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SOPER. 431 
 
 THE EPIDEMIC OF TYPHOID FEVER AT ITHACA, N. Y. 
 
 BY GEORGE A.- SOPER, PH.D., CONSULTING ENGINEER AND 
 SANITARY EXPERT, NEW YORK CITY. 
 
 [Presenied September IS, 1904.] 
 
 Mr. President, Ladies and Gentlemen, of the New England Water 
 Works Association, — The epidemic of typhoid fever which broke 
 out at Ithaca in the winter of 1903 deserves to be regarded as 
 one of the greatest outbreaks of this preventable disease which 
 ever occurred in New York State. In the typhoid history of 
 the whole country there have been few epidemics which have 
 exhibited a larger number of cases. 
 
 Sanitary experts who visited Ithaca at the time of the epi- 
 demic were unanimous in their opinion as to its cause. Man}'' 
 who are familiar with the epidemiology of typhoid have said 
 that seldom, if ever, has the danger of an epidemic been so 
 unmistakabty in evidence beforehand. Speaking now, more than 
 a year after the outbreak, and with an intimate knowledge of 
 the situation, it is difficult to understand why the cit}'^ was not 
 alive to the necessity of taking steps which would have rendered 
 life and health secure. Apparentlj' the people of this university 
 town neither knew nor cared any more about the teachings of 
 sanitary science than do the inhabitants of the scores of other 
 cities in wliich epidemics occur. They were blinded to the dan- 
 gers of the situation by the seeming healthfulness of the city's 
 site, and so failed to establish those sanitary safeguards which 
 are indispensable to every growing community. 
 
 STATISTICS OF THE EPIDEMIC. 
 
 The consequence of this mistake was terrible. With a popu- 
 lation given by the last United States census as 13 156, it is 
 estimated that 1 350 cases of typhoid occurred, with 82 deaths, 
 in little more than three months. No less than 522 homes were 
 visited by the disease; in over 150 of these there were two or 
 more persons attacked. 
 
432 TYPHOID FEVER AT ITHACA. X. Y. 
 
 The onset of the epidemic was gradual. A few cases first 
 occurred in all parts of the city. Later it was observed that 
 there were more cases in the section occupied by the students 
 of Cornell University than in an}^ other. There were, at this 
 time, connected with Cornell about 3 000 teachers and students. 
 
 One in everj' ten was taken with the fever, and one in every 
 hundred died of it. It is probable that more t5'phoid occurred 
 in the section occupied bj' the students than in other sections 
 of the city because of the peculiar susceptibilitj- of young people 
 to t3'phoid and also on account of the fact that some of the 
 students lived amid surroundings which were insanitary. 
 
 The epidemic is ofHcially regarded to have begun on the 11th of 
 Januarj^, 1903, and to have extended to the 1st of April of the 
 same year. But in reality there were some cases before the date 
 given, and there were man}^ after it. Plate I is a map of the 
 city showing the location of the tj'phoid cases during the first 
 week of the epidemic. 
 
 What might be termed a long, low wave of tj'phoid appears 
 to have set in about September, 1902, and continued until about 
 January, 1904. In this whole period it appears that tjrphoid 
 fever was somewhat unduly prevalent. It is impossible to state 
 the facts. Under the most favorable circumstances nothing is 
 more difficult than to obtain an accurate knowledge of the 
 extent to which typhoid occurs in a communit}^ Records of 
 cases of typhoid fever were never accuratelj" collected at Ithaca, 
 and were gathered ^ith difficulty during the epidemic. The 
 official figures collected for the State Department of Health were 
 made up with great care, but they are known to be defective. 
 The total number of cases given above, which is the official figure 
 of the State Department, was estimated from a large amount 
 of data collected in various ways, and does not represent the 
 number of cases actually reported by the physicians. The number 
 so reported was much smaller. 
 
Cornell University 
 Library 
 
 The original of this book is in 
 the Cornell University Library. 
 
 There are no known copyright restrictions in 
 the United States on the use of the text. 
 
 http://www.archive.org/cletails/cu31924077144032 
 
PLATE I. 
 
 ^AAp 
 
 Of The 
 
 City of IthACaN.Y. 
 1899 
 
 showing location of Typhoid Fever 
 cases during, first week of epidemic 
 Jan 8- tSL, ISOA - marked thus- 
 
so PEE. 
 
 433 
 
 Table No. 1. 
 
 Showing the number of cases of typhoid fever reported by the physi- 
 cians of Ithaca, N. Y., from January 10 to April 1, 1903. (The actual 
 number of cases was much greater and they were somewhat more regularly 
 distributed.) 
 
 , 
 
 II 
 
 «1 
 ^1 
 
 
 Typhoid Cases 
 Reported. 
 
 Total Cases Re- 
 ported lor Week. 
 
 
 1 
 
 Typhoid Cases 
 Reported. 
 
 Total Cases Re- 
 ported lor Week. 
 
 1 
 
 Typhoid Cases 
 Reported. 
 
 Total Cases Re- 
 ported lor Week. 
 
 Jan. 10 
 
 ~0 
 
 
 Jan. 30 
 
 14 
 
 Feb. 
 
 19 
 
 13 March 11 
 
 3 
 
 11 
 
 1 
 
 
 31 
 
 22—105 
 
 
 20 
 
 18 
 
 12 
 
 
 
 12 
 
 3 
 
 
 Feb. 1 
 
 30 
 
 
 21 
 
 11—102 
 
 13 
 
 2 
 
 13 
 
 1 
 
 
 2 
 
 37 
 
 
 22 
 
 19 
 
 14 
 
 1— 18 
 
 14 
 
 4 
 
 
 3 
 
 26 
 
 
 23 
 
 11 
 
 15 
 
 2 
 
 15 
 
 5 
 
 
 4 
 
 19 
 
 
 24 
 
 5 
 
 16 
 
 
 
 16 
 
 3 
 
 
 5 
 
 17 
 
 
 25 
 
 7 
 
 17 
 
 
 
 17 
 
 4—21 
 
 6 
 
 19 
 
 
 26 
 
 7 
 
 18 
 
 1 
 
 18 
 
 5 
 
 
 7 
 
 22—170 
 
 
 27 
 
 4 
 
 19 
 
 
 
 19 
 
 6 
 
 
 8 
 
 26 
 
 
 28 
 
 6— 59 
 
 20 
 
 
 
 20 
 
 6 
 
 
 9 
 
 21 
 
 March 
 
 L 1 
 
 18 
 
 21 
 
 0— 3 
 
 21 
 
 6 
 
 
 10 
 
 19 
 
 
 2 
 
 3 
 
 22 
 
 
 
 22 
 
 12 
 
 
 11 
 
 17 
 
 
 3 
 
 2 
 
 23 
 
 
 
 23 
 
 10 
 
 
 12 
 
 21 
 
 
 4 
 
 1 
 
 24 
 
 1 
 
 24 
 
 9- 
 
 -54 
 
 13 
 
 15 
 
 
 5 
 
 4 
 
 25 
 
 1 
 
 25 
 
 11 
 
 
 14 
 
 18—137 
 
 
 6 
 
 2 
 
 26 
 
 
 
 26 
 
 14 
 
 
 15 
 
 19 
 
 
 7 
 
 1— 31' 
 
 27 
 
 1 
 
 27 
 
 13 
 
 
 16 
 
 12 
 
 
 8 
 
 2 
 
 28 
 
 0— 3 
 
 28 
 
 16 
 
 
 17 
 
 13 
 
 
 9 
 
 5 
 
 29 
 
 
 
 29 
 
 15 
 
 , 
 
 18 
 
 16 
 
 
 10 
 
 5 
 
 31 
 
 0—703 
 
 
 Total cases reported, Jan. IC 
 
 1 — March 31, inclusive 
 
 ,703. 
 
 
 The total number -of 
 
 typhoid 
 
 f ever_cases which ■ 
 
 were directly 
 
 or in dire ctly attributable to the outbreak at Ithaca will never be 
 known, and ca,nnot safely be estimated.. If to the number which 
 occurred in the epidemic, there were added those which occurred 
 before and after it, and the cases which broke out in other places 
 to which infection was carried by those who fled from the city, the 
 total would be. considerably increased. 
 
 ORIGINAL SOURCE OF THE EPIDEMIC. 
 
 In seeking to determine the cause of the epidemic, inquiry was 
 directed to every conceivable quarter. As the infection was 
 general, ajsommon cause was naturally suspected; -The city was 
 not in an entirely sanitary condition, and it was appreciated that 
 while certain features existed which were favorable to, health. 
 
