TD 423 F95 Cornell University Library TD 423.F95 Water and public health.The relative pur 3 1924 004 042 572 Cornell University Library The original of tliis book is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924004042572 WATER AND PUBLIC HEALTH THE RELATIVE mJEITY OF WATERS KFERENT SO^l FROM DIFFERENT SOURCES. '; V JAMES H. FUERTES, PAemher of ike American Society of Civil Engineers. FIRST EDITION. FIRST THOUSAND. NEW YORK: JOHN WILEY & SONS. London: CHAPMAN & HALL. Limited. 1897. nit >:;^v1l■,t' Y >, /. I ^ ! ' Copyright, 1897, BY JAMES H. FUERTES. ROBERT DRUMMOND, ELECTROTYPEE AMD PRINTER, NEW YORK. PREFACE. The idea suggested itself to the writer some time past to group the principal cities of the world into classes according to the quality of their public water- supplies and then to make a comparative study of their mortality statistics. In the matter which follows, which is the outgrowth of this suggestion, considerable ground has been gone over briefly which has already been fully covered, but it seemed advisable to bring some of these widely scattered observations together in order to preserve continuity in the development of the subject and to permit, by statistical evidence, the exclusion of the minor influences, in order that the importance of pure water might stand out in bolder relief. The statistics which have been collected introduce certain elements of inexactness and uncertainty, which, it is true, may be urged against all such studies. The principal elements of uncertainty enter in the calcula- tion of the death-rate, as the population assumed may be incorrect, or, there may be errors in the reports of the physicians or health boards. It may be assumed, IV PREFACE, however, that in all large cities these causes of error are perhaps equal, and that by compiling the statistics of a great number the inaccuracies will counterbalance so as not to seriously influence the general deductions that may be drawn. The statistics of typhoid fever and population in our American cities are taken mostly from the pub- lished reports of the cities and of the State boards of health. Those which could not be obtained from these sources have been secured by correspondence. The similar data for the European cities were obtained in the same manner; much of this information has already been compiled and published, however, in a very interesting paper on " The Water-supplies of Cities," by J. W. Hill, M. Am. Soc. C. E., read in January, 1896, before the faculty and students of the University of Illinois. The statistics of a few of the cities have been taken from this compilation. The descriptions of the sources of supply for the American cities are from private notes, municipal reports, reports on improved supplies, and descriptions in current literature. Many supplies, where particular features demanded study to facilitate a proper classi- fication, have been the subject-matter of much corre- spondence. The sources of supply of the European cities are described mainly from my private notes, supplementing those which I lacked by reference to published reports and descriptions. I gladly take this opportunity to acknowledge my great appreciation of the kindness of the many engi- neers, government and municipal ofificers, water-works PREFACE. V officials, health officers, and physicians, both at home and abroad, who have, frequently at great individual trouble, favored me with the information desired; it would be impracticable to make individual acknowl- edgments to so great a number of persons. I wish, however, to make one exception in favor of my friend Rudolph Hering, C.E., who has extended to me many friendly professional courtesies. James H. Fuertes. New York, December, i8g5. CONTENTS. CHAPTER I. PAGB Etiology and Prophylaxis of Typhoid Fever i I. General Considerations i II. Rainfall and Typhoid Fever 5 in. Effect of Pure Water and Sewers upon Typhoid-fever Death-rates 14 IV. Effect of Pure Water alone upon Typhoid-fever Death- rates 16 V. Effect of Waters known to be Polluted upon Typhoid- fever Death-rates ig VI. Relation between the Quality of Water supplied to a City and the Typhoid-fever Death-rate 22 CHAPTER II. When does Pure Water Pay ? 