These authors have records covering 252,186 individuals in scattered institutions in the United States. Among those eating from machine washed dishes the rate was 108 per 1,000 while those eating from hand washed dishes suffered at the rate of 324 per 1,000. The ratio was 1 to 3 between the two groups. Seventy-five per cent. of the cases occurred in that group which ate from dishes not disinfected with boiling water. They do not state the number of individuals in each of the two groups. Lynch and Cumming claim that in the act of coughing only a few organisms are expelled from the mouth, rarely over 1,500, and conclude that transmission by direct contact through the air route but rarely, if ever, takes place. While about 1,500 organisms are expelled onto the floor by an act of coughing, a sterile glove wiped across the lips may pick up nearly 2,000,000 organisms. Such organisms may be readily transferred to inanimate objects which are handled by many people. Hemolytic streptococci and pneumococci may be isolated with great regularity from the hands of carriers or patients, from table ware, inanimate objects touched by these patients, and from floor dust. Diphtheria and tubercle bacilli have been isolated from the hands and eating utensils of patients. The average count of a large number of restaurant dishwater specimens was 4,000,000 bacteria per c.c. The temperature of this water averaged 43° C. and the dishes were practically never scalded. The water was often so highly polluted, “that the dishes are more highly contaminated after they are washed than before washing begins. The spoon or fork is often freer from organisms just after being used by the restaurant patron than when taken from the restaurant’s polluted dish water.” Major John S. Billings, epidemiologist at Camp Custer, reported that one of the larger organizations did not properly observe the regulation requiring that all mess kits and table equipment be properly sterilized. The disease appeared early and spread unusually rapidly in this particular organization. In summarizing the subject of transmission through utensils, we may say that the evidence is suggestive but inconclusive. It is possible, even probable, that this is one mode of transmission. That it is the most important has not been proved. Lynch and Cumming do not take into consideration that the regiments with more sanitary methods of cleansing the dishes are apt to be those regiments with more sanitary habits throughout their daily routine. Those restaurants using mechanical dish washers are usually the cleaner restaurants. Pontano in Italy is quoted by the Office International d’Hygiène Publique as having observed in his epidemiological study that there was a constant connection between the living conditions and the severity of the complications. Notable differences were observed in neighboring houses according to the hygienic conditions of the various households.