434 TYPHOID FEVER AT ITHACA, N. Y. 
 
 there were others which favored the spread of the fever. Among 
 the features favorable to health may be mentioned an exce llent cli-^ 
 malfjand an abundance of high ground. The unfavorable features ' 
 included an incomplete sewerage system; a high ground water 
 level in a large part of the citv; an inadequate and polluted 
 water suppl}-; the presence of innumerable shallow wells; and 
 an unusual prevalence of prj\;^te cesspools and privies. 
 
 There is no room to doubt at the present time that the water 
 supply s as-the ^original source of th e diseas e, and that the fever 
 spread through the cit}' the more readily and became more 
 secureh' established because of the insanitar}^ conditions referred 
 to, and carelessness and ignorance in nursing the sick. 
 
 The water supply, or supplies, of Ithaca were derived from 
 three separate sources. Two of these sources were in the control 
 of the Ithaca Water Company, while the third source was in the 
 control of Cornell Universitj'. It has been claimed by the 
 universitj' authorities that no fever occurred among the people 
 who used exclusively the university's water supply. This is 
 true. The university's water was polluted, but was not 
 infected, so far as I could find out. It was supplied exclusivelj' 
 to the campus. It seems certain that the infectious matter came 
 to the cit}' through one or both of the supplies of the water 
 companj'. 
 
 The two water supplies of the water company are derived 
 from creeks. The larger source, Six-Mile Creek, drains an area 
 of countrj' of about fort3'-six square miles. The run-off after 
 storms is rapid, and the stream is subject to sudden and verj'- 
 decided fluctuations in volume. The dr}'- weather flow is about 
 one million gallons per twentj'-four hours; the largest quantity 
 of water that has been observed to flow in the creek was about 
 three thousand, times this volume. In^ short, Six-Mile Creek is a 
 torrential stream, deeply eroded through soil and rock and carry- 
 ing an immense amount of suspended matter, such as silt and 
 sand, after rains and thaws. 
 
 On the drainage area of Six-JIile Creek there was a population 
 estimated by the census of 1900 as 2 144, of whom 812 hved in 
 villages bordering the creek. The nearest village, called Brook- 
 ton, is five miles above the intake of the water works. No care 
 
Pr.ATE I. 
 
 
 
 
 Fig. 1. — General View of Ithaca, showing Cornell Universitv on 
 the hill, student quarter on the right, and valley of Six-Mile Creek 
 on extreme right. 
 
 Fig. 2. — Map showing drainage areas 
 of creeks near Ithaca. 
 
so PER. 435 
 
 whatever had been exercised for years to prevent drainage from 
 entering the stream, although at one time, under different manage- 
 ment, the protection/ of the drainage area is said to have been 
 very carefully lo9k6d after. At the time of the epidemic numerous 
 sources of poymion were evident. Representatives of the water, 
 company who" were sent out at my i-equest to inspect the drainage 
 area brought in records of over one hundred nuisances. Within 
 the very city of Ithaca, and but a few rods above the intake of 
 the water works, there were located on the precipitous banks of 
 Six-Mile Creek or its tributaries no less than seventeen privies. 
 
 There was no system of purifying the water, unless a primitive 
 filter crib could be so called. The crib was located on a bank of 
 the stream and was principally useful in excluding pebbles and 
 leaves from the pumps. A small impounding reservoir had been 
 formed by throwing a dam across the stream a short distance 
 below the intake crib. Besides the intake crib, there were 
 two other intakes; one above the impounding reservoir, and one 
 below it. These were but little used, and all took the same 
 water. 
 
 The water was pumped from the creek into a standpipe of 
 small capacity, and flowed thence through the mains to the con- 
 sumers. 
 
 A second source of supply of the water company was Butter- 
 milk Creek, draining about twelve square miles of country. Here 
 were duplicated, but on a smaller scale, the sanitary conditions 
 of Six-jMile Creek. Most of the water which supplied the city 
 came from Six-Mile Creek, but a general and uncertain mixture 
 of the two took place in the pipes. 
 
 From what has just been said it will be apparent that the 
 conditions were ideal for an epidemic. During periods of dry 
 weather quantities of refuse of all descriptions accumulated on 
 the banks of the creeks and their tributaries, to be scoured down 
 into the water supply by the next rain or thaw. 
 
 In a very careful survey of the drainage areas which I made 
 during the course of the epidemic, I was able to locate six cases 
 of typhoid fever which had occurred in the twelve months pre- 
 ceding the outbreak at Ithaca. It is possible that other sources 
 of infectious matter existed. For example, there was one hotel 
 
436 TYPHOID FEVER AT ITHACA, N. Y. 
 
 on the upper waters of Six-Mile Creek which was frequented by 
 people in search of health, and it is not impossible that some 
 persons recovering from typhoid spent the summer or autumn 
 there. Such people are as dangerous as those actually confined 
 to their beds with tj^phoid, for in about twenty per cent, of all 
 cases the germs of typhoid become established in the bladder 
 and are given off in great .numbers with the urine for weeks and 
 sometimes months after apparent recoverj^ 
 
 If there was dangerous filth on the banks of the streams 
 supplying Ithaca with drinldng water, the weather conditions 
 just previous to the outbreak of the epidemic were such as to 
 wash this material into the creeks. The report for December, 
 1902, of the New York Section of the Climate and Crop Service 
 of the United States Weather Bureau, says that December was 
 noted for exceptionally heavy precipitation, the fall of snow 
 and rain at Ithaca being more than twice as much as for any 
 other December since the establishment of the station in 1879. 
 General rains and thawing conditions prevailed from the nineteenth 
 to the twentj'-second, with very hea^'}- falls on the thirteenth, 
 sixteenth, and twenty-first. 
 
 If we assume that infectious material was scoured from the 
 banks of the streams during these rains and thaws we must 
 account for the fact that three or four weeks seem to have elapsed 
 from the time when it was taken into the water works system to 
 the beginning of the epidemic in the city. Theoretically, it would 
 take only two or three days for the water to get from the creek 
 to the consumer by waj^ of the force mains, standpipe and dis- 
 tribution system, and we should expect the first cases of fever 
 to develop within two weeks from this time. The actual time 
 which elapsed was nineteen days; the outbreak was not in full 
 force for several days after. The apparent delay in the appear- 
 ance of the epidemic is probably due to the fact that the dates 
 of the commencement of the attacks are in reality the dates 
 when the physicians were first called; several days may have 
 elapsed between the appearance of the first symptoms and the 
 calling of medical aid. 
 
Plate II. 
 
 ^ 
 
 O 
 
 Fig. 1. — Some sources of pollution of Six-Mile Creek at Brooktoii. 
 
 Fig. 2. — Some sources of pollution of Six-Mile Creek at Brookton. 
 
sopER. 437 
 
 OTHER THEORIES OF THE CAUSE. 
 
 Before lea%dng our discussion of the cause of the epidemic it 
 may be well to take account of a belief which was held by many 
 that the outbreak was not due to pollution of the streams bj' 
 permanent residents on the drainage areas but was caused bj^ 
 the offscourings of a gang of Italian laborers who were at 
 work on the construction of a dam on Six-Mile Creek, a short, 
 distance above the water company's intake. i 
 
 Careful investigation of the grounds of this theory was made 
 without discovering, however, that excrement from this source' 
 had entered the stream, or that any of the laborers had been ill. 
 It is, of course, conceivable that one or more of the laborers had 
 recently recovered from typhoid and that their infected urine 
 entered the creek, but the chance of such contamination seems 
 remote. 
 
 The work was in charge of professional engineers of high 
 standing, and precautions were apparently taken to prevent 
 any polluting matter from entering the stream. A young man 
 who had recently graduated in engineering at Cornell was espe- 
 ciall}^ detailed to look after this matter. There is little doubt 
 that bad feeling between the citizens and the water companj-, 
 caused bj'' a dispute over the construction of a new dam, accounted 
 in some measure for the mental attitude of some citizens on this 
 point. 
 
 Another possible source of typhoid material existed on one of 
 the tributaries of Six-Mile Creek within three miles of the water 
 works intake. At this point a gang of laborers of mixed nation- 
 ality but common bad character had been engaged in building 
 an elaborate railroad culvert, through the late summer and earty 
 fall months. One " Toothless Ben/' a member of this partj', 
 was taken with typhoid fever while on the work and was even- 
 tually compelled to leave it and go home to be nursed. I found 
 ample evidence that these men had defecated on the banks of the 
 stream, but whether infectious matter from "Toothless Ben" had 
 been deposited here and had later been washed down into the 
 water supply of Ithaca it was not possible to determine. 
 
