 population, with a 
 sewer emptying into a neighboring stream, we had an unusual period of drouth, 
 the stream becoming very low and the sewage emptying above the water level. 
 This left a polluted cesspool accessible to flies and other vermin. About a dozen 
 cases broke out in the immediate vicinity of this, the rest of the' city being en- 
 tirely free from it. The epidemic stopped as soon as the frost came and killed 
 the flies. I believe that more cases of typhoid fever are caused by flies than by 
 any other source of infection. They carry the germs and plant them in good 
 culture media, such as milk, vegetables and otlier food products. 
 
 J. Grassick, M. D., 
 
 Grand Forks, N. D., Nov. 16, 1908. Secretary State Board of Health. 
 
 A TYPHOID OUTBREAK DUE TO CONTAMINATED MILK. 
 
 Several years ago there occurred a small outbreak of typhoid fever of 
 about a dozen cases. Each family affected derived its milk supply from the 
 same dairy. There was no other common probable source of infection. In- 
 vestigation of the dairy disclosed conditions which could very well have pro- 
 duced the infection, and the then acting health officer attributed the outbreak 
 to contaminated milk. We exclude from the city the product of any dairy on 
 
 10 
 
the premises of which there is typhoid fever and continue the exclusion of the 
 product until all conditions which might favor the transmission of the disease 
 are removed. We are also quite convinced that contaminated water is of the 
 utmost etiologic importance in regard to this disease. 
 
 David J. Levy, M. D., 
 
 Kalamazoo, Mich., Nov. 19, 1908. Health Officer. 
 
 AGAINST THE THEORY OF FLY EPIDEMICS. 
 
 We have studied the question of transmission of typhoid fever by flies 
 to some extent, and are of the opinion that flies are common carriers of typhoid 
 fever; especially is this true of isolated cases. However, we do not believe that 
 flies cause epidemics of typhoid fever. Where we find a number of cases in a 
 locality we are convinced that the water or milk is affected. 
 
 T. D. Tuttle, M. D., 
 
 Helena, Mont., Nov. 6, 1908. Secretary State Department of Public Health. 
 
 FLIES SPREAD TYPHOID WITHIN AN INFECTED HOUSE. 
 
 Generally speaking, neighborhood typhoid (local epidemics) is due to 
 milk and flies. If a considerable number of cases develop in a given vicinity, 
 it is our policy to devote especial attention to the milk supply of that vicinity. 
 During the past year I should say that we have had definite proof of the milk 
 origin of about six such small local epidemics. The typhoid that spreads within 
 a house from one member of a family to another, or from one occupant of a 
 house to others, we believe to be due to flies and fingers. 
 
 W. A. Evans, M. D., 
 
 Qiicago, Nov. 6, 1908. Commissioner of Health. 
 
 THE FLY CAMPAIGN IN FLORIDA. 
 
 It gives me pleasure to send you under separate cover a 'ffiy card”* 
 which the State Board of Health of Florida has lately published and distributed. 
 I think that you will discern from this poster the position of this board in 
 regard to these disease-carriers, and as confirming the reports of Shakespeare, 
 Vaughan and others as to the danger which the fly is as a constant menace to 
 the public hoalth in conveying the typhoid fever on its proboscis and feet. 
 
 Joseph Y. Porter, M. D., 
 
 Key West, Fla., Nov. 5, 1908. State Health Officer. 
 
 DR. GOTTFRIED KOEHLER, CHIEF FOOD INSPECTOR OF DEPART- 
 MENT OF HEALTH OF THE CITY OF CHICAGO, SAYS: 
 
 We have been actively engaged in a crusade against the transmission 
 of this disease [typhoid] by flies during the past year. In 1902, when we had 
 quite an epidemic of typhoid fever in this city, Dr. Alice Hamilton made some 
 investigations on the above named question and came to the conclusion that 
 flies were an important medium for the transmission of typhoid. Her article 
 appeared in Vol. 40, of the American Medical Association,” page 576. It 
 
 was entitled, “The Fly as a Carrier of Typhoid.” The work was done in the 
 laboratory of the Memorial Institute for Infectious Diseases. 
 
 Chicago, Nov. 5, 1908. 
 
 ♦Reproduced opposite page 47 of this pamphlet. 
 
 11 
 
FLIES CARRY GERMS FROM EXCRETA TO FOOD. 
 
 I have not been making any special investigations with regard to this 
 matter, but am of the firm opinion that a large percentage of the cases of 
 typhoid fever which cannot be traced directly to contaminated water, milk or 
 other food products are caused by the infection of food by flies that have had 
 access to some privy or place where the excreta of typhoid fever patients is 
 present. The fact that from two to three per cent of all cases of typhoid fever 
 are now recognized as being more or less chronic bacilli-carriers only empha- 
 sizes the danger. Even if every case was properly nursed, and the excreta 
 properly disinfected during the active stage of the disease, the danger may still 
 be present for months and even years in some cases. Flies having access to the 
 excreta of such people become, of course, just as dangerous as if these people 
 were actively suffering from the disease. Of course it is difficult to prove fly 
 infection in specific cases. I have lately had brought to my attention four 
 cases of typhoid fever in one family, in which the likelihood of flies carrying 
 the disease is considerable. There is a privy vault on the premises, and the 
 undisinfected excreta of the first patient were deposited in it. The other three 
 cases were not taken sick for several weeks, and were all children who did not 
 nurse the first case at all, and this case was removed shortly after the onset of 
 the disease. Flies were very prevalent. We caught some of them and are 
 making a bacteriological examination of them to see if we can find any typhoid 
 fever bacilli. This work has not yet been completed and it is doubtful whether 
 or not we will succeed in isolating the desired organisms. Of course a nega- 
 tive result will be of no significance. 
 
 With regard to my opinion as to the transmission of typhoid fever through 
 polluted milk and water, there is no question that these two media are fre- 
 quently the vehicle of the disease, but I could not give an opinion as to the 
 percentage of typhoid fever contracted from milk and water and from fly infec- 
 tion. Selskar M. Gunn, M. D., 
 
 Orange, N. J., Nov. 4, 1908. Health Officer. 
 
 MOST WASHINGTON TYPHOID DUE TO FLIES. 
 
 In a public address before a convention of public health officers held in 
 Oregon in 1902, I stated that too much stress was laid upon the pollution of 
 water and not enough upon flies, as I believed the vast majority of cases were 
 due to the latter. While I do not believe that either impure milk or polluted 
 water is directly responsible for more than a very small portion of typhoid 
 fever cases, and that the former opinion of considering these two articles the 
 source of all cases was vicious, inasmuch as it has prevented proper investiga- 
 tions of other possible and probable sources of the disease, I do, however, 
 think that both impure milk and polluted water supplies indirectly increase the 
 number of typhoid fever cases, by the fact that both lower the resistance of the 
 normal healthy person to this disease, and thereby enable the bacilli to thrive 
 in cases where they would, ordinarily, with pure water and pure milk, not 
 do so. They are also, in my opinion, capable of transmitting the typhoid bacilli 
 in a small proportion of cases, and we should, therefore, be careful not to 
 cause the pendulum to swing too far the other way, so that they will not be 
 considered in connection with an investigation of this disease. 
 
 Elmer E. Heg, M. D., 
 
 Seattle, Wash., Nov. 10, 1908. Secretary State Board of Health 
 
 12 
 
AGENCY OF FLIES IN SPORADIC CASES OF TYPHOID. 
 
 That typhoid germs may be transmitted by flies has, it seems to me, 
 been abundantly proved, especially in our experience during the Spanish- 
 American War. That typhoid bacilli may be transmitted through impure milk 
 and water supplies there is absolutely no question. The numerous epidemics of 
 typhoid on record, proved to have been caused through both these agencies, are 
 convincing beyond question. As to the cause of many so-called sporadic cases, 
 the source of which is generally not discovered, I am of the opinion that flies 
 may be one of the prolific factors, but to what extent is a matter of conjecture. 
 
 Concord, N. H., Nov. 4, 1908. Irving A. Watson, M. D. 
 
 FROM THE SECRETARY OF THE DELAWARE STATE BOARD 
 
 OF HEALTH, 
 
 This Board has always acknowledged the grave dangers of polluted 
 water and milk supplies, and in all epidemics has especially investigated these 
 acknowledged sources of infection. My individual opinion as to the trans- 
 mission through the medium of flies is that they are common carriers of typhoid 
 bacilli. Of course typhoid fever is with us when Jack Frost has sent the fly 
 to his winter quarters. A. E. Frantz, M. D. 
 
 Wilmington, Del., Nov. 7, 1908. 
 
 FLIES MORE DEADLY THAN SPANISH BULLETS. 
 
 The communicability of typhoid fever through the medium of the house- 
 fly has interested me ever since the Spanish- American War. I have made a 
 compilation of figures regarding typhoid fever as we saw it then. It shows 
 that of 133,513 men, 22,420 had typhoid fever, from which 1,924 died; the 
 number of deaths from all causes was 2,197. Comparing this with the exper- 
 ience of the Twenty-third Regiment, U. S. Infantry, encamped at the James- 
 town Exposition grounds for six months in the summer of 1907, we have an 
 object-lesson that should be known to all. The latter organization had only 
 about two per cent of sickness of all kinds, virtually had no flies or mosquitoes, 
 though living on swampy ground only ten feet above ocean level. Reports of 
 its experience can be found in copies of the “Military Surgeon” for the latter part 
 of that year. In this locality we have had rather more than our usual number 
 of fall typhoid cases, in persons who have had their summer outings in tents and 
 in attendance at camp meetings. 
 
 D. S. Burr, M. D., 
 
 Binghamton, N. Y., Nov. 8, 1908. Health Officer. 
 
 FLIES SPREAD TYPHOID MORE RAPIDLY THAN MILK OR WATER. 
 
 During the past summer there were some two hundred cases of typhoid 
 directly traceable to the water supply contaminated by sewage, the foci of infec- 
 tion following plainly the line of the water mains so infected. In none of these 
 cases (except in so far as the fly may have played an important part in trans- 
 ferring the contagion from patient to patient in food products, etc.) could the 
 fly be charged with having carried the original infection. On the other hand, 
 the writer, who was then surgeon of the Thirteenth United States Infantry, can 
 positively state that the outbreak of typhoid fever in the army camps at Mobile 
 
 13 
 
and Tampa in the spring and summer of 1898 was directly traceable to the fly 
 as the chief and practically only medium of transmission of the disease. 
 
 The facts given above would indicate my opinion as to the transmission 
 of the disease through polluted milk and water supply. 'I am inclined to the 
 opinion, however, that, once started in a community through any original source, 
 the danger and liability of extension of the disease through the medium of the 
 house-fly is incomparably greater than from polluted milk or water only, without 
 the fly. William B. Winn, 
 
 St. Louis, Mo., Nov. 6, 1908. Assistant Health Commissioner. 
 
 FLIES JOINTLY RESPONSIBLE WITH POLLUTED WATER 
 AND MILK. 
 
 I am firmly convinced from the experiments of others and my general 
 observation and knowledge of the habits of the fly that it is a factor of consid- 
 erable importance in the spread of such diseases as typhoid fever. I am certain 
 from investigations of epidemics which I have made in Iowa and from my 
 knowledge of the investigations of epidemics made by other competent and reli- 
 able men, that epidemics of typhoid fever are often the result of polluted water 
 supplies and frequently, also, of milk that has been polluted either by water or 
 more directly by individuals who carry typhoid bacilli with them. I certainly 
 believe that milk and water represent a far more important source of infection 
 than flies. Henry Albert, M. D., 
 
 Director Hygienic Laboratory, Iowa State University. 
 Iowa City, Nov. 10, 1908. 
 
 FLY-BORNE TYPHOID VERY FREQUENT IN VIRGINIA. 
 
 I believe that very few of our typhoid epidemics in Virginia are caused 
 by polluted water or milk. Flies certainly play a very large part in the epidemi- 
 ology of the disease. This department will be glad to furnish you any further in- 
 formation in regard to the matter that you may desire, or co-operate with you in 
 any investigation of the matter. The small local epidemics in Virginia towns offer 
 very inviting fields for the study of typhoid, and it is the purpose of this depart- 
 ment to put several men on the problem next summer. 
 
 Allen W. Freeman, M. D., 
 
 Richmond, Va., Nov. 9, 1908. Assistant State Health Commissioner. 
 
 FLIES SHOULD BE KEPT FROM SEWAGE. 
 
 I have had occasion to investigate a number of typhoid outbreaks in this 
 State, some of which I have attributed to flies, although perhaps no more fre- 
 quently than to impure milk and polluted water. Flies, milk and water I con- 
 sider the common causes of the disease, and believe the fact that typhoid fever 
 is most prevalent at the season of the year when flies are most numerous is 
 significant. Since we know that two or three per cent of all persons who have 
 had typhoid fever become chronic bacilli carriers, and that there are many walk- 
 ing cases of the disease which go unrecognized, it is evident how important is the 
 proper disposal of sewage, so that it cannot be accessible to flies or be carried by 
 heavy rains into our springs and water supplies. The proper disposal of sewage 
 and excrement is the most important question in the prevention of typhoid fever. 
 
 Joseph H. Townsend, 
 
 Hartford, Conn., Nov. 6, 1908. Secretary State Board of Health. 
 
 14 
 
FLIES AN IMPORTANT FACTOR IN MARYLAND TYPHOID. 
 
 I firmly believe that flies are an important factor in the dissemination of 
 typhoid in our State. Unsanitary conditions which exist around the homes of the 
 general public, especially in the country districts, make the control of this pest of 
 paramount importance. 
 
 I was interested yesterday to hear a discussion by Dr. C. W. Stiles, of the 
 Marine Hospital Service, Washington, D. C., at the first meeting of the Commis- 
 sion on Country Life. He stated that typhoid fever was distinctly a farm disease, 
 from an extended investigation that he had conducted throughout the Union in 
 comparing the number of cases in the country and in the city. It was also shown 
 that typhoid fever was more prevalent in those States where flies were present 
 for a longer period throughout the year and reproduced more rapidly. He stated 
 that in the majority of farmers’ homes that he had visited in the South there were 
 no privies, especially for the laboring class, and that in districts where the negro 
 population was greatest this disease was more prevalent among the whites. 
 
 Congratulating you upon the great work that you are accomplishing, I am, 
 
 Very truly yours, 
 
 Thomas B. Symons, 
 
 College Park, Md., Nov. lo, 1908. State Entomologist. 
 
 NO DISPUTE AS TO TRANSMISSION BY FLIES. 
 