36 CHAPTER III. Sanitary Value of Impounded and- Other Supplies 40 CHAPTER IV. Conclusion ' 44 APPENDIX A. DEATH-kAfES FROM TYPHOID FEVER PER 100,000 OF POPU- LATION IN Various Cities for the Years 1890-1895, INCLUSIVE , , . , 47 vii VIU CONTENTS. APPENDIX B. PAGE Descriptions of the Sources of the Water-supvlies of Various Cities 49 APPENDIX C. Annual Precipitation of Rain in Various Cities for the Years 1890-1895, inclusive 59 APPENDIX D. Table showing the Number of Times that Different Typhoid-fever Death-rates per Hundred Thousand recur in all the Cities quoted in Appendix A, for the Years 1890-1895, when the Cities are classed accordincj to the Qualities of their Water-sup- plies 61 LIST OF ILLUSTRATIONS. FIGURB PACE 1. Map Showing Typhoid Fever at Cuxhaven, Germany, in 1894 and 1895 4 2. Typhoid Fever, Ground-water Levels, and Sewer In- troduction in Munich 7 3. Typhoid Fever in Hamburg and Altona, 1883-1895... 8 4-17. Typhoid Fever and Rainfall in American Cities 10 18-31. Typhoid Fever and Rainfall in American Cities 11 32-45. Typhoid Fever and Rainfall in American Cities 12 46. Typhoid Fever, and Sewer and Water Introduction, in Frankfort on the Main 15 47. Typhoid Fever, and Sewer and Water Introduction, in Warsaw, Poland 15 48. Typhoid Fever, and Sewer and Water Introduction, in Danzig IS 49. Diagram showing Reduction of Typhoid-fever death- rates following an Improvement in the Quality of the Water at Chicago, 111 17 50. Diagram showing Reduction of Typhoid- fever Death- rates following an Improvement in the Quality of the Water at Newark, N. J 17 51. Diagram showing Reduction of Typhoid-fever Death- rates following an Improvement in the Quality of the Water at Lawrence, Mass 17 52. Diagram showing Reduction of Typhoid-fever Death- rates following an Improvement in the Quality of the Water at Zurich, Switzerland 17 53-62. Diagrams showing the Typhoid Fever Fluctuations in Towns on the Hudson and Mohawk Rivers 20 ix LIST OF ILLUSTRATIONS. 63-68. Diagrams showing the Typhoid-fever Death-rates in Various Cities, grouped according to the Quality of their Water-supplies, for the Years 1890-1895, in- clusive Six insets, opposite 32 69-70. Diagrams showing the Limits between which 75 per Cent of the Typhoid-fever Death-rates per 100,000 Fall, and the Distribution of the Populations using the Different Classes of Water in Europe and Amer- ica 33 WATER AND PUBLIC HEALTH. CHAPTER I. ETIOLOGY AND PROPHYLAXIS OF TYPHOID FEVER. I. General Considerations. The bacilli of typhoid fever have rarely been found in a public drinking-water supply, although close watch to detect them has been kept for several years. Negative results in the search for the bacilli, however, would not prove that they are not frequently present, because, since they do not propagate to any consider- able extent in fresh water, they become widely scat- tered by dispersion, and therefore are difficult to detect by analysis. The difficulties are further in- creased by the impossibility in laboratory experiments of examining more than a very small quantity of water at a time. There is much evidence in support of the belief that typhoid fever in man results from the development of the B. typhosis in his body. The bacillus of Eberth has been repeatedly found in polluted waters suspected 2 WATER AND PUBLIC HEALTH. of causing typhoid fever. Fraenkel * and Simmonds state that they have produced the disease in monkeys, rabbits and mice by inoculation with pure cultures of the