 Finally, an irregularity in the operation of the pumps of the 
 
43S TYPHOID FEVER AT ITHACA, N. Y. 
 
 water company remains to be mentioned as having a possible 
 bearing on the cause of the epidemic. Owing to the expected 
 need of an unusually large supply of water for some tests of fire 
 apparatus, an extra, and generally idle, pump was set in opera- 
 tion for several days preceding December 25. The intake of 
 this pump was in a penstock directly connected with Six-Mile 
 Creek. The water was neither purified nor screened, but was 
 forced directly to the standpipe which was, at the same time, 
 being supplied by the regular pumps. 
 
 Whatever theory is accepted to account for the infection of 
 the water, it seems necessarj^ to conclude either that the germs 
 multiplied after entering the distribution s}'stem, or that they 
 were taken in during a period of several weeks. It is scarcely 
 conceivable that a sufficient number could have been taken from 
 the creeks at one time to last as long as the water remained 
 infected. It is equally improbable that the germs multiplied in 
 the pipes. It seems necessary to conclude that the impounding 
 reservoir remained infected for several weeks. The whole water 
 works system should have emptied itself in less time than one 
 week. 
 
 The onset of the eisidemic was verj'' gradual. The first case 
 required the services of a physician on Januarjj^ 11. Two new 
 cases were seen on the next daj''. On the daj- following there was 
 but one case. On January 14 there were four; on the 15th, five; 
 on the 16th, three. Presently, the daily number of new cases 
 largely increased. On the 22d there were twelve; on the 28th, 
 sixteen; on Januarj' 31, twentj'-two; on Februarj'- 2, thirty-six. 
 Thereafter the number decreased and increased alternately with 
 a general declining tendency. 
 
 PREVIOUS HISTORY OF TY'PHOID AT ITHACA. 
 
 In considering an outbreak of typhoid it is instructive to 
 inquire whether the disease is new to the place or has existed 
 pre\'iously. The value of such evidence depends upon its accu- 
 racy-. Unfortunately the records of cases and deaths from the 
 infectious diseases are not kept with sufficient accuracy even in 
 our best regulated cities to enable a correct idea to be formed 
 of the amount of typhoid which has been present. 
 
Plate III. 
 
 sai 
 
 Fig. ]. — Privy und Ditch at RrooktDii on 
 lid to liave leceived t3-ptioid dejections. 
 
 Six-Mile Creek: 
 
 Fig. 2. — Six-Mile Creelc between 
 Slaterville and Brockton. 
 
SOPER. 439 
 
 Previous to the epidemic, no records whatever had been made 
 of the cases of typhoid fever which had occurred in the city at 
 large. The best information that can be gained on this point is 
 contained in the records of the principal hospital. These records 
 show the comparative amount of typhoid which occurred from 
 year to year. 
 
 Were the death records accurate, some idea could be gained 
 from them of this relation. The following letter, however, from 
 one professor of Cornell to another shows the incompleteness 
 of even this generally accepted source of information: 
 
 Ithaca, N. Y., March 12, 1903. 
 
 Dear Dr. T , The death rate of Ithaca is something almost impossi- 
 ble to ascertain, owing to omissions in the record. Several j'ears ago I 
 had three students worlcing on the subject for months and we reached the 
 conclusion that the omissions from the record were 29.4 per cent, in one year, 
 and 33 per cent, in another. On the basis of the corrected figures they 
 established for 1892 and 1893, the true death rate was 16.5 instead of 13.4, 
 which was claimed. Recent official figures are doubtless more accurate, 
 owing to the changes made in the registration law about 1895. 
 
 That the records, however, are still incomplete is shown by the Twelfth 
 Census. The registration record of the city for the census year from June 1, 
 1899, to May 31, 1900, shows 196 deaths; the census enumerator's returns, 
 obtained by asking at each house in town whether any death had occurred 
 in that family during the preceding twelve months, showed 100 deaths. 
 Successive comparisons of these two lists, name by nanie, showed in the 
 latter 17 names not in the former, giving a total of 213 deaths in the city 
 for that j'ear, as accepted by the Census Office, or a death rate for 1900 
 of 16.3. 
 
 Yours sincerely. 
 
 A report from Dr. F. C. Curtis to Dr. Daniel Lewis, State 
 Commissioner of Health, gives the opinion of the medical ex- 
 pert of the State Department of Health on the previous history 
 of typhoid at Ithaca. The report is dated Albany, February 7, 
 1903: 
 
 Sir, — The records show that for the past two or three years Ithaca has had 
 an autumnal prevalence of typhoid fever. In 1900 and 1901, the mortality 
 rate from this cause was about 40 per 100 000 population; and in 1902,^^ 
 however, there was but a single death. 
 
 The following table has been made out from data taken from 
 the books of the Ithaca City Hospital: 
 
440 TYPHOID FEVER AT ITHACA, N. Y. 
 
 Table No. 2. 
 
 Cases of typhoid fever and similar diseases treated at the Ithaca City Hospital 
 from 1892 to 1902 inclusive. 
 
 1892 1S93 1894 1895 1896 1897 1898 1899 1900 1901 1902 Totals 
 
 Jan. 
 
 
 
 
 
 1 
 
 
 
 
 
 
 
 
 
 
 
 1 
 
 
 
 1 
 
 3 
 
 Feb. 
 
 
 
 
 
 1 
 
 
 
 1 
 
 
 
 
 
 
 
 2 
 
 2 
 
 3 
 
 9 
 
 March 
 
 
 
 
 
 
 
 1 
 
 1 
 
 
 
 
 
 3 
 
 
 
 1 
 
 2 
 
 8 
 
 April 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 1 
 
 4 
 
 5 
 
 May- 
 
 1 
 
 
 
 
 
 1 
 
 
 
 
 
 
 
 
 
 1 
 
 
 
 4 
 
 7 
 
 June 
 
 
 
 2 
 
 1 
 
 
 
 
 
 1 
 
 
 
 
 
 
 
 
 
 
 
 4 
 
 July 
 
 5 
 
 
 
 
 
 
 
 
 
 2 
 
 1 
 
 
 
 
 
 
 
 
 
 8 
 
 Aug. 
 
 3 
 
 
 
 
 
 2 
 
 6 
 
 2 
 
 3 
 
 
 
 
 
 7 
 
 2 
 
 25 
 
 Sept. 
 
 10 
 
 3 
 
 3 
 
 2 
 
 4 
 
 9 
 
 1 
 
 
 
 7 
 
 10 
 
 3 
 
 52 
 
 Oct. 
 
 3 
 
 3 
 
 4 
 
 1 
 
 2 
 
 1 
 
 1 
 
 1 
 
 4 
 
 10 
 
 2 
 
 32 
 
 Nov. 
 
 
 
 2 
 
 3 
 
 
 
 1 
 
 
 
 1 
 
 1 
 
 9 
 
 3 
 
 
 
 20 
 
 Dec. 
 
 2 
 
 1 
 
 
 
 
 
 
 
 
 
 
 
 
 
 3 
 
 2 
 
 2 
 
 10 
 
 Totals 24 11 13 7 15 15 7 5 27 36 23 183 
 PUBLIC ALARM FOLLOWING THE OUTBREAK. 
 
 The outbreak of the epidemic caused a great deal of concern 
 among the people who lived at Ithaca or who had sons at the 
 university. It soon became known that the City Hospital was 
 full to overflowing and that the Cornell Infirmary, where sick 
 students were always treated, was becoming overcrowded. The 
 hospital called for public aid to help meet the extraordinary 
 expenses incurred in caring for so many of the sick, and sub- 
 scriptions were opened to give similar help to the infirmary, 
 where the students were being treated. 
 
 The local board of health, with the aid of its health officer, 
 Prof. E. Hitchcock, Jr., and Profs. E. M. Chamot and V. A. Moore 
 of Cornell, made some investigations as to the cause of the 
 epidemic which disclosed the unsanitary conditions on the drain- 
 age areas from which the water was obtained, and pointed to the 
 public water supply of the Ithaca Water Company as the probable 
 source of the infection. The board promptly ordered that the 
 city water be boiled before being used for drinking purposes. ; 
 
 It is important to state that Professors Moore and Chamot,' 
 in reports previously made to the local board of health, had 
 warned that body that the water supply was polluted; and that 
 the results of their analyses had been suppressed and kept froni 
 
]'X,ATE IV. 
 