 This department is satisfied that typhoid bacilli in drinking water and milk 
 are a common source of infection. We have had two or three typhoid epidemics 
 through the milk in this State during the last twelve months. That flies transmit 
 the disease I think cannot be disputed, given the necessary conditions and their 
 access to typhoid excreta and to food. I think that the deductions obtained from 
 the investigations at Camp Wyckofif at Montauk Point, after the Spanish War, 
 was an illustration which came very close to our doors. 
 
 Gardner T. Swarts, M. D., 
 
 Providence, R. I., Nov. 9, 1908. Secretary State Board of Health. 
 
 “COMMON CARRIERS” OF TYPHOID BACILLI. 
 
 It is the opinion of this Board that polluted milk and water supplies are the 
 main sources of typhoid fever in localities where sewers are in use. Where in- 
 fected faeces or urine are deposited in open places or vaults we believe that flies 
 act as common carriers of the typhoid bacilli. 
 
 Gustavus a. Badger, 
 
 Lynn, Mass., Nov. 18, 1908. Clerk Board of Health. 
 
 FROM THE HEALTH DEPARTMENT OF OAKLAND, CAL. 
 
 This Health Department has made no investigations to establish the possi- 
 bility of fly transmission of typhoid, but it is our belief that the fly is a frequent 
 carrier of the agents of infection in typhoid as well as several other contagious 
 diseases. We believe, however, that the common mode of transmission is by 
 drinking water polluted with sewage ; and we know that certain epidemics have 
 occurred through pollution of milk with the typhoid bacilli at the dairy. The 
 epidemic of a few years ago in our neighboring city of Palo Alto was directly 
 traced to milk pollution. E. W. Ewer, M. D., 
 
 Health Officer. 
 
 Oakland, Cal., Nov. 12, 1908. 
 
 15 
 
MICHIGAN TYPHOID CASES TRACED TO FLIES. 
 
 We have some data bearing on the agency of flies in the spread of typhoid 
 fever, thirty-eight cases having been reported as traced to flies, together with 
 some data relating to precautions exercised toward exclusion of flies from the 
 sick room of a typhoid fever patient. 
 
 Because the recognition of flies as an agency in the spread of typhoid 
 fever and tuberculosis is of such recent growth, and because we have meagre data 
 on which to base an opinion, I fear I cannot give you much assistance on this 
 point ; but at the same time I may say that I do not doubt that flies are a greater 
 agency in the spread of these two diseases than we can at present say. I am not 
 ready to subscribe to the belief that they are of greater importance than either 
 water or milk. F. W. Shumway, M. D., 
 
 Secretary State Board of Health. 
 
 Lansing, Mich., Nov. 17, 1908. 
 
 FLIES A DANGER IN PUBLIC INSTITUTIONS. 
 
 It has been my observation in our institutions that the scattering cases of 
 typhoid are mostly traceable to milk and especially the water supplies. In schools 
 (industrial, blind, etc.) prisons, soldiers’ homes, etc., when large outbreaks have 
 occurred after single cases it has usually been traceable to flies. Usually the 
 cause of the first case is uncertain. Louis Leroy, M. D., 
 
 Bacteriologist. 
 
 Memphis, Tenn., Nov. 19, 1908. 
 
 GENERAL BENEFIT OF ANTI-FLY CAMPAIGNS. 
 
 I have always considered the fly a potential danger which varies greatly 
 under different conditions. Just how much disease to attribute to this insect pest 
 in the aggregate would be a difficult matter to estimate. I believe that the move- 
 ment for the restriction of the fly nuisance a good one ; for whatever makes for 
 cleanliness by the prompt removal of filth and refuse from our environment and 
 its ultimate distruction as a breeding ground for flies opposes to a certain degree 
 the transmission of many other disease germs than those which the fly presum- 
 ably carries. Theobald Smith, M. D., 
 
 Harvard University Medical School. 
 
 Boston, Nov. 13, 1908. 
 
 FLIES RESPONSIBLE FOR A LARGE PERCENTAGE OF TYPHOID 
 
 CASES. 
 
 The Board of Health of this city has always held the common house-fly re- 
 sponsible for the transmission of typhoid in a large percentage of cases. The 
 annual report of the Board of Health for the fiscal year ending July i, 1907, 
 describes experiments that conclusively prove the house-fly responsible for prac- 
 tically 151 cases of typhoid fever subsequent to the great earthquake and fire. 
 
 W. C. Hassler, M. D., 
 
 San Francisco, Nov. 23, 1908. Chief Sanitary Inspector. 
 
 TYPHOID DEATH-RATE CUT IN HALF BY FLY CAMPAIGN. 
 
 We have been making strenuous efforts to protect the homes of this city 
 against flies. I am very glad to state that the death-rate from typhoid fever, with 
 
 16 
 
the same water supply, has been more than cut in half so far this season. We be- 
 lieve that work along these lines has produced remarkable results. However, it 
 is but fair to say we have been making strenuous efforts to put the city in better 
 sanitary condition in other respects. Our milk supply has been carefully watched, 
 as has the ice supply. We believe, nevertheless, that keeping the flies from our 
 homes has produced very important results. 
 
 J. E. Crichton, M. D., 
 
 Seattle, Wash., Oct. 21, 1908. Commissioner of Health. 
 
 MILK INFECTED THROUGH FLIES. 
 
 In my opinion flies are responsible for more transgressions along the lines 
 stated than people at present appreciate, especially as relates to typhoid fever. I 
 am convinced that in many instances typhoid-infected milk results from contami- 
 nation through flies. There was a notable example of this within my observation 
 two or three years ago in which the circumstances seemed to prove that the milk 
 produced by a small dairy, which was responsible for typhoid fever in twenty-six 
 families, was infected by contact with flies. At a previous time there had been 
 a case of typhoid on the premises and the excreta had been deposited in a privy 
 vault without having been disinfected. T. B. Beatty, 
 
 Salt Lake City, Utah, Nov. 27, 1908. Secretary State Board of Health. 
 
 FROM THE MAINE STATE BOARD OF HEALTH. 
 
 Basing our opinion upon the statements of other persons outside of our 
 members, we believe that flies constitute a serious source of danger when they 
 have access alike to typhoid infection and food supplies. While I amx not in a 
 position to make any positive statements on this point, my personal belief is that 
 infected milk and infected water supplies are far from being an inconsiderable 
 cause of typhoid fever. A. G. Young, M. D., 
 
 Secretary. 
 
 Augusta, Me., Nov. 5, 1908. 
 
 CINCINNATrS EXCELLENT TYPHOID RECORD. 
 
 Cincinnati has had a most interesting experience during the last year. 
 During the month of October, 1908, there were but thirty cases of typhoid re- 
 ported, notwithstanding that this disease was practically epidemic throughout the 
 entire valley, and the low state of the Ohio River (the lowest in many years) 
 had made it practically an open sewer. The fact that Cincinnati has not exper- 
 ienced the worst epidemic of typhoid in its history I ascribe to the wonderful work 
 of our newly completed municipal water works. Of these thirty cases reported 
 in October, fully one-half were children, for the most part infants. From this it 
 can be readily inferred either that infection occurred through the milk supply or 
 that in children there is a susceptibility to the typhoid germ. Personally I believe 
 that it is due to a polluted milk supply, as the milk conditions of our city are truly 
 deplorable. In Newport, Kentucky, there have recently been over thirty cases of 
 typhoid fever traced to one dairyman. While I recognize the agency of flies in 
 the conveyance of typhoid, also the possibility of the contagiousness of the disease, 
 yet I believe that the large majority of cases are due to polluted drinking water. 
 
 Mark A. Brown, M. D., 
 
 Cincinnati, Nov. 12, 1908. Health Officer. 
 
 17 
 
UNITED ACTION AGAINST THE FLY IN MASSACHUSETTS. 
 
 I have in hand your note of the 3rd inst., with reference to flies and 
 typhoid fever. It is a pleasure to report to you from two sources, the Health 
 Department and the special committee of the Massachusetts Association of Boards 
 of Health. From the former Board I may say that no definite plan of warfare 
 has been adopted. The matter has been under consideration for a long time, 
 and it is through the action of the Boston Board that the Massachusetts Asso- 
 ciation has taken up the matter. The reason for this is that it seemed as if 
 the different boards could better take up the matter with a uniform policy, rather 
 than with a different one for each few square miles of territory. Any success- 
 ful war, therefore, would not only affect the immediate territory interested, but 
 would be a factor towards the immunity of neighboring communities. With 
 reference to the Health Department of the City of Boston, I may say that the 
 attitude is conservative. We know that the fly can carry infection, but we are 
 utterly unable to say to what extent. We have been able, in most of our epi- 
 demics, to trace the infection to milk or the well-water with which the utensils 
 were washed. In our latest cases it was an employee on the milk farm or at the 
 dairy. The drinking supply in the larger cities of Massachusetts is pretty well 
 guarded, so that we do not now look for much typhoid from that source. On the 
 contrary, the country supplies are not well guarded. We are regarding the in- 
 fection by the means of flies as possible, and as a factor to the spread of the 
 disease, but we consider it as yet not to be a major factor, and believe that the 
 milk infection is much more dangerous. 
 
 In July the Massachusetts Association appointed a committee to con- 
 sider the fly nuisance. This committee included Dr. C. V. Chapin, of Prov- 
 idence, chairman; Dr. Charles E. Simpson, of Lowell, Dr. Lyman A. Jones, 
 of North Adams; James C. Coffey, of Worcester, and John Ritchie, Jr., of Bos- 
 ton. A printed circular* prepared by Dr. Chapin, used by him in his Providence 
 work, was presented by the Committee at the meeting of the Massachusetts 
 Association, and it was voted to continue the committee and empower it to 
 secure the distribution of the circulars during the winter and early spring, so as 
 to catch the next fly season in advance. John Ritchie, Jr., 
 
 City Health Commissioner. 
 
 Boston, Nov. 6, 1908. 
 
 A CANADIAN OPINION. 
 
 I can refer you to no investigation in re transmission of typhoid fever 
 by the medium of flies. However, I believe them to be one cause of its propa- 
 gation, none of the others being excluded, among them the well known source 
 of infection by the medium of polluted water supply. 
 
 E. Pelletier, M. D., 
 
 Secretary, Board of Health, Province of Quebec. 
 Montreal, Canada, Nov. 4, 1908. 
 
 TWO WATER-BORNE EPIDEMICS IN OREGON. 
 
 We have made no investigation of the transmission of typhoid fever by 
 flies, although it is the opinion of our board that this is one of the most 
 ijnportant ways. With regard to the transmission of typhoid fever by impure 
 
 *Reproduced on page 46 of this pamphlet. 
 
 18 
 
milk and polluted water supply, I will say that we have had two serious epidemics 
 in this State, one occurring at Eugene in 1905, in which the water supply was 
 polluted directly from the sewer system, and another occurring at The Dalles, 
 Oregone, in which the infection was traced to the water supply. Bacteriological 
 examination of this water demonstrated the presence of faecal infection. 
 
 Robert C. Yenney, M. D., 
 
 Portland, Ore., Nov. 7, 1908. State Health Officer. 
 
 FROM DR. L. R. THURLOW, HEALTH OFFICER OF PLAINFIELD, N. J. 
 
 Thus far this year we have had two distinct outbreaks of typhoid fever. 
 The first was in August, and there were eight cases at the time, all of which 
 were in one neighborhood. The second was in October, when eighteen cases 
 were reported. In both of these instances the importance of transmission of 
 the disease by flies was carefully considered. The first outbreak occurred in a 
 good portion of the city ; there were no vaults or cesspools, and the houses were 
 all well screened. The second outbreak was not confined to any one locality, and 
 the indications seemed to indicate a milk infection. We were, however, unable 
 to find any possibility of infection on the dairy premises, or in any part of the 
 transportation or delivery of the milk. 
 
 In regard to the transmission of typhoid fever by impure or polluted 
 water compared with the transmission of flies, my experience points to water 
 as the most important source of infection; second to this, milk. 
 
 Plainfield, N. J., Nov. 20, 1908. 
 
 A MILITARY CAMP EPIDEMIC CAUSED BY FLIES. 
 
 At the time of the Spanish-American War the Fifteenth Minnesota Vol- 
 unteers, encamped at the Fair Grounds, suffered an epidemic of typhoid. The 
 State Board of Health investigated the epidemic and published their findings in 
 their annual report. This epidemic was shown to have been spread by flies, and 
 so far as I know was the first epidemic of typhoid studied from that point of 
 view. There is no doubt that typhoid is spread by means of an impure milk and 
 water supply, though no epidemics have been traced to that cause here, as our 
 water and milk supply is excellent J. M. Armstrong, M. D., 
 
 St. Paul, Minn., Nov. 27, 1908. Assistant Commissioner of Health. 
 
 FLIES MOST DANGEROUS IN CAMPS. 
 
 The writer is of the opinion that flies play no part in the present increase 
 in cases of typhoid in this city, as the increase began during March, and the 
 decrease during the summer months. During the past summer, which was 
 extremely dry, there was a decrease in the number of cases, but I am expect- 
 ing more trouble as a result of the present and future rainfalls. I am of the 
 opinion that flies play a very important part in spreading the disease under 
 certain conditions, such as prevail in camps where sanitation is imperfectly 
 maintained. Milk is such an excellent culture for germs that it is easily con- 
 taminated if placed in cans washed in water containing typhoid, or if exposed 
 to an atmosphere contaminated with germs of scarletina or diphtheria. This 
 is too well known, doubtless, to require mention. 
 
 R. W. Robinson, M. D.» 
 
 Auburn, N. Y., Nov. 20, 1908. Health Officer. 
 
 19 
 
CASES CASTING SUSPICION UPON FLIES. 
 
 At the request of Mr. E. S. Allen, I am forwarding certain information 
 in regard to cases of typhoid fever at the '‘Mountain House Property’’ in this 
 village. John Flannery — age twelve years — had been sick some two weeks; 
 no doctor in attendance; was removed to St. Mary’s Hospital on November 23; 
 typhoid fever. He had been visiting in West Orange and Millburn about a 
 month before removal. Own water supply and own milk supply. No milk 
 or water used on premises except own supply. No oysters used. At this 
 date the rest of the family were in perfect health. On October 5, Willie — age 
 thirteen years — and Leo — age eight years — were removed to Memorial Hospital. 
 Annie — age six years — was not feeling well, but was not sick enough to stay 
 in bed. On October 24 Annie was removed to Memorial Hospital. Sample of 
 water examined showed but slight amount of organic matter, probably due 
 to leaves in spring. Flies were then caught in a cage placed in the closet 
 in which milk, cake and bread were kept. Colon bacilli have been isolated from 
 the feet of these flies. Up to the present we have been unable to get typhoid 
 bacilli, but probably may be able to identify. The house was swarming with 
 flies. The privy, standing seventy-five feet from unscreened window, contained 
 numerous flies. There was a direct connection between the room in which the 
 food closet was situated and the unscreened window. Although these people 
 were told after the first case to kill all the flies and to disinfect the privy, there 
 was no evidence that anything had been done. The board cleaned the house, 
 floors, etc., killed flies and disinfected the privy after October 15. 
 
