The proportionate number of cases of typhoid fever among the users of a polluted water varies with the number of typhoid germs in the water. Excessive pollution causes severe epidemics or continued high death-rates according as the infection is continued or intermittent. Slight infection causes relatively few cases of fever. Pittsburg and Allegheny, taking their water-supplies from below the outlets of some of their own sewers, have suffered severely (103.2 and 127.4 deaths from typhoid fever annually per 100,000, respectively, from 1888 to 1892). Wheeling, W. Va., with similar conditions in 1890, was even worse, a death rate of 345 per 100,000 from this cause being reported, while Albany had only comparatively mild epidemics from the less directly and grossly polluted Hudson. Lawrence and Lowell, taking their water from the Merrimac, both had for many years continued excessive rates, increasing gradually with increasing pollution; and the city having the most polluted source had the higher rate. In Berlin and Altona, in winter, with open filters, epidemics of typhoid fever followed decreased efficiency of filtration, but the epidemics were often so mild that they would have entirely escaped observation under present American conditions. Chicago has for years suffered from typhoid fever, and the rate has fluctuated, as far as reliable information can be obtained, with the fluctuations in the pollution of the lake water. An unusual discharge of the Chicago River results in a higher death-rate. Abandoning the shore inlet near the mouth of the Chicago River in 1892, resulted in the following year in a reduction of 60 per cent in the typhoid fever death-rate.[49] This reduction shows, not that the present intakes are safe, but simply that they are less polluted than the old ones to an extent measured by the reduction in the death-rate. It is not supposed that in an epidemic of typhoid fever caused by polluted water every single person contracts the disease directly by