 Fig. 1. — Outlet of drain from Acetylene Plant at 
 Slaterville Springs on Six- Mile Creek. 
 
 Fig. 2. — Six-Mile Creek at Slaterville. 
 
SOPER. 441 
 
 the public press by the board for fear of alarming the people. , 
 These and other disclosures of real or imaginary delinquencies' 
 on the part of the local board of health, water company, and 
 trustees of Cornell University gave the friends and foes of the 
 university and city abundant food for criticism. The result was 
 that more time was spent in trying to fix the blame for the epi- 
 demic than in bringing it to an end. 
 
 By this time the city was in a condition bordering on panic. 
 New cases of fever were appearing at the rate of twenty or more 
 a day and the epidemic was gaining headway rapidly. Hundreds 
 of students were leaving the university, notwithstanding stren- 
 uous efforts to keep them in the city. The railroads brought no 
 one to Ithaca but carried heavy loads away. Business was at a 
 standstill. The public press throughout the country, making 
 capital of the epidemic, gave the widest possible advertisement 
 of the unfortunate situation. 
 
 When the number of cases had reached several hundred the 
 State Department of Health sent a representative to Ithaca in 
 the person of its expert on infectious diseases. Dr. F. C. Curtis. 
 Dr. Curtis spent a day at Ithaca investigating the conditions, and 
 a few days later forwarded a report stating that undoubtedly the 
 disease was typhoid fever and that the water supply of the water 
 company was to blame for the epidemic; the source of the 
 infection was probably a gang of Italian laborers. He advised 
 the people to boil the water, and prophesied that in a short time 
 the epidemic would wear itself out. 
 
 But matters grew steadily worse and the Commissioner of 
 Health of the State, Dr. Daniel Lewis, went to Ithaca to inves- 
 tigate personally. Consultations were held, pubUe addresses were 
 made and various measures of relief were recommended. Fore- 
 most among the instructions given by Dr. Lewis to the local 
 board of health was to insist on thorough disinfection. This 
 should include not only the disinfection of the stools, but also of 
 •the urine of the typhoid fever patients. It was desirable that 
 household disinfection should be practiced also; and to insure 
 that this should be properly done the commissioner recom- 
 mended that competent medical inspectors be employed. Fi- 
 
442 TYPHOID FEVER AT ITHACA, X. Y. 
 
 nally, but of the utmost importance, the local board of health 
 was urged to compel physicians to report their cases of typhoid 
 fever under the penalty of being fined from twenty-five to fifty 
 dollars for each offence. 
 
 But the people of Ithaca were beyond advice. Internal dissen- 
 / sions, and the utter demoralization of the commercial and edu- 
 cational interests of the city, not to speak of the spirit of appre- 
 hension which pervaded every household, made it impossible for 
 them to unite on any form of local leadership to initiate the 
 measures which were necessary to restore public confidence and 
 put an end to the epidemic. 
 
 It was under these circumstances that I was requested b}* the 
 State Department of Health to go to Ithaca and see if I could 
 bring about relief. I arrived at Ithaca on ;\Iarch 4. Thanks 
 to the energetic cooperation which I at once received from the 
 officials and employees of the city government, the authorities 
 and professors of Cornell University, the president and others 
 of the Ithaca Water Companj'-, and the citizens themselves, the 
 difficulties of the situation cleared rapidly. Pubhc health work 
 of a kind seldom seen outside of militarj' situations soon regained 
 for the board its lost prestige. Public confidence was gradually 
 restored. The authorities of Cornell, from being on the point of 
 f closing the university, decided to keep it open and to hold a 
 V* summer session. The frightened students returned; business 
 "■^..was re-established. By the 1st of April I notified the local board 
 of health that I saw no further need of mj^ services and 
 that I should return to New York, leaving the sanitary work 
 in their hands. I was requested to remain and super\-ise the 
 work of the board until September 1, 1903, taking up. at the 
 same time, the study of means for improving the drainage of 
 the city. Satisfactory arrangements were made for this work and 
 I remained. 
 
 Throughout my residence at Ithaca my official position was 
 that of representative at Ithaca of the New York State Depart- 
 ment of Health. In this capacity I acted as expert ad^-isor to 
 the local board of health. The steps taken to extinguish the 
 fever were carried out by the local board, acting, as a rule, upon 
 suggestions from me. 
 
Plate V. 
 
 Fig. 1. — "Dirty Baker." 
 
 Fig. 2. — Home of " Dirty Baker," Buttermilk Creek drainage area. 
 
soPER. 443 
 
 THE SANITARY CAMPAIGN. 
 
 At the outset it was recognized that there must be money 
 available for the sanitary work. The nature and extent of the 
 preventive and corrective measures which were thought neces- 
 sary were explained to the board of aldermen, who thereupon 
 pledged to the board of health the credit of the city. 
 
 The first thing to be done was to determine the origin and 
 extent of the epidemic. An investigation was begun to discover 
 as nearly as practicable where each case of fever originated, 
 and when and where it occurred. Statistical records were made 
 embodying this and various other pieces of information con- 
 nected mth the identification and location of the fever victims. 
 The work was carried on with extreme care, several men being 
 engaged upon the records for mam^ weeks. 
 
 In order to bring about harmony of action, numerous con- 
 ferences with representatives of the principal interests at Ithaca- 
 were held. Some of these were of a public, and others of a 
 private, nature. At a meeting of the board of health, at which 
 representatives of the city government, of the water company, 
 and of the university were present, all pledged themselves to 
 harmonious action. At a meeting of the physicians of the city, 
 various technical matters and many opinions concerning the 
 epidemic were discussed. Public conferences in the form of 
 lectures were held, at which the principles of disinfection and 
 household sanitation were dealt with. In articles offered to the 
 press, instructions . were given in the use of various protective 
 measures against the fever, and the sanitary ordinances of the 
 city which had a bearing on the situation were dwelt upon. 
 
 It was found earty that the disinfectants emploj-ed by the 
 nurses were not of reliable quaUty, and, as good disinfectants 
 were difficult to obtain, the city was advised to prepare and supply 
 these necessities. The disinfectants chosen for distribution by 
 the city were milk of lime and bichloride of mercury. These 
 were supplied wherever a case of fever existed, four wagons 
 being employed to make the rounds. The total quantity of milk 
 of lime distributed was 23 231 gallons. The quantity of bichlo- 
 ride of mercury was 1 930 gallons. 
 
444 TYTHOID FEVER AT ITHACA, X. Y- 
 
 An investigation was set on foot to determine the cause of 
 the epidemic, and various important matters connected with 
 this topic were soon discovered. There was no doubt that , 
 the drinking water suppHed by the water company was the original i 
 cause of the epidemic, but it was evident that the disease .was , 
 being transmitted from person to person through carelessness' 
 and ignorance in nursing the sick. The sanitary condition of 
 the city, which had been somewhat improved within eight or ten 
 years, was in need of improvement. 
 
 'There were two obvious sources of danger in this direction. 
 The city contained about. 1 300 wells and nearly an equal number 
 of privies. The latter were constructed without reference to 
 -seepage, unless a desire to have the liquid wastes escape into 
 the ground might be so interpreted. It was thought advisable 
 to clean and disinfect the privies and to analyze the waters of 
 the wells. This work was undertaken in April and concluded 
 in August. 
 
 The total volume of excrement removed was 418 193 gallons. 
 The material excavated from the privies was taken into the 
 country and plowed into the soil. Twelve acres of poor ground 
 were used for the purpose. Later, a remarkably successful crop 
 of corn was grown upon this ground. It is a satisfaction to be 
 able to say that in this extensive and dangerous piece of scaveng- 
 ing work there was no sickness nor accident among the fifteen 
 .employees and eight horses continuously engaged. 
 
 As a result of the analyses of well waters, over 30 per cent, 
 -of the wells were condemned. The total number of. waters 
 analyzed was 946. It is interesting to note that whole por- 
 tions of the city could be blocked out by the records of the 
 -well examinations. In some sections, the water of nearly every 
 well was polluted, while in other sections the wells could all be 
 •depended upon as good. The good wells were in clay; the poor 
 ones in fissured rock. 
 
 In order to determine the character of many suspected cases 
 ■of fever, a large number of Widal examinations of blood were 
 made. These proved of great value. 
 
 To make certain that the milk supplies did not become, infected, 
 ^careful inspections were made of all the dairies furnishing the 
 
Plate VI. 
 
 Fig. 1. — On the flats of Ithaca ; flood due to high water in Caj'uga Lake. 
 