 A. C. Benedict, 
 
 South Orange, N. J.» Nov. 23, 1908. Health Department Inspector. 
 
 PITTSBURG SUFFERS MOST FROM WATER. 
 
 During the past year typhoid fever sank to about one-fourth its previous 
 prevalence. We had an increase in August in about the usual proportion. 
 There is one reason why the great epidemic prevalence of typhoid fever in 
 Pittsburg cannot be explained by flies, and that is that we have almost as 
 much typhoid fever in the cold weather as in the warm. It is also true that 
 where houses are not connected with sewers the methods of disposal of excreta 
 do not favor the access of flies, owing to darkness. I do not mean by this 
 expression to assert that flies have nothing to do with the dissemination of 
 typhoid fever during the warmer months, but they certainly do not cause the 
 excessive typhoid fever rate which we have been accustomed to until the past 
 year. E. T. Matson, M. D., 
 
 Executive Officer Typhoid Commission, Bureau of Health. 
 Pittsburgh, Pa., Nov. 17, 1908. 
 
 FROM DR. JAMES BOSLEY, HEALTH COMMISSIONER OF 
 BALTIMORE. 
 
 We are familiar with the report of Dr. Jackson and indorse the con- 
 clusion that the common house-fly is a possible carrier of disease under certain 
 conditions. As far as Baltimore is concerned, we have as yet had but little 
 evidence that the fly has been directly concerned in the transmission of typhoid 
 fever, which we believe, however, to be due more to the fact that the fly has 
 not been in contact with typhoid stools, than to its inability to carry the organism 
 
 20 
 

 PRIVY VAULTS, SWARMING WITH FLIES, ADJOINING KITCHK^ DOOR 
 These conditions, inviting disease and insuring the pollution of food, are practically duplicated in hundreds 
 of towns besides Pittsburg, in which this photograph was taken. 
 
 By courtesy of The Survey 
 
 FLY ON PIECE OF SPONGE CAKE 
 His last promenade may have been over unmentionable filth in the neighborhood 
 of the dining room. 
 
 Photograph by W. L. Underwood. 
 
 (Permission of Doubleday, Page & Co.) 
 
if infected. At present we consider that typhoid fever in Baltimore is mainly 
 due to the transmission of polluted milk and polluted water. In our judg- 
 ment transmission of typhoid fever by flies must be very much less than trans- 
 mission by milk and water. 
 
 Baltimore, Md., Dec. 5, 1908. 
 
 A NON-COM MITAL REPORT. 
 
 We have made no investigations, but feel very positive that flies play a 
 most important part in the transmission of typhoid and other germs. As to 
 the relative importance of flies and milk or water, we have no positive informa- 
 tion. C. C. Lytle, M. D. 
 
 Geneva, N. Y., Dec. 5, 1908. 
 
 TYPHOID IN MINING CAMPS. 
 
 I know of no cases in the State of Wyoming where typhoid fever was 
 transmitted by flies, although there may be many cases, were they investigated, 
 due to that means of transmission. I do know that we have typhoid fever 
 in two localities in the State of Wyoming — mining districts — where the disease 
 is epidemic on account of polluted water supply for domestic purposes. This 
 has been investigated on two or three occasions-. 
 
 Amos W. Barber, 
 
 Cheyenne, Wyo., Dec. 7, 1908. Secretary State Board of Health. 
 
 A SCREENING MOVEMENT IN GALVESTON. 
 
 Our Health Department, by dint of having all cisterns screened, standing 
 water drained off or coated with petroleum, all cesspools in the outlying, un- 
 sewered districts, and all barrels, etc., held in the cotton yards for fire ex- 
 tinguishing purposes, treated with crude carbolic acid, has practically exter- 
 minated the mosquito. The treating of cesspools with crude carbolic acid and 
 the enforcement against permitting accumulation of manure, etc., has very 
 materially lessened the fly pest. 
 
 We are now preparing an ordinance compelling the screening of all 
 kitchens, pantries, dining-rooms, etc., in all hotels, boarding houses, restaurants, 
 etc., and butchers’ and fishmongers’ shops, fruit stands and wagons, and I 
 could use your promised literature to very good advantage in popularizing this 
 screening movement. C. W. Trueheart, M. D., 
 
 Health Officer. 
 
 Galveston, Tex., Dec. 2, 1908. 
 
 MONEY NEEDED FOR TEXAS INVESTIGATIONS. 
 
 In reply to yours of the 30th ult., will state that this department has 
 not been making any investigations with regard to the transmission of typhoid 
 or other germ diseases by flies. I hope your committee will be successful in 
 arousing more universal interest in this matter, and particularly awaken our 
 section and our Legislature to the necessity for more money and more authority 
 in investigation and research along these lines in our State. 
 
 William M. Brumby, M. D., 
 
 Austin, Tex., Nov, 9, 1908. State Health Officer. 
 
 21 
 
THE FLY ONE OF THE GREAT TYPHOID-SPREADING AGENCIES. 
 
 I have made no investigations as to the transmission of typhoid by flies, 
 other than in a general way, but I think that this is one of the great means. 
 Dairies often spread the disease, as does polluted water, but these are not the 
 sole causes. Direct contact and house infection are also means of transmission. 
 In fact, I recognize any means which transmits the germs from one person to 
 another. I consider milk and water as two of the great means of producing 
 epidemics. L. M. Powers, M. D., 
 
 Los Angeles, Cal., Nov. 8, 1908. 
 
 Health Officer. 
 
 FROM THE HEALTH OFFICER OF ALBANY, N. Y. 
 
 In my judgment abundant evidence exists as to the medium of flies as 
 a means of transmission of germ diseases, and every effort should be made by 
 the various political divisions of the State and by individuals and societies to 
 prevent the propagation of flies, by the proper care of manure and other breed- 
 ing sources. During the fly season efforts should be made in localities in which 
 flies are common to prevent their ingress into houses and their proximity to 
 the food supply. While the evidence seems to be sufficient that germ diseases 
 may be transmitted through flies, it is extremely doubtful whether flies are 
 often or ever the means of transmission of typhoid fever. I know of no inves- 
 tigations showing the relation of cause and effect between typhoid fever and 
 the common house-fly. I do not believe, however, that flies are a common 
 source of origin of typhoid fever. The evidence appears to be indisputable that 
 typhoid fever is a water-borne disease and that polluted water is still the 
 most active, the most prominent and the most serious cause of the propagation 
 of typhoid fever. Enough is known also to render it certain that a minority of 
 the cases of typhoid fever arise from a polluted milk supply. 
 
 Joseph D. Craig, M. D., 
 
 Health Officer. 
 
 Albany, N. Y., Nov. ii, 1908. 
 
 SEWAGE THE MOST COMMON MEDIUM OF INFECTION. 
 
 I have read the very interesting report of Dr. Jackson and consider 
 that it contains matter for serious thought. It is my opinion that typhoid 
 can be transmitted in several ways, and that in the majority of instances it 
 is media other than flies that constitute the greatest source of danger. As to 
 the principal method, with the ever-increasing amount of sewage in the public 
 water supplies, it seems to me that this is the most common medium. That 
 flies do transmit typhoid bacilli, I think the experience of our Spanish-American 
 War fully establishes. William G. Prince, 
 
 Buffalo, N. Y„ Nov. g. 1908. Bacteriologist Department of Health. 
 
 DANGER OF FLIES IN AUTUMN. 
 
 I am of the opinion that a great deal of disease is carried by house- 
 flies, especially in the fall of the year, when people are prone to remove their 
 screens too early, with the drying up of the grasses and other vegetable mat- 
 ter. Probably the germs that repose in these media are carried into houses 
 when no obstructions are offered. F. J. Patton, 
 
 Duluth, Minn., Nov. 10, 1908. Health Commissioner. 
 
 22 
 
FLIES HELD TO BE “PROBABLE FACTORS” IN TYPHOID 
 TRANSMISSION. 
 
 Though this bureau has made no special investigations of flies as carriers 
 of disease, we have, nevertheless, looked upon thern as probable factors in 
 such transmission. We have accordingly enforced, in so far as it was pos- 
 sible, regulations aiming to protect food-stuflfs exposed for sale, against flies* 
 and to educate people in the matter of excluding flies from their houses, 
 pantries, etc. As to the roles played by polluted milk and water in the dis- 
 semination of typhoid fever, permit me to say that our opinion upon this point 
 
 is fixed and based upon what we regard as absolutely convincing argument. 
 Until the introduction of filtered water in the city of Philadelphia we were 
 notorious as a typhoid center. With the introduction of filtered water in this 
 city typhoid fever has been practically eliminated from those districts receiving 
 that water, and its elimination progresses with the extension of the system 
 carrying purified water. On the milk question, we have on our records several 
 cases in which typhoid fever was conveyed by milk, as convincing as circum- 
 stantial evidence could make them. A. C. Abbott, 
 
 Philadelphia, Pa., Nov. 5, 1908. Bureau of Health. 
 
 HOUSE-FLIES UNDOUBTEDLY CARRY TYPHOID GERMS. 
 
 It has been proved beyond a question of doubt that typhoid fever 
 may be transmitted by the common house-fly. That the disease may be acquired 
 through polluted milk and water is a well-established fact. It is diflicult to say 
 which of the causative factors indicated is responsible for the greater number 
 of cases of typhoid fever. However, but few sanitarians, in my opinion, will 
 subscribe to the statement that typhoid infection from milk and water is insignif- 
 icant as compared with that through the agency of flies. 
 
 James A. Egan, M. D., 
 
 Springfield, 111 ., Nov. 3, 1908. Secretary State Board of Health. 
 
 DIFFICULTY OF TRACING FLY INFECTION. 
 
 The experience of this department, covering five years, and the investi- 
 gation of 5,808 cases of typhoid fever, have indicated their distribution as to 
 causation as follows: 
 
 Cases imported into the District of Columbia, of unknown origin, 940. 
 
 Cases of local origin: 
 
 Contact cases 366 7.51 per cent. 
 
 Due to milk 135 2.77 per cent. 
 
 Of unknown origin 4*3^7 89.72 per cent. 
 
 Some of the cases of unknown origin are doubtless due to polluted water, 
 and some are probably due to flies. It is very diflicult, however, to trace infec- 
 tion by flies with any degree of accuracy. Such observations as have been 
 made by this department indicate that the extent to which flies act as carriers 
 of typhoid fever infection is much exaggerated. In view of the possibilities, 
 however, of the dissemination of disease through these pests, the Health De- 
 partment is doing whatever it can to diminish the number of flies in the com- 
 munity and toward preventing them from contaminating food products. 
 
 William C. Woodward. M. D., 
 
 Washington, D. C., Nov. 9, 1908. Health Officer. 
 
 23 
 
UNDECIDED AS TO TYPHOID SOURCES. 
 
 I have not made any investigations as to typhoid transmission by flies. 
 As to typhoid transmission by milk or water, here in Galveston the city water 
 is artesian well-water mainly, and typhoid from water infection can almost be 
 excluded, only a few wooden cisterns being used. During the past summer 
 there were a number of mild cases of typhoid in Galveston which were attributed 
 to the distribution of the germs by flies, but as to whether the flies were the 
 real carriers or not was not worked out. 
 
 Galveston, Tex., Nov. 14, 1908. 
 
 M. A. Wood, 
 
 IMPORTANCE OF PROPER DISPOSITION OF TYPHOID DISCHARGES. 
 
 jReplying to your letter of November 4, I would say that I have not 
 made any investigations personally with regard to the transmission of typhoid 
 germs by flies, but it stands to reason that this is one of the many methods of 
 disseminating typhoid fever. Replying to your further inquiry, I would say 
 that I think it a great practical and theoretical error to attempt to lay special 
 stress upon any one means of transmission to the exclusion of the many other 
 means which exist; not only can typhoid fever be transmitted by flies, but 
 also by milk, water and other means. It seems to me that in general it would 
 be well to emphasize the important fact that the infectious material is found in 
 concentrated form in the discharge; hence, when this is properly disposed of, 
 the work of safeguarding against typhoid is reduced to a minimum. 
 
 C. W. Stiles, 
 
 Chief Division of Zoology, Public Health and Marine Hospital Service. 
 Washington, D. C., Nov. 5, 1908. 
 
 FLIES AS ACTIVE AGENTS IN TRANSMITTING TYPHOID. 
 
 We have made no special investigation with regard to transmission of 
 typhoid and other germ diseases through the medium of flies. We have real- 
 ized, however, that undoubtedly the common house-fly has been an active agency 
 in the transmission of disease, and in our lectures emphasize the danger of 
 such transmission and the necessity of eliminating, as far as possible, this factor. 
 In regard to the transmission of typhoid fever and the forces bringing this 
 about, experience proves to us that milk and polluted water are undoubtedly 
 very active agencies. We have had in recent years two milk epidemics of 
 typhoid fever. In one case we traced 116 cases of typhoid in the city of Port 
 Washington to a dairyman who had typhoid in his own family. One hundred 
 and fifteen of these cases were using milk from this man. One patient did not 
 receive his milk from this source, but was a frequent visitor of a restaurant 
 where milk was obtained from this dairyman. This epidemic was in the early 
 autumn and, strange as it may seem, there were no other cases of typhoid fever 
 at this time in this city, with a population of about 5,000. We have just had 
 an epidemic of typhoid fever in the city of Sheboygan, due to polluted water 
 from Lake Michigan, precipitated probably from a large leak in one of the 
 intake pipes and a defect in the wall of the well connecting with a flue extending 
 to the lake shore some twenty feet away. The epidemic at Sheboygan was 
 not confined, however, entirely to the users of water furnished by the water 
 company. It was more or less distributed throughout the city in the homes 
 
 24 
 
of well-water users, but largely confined to the adult population who were 
 active business people and liable therefore to obtain drinking from various 
 points throughout the city. The fly here may have been a factor in the trans- 
 mission of this disease. I cannot believe that the transmission through infected 
 milk and water is insignificant in comparison with other agencies. My obser- 
 vation leads me to believe that these are fundamentally the dangerous factors. 
 We are examining much well water and water furnished by a water system in 
 the smaller localities, and in a large percentage of our investigations we find 
 polluted water in those localities where typhoid is reported. 
 