microbe, and recently Sanarelli f has announced that he has also been successful in his labors in the same field. The typhoid bacillus has frequently been found in the dejecta of typhoid patients in the early stages of the disease, and it has been found by post-mortem examinations in the organs of the bodies of persons dying of typhoid fever. If it be granted that this is the cause of typhoid fever, the human body constitutes a laboratory which can analyze a greater quantity of water at a time than would be possible in experiments. Certain organs of the body, by their various temperatures and chemical compositions, afford favorable conditions for the growth of many specific microbes. If then a person should have typhoid fever after having drunk water that is known to have been recently polluted with the dejecta of another typhoid patient, we would not err in attributing his sickness to that cause. Under such assumptions we could not then desire a better bacterial analysis of a water known to be polluted with the dejecta of typhoid-fever patients than would be given by the health records of a city supplied with such water, where every inhabitant may be considered as a culture-plate ready for inoculation. It is natural and rational to look to the water for a * Die Aetiologische Bedeutung des Typhus-bacillus, i885. f See Annales de I'Institut Pasteur, ETIOLOGY AND PROPHYLAXIS OF TYPHOID FEVER. 3 predominating cause of infection, because ultimately, unless deprived of life, bacilli from the dejecta of typhoid patients find their way by surface washings, percolation, or direct discharge through sewers and drains, into the ground-water or watercourses which contribute to our water-supplies. The cases where the weightiest circumstantial evidences have led to the charging of water-supplies with the responsibility for typhoid-fever epidemics are very numerous. A recently reported case at Cuxhaven on the Elbe, Fig. I, is quoted by Dr. J. J. Reincke of Hamburg, in a paper before the Hamburger Aerztlichen Verein, June 2, 1896, entitled" Zur Epidemiologiedes Typhus in Hamburg und Altona." * In this paper he states that in 1894, of the 52 cases which occurred in the village, 22 were along a ditch that supplied water for many families, and that had undoubtedly been in- fected by a case of typhoid from a hospital near by. In 189S its greatest severity was centred principally about two limited localities. One of these was around an infected well in the water of which Professor Dunbar, on September 14th, isolated bacilli which " were not different from the typhoid bacilli. ' ' Eighty-one people reside around the court in which this well was situated, o£ whom 23 were taken sick with typhoid fever. Of 18 persons living in a court in another locality, where an open ash and refuse pit was used also as a dumping- place for night-soil, 12 were taken sick with typhoid; through the servants and members of the afflicted families it was carried to other localities. * Deutsche Vierteljahresschrift filr Sffentliche Gesundheits- pflege, voL xxvill., part 3, 1896. CUXHAVEN, GERMANY DEATHS FROM TYPHOID FEVER IN 1894, . " " " " 1895, . Fig. I. ETIOLOGY AND PROPHYLAXIS OF TYPHOID FEVER. 5 II. Rainfall and Typhoid Fever. Before commencing a discussion of the data that have been collected it may be advisable to say a word about the different theories advanced to account for typhoid propagation. There are two generally proposed theories, the drinking-water theory and the ground- water theory, both of which have enthusiastic advo- cates. In support of their propositions there is an enormous accumulation of published statistical data, and it is not the purpose of this study to follow out the merits of either theory in a general way. There are of course other modes of infection by which typhoid fever can be introduced, but the reference