 Fig. 2. — On the low lands of Ithaca. 
 
SOPER. 445 
 
 citizens_with milk. Other food supplies were examined into, 
 and the quality and care of these important necessities were 
 much improved. 
 
 The work on the statistics of the epidemic soon showed that 
 a disproportionately large number of the students of Cornell 1 
 University had been attacked by fever, and, in consequence of 
 this fact, inspections of boarding and rooming houses occupied 
 by the students were systematically made. Every point of sani- 
 tary importance connected with the living quarters of the students 
 was carefulty examined and recorded, as a result of which each 
 house was given a sanitary rating. A list was published con- 
 taining the address of every boarding house which passed the- 
 examination. 
 
 One of the most important measures adopted, and, it is thought,, 
 an innovation in the management of typhoid epidemics, wasJ 
 the use of urinary germicides to eliminate bacterial infection! 
 from the bladders of convalescents. As is well known, the' 
 bladder, in a large number of cases of typhoid fever, becomes, 
 infected and enormous numbers of the disease germs are given 
 off in the urine. Analyses of urine were made to determine the 
 existence of the bacillus typhosus. In the event of the discovery 
 of this germ the patient was held under observation and given 
 urotropin until the bacillus disappeared. 
 
 It was not long after the introduction of systematic measures 
 for the suppression of the epidemic that public confidence began 
 to be restored. The number of new cases of fever reported from 
 day to day rapidly diminished, and although an occasional case 
 appeared for several months, the epidemic ceased by AprU 1. 
 
 THE LESSON OF THE BARNES WELL. 
 
 It is proper to refer, before closing this account of the Ithaca 
 epidemic, to an outbreak of fever which took place in one sec- 
 tion of the city after most of the ^ther cases had disappeared. 
 This outbreak was^theTesult onhe ""contamination of a well 
 on the property of a man named Barnes. . The Barnes well 
 had been famous; people who Iiad learned to fear the city 
 water went to the Barnes well with a feeh'ng of perfect safety. 
 
446 TYPHOID FEVER AT ITHACA, N. Y. 
 
 No one had ever been made sick from drinking this water. So 
 great was the demand upon the well that the water was actually- 
 piped to another, house. 
 
 It was the original intention of the local board of health to 
 examine every well in the city, and had this plan been carried 
 out, the Barnes well would have been found to be polluted 
 in time to prevent the outbreak which followed. Unfortunately, 
 in a moment of econom}'^, the well examinations were stopped 
 and the Barnes well was one of a very few not tested. 
 
 In about two weeks after the board of health stopped analyzing 
 the well waters, many of the people who had been drinking from 
 the Barnes well were taken Dl. In all there were fifty cases of 
 typhoid and five deaths traced to this well. 
 
 "V^^len suspicion was directed to the well, I visited it and had 
 the drain pipe from the water closet in the Barnes house exca- 
 vated. The drain ran within three or four feet of the well. 
 When the laborers dug the earth from beneath the drain, they 
 found that the joints had been scamped; that is, insecurely and 
 improperly closed. When the water closet in the Barnes house 
 was flushed, the water would run through the drain to a point 
 about ten feet from the well, whence it would flow out into the 
 porous soil through the leaky joint and so into the well. On 
 anatysis, the water of the well was found to be grossly polluted. 
 We needed, however, to find out how the drainage which 
 entered the well had actually infected it. It was then discovered 
 that Mrs. Barnes had suffered, some weeks before, with a mild 
 attack of typhoid fever, which had been pronounced by her phy- 
 sician to be grippe. We proved the real character of her disease 
 by taking a specimen of her blood and examining it in the labo- 
 ratory. The dejecta from this patient passed down through the 
 water closet without disinfection; it escaped from the drain pipe 
 into the well and, as we have said, occasioned fifty cases and 
 five deaths. 
 
 INDEPENDENT SANITARY MEASURES. 
 
 I have not mentioned aU of the sanitary measures which were 
 taken to suppress the epidemic of typhoid and guard against 
 future difficulty, but have indicated some of the most important 
 
Plate V I. 
 
 Fig. 1. — Conditions wliich added to the diffleulty of sanitation on the 
 low lands of Ithaca. 
 
 i'v-f-g.Pil.V- 
 
 Fig. 2. — Celery and other vegetables growing in a back yard at Ithaca. 
 
SOPER. 447 
 
 Tvith the idea of furnishing examples of the work done by the 
 local board of health, under my advice. Important things were 
 ■ done by the city, the water company, and the university, sometimes 
 without formal cooperation with the health authorities. The 
 water company constructed a municipal filter plant at a cost of 
 :something like seventy thousand dollars. The plant was designed 
 by Mr. Allen Hazen and built under the supervision of Prof. 
 ■Gardner S. Williams. This filter is now in operation, purifying 
 the water of Six-Mile Creek, on the rapid or mechanical filter 
 principle. 
 
 The water mains of the distribution system were flushed, 
 the city being divided into sections for this purpose, and the 
 whole work was carried on under the direction of Professor 
 Williams. 
 
 pilules were made and established legally for conserving the 
 ypurity of the water of Six-Mile Creek and Buttermilk Creek. 
 These rules .included precautions to be taken in the construc- 
 tion and maintenance of privies, the disposal of sewage, stable 
 wastes, etc., and forbade washing and bathing in the streams. 
 The citizens undertook to find a new source of water supply 
 v'which could not be contaminated, and sunk many wells in this 
 undertaking. It is reported that their efforts have at last proved 
 ;successful and that there is now an abundance of water avail- 
 able from the wells. 
 
 New methods of cleaning the streets and disposing of garbage 
 
 "^-^nd other refuse were inaugurated. A cremation plant for the 
 
 consumption of refuse was erected to meet the emergency of 
 
 the epidemic. Although this plant was for temporary use only, 
 
 it is said to be in operation still. 
 
 A thorough municipal house-cleaning was instituted early 
 v/in the spring. House-holders were induced to open up their 
 hermetically closed dwellings to the free air and clean them out 
 from attic to cellar. Back yards, forgotten alleys, and other 
 unsightly places were cleaned up. The amount of rubbish 
 brought to light was astonishing. 
 
 The sanitary code of the city was enforced in a manner pre- 
 
 ^^/viously -unknown. Emphasisjrwas placed .upon the n^^ of 
 
 Tjoiling the city water before using it, but, strange as it may seem, 
 
448 TYPHOID FEVER AT ITHACA, N. Y. 
 
 this precautionary measure was continually evaded. To further 
 prevent the people from drinking this dangerous supply, water 
 from a pure, free-flowing well was peddled from house to house 
 at the nominal price of one cent per gallon. 
 
 COST OF THE WORK. 
 
 The total cost of the sanitary campaign was somewhat over 
 SIOS 000. This takes into account the cost of the filtration plant 
 buUt by the water company. The board of health itself spent 
 SIOOOO. The privy cleaning cost §5 000 more; the inspection 
 and plumbing improvements of students' boarding houses are 
 estimated to have cost about $10 000 additional; the construe- \ 
 tion of the garbage destructor and improved collecting service 
 cost S3 000. Filters, which I have not before mentioned, con- 
 structed for the purification of the water supply of Cornell 
 University, cost about SIO 000. 
 
 PRESENT OUTLOOK WITH RESPECT TO TYPHOID. 
 
 The history of typhoid at Ithaca from the end of the epidemic 
 to the present time may be of interest. I have just been in- 
 formed by the health officer that in the year ending September 1, 
 1904, there were in the whole city thirty-six cases of typhoid 
 fever. Of these, twenty-eight occurred before the first of Jan- 
 uary and the remainder since. Those which took place from 
 September to January are regarded by the board of health of 
 Ithaca as due to the drinking of water from mains which had 
 not been thoroughly cleaned. 
 
 It is doubtful if typhoid fever •will ever gain a foothold in the 
 city again. The work of extinguishing it was thorough and 
 apparently complete. The record for the year following the 
 epidemic is probably cleaner than any record would have been 
 for many years, had the returns of cases been as accurately made. 
 The site of the city is one of great beauty and natural attrac- 
 tiveness. It can, and probably will, be made one of the healthi- 
 est and best regulated cities in the world. If this is done, its 
 destiny is clear. So long as the great university remains, Ithaca 
 will be a citj- of homes, and the people will be intelligent and. 
 
Plate VIIJ. 
 
 Fig. 1. — Sewei- raanliole overflowing, during exceptionally high stage 
 of Cayuga Lake. 
 