 C. A. Harper, M. D., 
 
 Madison, Wis., Nov. 6, 1908. Secretary State Board of Health. 
 
 SPORADIC CASES OFTEN DUE TO FLIES. 
 
 There is no question in my mind but that severe epidemics of typhoid, 
 outside of hospital or army quarantines, are nearly all due to the milk or water 
 supply. Sporadic cases and epidemics often have their origin by the germ 
 having been carried by the fly. Dr. Ralph W. Cornell, 
 
 Health Commissioner. 
 
 Omaha, Neb., Nov. 6, 1908. 
 
 FROM DR. G. A. BADING, MILWAUKEE’S HEALTH OFFICER. 
 
 There can be no question of the possibility of transmission of typhoid 
 bacilli by means of flies, particularly in districts where sewage facilities are 
 not provided and where, consequently, the old-fashioned vaults are still in use. 
 This is not the case in our city, and for that reason the particular subject of 
 transmission of typhoid by means of flies has not concerned us to any extent. 
 We have had several instances where mild typhoid epidemics in particular 
 localities were unquestionably due to an infected milk supply, and only last 
 year had a nest of typhoid cases which we traced to polluted water, there being 
 a shallow well from which the water supply had been furnished. On investi- 
 gation, the well water was found polluted to such an extent as to lead us to 
 ascribe the outbreak to that source. 
 
 Milwaukee, Wis., Nov. 7, 1908. 
 
 EXPERIENCE OF A NEBRASKA ENTOMOLOGIST. 
 
 In reply to your communication of November 4 regarding the trans- 
 mission of typhoid and other diseases by flies, I wish to report as follows: 
 I have never made any specific experiments along the line suggested, but have 
 carefully compiled statistics and other accounts that have led me to believe 
 that the house-fly {Musca domestica) and several of its allies are responsible 
 for varying percentages of germ diseases that attack human beings. These 
 percentages depend upon conditions and circumstances that vary among them- 
 selves. In the case of the work of Dr. Jackson, with which I am acquainted 
 only through the report which was issued July last, it can be seen that flies 
 caused a very large percentage of the contamination. I believe that under cer- 
 tain conditions the typhoid germ can be and is transmitted by the contamination 
 of drinking water, milk, etc. A number of years ago our family had a siege 
 of typhoid fever. Eight members suffered attacks from the disease. We had 
 just moved into a new country and used river water for domestic purposes. Our 
 
 25 
 
parents and grandparents drank tea and coffee and escaped the contamination, 
 while seven children and a servant drank water. All of those using water came 
 down with typhoid in due time. Other persons in the small town contracted 
 the disease also. Investigation revealed a case of the disease ten miles up 
 stream some weeks previously, where the sewage from the sick room was 
 thrown into the river. Other cases likewise occurred further down stream. 
 Cases of typhoid have been traced to the use of milk right here in Lincoln, both 
 where the disease occurred in the family of the milk man and where germs 
 of the disease were found in the well-water used in washing milk cans. Of 
 course in some of these last named instances the flies might readily have been 
 the agency for spreading the bacilli. Lawrence Bruner, 
 
 State Entomologist. 
 
 Lincoln, Neb., Nov. 7, 1908. 
 
 FROM DR. F. H. PECK, HEALTH OFFICER, UTICA, N. Y. 
 
 While we have never made any investigation in regard to the trans- 
 mission of typhoid and other germs through the medium of house-flies, we 
 have no doubt that this is a frequent cause of infection. As to the transmission 
 through impure milk, it is generally conceded that the only impurities of milk 
 that will carry are its infection through impure water supply, either through 
 adulteration or the use of water in washing milk utensils. We believe that 
 the most potent source of typhoid infection is polluted water. 
 
 Utica, N. Y., Nov. 7, 1908. 
 
 MILK FREQUENTLY INFECTED BY FLIES. 
 
 We have been able to trace one small epidemic of typhoid to a city 
 dairy where in our opinion the milk was infected by flies which had received 
 the infected organism from an overflowing vault. In this city typhoid is un- 
 common; the cases which occur from polluted water are few and are limited 
 to the users of surface wells. It has for some time been the opinion of this 
 department that typhoid in Fort Wayne was chiefly the result of infected milk, 
 of flies and of contact infections; but the exact relationship existing between 
 these factors we have been unable to determine. It is to be borne in mind, 
 however, that milk is frequently infected by flies. 
 
 H. O. Bruggerman, M. D., 
 
 Fort Wayne, Ind., Nov. 7, 1908. Secretary Board of Health. 
 
 TYPHOID AND “CARRIER” CASES. 
 
 My opinion is that, while flies may be a factor of some moment, in such 
 places as military, lumber or mining camps, under ordinary conditions which 
 prevail in our cities flies have little part in the spread of typhoid fever. It does 
 not seem to me that the evidence printed by your committee was at all con- 
 clusive. As regards water infection, I believe that in very many communL 
 ties a large amount of typhoid fever — in some cities, most of it — is caused by 
 contaminated water. In such cities as New York and Providence I believe 
 that practically no typhoid fever is due to infected water. I doubt if milk 
 causes much typhoid, except in the way of sharp outbreaks. On the whole, 
 perhaps 5 to 10 per cent, of our typhoid fever may be considered to be due to 
 milk, though I rather incline to the smaller figure. In cities with a good water 
 
 26 
 
supply and few privy vaults, like New York and Providence I believe that by 
 far the larger part of the typhoid fever is caused by contact infection, and 
 that “carrier” cases are an extremely important factor in its spread. 
 
 Charles V. Chapin, 
 
 Providence, R. I., Nov. 4, 1908. Superintendent of Health. 
 
 FROM DR. SAMUEL A. DIXON, PENNSYLVANIA’S HEALTH 
 
 OFFICER. 
 
 In answer to your letter of the 2nd inst., I beg to say that the statistics 
 of the world show that water is responsible for the transmission of typhoid 
 fever more than anything else known, and I believe impure milk is a close 
 second. 
 
 Harrisburg, Pa., Nov. 5, 1908. 
 
 FROM THE STATE HEALTH OFFICER OF ALABAMA. 
 
 While I am satisfied that flies play an important role in transmitting 
 typhoid fever, and possibly other diseases, yet I am satisfied that typhoid fever 
 is not infrequently transmitted through polluted milk and water. 
 
 W. H. Sanders, M. D., 
 
 Montgomery, Ala., Nov. 4, 1908. 
 
 ALL THREE CAUSES OPERATE IN MARYLAND. 
 
 The question of the relative importance of the fly in transmitting typhoid 
 fever is only to be determined by the importance of other hygienic factors. 
 With an extremely bad water supply, transmission by flies and milk becomes 
 relatively unimportant. When the water supplies are improved, we find a larger 
 proportion of cases due to infected milk, direct contagion, and the action of 
 flies. I regard winter typhoid fever as due almost exclusively to water. I do 
 not consider that there is any warrant for the statement that all other causes 
 of transmission of typhoid are insignificant as compared to that contracted 
 through the medium of flies. Marshall L. Price, M. D., 
 
 Secretary State Board of Health. 
 
 Baltimore, Md., Nov. 4, 1908. 
 
 MONTCLAIR, N. J., HAS ABOLISHED VAULTS. 
 
 Owing to the small number of cases of typhoid fever that we have in 
 a community of this size, local investigations would be of slight value. In order 
 to prevent the spread of this disease by flies we have abolished practically all 
 of the privy vaults in town, and have declared all such vaults to be a nuisance, 
 by ordinance. We also try to secure proper screening of houses in which there 
 is typhoid fever. I hardly see how there can be any question of the danger 
 of transmission of typhoid fever by the use of impure water and milk, for they 
 can become contaminated by the specific germs at any time, and the epidemics 
 that have been traced to infected milk and water supplies are extremely numer- 
 ous. C. H. Wells, M. D., 
 
 Health Officer. 
 
 Montclair, N. J., Nov. 13, 1905. 
 
 27 
 
FROM THE MASSACHUSETTS BOARD OF HEALTH. 
 
 Of eighteen local outbreaks of typhoid fever in different parts of Massa- 
 chusetts, investigated under the direction of Dr. Charles Harrington, late secre- 
 tary of this board, during the years 1905 and 1906, fourteen were traced to milk 
 and three to polluted private or semi-private water supplies. One could not be 
 explained. In eleven of the fourteen outbreaks traced to milk, there was a his- 
 tory of typhoid fever at the place of production, and in the others there was 
 none. Dr. Harrington’s opinion of the matter, stated in his own words, is as 
 follows : 
 
 “With suitable State supervision of milk production, under which it 
 would be unlawful under heavy penalty to ship milk from dairies where typhoid 
 fever or other diseases, communicable through milk, are known to exist until the 
 authorities are satisfied that it can be done with entire safety, such outbreaks 
 could be largely prevented; but under the most practicable and efficient super- 
 vision there will be milk-bome typhoid outbreaks which cannot be traced to any 
 antecedent case on the farm. This is because in any community in which 
 typhoid is endemic, there exist numbers of persons who are unconscious car- 
 riers and disseminators of the typhoid bacillus.” 
 
 William C. Hanson^ M. D., 
 
 Boston, Mass., Nov. 12, 1908. Acting Secretary. 
 
 CORNELL EPIDEMICS FROM MILK AND WATER. 
 
 We have no data concerning flies. We do know that our typhoid epidemic 
 five years ago was due to polluted water. It occurred in the winter time, and 
 those drinking water not connected with the infected water supply escaped 
 trouble. This year ten cases of mild typhoid occurred, and on investigation 
 we discovered that all ten received milk from one man. As all came down with 
 the disease about the same time, and as we have about thirty milk dealers, we 
 feel sure that infection in this instance was due to milk. 
 
 H. H. Crum, M. D., 
 
 Ithaca, N. Y., Nov. 5, 1908. Health Officer. 
 
 FROM THE “OLD NORTH STATE.” 
 
 I have made no special observation as to the transmission of typhoid 
 fever by flies, but I believe that the disease is still transmitted to a very con- 
 siderable extent by infected water and milk. This is especially true where 
 the outbreak is extensive. Richard H. Lewis, M. D., 
 
 Secretary, State Board of Health. 
 
 Raleigh, N. C., Nov. 9, 1908. 
 
 The compiler of this pamphlet wishes to acknowledge the assistance 
 given him in his work not only by those whose letters or other writings are 
 quoted, but also by the following: 
 
 G. S. Dimmick, Inspector of Milk and Foodstuffs, Galveston, Tex. 
 
 Joseph H. Beek, Secretary, St. Paul Jobbers’ and Manufacturers’ Asso- 
 ciation, St. Paul, Minn. 
 
 Melville F. Rogers, M. D., Secretary, Savin Hill Improvement Associa- 
 tion, Dorchester, Mass. 
 
 Laura Keisher, M. D., Bureau of Labor, Washington, D. C. 
 
 Thornas F. Wiseman, Secretary, Board of Health, Fall River, Mass. 
 
 Morris Knowles, Chief Engineer, Bureau of Filtration, Pittsburg, Pa. 
 
 28 
 
THE TRANSMISSION OF DISEASE BY FLIES* 
 
 By Daniel D. Jackson, S. B. 
 
 Flies, as carriers of disease, have engaged the attention of sanitarians 
 for a decade or more, but it has been only within the last two years that ex- 
 tensive studies have been made to establish the extent to which this method of 
 transmission is carried on. 
 
 This recent work has produced a fuller realization of the gravity of the 
 situation, and my remarks on this occasion are intended to give you a resume 
 of what has been brought out by the work of the Merchants’ Association Com- 
 mittee in New York City, and to make a broader use of the principles involved, 
 so as to apply to a greater or less degree to the majority of cities in this coun- 
 try and to any city, town or village in any country where sanitary laws are 
 neglected. 
 
 One of the first to suggest that the transmission of typhoid fever was 
 in many cases due to the agency of the house-fly was Dr. George M. Kober, of 
 Washington, D. C. In the report of the Health Officer of the District of Colum- 
 bia, June 30, 1895, he states that flies may carry to our food supply infectious 
 matter gathered from box privies and from other exposed faecal deposits. 
 
 Seven years previous to this Celli had shown that flies fed with pure cul- 
 tures of typhoid fever bacilli excreted the germs in a virulent condition. 
 
 In 1897 Dr. Wallace Clarke, Health Officer of Utica, N. Y., noted that 
 60 per cent, of the contagious diseases in Utica occurred in the Eighth Ward, 
 a locality not overcrowded and under the same general sanitary regulations as 
 the rest of the city. He found, however, that the garbage dump in this ward 
 had been used also as a dump for human excrement, and that during August 
 (the time of the epidemic of intestinal disease in that city) these dumps were 
 swarming with flies. He at that time attributed the cause of the disease to 
 fly transmission. These dumps have since been removed and proper sanitary 
 methods of sewage and garbage disposal have been adopted, and the death rate 
 of the Eighth Ward of Utica has been thereby reduced to normal. 
 
 In September, 1898, Dr. H. A. Veeder published in the New York 
 “Medical Record” a paper entitled, “Flies as Spreaders of Disease in Camps»” 
 in which he showed that these insects were the carriers of typhoid fever in 
 the army camps during the Spanish-American War. Similar data were brought 
 out by Dr. George M. Sternberg, Surgeon-General, United States Army, in 
 the Philadelphia “Medical Journal” of June, 1899. 
 
 The same year Dr. George H. F. Nuttall wrote an excellent paper on the 
 role of insects in the spread of disease in Volume VIII. of the Johns Hopkins 
 Hospital Reports. The “Report on the Origin and Spread of Typhoid Fever 
 in the United States Military Camps during the Spanish-American War of 
 1898,” by Drs. Reed, Vaughan and Shakespeare, shows that every regiment 
 
 ♦Read before the joint convention of the American Civic Association and the National Municipal 
 League, at Pittsburg, Nov. 19, 1908. 
 
 29 
 
constituting the First, Second, Third, Fourth, Fifth and Seventh Army Corps 
 developed typhoid fever, and that more than 90 per cent, of the volunteer 
 regiments developed it within eight weeks after going into camp. This report 
 also shows that not infected water, but infected flies, were the important factor 
 in the spread of the disease in these camps, and in spite of the fact that more 
 than 80 per cent, of the total deaths were caused by typhoid fever. 
 
 Following these revelations. Dr. L. O. Howard, Entomologist of the De- 
 partment of Agriculture, published several papers on the habits of the house- 
 fly, in one of which (Farmer’s Bulletin No. 155, 1902) he showed that the fly 
 was a potent factor in the transmission of typhoid in country districts, due to 
 neglected box privies. 
 