 Fig. 2. — Method of disposing of excrement re- 
 moved from privies after the epidemic. 
 
DISCUSSION. 449 
 
 ■cultivated. They should now be far-seeing in sanitary matters. • 
 -Seldoin has so terrible a lesson of the consequences of sanitary / 
 neglect ^beeiPgiven^ Tlmt'the^world bielieves -that this lesson 
 has been well learned is evident by the fact that the prosperity 
 of the city suffered no permanent impairment. The freshman 
 ^lass which entered Cornell in the autumn following the epidemic 
 was the largest in the history of the university. 
 
 DISCUSSION. 
 
 Mr. Frank L." Fuller.* We have all been very deeply inter- 
 ested in what Mr. Soper has said, and I think we are greatly 
 indebted to him. Those of us who have to do with water supplies 
 ought to receive a new impulse to see to it that our supplies are 
 carefully guarded from sources of pollution. It seems to me / 
 that this is the most vivid illustration of carelessness and poor/ 
 management that we could have had brought before us. V 
 
 There is one question I should like to ask Mr. Soper. He spoke 
 about the cleaning of the water pipes during the latter part of 
 the time of the epidemic, and I should like to ask what method 
 was pursued in doing it. 
 
 De. Soper. The question was thoroughly considered, and 
 it was proposed by Prof. L. M. Dennis of the Department of 
 Chemistry of Cornell that the pipes should be disinfected. He 
 wanted to send to Europe, I think, for a large quantity of per- 
 manganate of potash,- and run it into the distribution system in 
 some way and so destroy all the infectious germs. Professor 
 Dennis thought this would not do any injury to the pipes or to 
 the connections. It was finally decided, however, that it might 
 not prove as effective as hoped, and that it might have this 
 effect: If the pipes were not thoroughly disinfected a calamity 
 might result, as the people would in aU probability give up 
 boiling the water if they thought the germs in the pipes had 
 all been destroyed. Other methods of disinfecting the pipes 
 were considered, and after a conference with representatives of 
 the water company, and particularly with Prof. Gardner S. 
 Williams, who was the engineer of the water company, it was 
 thought best to flush out the mains as thoroughly as feasible, as 
 
 * Civil Engineer, Boston, Mass. 
 
450 TYPHOID FEVER AT ITHACA, N. T. 
 
 soon as the improved water supply was available, — that is, as 
 soon as the filters were put in operation; and that was done by 
 dividing the city into sections, and concentrating the pressure 
 first in one quarter and then in another. I should not like to 
 say that I considered that sufficient. I do not believe that Pro- 
 fessor Williams did, and I do not believe any one would, but it 
 seemed to be the best thing that was available at that time. 
 
 A ]\Iembek. What was the condition of the inside of the pipes? 
 Were they smooth, showing the treatment which the pipes were 
 originally subjected to, or were they covered with tubercles and 
 was sediment deposited, or were they clean and bright? 
 
 Dr. Soper. I think there were many portions of them which 
 were tuberculated, and there was considerable sediment, I think, 
 in some of them. 
 
 Mr. Kenneth Allen.* I think perhaps this is the most 
 thorough investigation which has ever been made of a public 
 water supplj', and I think one of the interesting features of the 
 investigation is the number of different points of attack that 
 were develoiied, the many different sources of infection that were 
 brought out. I would like to ask Dr. Soper if it was supposed 
 that there was much infection through dust containing tj'phoid 
 germs being blown about? 
 
 Dr. Soper. It did not seem to be so. You see" it was so early 
 in the season that there was little dust excepting in houses, but 
 it was thought that dust might have played quite an important 
 part in the houses. 
 
 Mr. Allen. You spoke of the danger of infection from pig- 
 pens and manure heaps. The original source, of course, would 
 have to come from a typhoid fever patient, would it not? 
 
 Dr. Soper. The danger I referred to was this: In the epi- 
 demics I have investigated, I have invariabl}'' found that the male 
 population of the farm uses the manure pile as a receptacle for 
 their excrement. The women use the privj"-, and the men go out 
 to the barn. Now, if a man has typhoid germs in his intes- 
 tines and in his bladder and is throwing them off, he will throw 
 them off into the manure pile. 
 
 Mr. Allen. That is a very interesting point. Is it known 
 
 * Engineer and Superintendent, Water Department, Atlantic City, N. J. 
 
DISCUSSION. 451 
 
 or is there a preponderance of opinion one way or the other, as to- 
 the identity of the form of the typhoid bacillus? 
 
 Dr. Sober. That is, perhaps, one of the most vexed problems 
 now before bacteriologists. One of the latest ideas I am almost 
 afraid to speak about because it seems to tend to upset past theories 
 which have been very carefully built up. But there is a young 
 man who has made some observations in Strasburg who claims 
 that the ordinary colon bacillus may, under some circumstances, 
 be transmuted or transformed into the typhoid germ. But I 
 think it is the prevailing opinion among conservative bacteriolo- 
 gists that we should regard that theory with doubt until the 
 matter is more carefully investigated. 
 
 Mr. Allen. I happened to be at Ithaca when Dr. Soper 
 was making these investigations, and I can testify to the feeling 
 of panic there was among the people there, especially the students. 
 
 Mr. E. H. Foster. I should like to ask Professor Soper how 
 near to tlie intake of the water company the first positively known 
 source of pollution was, and how near it the culvert was where 
 " Toothless Ben " was working. 
 
 Dr. Soper. I can answer the second question more briefly 
 than the first. The culvert where " Toothless Ben " worked was 
 within three miles of the intake, measured by the stream. The 
 nearest source of pollution was, I should say, an eighth of a mile, 
 and that was one which a superficial investigation might have 
 hit upon as the cause of the epidemic. It was the residence of 
 a woman of notorious character. Just prior to the epidemic she 
 had been suffering from a disease which she herself pronounced 
 unmistakablj'' typhoid fever. Her phj'^sician did not call it that. 
 He said she suffered from grippe. With a good deal of difficult}'^ 
 I got some specimens of her blood, and they did not give the posi- 
 tive result of tj'phoid. That, however, did not prove that the 
 woman had not had it. There is no doubt that the waste from 
 the house was thrown down the precipitous bank of the stream 
 within an eighth of a mile of the intake of the water supply. It 
 may be that this was the cause of the epidemic. 1^ must saj', 
 however that I have not in my own mind fixed upon the pollution 
 of the water supply at any one specific point as the sole and suffi- 
 cient cause of the Ithaca epidemic Among such a large number- 
 
452 TYPHOID FEVER AT ITHACA, N. Y. 
 
 of sources of pollution as were obvious, it was difficult to dis- 
 criminate. Any one of over a dozen might have been the cause. 
 
 Mr. L. M. Hastings.* I suppose that what we have heard 
 here to-day brings to the mind of every superintendent the possi- 
 bility of the pollution of his own supply. When we have heard 
 how great a result may come from a slight cause, it certainly is 
 a' matter for the gravest consideration and something to incite 
 us to the closest examination of our water supplies. I remember 
 a few years ago Professor Sedgwick spoke of the epidemic at 
 LoweU, and he traced that, I think, to one solitary case of typhoid 
 on a stream some mUes from the city. Now, if that is the case, 
 what protection have we against an epidemic from a cause which ' 
 it is impossible to detect? If a single case of typhoid on a remote 
 branch of the system may affect the whole system, it does seem 
 is though our health and lives were in a pretty precarious situa- 
 tion. 
 
 There are some precautions which I suppose we can take to 
 reduce the likehhood of infection. I suppose the first thing 
 ;vould be to make a sanitary survey of the whole watershed and 
 ocate the most dangerous points. That is most commonly done 
 lowadays by a house-to-house visitation and abolishing as far as 
 jossible the points of contagion. In some cases where privies 
 lave existed before the taking of the water supply, it would seem 
 IS though the only thing to be done was to introduce some im- 
 jrovement, and I know that on the Cambridge supply where 
 luch danger has existed, the water board at its expense has 
 abolished pri^•ies and open cesspools and substituted water-tight 
 )rick vaults. Those brick vaults are cleaned out by the water 
 )oard. This is a precautionary measure against just such cases 
 is Dr. Soper has referred to this morning. I don't know whether 
 iuy method of disinfection by copperas or other chemicals 
 voxild be sufficient, but it does seem to me that where such sources 
 if pollution exist on the water supply or its branches, something 
 if this sort would be efficient. 
 
 There is one matter the doctor spoke of which interested me. 
 le said that young men are more subject to typhoid infection 
 han old men are. I suppose in a generic way that that is true, 
 
 * City Engineer, Cambridge, Mass. 
 