 It remained for the Water Pollution Committee of the Merchants’ Asso- 
 ciation of New York to show that the fall rise of typhoid fever, which occurs 
 in most cities, and the enormous summer death rate of children from 
 diarrhoeal diseases are also chiefly chargeable to that most detestable of insects, 
 the common house-fly. In 1907 this Committee was appointed by the Merchants’ 
 Association to study and to take measures to prevent, as far as possible, the 
 increasing pollution of the inland waters of New York State. Among the 
 first efforts of the Committee was a study of the pollution of New York Harbor 
 and the sanitary condition of the water-front. 
 
 The Committee’s report, published in December of the same year, shows 
 by careful sanitary inspections and by statistical and bacteriological data that 
 the activity of the house-fly is the chief cause of intestinal diseases in New 
 York City. Further investigations have shown that in most cities where the 
 water supply is not contaminated, and in fact everywhere throughout the world 
 where water supplies are good, the house-fly is the chief source of typhoid 
 fever and other intestinal diseases by the transmission of the germs of exposed 
 faecal matter to the food used for human consumption. 
 
 I will endeavor to give a brief outline of the studies of our Committee 
 and then to show you that their conclusions have a wider and more important 
 application than was at first deemed possible. 
 
 The reports of a corps of inspectors along the water-front of Greater 
 New York all showed the presence of exposed faecal matter; in some cases 
 solid matter from sewers not removed by the tides and in many instances due 
 to the intolerable toilet conditions on the docks. During the hot weeks in sum- 
 mer these human excreta were found to be swarming with flies. By the use 
 of staining fluids, and by other methods these flies were shown to be traveling 
 back and forth from this filthy material to the food of the nearby restaurants 
 and homes. Microscopic examinations of these flies showed them to be carry- 
 ing on their mouths and legs considerable quantities of the filthy matter over 
 which they had walked, and this matter, as would be expected, contained many 
 thousands of faecal bacteria. It was then demonstrated by bacterial methods 
 that this faecal matter containing disease germs would be strewn about on food 
 wherever the fly walked. 
 
 A careful study of the seasonal prevalence of flies by means of daily 
 counts from fly cages in different parts of the city showed that they were active 
 in large numbers only in the comparatively few hot weeks of summer, while 
 the health statistics showed that these were the weeks when an abnormal num- 
 ber of cases of typhoid fever and diarrhoea were contracted. The reported 
 
CHART No. 3 
 
 rcA/'(/ary Marc/i /Ipri/ May yune c/u/y /lagasf Sepfember October Noi^e/nber December 
 
 
 y388 /807 
 /888 ~/S 9 :^ 
 
 /3SS -/890 
 yS 9 J 9 J 
 
 /338-t897 
 
 /388 -1897 
 / 8 87-/896 ^ 
 
 /888-/897 
 
 /889-/698 
 
 / 8 88-/897 
 
 DRtSDtN 
 
 y/tNNJ! 
 
 — i 
 VI^Nf/A 
 
 MUNICH 
 
 0 
 
 C/ tie 5 /lai/jny yood Water 
 Supplies and oeiraye D/6p(, 
 ah, and txce//ent Oeneru 
 Sanitary C o/iditions, 6hj, 
 my Dniform/y Loiy 7ypti,j, 
 Pate Pepardte6s of Tempt, 
 d/t/re. 
 
 BALTIMORE 
 
 ■s,o. BOSTON 
 
 NtWYORK 
 
 BM TMORt 
 
 II oT C/iar///jy.Co/npara/TRelj 
 Poor Se/rape /9/6po6at6 
 or Dad Oenera/ Sanitary 
 Condit/oniS, a//omny oT/k 
 Tran6/n/6S/on of Disease , 
 by Pi ies and a At on //i/y \ 
 Typ/w/d Pea//i Pa/e fo/ion 
 /ny //je Te/npera/are. 
 
 ammmn C/MC/NNjiri 
 
 ^ cr/CHao 
 
 m 
 
 P/f/UDtLPHM 
 
 PHILADELPHIA 
 
 Cd/es iiar/ny a/ //le tm 
 of C/iart/na Poor tVah 
 Sapp /ies and Pn/for/n 
 iy t t/y/i Typ/.o/d Pates 
 T/iroayhoa/ t/ie Ybar, i 
 frith a Hie Pe^ od to 
 Te/npera/are. 
 
 danaary Tebraa/y Marcti 4pr/J May dane da/y Mayast September October A/oye/T/ber December 
 
 O/nOJTrtM 6/fOP7MO TtvCRdOt AIOMT/iLY 
 P7lRl4TiO/y/<S //V THT TvPTfCiO PRYCR DTrlTti PolTCS OT TnPTT 
 
 MERCHANTS ASSOC/AffON 
 Committee on Pollution dr th£ 
 Waters or New YoriS 
 
 TyPPS OT CiTiTS 
 per 700,000 
 
 Edward Hatch, Jr.. cmaipmaS 
 
 J.PlERPONT MORCAN JORN Y. GS, >L YER. 
 
 Albert Vander Veer,/^.D. Daniel D. JAcesd 
 
 \ 
 
■. ; 
 
 • v”. ■ 
 
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 is I ' ' 
 
 ■'f*' . 
 
 
 p 
 
 m 
 
 
 fi . 
 
 t 
 
 i. 4- • ; 
 
 
 V 
 
 &i'4 
 
U.NDEf) 5 YE/IP3. 
 
 U^NUAPY FEBPVYIPY AfYIPCH APP/L MAY JUNE JULY AUeUST 3EPTEMBEP OCTOBEP NOVEMBEQ DECEMBEP MERCHANTS ASSOCIATION 
 
 kV£EK3-l E 3 4 5 6 7 Q S 10 H 12 13 14 /5 !6 17 /8 J9 20 2! 22 25 24 2526 27 28 29 303/ 32 35 34 35 36 57 38 53 40 4/ 42 43 44 45 46 47 48 49 SO 5/ 52 COMMITTEE ON POLLUTION OF THE 
 
CHART No 
 
number of cases of these diseases rose with the rise in the prevalence of flies 
 and fell with but slight lag with the decrease in the numbers of flies trapped. 
 
 Finally maps were made showing by black dots the location of every 
 fatal case of intestinal disease during the fly season. A black belt was found 
 to run along the water-front. Most of the deaths were within three blocks 
 of the shore line. Wherever there was any material exception to the rule 
 investigation showed the presence of exposed out-houses and faecal matter 
 swarming with flies; in other words, conditions as bad as along the water- 
 front. Here also, then, had filth and flies combined in the destruction of 
 human life. 
 
 Do not think for a moment that because you do not live in New York 
 these matters do not directly affect each and every one of you here. The 
 statistics in practically all American cities — and in many foreign cities, too, 
 for that matter — show a marked rise in the number of deaths from typhoid 
 fever and intestinal diseases during the fly season. 
 
 In cities where flies are the chief cause of intestinal epidemics the other 
 seasons of the year show comparative freedom from the disease, while in cities 
 where water and milk epidemics exist these epidemics may occur at any season 
 of the year. The milk epidemic, however, often takes place during the fly sea- 
 son because of the infection of milk by flies at the farm or in the local milk 
 depots. 
 
 The danger to health is greatest in parts of the city where sanitary 
 precautions are most neglected, but even if you live in a comparatively well- 
 cared-for part of town do not receive the fly into your home as a harmless 
 visitor, for he may come in a carriage or on horseback from the filthiest spot 
 in the city. 
 
 Hitherto the fly has been regarded complacently as a harmless nuisance 
 and considered to be an annoying creature with great persistence and excessive 
 familiarity. Regarded in the light of recent knowledge the fly is more 'dan- 
 gerous than the tiger or the cobra. Worse than that, he is, at least in our 
 climate, much more to be feared than the mosquito and may easily be classed, 
 the world over, as the most dangerous animal on earth. 
 
 It has been for some time thoroughly well demonstrated that he is one 
 of the chief agencies in the spread of Asiatic cholera. We now know him to 
 be the source of a high percentage of the cases of typhoid fever and the chief 
 disseminator of diarrhoeal diseases, from which about 7,000 children die annually 
 in New York City alone. 
 
 On Charts No. i and 2, which are presented, can be seen the seasonal 
 rise and fall of reported deaths from typhoid fever and other diarrhoeal dis- 
 eases. It will be noted that year after year they correspond to the Tise and 
 fall of the prevalence of house-flies. 
 
 On Chart No. 2 is shown a comparison of the weekly death rates per 
 100,000 from diarrhoeal diseases of children for six typical American cities. The 
 cities represented by full lines had at the time of charting good water supplies, 
 comparatively free from contamination, while those given by the broken lines 
 had poor or questionable water supplies. 
 
 It will be noted that in the cities of the first type the deaths of children 
 from intestinal disease is higher throughout the year, but that in all of the cities 
 
 31 
 
a sudden and very marked rise takes place during the fly season. It will also be 
 noted that in the cities further south the rise comes earlier in the year. 
 
 On Chart No. 3 are given the seasonal rise and fall of three diiferent 
 classes of cities: 
 
 I. Cities having good water supplies, proper sewage disposal systems 
 and excellent general sanitary conditions, showing an uniformly low typhoid 
 rate throughout the year, regardless of temperature. 
 
 II. Cities having fairly good water supplies, but at the time of chart- 
 ing comparatively poor sewage disposal systems or bad general sanitary con- 
 ditions, allowing the transmission of disease by flies. These diagrams show 
 monthly typhoid death rates, which, if set back two months to correspond with 
 the contraction of the disease, follow the temperature and the activity of the 
 insects. 
 
 III. Cities having at the time of charting poor water supplies and 
 uniformly high typhoid rates throughout the year with little relationship to tem- 
 perature. 
 
 In the accompanying table will be found the actual figures by weeks dur- 
 ing 1907 and 1908 of the deaths from diarrhoeal diseases in New York City, 
 and the number of flies caught in traps at a representative station in the city 
 during the fly season. If during this season we subtract fifty deaths a week as 
 being the normal weekly death rate from diarrhoeal diseases, excluding typhoid 
 fever, we shall have 4,496 deaths due to flies during 1907 and 4,012 deaths due to 
 flies during 1908. 
 
 By the same process, if we subtract six deaths a week as being the normal 
 death rate from typhoid fever in New York City, due to imported cases and direct 
 transmission from these cases, we have about 330 deaths from typhoid fever 
 during the fly season in 1907 traceable to flies, as against an estimate of 260 
 deaths from the same causes in 1908. 
 
 In other words, there has been in New York City this year a reduc- 
 tion during the fly season of about seventy deaths from typhoid fever and 484 
 deaths from diarrhoea. Most of the unsanitary conditions pointed out in last 
 year’s report have not yet been remedied. These evils exist in most of our cities 
 as well as in our country districts, and we as Americans should agitate this mat- 
 ter of sewage disposal and general sanitation, not only for humane purposes, 
 but for patriotic reasons as well, so that we may not feel ashamed to compare 
 our death rates from filth diseases with those of European cities. 
 
 82 
 
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 DAMAGES FOR SICKNESS CAUSED BY FLIES 
 
 The courts have passed upon the question of damages for a sufferer from 
 typhoid who could trace his illness to flies feeding upon the filth of sewage. 
 A few years ago a man living in Germantown, Philadelphia, recovered heavy 
 damages from the city for his illness, which he proved was caused by a stream 
 flowing through his yard which had been polluted by sewage from a house ten- 
 anted by a typhoid patient. The defence relied upon proof that the plaintiff 
 had neither drunk from nor bathed in the stream, but an entomologist con- 
 vinced the jury that he had contracted the disease through the medium of flies 
 which had carried the infection from the stream to the food exposed to their 
 visits in his house. 
 
 33 
 
HOW THE ‘TYPHOID FLY" IS FOUGHT IN 
 
 WASHINGTON 
 
 Dr. L. O. Howard, Ckief of the Bureau of Entomology ^ U. S. Department 
 of Agriculture, in Bulletin No. j 8 
 
 The name “typhoid fly” is here proposed as a substitute for the name 
 “house-fly,” now in general use. People have altogether too long considered 
 the house-fly as a harmless creature, or, at the most, simply a nuisance. While 
 scientific researches have shown that it is a most dangerous creature from the 
 standpoint of disease, and while popular opinion is rapidly being educated to the 
 same point, the retention of the name house-fly is considered inadvisable, as per- 
 petuating in some degree the old ideas. Strictly speaking, the term “typhoid 
 fly” is open to some objection, as conveying the erroneous idea that this fly is 
 solely responsible for the spread of typhoid; but considering that the creature is 
 dangerous from every point of view, and that it is an important element in the 
 spread of typhoid, it seems advisable to give it a name which is almost wholly 
 justified and which conveys in itself the idea of serious disease. Another repul- 
 sive name that might be given to it is “manure fly,” but recent researches have 
 shown that it is not confined to manure as a breeding place, although perhaps 
 the great majority of these flies are born in horse manure. For the end in 
 view, “typhoid fly” is considered the best name. 
 
 In 1899 the writer began the study of the typhoid or house-fly under both 
 country and city conditions. He made a rather thorough investigation of the 
 insect fauna of human excrement, and made a further investigation of the species 
 of insects that are attracted to food supplies in houses. In a paper entitled “A 
 Contribution to the Study of the Insect Fauna of Human Excrement (with 
 special reference to the spread of typhoid fever by flies),” published in the Pro- 
 ceedings of the Washington Academy of Sciences, Volume H, pages 541-604, 
 December 28, 1900, he showed that 98.8 per cent of the whole number of insects 
 captured in houses throughout the whole country under the conditions indicated 
 above were Musca domestica, the typhoid or house-fly. He showed further that 
 this fly, while breeding most numerously in horse stables, is also attracted to hu- 
 man excrement and will breed in this substance. It was shown that in towns where 
 the box privy was still in existence the house fly is attracted to the excrement, 
 and, further, that it is so attracted in the filthy regions of a city where sanitary 
 supervision is lax and where in low alleys and corners and in vacant lots excre- 
 ment is deposited by dirty people. He stated that he had seen excrement which 
 had been deposited overnight in an alleyway in South Washington swarming 
 with flies under the bright sunlight of a June morning (temperature 92° F.), 
 and that within 30 feet of these deposits were the open windows and doors of 
 the kitchens of two houses kept by poor people, these two houses being only 
 elements in a long row. The following paragraph is quoted from the paper just 
 cited : 
 
 34 
 
“Now, when we consider the prevalence of typhoid fever and that viru- 
 lent typhoid bacilli may occur in the excrement of an individual for some time 
 before tire disease is recognized in him, and that the same virulent germs may 
 be found in the excrement for a long time after the apparent recovery of a 
 patient, the wonder is not that typhoid is so prevalent but that it does not pre- 
 vail to a much greater extent. Box privies should he abolished in every com- 
 munity. The depositing of excrement in the open within town or city limits 
 should be considered a punishable misdemeanor in communities which have 
 not already such regulations, and it should be enforced more rigorously in 
 towns in which it is already a rule. Such offenses are generally committed after 
 dark, and it is often difficult or even impossible to trace the offender ; therefore, 
 the regulation should be carried even further and require the first responsible 
 person who notices the deposit to immediately inform the police, so that it may 
 be removed or covered up. Dead animals are so reported ; but human excrement 
 is much more dangerous. Boards of health in all communities should look after 
 the proper treatment or disposal of horse manure, primarily in order to reduce 
 the number of house-flies to a minimum, and all regulations regarding the dis- 
 posal of garbage and foul matter should be made more stringent and should be 
 more stringently enforced.’’ 
 
 Even if the typhoid or house-fly were a creature difficult to destroy, the 
 general failure on the part of communities to make any efforts whatever to 
 reduce its numbers could properly be termed criminal neglect ; but since, as will 
 be shown, it is comparatively an easy matter to do away with the plague of flies, 
 this neglect becomes an evidence of ignorance or of a carelessness in regard to 
 disease-producing filth which to the informed mind constitutes a serious blot 
 on civilized methods of life. 
 
 The orders of the health department of the District of Columbia, pub- 
 lished May 3, 1906, if carried out will be very effective. These orders may be 
 briefly condensed as follows: 
 
 All stalls in which animals are kept shall have the surface of the ground 
 covered with a water-tight floor. Every person occupying a building where 
 domestic animals are kept shall maintain, in connection therewith, a bin or pit 
 for the reception of manure, and pending the removal from the premises of the 
 manure from the animal or animals shall place such manure in said bin or pit. 
 This bin shall be so constructed as to exclude rain water, and shall in all other 
 respects be water-tight, except as it may be connected with the public sewer. It 
 shall be provided with a suitable cover and constructed so as to prevent the 
 ingress and egress of flies. No person owning a stable shall keep any manure or 
 permit any manure to be kept in or upon any portion of the premises other than 
 the bin or pit described, nor shall he allow any such bin or pit to be overfilled or 
 needlessly uncovered. Horse manure may be kept tightly rammed into well- 
 covered barrels for the purpose of removal in such barrels. Every person 
 keeping manure in any of the more densely populated parts of the District shall 
 cause all such manure to be removed from che premises at least twice every week 
 between June i and October 31, and at least once every week between No- 
 vember I and May 31, of the following year. No person shall remove or 
 transport any manure over any public highway in any of the more densely 
 populated parts of the District except in a tight vehicle, which, if not in- 
 closed, must be effectually covered with canvas, so as to prevent the manure 
 
from being dropped. No person shall deposit manure removed from the bins 
 or pits within any of the more densely populated parts of the District without a 
 permit from the health officer. Any person violating any of these provisions 
 shall, upon conviction thereof, be punished by a fine of not more than $40 for 
 each offense. 
 
 In addition to this excellent ordinance, others have been issued from 
 the health department of the District of Columbia which provide against the con- 
 tamination of exposed food by flies and by dust. The ordinances are excellently 
 worded so as to cover all possible cases. They provide for the registration of all 
 stores, markets, cafes, lunch rooms, or of any other place where food or bever- 
 age is manufactured or prepared for sale, stored for sale, offered for sale, or 
 sold, in order to facilitate inspection, and still more recent ordinances provide 
 for the registration of stables. An excellent campaign was begun during the 
 summer of 1908 against insanitary lunch rooms and restaurants. A number of 
 cases were prosecuted, but conviction was found to be difficult. 
 
 For one reason or another, the chief reason being the lack of a sufficient 
 force of inspectors under the control of the health officers, the ordinance in 
 regard to stables has not been carried out with that perfection which the situa- 
 tion demands. In the summer of 1896, the health officer of the District, Dr. 
 W. C. Woodward, designated a region in Washington bounded by Pennsylvania 
 avenue. Sixth street. Fifteenth street, and the Potomac River, which was to be 
 watched by assistants of the writer. Twenty-four stables were located in this 
 region and were visited weekly by two assistants chosen for the purpose. The 
 result was that on the whole the manure was well looked after and the number 
 of flies in the region in question was very considerably reduced during the time 
 of inspection. 
 
 Were simple inspection of stables all that is needed, a force of four in- 
 spectors, specially detailed for this work, could cover the District of Columbia, 
 examining every stable, after they were once located and mapped, once a week. 
 The average salary of an inspector is $1,147, so that the total expense for the 
 first year would be something like $4,500. But the inspectors’ service is compli- 
 cated by the matter of prosecution. Much of the time of inspectors would be 
 taken in the prosecution of the owners of neglected premises. Moreover, the 
 health officer has found during the summer of 1908, in his prosecution of the 
 owners or managers of insanitary restaurants, that his inspectors were practi- 
 cally sworn out of court by the multiplicity of opposing evidence. This means 
 that it will be necessary in such cases to send two inspectors together in all 
 cases, so that the testimony of one may be supported by the testimony of the 
 other. This, perhaps, would double the number of necessary inspectors, making 
 the expense of the service something over $9,000. It is reasonably safe to state, 
 however, that with such an expense for competent service, or perhaps with a 
 slightly added expense, the typhoid fly could be largely eliminated as an element 
 in the transfer of disease in the District of Columbia, and the difficulty which the 
 authorities have had in locating the cause of a very considerable proportion of 
 the cases of typhoid in the District for the past two or three years indicates 
 plainly to the mind of the writer that the typhoid fly is a much more important 
 element than has been supposed. It is a comforting although comparatively 
 insignificant fact and a matter of common observation that in certain sections 
 of the city the typhoid fly has been much less numerous during the past summer 
 than in previous years. The writer is inclined to attribute this to the gradual 
 disappearance of horse stables in such sections, brought about by the rapidly 
 increasing use of motor vehicles. 
 
 36 
 
THE GUILT OF THE “TYPHOID FLY" 
 SCIENTIFICALLY ESTABLISHED 
 
 Frcytn the Report of Dr. Alice Hamilton on the Typhoid Fever Epidemic in 
 Chicago in July-September^ 1902 
 
 Two places were selected in the neighborhood of Hull House as espe- 
 cially favorable for such an examination.* The first was an unconnected privy 
 on Polk street, into which the discharges from two cases of typhoid fever were 
 being thrown without any attempt at disinfection. The vault was either very 
 shallow or very full, for the dejecta lay within three feet of the opening and 
 had caught on the projecting scantling within a foot of the opening. The flies 
 caught within the vault, on the fence of the yard, and inside the sick-room of 
 one of the patients, which was also used as a kitchen, were dropped into test- 
 tubes containing culture medium and allowed to remain there for periods vary- 
 ing from fifteen minutes to twelve hours, and were taken to the laboratory of 
 the Memorial Institute for Infectious Diseases for examination. The full details 
 of this part of the investigation have been published in the “Journal of the Amer- 
 ican Medical Association.” In two of the tubes, the one from the sick-room and 
 the one from the yard, the typhoid bacillus was discovered. In one of the tubes 
 inoculated by flies from the vault a bacillus was discovered closely related to but 
 not identical with the typhoid bacillus, belonging apparently to the group inter- 
 mediate between the typhoid and colon groups. This is a group of bacilli which 
 have been isolated from patients suffering from typhoid-like affections. 
 
 The second place chosen was a yard on Aberdeen street containing one 
 large, full and filthy vault, not connected with the sewer. This is used by six- 
 teen families. Flies from the three privies built over this cesspool were used 
 to inoculate four tubes. Other flies from the fence of the yard and from the 
 walls of the two houses bounding the yard at varying distances from the vault 
 were dropped into six tubes. In three of these tubes the typhoid bacillus was 
 discovered. 
 
 At the time the collection was made there were no fresh typhoid dis- 
 charges being emptied into this vault, so that the presence of living typhoid 
 bacilli on the legs of the flies apparently proves either that the bacilli already in 
 the vault were living and multiplying, or that the discharges of the recovered 
 cases still contained typhoid bacilli. In the Polk street house the flies caught in 
 the sick-room are especially interesting. This room was also used as a kitchen, 
 and at the time the collection was made the table was covered with food upon 
 which could be seen flies both living and dead. The conditions found at these 
 two places are repeated over and over in this neighborhood; and when one 
 considers that, in addition to the privies and defective plumbing, there are the 
 sewer-infected back yards, that food is kept more or less exposed, not only in 
 the houses, but in the groceries and fruit-stands, and that the houses are not 
 furnished with screens, it can easily be seen what an important part the house- 
 fly may play in the spread of typhoid infection in such a neighborhood. It can 
 also be seen that this is one factor which does not come into play to such an 
 extent in more well-to-do parts of the city, where the screens and good plumbing 
 
 *To show the agency of flies in the dissemination of typhoid infection 
 
 37 
 
are the rule, or in newer parts of the city, where the excrement is properly dis- 
 posed of. It seems, therefore, not unwarranted to assume that the contraction 
 of typhoid fever in this particular quarter of the city during the late epidemic 
 was due to the spread of the bacilli by flies from the undrained or imperfectly 
 drained cesspools, the leaking closets, and the infected earth of the yards. 
 
 When such conditions as these exist in any part of a city, they form a 
 lasting menace to the health of the community. The danger is not over with 
 the ending of warm weather and the subsidence of the epidemic. Experiments 
 have shown that the urine and faeces of recovered typhoid patients contain liv- 
 ing bacilli for many weeks after every trace of the illness is over. The winter 
 does not kill the bacilli: they have been found living in sewage-polluted soil 
 315 days after they were planted there, although in ordinary non-polluted soil 
 they soon disappear. 
 
 HOW TO CHECK THE BREEDING OF FLIES 
 
 From a Paper by Robert Newstead, A. L. S., F. E. S., in the ''Annals of 
 
 Tropical Medicine and Parasitology” of the Liverpool School of 
 Tropical Medicine — VoL i, November 4, 1908 
 
 If house-flies are to be reduced to a minimum, I would submit the fol- 
 lowing suggestions: 
 
 1. That stable manure and spent hops should not be allowed to accumu- 
 late in the middensteads* during the months of May to October, inclusive, for 
 a period of more than seven days. 
 
 2. All middensteads should be thoroughly emptied and carefully swept at 
 the period stated in i. 
 
 The present system of partly emptying such receptacles should in all 
 cases be discontinued. 
 
 The walls of middensteads should also be cemented over, or, failing this, 
 the brickwork should be sound and well pointed. 
 
 3. That all ashpits should be emptied, during the summer months, at in- 
 tervals of not more than ten days. 
 
 4. That the most strenuous efforts should be made to prevent children 
 defecating in the courts and passages; or that the parents should be compelled 
 to remove such matter immediately; and defecation in stables middens should 
 be strictly forbidden. The danger lies in the overwhelming attraction which 
 such faecal matter has for house-flies, which later may afterwards come into 
 direct contact with man or his foodstuffs. They may, as Veeder puts it, “in a 
 very few minutes ♦ ♦ ♦ load themselves with dejections from a typhoid or 
 dysenteric patient, not as yet sick enough to be in hospital or under observation, 
 and carry the poison so taken up into the very midst of the food and water ready 
 for use at the next meal. There is no long roundabout process involved.^^ 
 
 5. Ashpit refuse, which in any way tends to fermentation, such as bed- 
 ding, straw, old rags, paper, waste vegetables, dirty bedding from the hutches 
 of pet animals, etc., should, if possible, be disposed of by the tenants, preferably 
 by incineration, or to be placed in a separate receptacle so that no fermentation 
 
 *Manure pits^or similar receptacles. 
 
 sa 
 
FLY LARV^ AND PUP^ IN WASTE PAPER (ASH-PIT REFUSE) 
 NATURAL SIZE 
 
 EGGS OF HOUSE-FLY GREATLY ENLARGED, SHOWING TH 
 SEGMENTS OF THE LARV^ THROUGH THE CUTICLE 
 
 Photographs by Robert Newstead; by courtesy of the Liverpool School of Tropical Medicine. 
 
 BACTERIA LEFT BY FLY PASSING OVER GELATINE PLATE 
 (Permission of Doubleday, Page & Co.) 
 
i' 
 
 n 
 
 L 
 
 i 
 
could take place. If such precautions were adopted by householders, relatively 
 few house-flies would breed in the ashpits, and the present system of emptying 
 such places at longer intervals than, say, four to six weeks, might be continued. 
 
 6. The application of Paris green at the rate of 2 ounces to one gallon of 
 water to either stable manure or ashpit refuse will destroy 99 per cent of the 
 larvae. Possibly a smaller percentage of Paris green might be employed with 
 equally good results. 
 
 One per cent of crude atoxyl in water kills 100 per cent of fly larvae. 
 
 The application of either of these substances might, however, lead to 
 serious complications, and it is very doubtful whether they could be employed 
 with safety. Paris green, at the rate of i to 2 ounces to 20 gallons of water, 
 is used largely as an insecticide for fruit pests. It does no harm to vegetation 
 when applied in small quantities; but cattle might be tempted to eat the dirty 
 straw in manure which had been treated with the substance, and the results 
 might prove fatal if large quantities were eaten. 
 
 7. The use of sun-blinds in all shops containing food which attracts 
 flies would, in my opinion, largely reduce the number of flies in such places 
 during hot weather. Small fruiterers’ and confectioners’ shops, as a rule, are 
 not shaded by sun-blinds, and in their absence flies literally swarm on the arti- 
 cles exposed for sale. 
 
 8. The screening of middensteads with fine wire gauze would, undoubtedly, 
 prevent flies from gaining access to manure, etc., but it is very doubtful if this 
 method would meet with any marked success. The gauze would rapidly oxidize, 
 the framework supporting it would probably warp, and numbers of flies would 
 be admitted whenever the receptacle was opened. Moreover, the erection of 
 such a structure would prove a great inconvenience and a hindrance to the 
 removal of the refuse. This, however, does not prejudice the possibility of 
 erecting a good fly-proof screen in the future. 
 
 FLIES, CONSUMPTION AND TYPHOID 
 
 From a Paper by John B. Huber, M. D., Professor of Pulmonary Diseases, 
 Fordham University Medical School, New York, in the ''New 
 York State Journal of Medicine'' 
 
 The tubercle bacillus is unquestionably distributed by flies. No one 
 can doubt this who has seen the photograph which depicts a Petrie plate con- 
 taining a nutrient medium upon which was deposited a fly that had previously 
 walked in and had got the sputum of a consumptive entangled in its feet. A 
 glass cover confined the fly. The plate was at first perfectly clear ; soon colonies, 
 visible to the naked eye and made up of uncountable bacilli, developed upon the 
 track made by this fly. 
 