DISCUSSION. 453 
 
 that all young men are more subject to fevers and older men are 
 more subject to inflammations. I should like to ask the doctor 
 if he knows of any reason why young men should take the typhoid 
 fever more easily than old men. 
 
 Bk. Soper. No, I do not know of any reason. Of course, it 
 is not young men only, but young women also. If you examine 
 any exhaustive work on hygiene you will find tables showing the 
 relative prevalence of typhoid among people of all ages. It seems 
 that there is an age relation with many of the infectious diseases. 
 Measles and other diseases that we commonly speak of as diseases 
 of childhood attack young people more than old people, not be- 
 cause old people have had the diseases once and so are immune to 
 them, but apparently for some other reason, children are more 
 susceptible. 
 
 Me. Edward Atkinson. I remember there was a serious 
 epidemic at Windsor, Vt., a few years since. Desmond Fitz- 
 Gerald was sent for in haste, and he went up there and found a 
 single case of typhoid in a farmer's house which drained into the 
 water supply, and from that single case the water supply of Wind- 
 sor, which is one of the most healthy places in the country, had 
 been infected and an epidemic had resulted. 
 
 Prof, E. G. Smith.* I want to express my appreciation of 
 what Dr. Soper has said this morning and of the very thorough 
 way in which he has gone into the unearthing of the mysteries 
 of the epidemic at Ithaca. Those of us who have had to do with 
 this sort of a problem elsewhere realize very keenly the labor 
 involved and the thoroughness with which the work has been 
 done. I was much interested in the discussion of the cases, and 
 I raised in my own mind the question of how many of them were 
 due really to the water, and how many, or what proportion, of 
 those 1 350 cases were due to what we call " contact infection " 
 or "comrade infection." I don't know as the doctor has any 
 data bearing upon that point, but it is certainly an interesting 
 one. The fact remains, however, that the primary infection of 
 that community was due to the impurity of the water and to 
 the shocking conditions which existed above the intake of the 
 pubhc supply. 
 
 * Beloit, Wis. 
 
454 TYPHOID FEVER AT ITHACA, N. Y. 
 
 I wish I had time to say something which would be corrobo- 
 rative, perhaps, of the line of work whicli has been carried out at 
 Ithaca. There is another chapter there in this old, old story of 
 the pollution of our supplies, our great supplies and our small 
 supplies, by persons suffering from the acute stages of typhoid 
 fever, or, indeed, from those often more dangerous cases of what 
 are known as " walking typhoid." It has been my fortune to 
 examine into some of the epidemics, large and small, which have 
 prevailed in the Western states. I should like to go somewhat 
 into the details of the epidemic at Rockland, 111., which was 
 directly traceable to the pollution of the water supply. Perhaps 
 later when I may be in Boston, as I hope to be for a few months 
 this winter, I may have the pleasure of speaking to you upon that 
 epidemic, which certainh' was a most remarkable one, and the 
 historj'^ of which has not as yet, I believe, found its way into print. 
 
 I should like to speak of the epidemic at Baraboo, Wis., where 
 we had direct proof that the outbreak was due to contamination 
 of the water supply. It is a comparatively smaU town, two or 
 three thousand inhabitants onl}'-, and there were not more than 
 two hundred cases, with a death rate of perhaps one in thirty, and 
 the evidence was as certain as anything which has been presented 
 here regarding the outbreak at Ithaca. The town is situated on 
 a river. The sewage passes into a canal, which is taken from 
 above a dam below the city, and for some mysterious reason the 
 water supply pipe was laid on the bottom of that canal, the supply 
 being from wells on one side of the canal and the pumps being 
 situated on the other. Why the pipe was ever laid there I 
 cannot imagine, but worse than that, in the pipe was a T and 
 valve so that an extension could be put on, and there were 
 three joints. In consultation with Dr. Russell, of Madison, 
 Wis., I was called on to find the cause of an outbreak of typhoid 
 fever in the town, there being at that time about seventy-five 
 cases. After beating around for three or four days we plotted 
 out the cases as they were reported. We found that they would 
 come in, one, two, three or four, and then suddenly there would 
 be a rise to seven or eight cases; then the number would drop to 
 two or three, and then in the course of twelve or fourteen days 
 there would be another rise. That is, there were waves, as it 
 
DISCUSSION. 455 
 
 were, or periods when there were many more cases reported than 
 at other times. 
 
 That led to an investigation as to what had happened on certain 
 dates. Reckoning back to cover the period of incubation of 
 typhoid fever, about fourteen days, we went down to the pumping 
 station and asked them what they did on the date in question. 
 " Did you take any raw river water from the canal that day? " 
 " No, sir; the pumps were operated just exactly on that day as 
 on other days." I asked the engineer, " What did you do on the 
 thirteenth day of July? " reckoning back fourteen days. " We 
 didn't do anything except to operate the pumps just the same 
 that day as before." But somebody went out and came back in 
 a few minutes and said, " Why, that was the day we started the 
 steam pump." Well, on looking up the records we found that the 
 thirteenth day of July was a very hot day, and the water power 
 pumps were inadequate and the auxiUary steam pump had been 
 started. Reckoning back fourteen days the other way we found 
 that on the 27th of July the steam pump had been started again. 
 I turned to the superintendent and said, " You go down and 
 you will find that the packing is out of the joints in that pipe 
 at the bottom of the canal, and that j'^ou have got leaks 
 around the joints." Said he, " How do you make that out?" 
 I replied, " I will tell you. Ordinarily the silt will settle down 
 around the joints and the jar of the water pumps is not enough 
 to start it, but the pulsation upon the main pipe when the 
 steam pump was started has been sufficient to jar out the 
 silt." So they drew down the water and found five leaks, 
 one of which you could put your hand through. In other 
 words, the lead had dropped away, the silt had taken its 
 place, and the increased jar on the intake pipe had caused that 
 silt probably to be sucked in and caused a leak, so that the dirty 
 water from this canal could go through and find its way into the 
 main. Fourteen days after that first starting of the steam pump 
 the typhoid fever broke out, and fourteen days from" the time the 
 steam pump was started up the second time the fever increased. 
 We ordered that pipe taken out altogether, so that the canal water 
 could not find access at all to the mains, and the epidemic then 
 died out. 
 
456 TYPHOID FEVER AT ITHACA, N. Y. 
 
 I might go over the same story at Ashland, Wis. ; I might go 
 over the same story again at Duluth, Minn. ; and I might go over 
 the same story again in the city of Minneapolis, where there was 
 a second outbreak this year. And so you will find it is the same 
 story over and over again of the water supply being the primary 
 cause of the outbreak of this dread disease. 
 
 A friend back here (Mr. Hastings) asks how we are going to 
 prevent it. The only way is by eternal vigilance. I was called 
 upon to make an investigation of the Denver supply. What did 
 we find? At a point sixteen mUes above the lake we found a 
 brother and sister sick in bed with typhoid fever, and the dejecta 
 from those patients were thrown out, without any disinfection 
 whatever, into Bear Creek and found their way to the city. The 
 health commission went up and bought that house and took 
 the sick people — it was in warm weather — out into a tent 
 which was erected temporarily, and burned down the house, 
 cleaned up the debris and covered the spot with loam. To-day 
 if you went out where that house stood you would find a bright, 
 green grass plot. 
 
 Eternal vigilance, watching the plant continually and keeping 
 after it, is the only recommendation I have to make to those 
 who have to do with the operating of public water supplies, 
 for it is only in that way that they can be certain of guarding 
 against not only the open causes which everybody knows 
 about, but the far more insidious causes that the public never 
 wiU know about till the dire result of some great outbreak 
 follows. 
 
 Mr. M. N. Baker.* It is certainly appalling to think that 
 such an epidemic, caused by conditions such as have been 
 described, could have occurred so recently; and it is all the more 
 appalling when we realize the fact, as we must, that there are 
 hundreds of other communities that have the danger of the same 
 kind of epidemic, of equal severity, impending at the present 
 moment. As many of you doubtless remember, during the past 
 winter we had a large number of outbreaks, and one or two epi- 
 demics which rivaled in importance that at Ithaca. Those out- 
 breaks attracted a great deal of attention, and I think they have 
 
 * Associate Editor, EngineeriTig News, New York CSty. 
 
BISCUSSION. 457 
 
 done a great deal to arouse the public mind to the necessity of 
 guarding against them in the future. 
 