 It is certain that flies help greatly to swell the infant death rate. The 
 infant mortality is greatest in fly time. There are few more congenial culture 
 media for bacteria than milk, especially amidst the uncleanliness which obtains 
 in the houses of many very poor people. This fluid easily becomes contaminated 
 with the excreta of flies and with the noxious matter clinging to their feet. 
 Tuberculosis is thus in a very appreciable manner contracted by children, as 
 
 39 
 
also dysenteries and diarrhoeas. This is especially so since we are now con- 
 vinced that all kinds of diarrhoeas, except the comparatively few cases which 
 are induced by mechanical causes, are due to specific germs. The work, which 
 has been accomplished by the authorities, with the co-operation of medical and 
 other beneficent societies, has had the result that contamination of milk by flies, 
 before it reaches the consumer, is probably rare nowadays; the infection which 
 results from milk through the agency of flies becomes possible mostly after 
 delivery to the consumer. 
 
 Typhoid fever is certainly disseminated by flies, although there are, of 
 course, other sources of infection. Flies pollute food and drink by means of 
 the excreta which they convey from dung-heaps, manure-pits, open closets, and 
 of the refuse which they convey from rotting vegetable matter. They breed 
 almost exclusively in excrement. They certainly disseminate cholera ; and 
 cases of tetanus seem to have been originated through their agency. 
 
 THE HOUSE-FLY AND ITS CONNECTION 
 WITH DISEASE DISSEMINATION 
 
 From a Paper in the New York ''Medical Record” January 26, 1907, hy 
 Gordon K. Dickinson, M. D., Surgeon, City Hospital^ Jersey City, N, J. 
 
 Seven different varieties of flies are found in our houses, 98 per cent 
 of which is the common house-fly (Musca domestica) . Born in manure, gener- 
 ally that of the horse, or in decomposing matter of any kind, vegetable as well 
 as animal, they enter our homes to alight on foods there stored. Their tastes 
 are indelicate and omnivorous; they subsist on sputum, fsecal juices, and the 
 slime and dirt that stick to exposed surfaces. Their proboscides, through 
 which they feed, are connected with an extremely active salivary gland, capable 
 of pouring out a large quantity of saliva, which the fly projects against a dry 
 surface, swallowing the subsequent solution. Naturally, solid particles, living 
 organisms, parasites, and eggs, small enough, may pass into this digestive tube. 
 Bacilli of different types and eggs of the nematodes have been observed in the 
 proboscides, stomach, intestinal tract and defecations. The time that particles 
 remain in the digestive tract of the fly is from 12 to 23 days. Evidently the 
 
 digestive secretions are not active for harm, as organisms will not only pass 
 
 through alive, but increase in number while in transit. There must be some 
 
 absorption of the toxins of bacilli, for flies die in large numbers which have 
 
 had the fortune to imbibe such bacilli as those of the plague and anthrax. Flies 
 are large breeders, lay their eggs by preference in horse manure, but also in 
 decaying meat, meat broth, cut melons, dead animals, and even in cuspidors. 
 On these substances their larvae subsist until they hatch. From 10 days to 
 two weeks after the time the eggs have been laid the fly is fully hatched. It is 
 estimated that one fly, laying 120 eggs at a time, will have a progeny amounting 
 up to the sextillions at the end of the season. 
 
 Every privy, every open window, every dead animal in the street, expec- 
 torations of people suffering or incompletely recovered from any infectious 
 disease, the nares of scarletina patients suffering from catarrh or acquired 
 colds — in fact, all conditions where pathogenic bacteria or intestinal parasites 
 
 40 
 
OUR FIRST SUMMER BOARDER. THE ARRIVAL OF MADAM FLY, HER CHILDREN 
 
 AMD HER BAGGAGE. 
 
 By covirtesy of Good Housekeeping 
 
 CONSUMPTIVE SP!TT!NGomFLCOR. 
 FLIES FEEDING ON IT, CARRY THE 
 5ERMS OF THE DISEASE TO FOOD. 
 
 
 THE SPIT DRI^S AND CARELESS 
 SVYEEPING, DUSTING OR DRAUGHTS 
 CAUSE THE GERMS TO FLOAT IN THE AIR. 
 
 THE GERMS MAY ENTER 
 THE BODIES OF CHILDREN 
 PLAYING ON THE FLOOR, 
 THROUGH SORES oa WOUNDS 
 
 OTHERS MAY GET THE DISEASE BY BREATHING 
 OR SWALLOWING THE GERMS. 
 
 SPRAY GIVEN OFF IN SNEEZING OR COUGHING, 
 CONTAINS GERMS IN A MOIST AND ACTIVE STATE. 
 
 NEW 
 
 VORK STATE DEPARTMEINT OF HEALTH. 
 
 ONE OF THE POPULAR EDUCATIONAL BANNERS USED P,Y THE YORK ST^ O'' 
 
 HEALTH TO SHOW HOW HOUSE-FLIES CARRY THE GERMS Ol- 1 UliERCULOSIS 
 
may openly exist, make possible, and even probable, the spread of disease by 
 flies. This, being known, should be acted upon. There are few boards of 
 health as intelligent and far-sighted as that of Philadelphia, which has taken 
 vigforous measures to protect the public against infection of food by flies. In- 
 spectors are directed to visit all milk houses, butcher shops, grocery and candy 
 stores, and instruct the owners to place a covering over all articles. The order 
 reads: “The chiefs of divisions of nuisances, milk and meat, and cattle inspec- 
 tors are hereby instructed to visit all retail dealers exposing for sale in front of 
 their properties meats, fish, vegetables, fruits, candies, and cake, and instruct 
 the proprietors that a covering of some suitable material must be provided to 
 protect the goods so exposed from flies and insects generally.'" 
 
 When mosquitoes were discovered to have a part in the dissemination of 
 malaria and yellow fever, it was thought that a prevention of their breeding 
 was too great a proposition, yet it has been satisfactorily accomplished, so that 
 now one case of yellow fever in all Cuba will create more comment in the daily 
 papers than at one time an epidemic in Havana. Certainly, when the profes- 
 sion and the laity become alive to the dangers incident to the presence of flies, 
 and recognize in them a receptacle and a carrier, then will the problem be at- 
 tacked and solved. 
 
 Attached to all stables there should be built a pit of sufficient size, closed 
 tightly, with the exception of a ventilating window properly screened, and so 
 constructed that little direct light may enter. Manure, as soon as dropped from 
 the animal, should be pushed into this pit, and chloride of lime or crude oil fre- 
 quently scattered over its contents. All organic filth, such as human manure, 
 if conditions do not allow of a sewerage system, should be covered immediately 
 with sufficient earth. All offal and organic debris, in which flies can lay their 
 eggs and propagate, should be disposed of, secluded, or screened. Hospitals, 
 particularly where contagious diseases exist, and rooms containing the same, 
 should have all the windows and doors carefully screened, and every effort 
 made to rid the interior of such flies as may enter. All food, particularly milk 
 and such articles as are eaten uncooked, should receive full attention and pro- 
 tection. 
 
 PROTECTION OF FOOD SUPPLIES FROM FLIES 
 
 From a Paper in^'Country Life in America ” June, 1903, by William Lyman 
 Underwood, Lecturer in the Massachusetts Institute of Technology 
 
 It is most important that flies should be kept azvay from all food suppKes. 
 
 To this end every effort should be made, first, to do away with all places 
 that are favorable for the breeding of flies. Horse manure should be kept in a 
 closed pit, or the place where it is stored should be screened. Metal screens 
 that will not rust are best for this purpose, but, unfortunately, they are too 
 high-priced to permit of their being used by the majority of people who live in 
 the country. Cotton mosquito netting, however, is not very expensive, and, 
 though it will not last as long as the rust-proof metal screens, it is just as ef- 
 fective in keeping out the flies. Cotton netting can generally be purchased at a 
 trifle over three cents a square yard when bought by the piece, and each piece 
 contains sixteen square yards. Where it is not practical to use screens, chlo- 
 
 41 
 
ride of lime, if used in liberal quantities and well sprinkled through the manure, 
 will prevent the development of any eggs which may be deposited in the 
 manure. 
 
 In the second place, screens or cotton netting should be put upon the 
 kitchen and dining-room doors and windows, and a sheet or two of sticky fly- 
 paper, which can be bought at nearly every country store, should be placed in 
 all rooms where food is prepared, exposed, or eaten. Fly-traps, of which there 
 are several varieties upon the market, are also of great use in destroying those 
 flies which sometimes, in spite of nettings, find their way into rooms where the 
 screen doors are frequently opened. 
 
 Finally, the privy should be thoroughly screened, or, better yet, where 
 possible it should be done away with altogether. In no way can the wastes from 
 the human body be more safely and easily disposed of than through the medium 
 of water. Earth closets, where it is not practicable to introduce water for this 
 purpose, are coming very generally into use, and it is to be hoped that before 
 many years the old-fashioned country outhouse, with its exposure to flies and its 
 many other objectionable features, will be a thing of the past. 
 
 ON ONE FLY, 6,600,000 BACTERIA ' 
 
 The following tabulation, with the accompanying comments, is taken 
 from Bulletin No. 51 (April 1908), of the Agricultural Experiment Station at 
 Storrs, Conn. The investigations were made by W. M. Esten and C. J. Mason: 
 
 SOURCES OF BACTERIA FROM FLIES. 
 
 
 Source 
 
 Total 
 
 Number 
 
 Total 
 
 Acid 
 
 Bacteria 
 
 Rapid 
 
 Liquefy- 
 
 ing 
 
 Bacteria 
 
 Slow 
 
 Liquefy- 
 
 ing 
 
 Bacteria 
 
 Bacterium 
 lactis acidi 
 Group A 
 Class 1 
 
 Coli-aerog- 
 enes 
 Group A 
 Class 2 
 
 1907 
 July 27 
 
 [«} 1 fly. Bacteriological Lab- 
 oratory. 
 
 3,150 
 
 250 
 
 600 
 
 100 , 
 
 
 
 July 27 
 
 [i] 1 fly. Bacteriological Lab- 
 oratory. 
 
 550 
 
 100 
 
 0 
 
 0 
 
 
 
 Aug. 6 
 
 [c] 19 Cow Stable Flies. 
 Average per fly. 
 
 7,980,000 
 
 220,000 
 
 0 
 
 20,000 
 
 
 
 420,000 
 
 11,600 
 
 0 
 
 1,000 
 
 
 
 Aug. 14 
 
 [5] 94 Swill Barrel Flies. 
 Average per fly. 
 
 155,000,000 
 
 8,950,000 
 
 
 cT 
 
 4,320,000 
 
 4.630,000 
 
 1,660.000 
 
 95,300 
 
 0 
 
 0 
 
 46,000 
 
 49,300 
 
 Aug. 14 
 
 [e] 144 Pig Pen Flies. 
 Average per fly. 
 
 133,000,000 
 
 2,110,000 
 
 100,000 
 
 266,000 
 
 933,000 
 
 1.176,000 
 
 923.000 
 
 18,700 
 
 700 
 
 1,150 
 
 6,500 
 
 12,200 
 
 Sept. 4 
 
 [/■] 18 Swill Bai-rel Flies. 
 Average per fly. 
 
 118.800,000 
 
 40,480,000 
 
 '0 
 
 14,500.000 
 
 10,480,000 
 
 30,000,000 
 
 6,600,000 
 
 2,182.000 
 
 0 
 
 804,000 
 
 582,000 
 
 1 600,000 
 
 Sept. 21 
 
 [^] 30 Dwelling House Flies. 
 Average per fly. 
 
 1.426,000 
 
 125,000 
 
 0 
 
 12,500 
 
 
 
 47,580 
 
 4,167 
 
 0 
 
 417 
 
 
 V.. 
 
 Sept. 21 
 
 [/f] 26 Dwelling House Flies. 
 Average per fly. 
 
 22,880,000 
 
 22,596,000 
 
 120.000 
 
 34,000 
 
 
 
 880,000 
 
 ■ 869,000 
 
 4.600 
 
 1.300 
 
 
 
 Sept. 27 
 
 [z] 110 Dwelling House Flies. 
 Average per fly. 
 
 35,500.000 
 
 13,670,000 
 
 8,840,000 
 
 125,000 
 
 
 
 322,700 
 
 124 200 
 
 80,300 
 
 1,100 
 
 i 
 
 
 
 Aug. 20 
 
 [/] 1 Large Blue Bottle Blow Fly 
 
 308,700 
 
 2.200 mo 
 
 uld spores 
 
 
 
 
 
 Total average of 414 Flies. 
 Average % of 414 Flies. 
 
 1,222,570 
 
 367.300 
 
 7,830 
 
 73,500 
 
 
 
 
 30% 
 
 6% 
 
 6% 
 
 
 
 
 Average per fly of 256 flies, experi- 
 ments [d], [e~\ and [f] 
 
 3,061,000 
 
 765,000 
 
 2.30 
 
 208,700 
 
 211.500 
 
 553,800 
 
 
 Average per cent of 256 flies ex- 
 periments [rf], [<?] and [/]. 
 
 
 25% 
 
 
 8%. 
 
 7% 
 
 18% 
 
 From the above table the bacterial population of 414 flies is pretty well 
 represented. The domestic fly is passing from a disgusting nuisance and trou- 
 blesome pest to a reputation of being a dangerous enemy to human health. A 
 
 42 
 
species of mosquito has been demonstrated to be the cause of the spread of 
 malaria. Another kind of mosquito is the cause of yellow fever, and now the 
 house-fly is considered an agency in the distribution of typhoid fever, summer 
 complaint, cholera infantum, etc. 
 
 The numbers of bacteria on a single fly may range all the way from 550 
 to 6,600,000. Early in the fly season the numbers of bacteria on flies are com- 
 paratively small, while later the numbers are comparatively very large. The 
 place where flies live also determines largely the numbers that they carry. The 
 average for the 414 flies was about one and one-fourth millions bacteria on each. 
 It hardly seems possible for so small a bit of life to carry so large a number of 
 organisms. The method of the experiment was to catch the flies from several 
 sources by means of a sterile fly net, introduce them into a sterile bottle and 
 into the bottle a known quantity of sterilized water, then shake the bottle to wash 
 the bacteria from the bodies, to simulate the number of organisms that would 
 come from a fly in falling into a lot of milk. In experiments ‘‘D,” “E,” and “F” 
 the bacteria were analyzed into four groups. The objectionable class, coli-aero- 
 genes type, was two and one-half times as abundant as the favorable acid type. 
 If these flies stayed in the pig-pen vicinity there would be less objection to the 
 flies and the kinds of organisms they carry, but the fly is a migratory insect and 
 it visits everything ''under the sun.'' It is almost impossible to keep it out of 
 our kitchens, dining-rooms, cow stables and milk-rooms. The only remedy for 
 this rather serious condition of things is, remove the pig-pen as far as possible 
 from the dairy and dwelling house. Extreme care should be taken in keeping 
 flies out of the cow stable, milk-rooms, and dwellings. Flies walk over our 
 food and are the cause of one of the worst contaminations that could occur 
 from the standpoint of cleanliness and the danger of distributing disease germs. 
 
 HOW FLIES CARRY TYPHOID GERMS 
 
 From a Paper by Mark A. Brown, M. D., Health Officer of Cincinnati, O. 
 
 Unless the most stringent measures are immediately taken for the proper 
 disinfection of these [typhoid] discharges they become almost at once the haven 
 for innumerable flies, the bodies of which harbor innumerable typhoid germs. 
 The alternate visitations of the common house-fly from the latrine, trench or 
 privy, his natural habitation, to the kitchen and dining-room, afford most ample 
 opportunity for the infection of our food and drink, particularly of milk. This 
 illustration is by no means fanciful or far-fetched. The commission appointed 
 by the Government to investigate the typhoid epidemic which occurred among 
 our soldiers during the Spanish-American War, of which commission Vaughan, 
 of Ann Arbor, was chairman, reported that infection of food supplies by means 
 of flies was probably of even more importance than the infection of drinking 
 water. It is a noticeable fact that while officers and men drank the same water, 
 typhoid fever was comparatively much less among the former, as all unknow- 
 ingly the food supplies of the officers were much better protected from access of 
 flies. It would hardly seem necessary to demonstrate experimentally that flies 
 and other insects passively carry bacteria; nevertheless numerous carefully con- 
 trolled experiments have been made with this end in view, and successfully. 
 
 43 
 
TYPES OF FLY POSTERS 
 
 RULES FOR DEALING WITH THE FLY NUISANCE 
 
 KEEP THE FLIES AWAY FROM THE SICK, ESPECIALLY THOSE 
 ILL WITH CONTAGIOUS DISEASES. KILL EVERY FLY THAT 
 STRAYS INTO THE SICK ROOM. HIS BODY IS COVERED WITH 
 DISEASE GERMS. 
 
 DO NOT ALLOW DECAYING MATERIAL OF ANY SORT TO 
 ACCUMULATE ON OR NEAR YOUR PREMISES. 
 
 ALL REFUSE WHICH TENDS IN ANY WAY TO FERMENTATION, 
 SUCH AS BEDDING STRAW, PAPER WASTE AND VEGETABLE 
 MATTER SHOULD BE DISPOSED OF OR COVERED WITH LIME 
 OR KEROSENE OIL. 
 
 SCREEN ALL FOOD. 
 
 KEEP ALL RECEPTACLES FOR GARBAGE CAREFULLY COV- 
 ERED AND THE CANS CLEANED OR SPRINKLED WITH OIL OR 
 LIME. 
 
 KEEP ALL STABLE MANURE IN VAULT OR PIT, SCREENED 
 OR SPRINKLED WITH LIME, OIL OR OTHER CHEAP PREPARA- 
 TION. 
 
 SEE THAT YOUR SEWAGE SYSTEM IS IN GOOD ORDER ; 
 THAT IT DOES NOT LEAK, IS UP TO DATE AND NOT EXPOSED 
 TO FLIES. 
 
 POUR KEROSENE INTO THE DRAINS. 
 
 COVER FOOD AFTER A MEAL; BURN OR BURY ALL TABLE 
 REFUSE. 
 
 SCREEN ALL FOOD EXPOSED FOR SALE. 
 
 SCREEN ALL WINDOWS AND DOORS, ESPECIALLY THE 
 KITCHEN AND DINING ROOM. ^ 
 
 BURN PYRETHRUM POWDER IN THE HOUSE TO KILL THE 
 FLIES. 
 
 DON’T FORGET IF YOU SEE FLIES, THEIR BREEDING PLACE 
 IS IN NEARBY FILTH. IT MAY BE BEHIND THE DOOR, UNDER 
 THE TABLE OR IN THE CUSPIDOR. 
 
 IF THERE IS NO DIRT AND FILTH THERE WILL BE NO FLIES. 
 
 IF THERE IS A NUISANCE IN THE NEIGHBORHOOD WRITE 
 AT ONCE TO THE HEALTH DEPARTMENT. 
 
 ISSUED BY 
 
 The Merchants’ Association’s Committee on Pollution of 
 
 the Waters of New York 
 
 EDWARD HATCH, Jr., Chairman 
 J. PIERPONT MORGAN JOHN Y. CULVER, C. E. 
 
 JUIiY, 1008. albert VANDER VEER, H. D. DANIEL D. JACKSON 
 
FLY RULES OF THE CHICAGO DEPARTMENT 
 
 OF HEALTH 
 
 Screen all food and keep flies away from it. 
 
 Keep the streets clean. 
 
 Keep stable manure — breeding place for flies — in a vault or pit or 
 screened inclosure and sprinkle its surface with chloride of lime. 
 
 Quickly cover up food after a meal and bury or burn table refuse. 
 
 Keep damp cloths near meat dishes, milk jugs, and other food receptacles. 
 
 Burn pyrcthrum powder in the house. It will kill most of the flies and 
 those it does not will fall stunned, when they may be swept up and burned. 
 Sticky fly-papers are a second-rate palliative. 
 
 Remember that the exposure of any kind of refuse near a dwelling 
 furnishes a breeding place for flies, and if food is exposed the flies will deposit 
 germs upon it. 
 
 HEALTH DEPARTMENT BULLETIN 
 BEWARE OF FLIES 
 
 The common house-fly is a carrier of disease. Typhoid fever, diarrhoea, 
 dysentery and tuberculosis are carried by flies. 
 
 No longer do we consider flies as merely annoying, but we recognize in 
 them a very important factor in the spread of certain diseases, particularly those 
 mentioned above. 
 
 Flies Are Filthy. — The house-fly is particularly filthy, because it has 
 its birth-place and lays its eggs almost exclusively in horse manure. 
 
 Flies feed on food and also on the worst kind of filth. They go from one 
 to the other. It is easy to understand how they carry disease germs to out 
 food in this manner. 
 
 Our domestic animals, the dog and cat, though far from clean in all their 
 habits, we like to have about us, but we keep them in their proper place. The 
 house-fly, on the other hand, is tolerated everywhere, crawls over our hands and 
 faces, gets into the milk, walks over all our food, often soiling and contaminating 
 everything that comes in contact with its filthy feet and tongue. 
 
 Flies Also Feed on’ Sputum. — ^Who has not seen flies feeding on 
 sputum on our pavements and streets? And, as there are people who have con- 
 sumption, continually spitting on the public pavements, is it not simple to see how 
 the germ of the disease can be taken up by the fly, carried away, and perhaps de- 
 posited in our homes ? 
 
 It is particularly essential that flies be kept away from everything that 
 infants and very young children come in contact with, particularly all feeding 
 utensils and things that children are likely to put in their mouths. 
 
 How can we combat this dangerous nuisance? 
 
 The essential thing is to do away with the breeding places of these dirty 
 
 pests. 
 
 It may be said that flies will breed in any decomposing animal or veg- 
 etable matter. The most common places are manure, uncleaned stables, privies, 
 
 tf 
 
and in and about cans and receptacles used for the storage of garbage. 
 
 Every householder, in self defense, should destroy the breeding places 
 of these pests. 
 
 Store garbage in tightly covered cans, kept in a screened inclosure, so 
 that flies cannot get to it ; see that it is removed very frequently during the sum- 
 mer months. Wash and disinfect cans frequently. 
 
 Store manure so that flies cannot get at it to lay their eggs, and have it 
 removed once a week. 
 
 All persons selling food of any description should see that the goods are 
 protected from flies, and should not expose food in front of their stores where 
 it can be contaminated by both flies and street dust 
 
 Do not allow decaying matter of any kind to accumulate on your premises. 
 
 Screen the doors and windows of your house, particularly the kitchen, in 
 order to keep the flies from entering and getting on the food. 
 
 Remember that the female fly lays about one hundred and twenty eggs, 
 which in the course of a few hours become maggots, and after another transfor- 
 mation the full grown fly appears at the end of ten days. 
 
 As in most matters of sanitation and hygiene, cleanliness is the watch- 
 word. Cleanliness about your house and property will prevent flies breeding. 
 
 Board of Health, 
 
 Orange, N, J. 
 
 BEWARE OF FLIES* 
 
 Flies are filthy insects. They drink from the cesspools and dine in the 
 privy vaults. They eat the sputum on the 'sidewalk, and revel in the garbage 
 pail. They swarm on the baby’s diaper, and are greedy for the dressings from 
 a discharging wound. 
 
 Perhaps you think it is disgusting to read about such things, and so it is. 
 But is it not more disgusting to have these same flies, after their repast of filth, 
 drown in the milk pitcher, drop their specks on the frosted cake, or clean their 
 feet on the bread? Is it pleasant to see the flies that very likely have just come 
 from a neighboring privy crawl over the lips of the sleeping baby, or gather on 
 the nipple of its nursing bottle? Suppose the fly that was fished out of the milk 
 pitcher had just been eating the excrement of a typhoid fever patient, would you 
 like to drink the milk? Perhaps the flies that are walking on the fruit which 
 you purchased at the street corner had just been feeding on the sputum of a 
 consumptive. Does it not seem likely that flies may spread disease? That is 
 what many physicians and health officers think. 
 
 Perhaps hereafter you will screen the house, and protect the food from 
 
 flies. 
 
 The young of flies are maggots. They seem to prefer to breed in stable 
 manure. But they also breed in excrement of all kinds, in garbage, and in all 
 sorts of wet and filthy refuse. 
 
 Do you want to raise these filthy insects, these germ-carriers, these indi- 
 
 ♦This circular, written by Dr. C, V. Chapin, Health Officer of Providence, R. I. is in use in that city 
 and is recommended by the Massachusetts Association of Health Boards, 
 
 46 
 

 
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cators of untidiness, to be a pest in our own house, and perhaps carry disease 
 to your neighbors? Of course you do not. 
 
 Then keep the stable manure closely covered ar;d have it removed often 
 — once a week in summer, if possible. Keep the back yard and the alley clean. 
 Allow no refuse to accumulate anywhere. Connect with the sewer if there is 
 one in the street. Fix the privy so it will be fly-proof. After your own premises 
 are in order talk over the matter with your neighbors, and get them also to 
 read this circular. 
 
 BIBLIOGRAPHY 
 
 On the Habits, Life-Cycle and Breeding Places of the Common House-Fly — by 
 Robert Newstead, A. L. S., F. E. S. (Annals of Tropical Medicine and 
 Parasitology of the Liverpool School of Tropical Medicine; Vol. L, No. 4; 
 February, 1908. 
 
 Typhoid Fever: The Story of the Fly That Doesn’t Wipe Its Feet — ^by Woods 
 Hutchinson, A. M., M. D. (Reprinted by the Merchants’ Association of 
 New York from The Saturday Evening Post; 1908.) 
 
 The House-Fly and Its Connection With Disease Dissemination — ^by Gordon K. 
 Dickinson, M. D. (Published by William Wood & Co., New York; 1907.) 
 
 The House-Fly as a Carrier of Disease — by William Lyman Underwood, lec- 
 turer in the Massachusetts Institute of Technology. (Enlarged and ex- 
 panded by the author from his article in Country Life in America; 1903.) 
 
 Pollution of New York Harbor as a Menace to Health by the Dissemination of 
 Intestinal Diseases Through the Agency of the Common House-Fly — a re- 
 port by Daniel D. Jackson, S. B., to the Water Pollution Committee of the 
 Merchants’ Association of New York; 1908. 
 
 Report on the spread of typhoid fever in the United States military camps dur- 
 ing the Spanish-American War of 1898, by Drs. Walter Reed, Victor C. 
 Vaughan and Edward O. Shakespeare; 1905. 
 
 Insects and Disease — ^by John B. Huber, M. D., Professor of Pulmonary 
 eases, Fordham University Medical School, New York, in New York 
 ate Journal of Medicine^ November 1908. 
 
 Report of the Health Officer of the District of Columbia — ^by George M. Kober, 
 M. D., Washington; 1895. 
 
 Typhoid Fever in the Army — Editorial in Engineering News (New York), 
 September 22, 1898. 
 
 The Role of Insects in the Spread of Disease — by George H. F. Nuttall, M. D., 
 (Johns Hopkins Hospital Reports; Vol. VIII., 1898.) 
 
 A Contribution to the Study of the Insect Fauna of Human Excrement — ^by 
 L. O. Howard, Ph. D., Chief of the Bureau of Entomology, Department of 
 Agriculture. (Published by the Washington Academy of Sciences; 1900.) 
 
 47 
 
House* yiics — Bureau of Entomology Circular No. 71 (revised edition) — by 
 L. O. Howard. 
 
 How Insects Affect the Health in Rural Districts — ^U. S. Department of Agri- 
 culture, Farmers' Bulletin No. 155 — by L. O. Howard. 
 
 The House-Fly — Monthly Bulletin of Indiana State Board of Health, May, 1908. 
 
 The House-Fly Nuisance — ^by W. Frost and C. T. Vorhees, Country Life m 
 America, May, 1908. 
 
 Fighting the House-Fly — ^by E. V. Wilcox, Country Life in America, May, 1908. 
 
 House-Flies — ^article in Florida Health Notes, May, 1908. 
 
 The House-Fly as an Agent in the Dissemination of Infectious Diseases — ^by 
 Theobald Smith, M. D., American Journal of Public Hygiene, August, 1908. 
 
 Flies as Spreaders of Disease in Camps — ^by H. A. Veeder, M. D., New York 
 Medical Record, September, 1898. 
 
 CORRESPONDENCE INVITED 
 
 Readers of this pamphlet, especially physicians and others having to do 
 with the protection of the health of the public, are requested to communicate 
 with the chairman of this committee any observations bearing upon the prob- 
 lems associated with the fly nuisance. Address the Chairman, Water Pollution 
 Committee, Merchants’ Association, 66 Lafayette street. New York. 
 
 NOTE. — Newspapers and periodicals desirous of reprinting the matter 
 contained in this pamphlet arc at liberty to do so, either with or without credit 
 to the Merchants* Association. 
 
 48