 The precautions which can be taken against such outbreaks 
 naturaUy divide themselves under two heads. One of them, and 
 the first, concerns more particularly an association like this, 
 composed of water works superintendents and engineers. The 
 duty of a water works superintendent and of a water board is, of 
 course, to do all that is possible, first to prevent the pollution of 
 the water, and second, to make sure that the water when neces- 
 sary is purified before it is delivered to the consumer. 
 
 Now, in view of the almost insurmountable difficulties in pre- 
 venting occasional pollution in sparsely populated drainage areas, 
 and the general apathy and indifference of the public, whose 
 interest and support is necessary to prevent contamination, both 
 in the rural districts and in the districts nearer the cities, I think 
 we may say the time has come when we in the United States wiU 
 have to do as is done in Great Britain and Germany, and begin 
 to make our plans to effectually purify all water derived from 
 surface sources. That subject, of course, might be dealt with at 
 length, but as the time is short, I wish to pass on to the precau- 
 tions of the other line. 
 
 Those are more general in their nature, but as the water works 
 superintendents and other officials have such a great burden of 
 responsibility upon them, I think that they must trj^ to arouse 
 the public, the various municipalities and municipal authorities 
 of the country, to the necessity of a thorough reorganization of 
 the work of the local boards of health. Here is where the trouble 
 arises. Scarcely any of the cities of the United States, to-day, 
 large or small, are taking effective precautions through their local 
 boards of health to protect the purity of their water supplies and 
 to prevent these epidemics of typhoid which arise, not always 
 from water supplies, but from many other sources. 
 
 It is for the interest of water works authorities to have the 
 necessary work done to prevent the spread of typhoid through 
 other causes than the public water supplies. Many epidemics, 
 mild outbreaks generally, but sometimes quite considerable ones, 
 come through the milk supplies. The protection of the nulk; 
 supply is a rural question, and it comes in naturally and is closely i 
 
-458 TYPHOID FEVER AT ITHACA, N. Y. 
 
 related to the protection of surface water supplies. Now, I ven- 
 ture to say that with efficient board of health work, with suffi- 
 cient registration of vital statistics, such epidemics as occurred 
 at Ithaca, and more recently at Butler, Pa., and a number of 
 other places, could never have attained the importance that they 
 did. They would have been stamped out long before so much 
 mischief was done; and ordinarily the secondary infection would 
 be prevented by proper board of health work. 
 
 There are a few questions which it would be very interesting 
 indeed to discuss at greater length and to have the author of the 
 paper answer, but in view of the lateness of the hour, perhaps 
 the answers to those questions might be given in writing in closing 
 the discussion. There is one thing, however, which vitally con- 
 cerns us all in view of the educative value of such a study as was 
 made at Ithaca and has been presented in outline here. Why 
 was not that report, which was worked up with great care, and 
 which would have been of inestimable service in carrying on the 
 -campaign against the spread of typhoid fever throughout the 
 country, made public? Why has it been suppressed? The 
 report, as I understand it, was completed practically a year ago. 
 The study was made by the Department of Health of the State of 
 New York at great expense, and that report should have been 
 pubHshed in a large number of copies and circulated broadcast 
 . throughout the state of New York, in order to arouse other 
 communities to the necessity of carrying on preventive work. 
 
 Another question is, How could such conditions as existed at 
 Ithaca haye-arisenin-a university town? Now, that is rather a 
 delicate question and opens up an opportunity for a very great deal 
 of discussion. I thought, at the time, a great deal about it, and 
 this thing came to my mind among other things: Philadelphia, 
 for instance, in which is located the University of Pennsylvania, 
 a university city, has been suffering through these many years 
 from a very large number of cases of typhoid fever. The Uni- 
 versitj- of Pennsylvania, so far as we know, did comparatively 
 little, but there the problem was so great and so far beyond the 
 influence of the university that we might not expect it could do 
 much except through the individual efforts of some of the members 
 of the staff. I think as a matter of fact that some of them did 
 
DISCUSSION. 459 
 
 liave a ^ery great influence in the early days upon the protection 
 of the Schuylkill. But in a smaller place Uke Ithaca, and like 
 Beloit ;and many other places where there are universities, the 
 teaching staff of the university can have and should have a very 
 :great influence an the protection of the public health. I think 
 that is worthy of reflecting upon, at least. Has Ithaca an effi- 
 cient TDoard of health to-day? Is it in a position to keep down 
 these dangers along the same line? I have understood that, 
 notwithstanding its severe lesson, politics and a multiplicity of 
 ■conflicting interests of one sort and another have prevented the 
 carrying out of efficient work. 
 
 One of the greatest difficulties which any local board of health 
 has to contend with in trying to put the municipalitj'^ under its 
 care in proper condition to-day is the finding of the proper sort 
 of men to carry on the work of inspection and protection of the 
 public health. There is not in the United States to-day any 
 means of providing the training which is necessary for an execu- 
 tive iealth officer or health inspector, and we are continuoush'^ 
 confronted in the community in which I live — Montclair, N. J. 
 — with that fact. Every few years we have to go through the 
 finding of a new man to occupy the position of executive health 
 ■officer. We are in that position to-daj-. We had in Montclair 
 a few years ago an outbreak of typhoid fever which resulted 
 in something over eighty cases, — a milk epidemic — due 
 to a mild case of tj^phoid in the family of a milkman. It 
 was the case of a young man who worked in the dairy and 
 who went to a privy which was located a little higher than 
 :a well, from which water was drawn to wash the milk cans, 
 ■etc. We had, as I saj^, in Montclair some eighty cases, and the}' 
 w^ere all on one milk route. And this illustrates the fact that 
 the burden of this responsibility for typhoid does not all rest 
 upon the water works men, although water is generally at the 
 bottom of the matter. That epidemic aroused public interest 
 so much in Montclair that they have backed up the work of the 
 board of health ever since, and we have had almost without 
 exception during the last eight or ten years a trained man as 
 executive health officer in the town. We have generally gone to 
 Professor Sedgwick at the Massachusetts Institute of Technology 
 
460 TYPHOID FEVER AT ITHACA, N. T. 
 
 and asked him to find some man for us, because the course there 
 and the work under Professor Sedgwick and formerly under Pro- 
 fessor Drown seemed best to fit men for that position. But every 
 two or three years the man we get becomes so valuable that he 
 is sought for other lines of work elsewhere and given greater 
 compensation. We have just lost a man who has gone on to the 
 United States Geological Survey to assist in the work of the 
 investigation of water supplies and their pollution. And so we are 
 again confronted with the necessity of finding a competent man, 
 and there is no place to go where we can find a number of men 
 to draw upon for that work. 
 
 This Association and its members have an opportunity for a 
 great deal of usefulness in bringing the attention of the public 
 authorities to these other phases of water pollution resulting in 
 typhoid fever epidemics, and also in bringing home to our educa- 
 tional institutions their duty towards the smaller communities 
 in which they are located, and the need of courses in all of our 
 ■ leading institutions of learning which shall fit men to carry on the 
 health protective work of our cities and towns. 
 
 President Brooks. I have noticed that that old fallacy 
 which was advanced bj^ Franklin years ago in England as to the 
 ability of running water to purify itself by oxidization in going 
 a certain distance seems to have more vitality than any error I 
 ever knew of. People living on water drainage areas discharge 
 their filth into the water supply with the idea that it will become 
 perfectly harmless by running a short distance. Do you not find ,'' 
 that idea to exist quite generally. Dr. Soper? 
 
 Dr. Soper. I do, indeed. 
 
 President Brooks. It seems to be something which has 
 become thoroughly instilled in the minds of many people, espe- 
 cially those living in the rural districts; they seem to feel that 
 filth can be cast into a running stream with perfect impunity. I 
 might say also, in connection with what ilr. Baker has said in 
 regard to the cooperation of local boards of health, that we find 
 it very difficult to interest the boards of health of adjoining towns 
 in the welfare of their neighboring cities. They may be interested 
 in their own affairs, but if our water supply is collected in their 
 towns they take very little interest in preventing its pollution. 
 
DISCUSSION. 461 
 
 "We may say to them that their people visit us, and that our 
 people visit them, and that there is an intimacy between the 
 people of the different communities which makes it incumbent 
 upon them to guard our supply as jealously as their own, but that 
 does not seem to have any force with them. Here in New Eng- 
 land, where our milk supply comes from adjoining towns, our 
 local board has nothing to do with the conditions under which 
 the milk is furnished, and it really seems sometimes as though if 
 any really efficient work is to be done, it will devolve upon the 
 state to do it.