here is to its origination and perpetuation in abnormal proportions. In general, the bacillus can be conveyed into a water-supply in one of the following ways: (a) By its carriage directly into a stream with the sewage of a city. (&) By its being carried into a stream by surface washing from rain, snow, etc. (c) By its being carried down into the subsoil by percolation. {d) By flying insects, birds, etc. (e) By wind and rain. In our large cities using well-waters I have been unable to show any well-defined relation between the precipitation of rainfall (fluctuation of ground-water level) and the cases of typhoid. The reason is, per- 6 WATER AND PUBLIC HEALTH. haps, that the cities for which I have such records, Washington and Louisville, use also a large amount of other water subject to pollution, so that it is im- possible to differentiate the effect of the rainfall, "^he statistics of Munich, which are given in Fig. 2, show^y this effect very consistently; it will be seen that when the ground-water level was low typhoid fever was high, and vice versa. The same is true also of Ham- burg and Altona, Fig. 3. If the typhoid-fever death- rate is dependent alone upon the fluctuations of the ground-water level, we should expect that it would not be affected by the quality of the water supplied for drinking purposes, and that in cities provided with sewers and drains there would be uniformly lower and less fluctuating typhoid death-rates than in those not drained. We find, however, cities like Washington, Philadel- phia, Pittsburgh, and Cincinnati with very high and variable rates, while many others, having no better drainage systems, have very low rates with a small range of fluctuation. It has not been possible to get records of the ground-water levels at the different cities. This, however, must be a function of the rain- fall and in a period of several years, it would be in some degree proportional to and vary in the same direction with it. A curve plotted with the annual precipitation for ordinates, and the years for abscissse, should be similar in shape then to one representing the ground-water fluctuations year by year for the same period, providing the ground-water level was not maintained constant by deep drainage. ETIOLOGY AND PROPHYLAXIS OF TYPHOID FEVER, 7 i SROUND WATER LEVEL IN MM 189 =,gg gfeSSS DEATHS PER 100,000 ssgsSggggggliiiiigiiiiiiiii T ■n i % 5 1 O 1 is 3 ■- 1 1 i 1 C 1 6 u. 7 i '- s. I 8 T E 1 9 i, ]^ 1 H X m 60 is T^ X IP o s i Jm 1 m 3 T P 1 i J ] 6 1 \ t 6 1 1 7 1 1 3 8 'J z 9 , o 70 "I" 3) 1 1 < 2 ,r 5 3 a i H 6 i 6 . 1 1 7 ,1 1 1. - ° 8 || 1 9 1 S3 ■" r 5 ■" > 80 = S corO 3,5 1 1 1 1 i Siigi 2 r >!jm "zD^ai J ;|SS_ bD3H> 1 ii y TES PER 100,000 yPHOID FEVER. EDUCTION OF RATE THE INTRODUOTIOM AND PURE WATER, Fig. 2 WERS SHOWS THE PERCENTAGE OP NED TO THE SEWERS. PUBLISHED BY DR. MAX VON PETTE ROM MUNICIPAL REPORTS. _WATER FROM SPRINGS IN MANGFAL INTRODUCED. 6 1 / 6 A 7 1' '4 8 i' 9 / 90 J / 1 1 i , I 3 1 / 1894 1 RAINFALL rM MILLIMETRES WATER AND PUBLIC HEALTH. ALTONA. o g i g i i HAMBURG. „ s g 1 i rlS% b _ - JU - — Ih ;,-T 4^ K- - = = =EL = = ^. = =^ = = ^M - in:;; """it -='fM s ^v — H^- "-—' • • ^v^ _ --CL -- _<^ 1^3 9^ ^BL II r ' Hr .__„ = .-- — I ^|J u< ^Hi 2 i . "^^^■L __ ■Hbi 1 II 1- l\:%i\\t ^^^^^^H ■ H'HBll!!! r.'-hiii --j^S^±------ ..,:: = _.._. 1^ ^Btt mKUmerJ^z-.zy' --I---MI IHlih;: =iSv^^?^.„ "iinSSHs; ^ iittiiun '»;8^ ttffl <^ ^U T ±;;: 11 i^& ■ ;;. :=0- ■ ■ ■ I JT .m 1 ... •-"- '--.. T1TT iHBJIIIil li'-'l —^, j....r"-= :^T^^ "3s ""■"SS'-iB -- ^CLLL ■III _._ — t i= L"K~ J uw tt= p.-- 1 , 3 ??^- = ": : : s ^"^ --' — j|- ^.!-..±.i »j ^BL K^ V ii*= fe KL , , m - ^---L — HF 1 T"" jr^= = ..... i ^ feR^^^^^: :;::::-S; --JB L__ "1 ^ -.-<;; ^s ! i ^ H ::: — ±_ B:::::: ::Ui^^kz ^'"i "M [-■[-- — 3 i^" H .'....!£''■■ ■jilBJI 1 :-- -X- , J ^ H- ■ ^ = n^ j± ij_ „ ± ---■■ ■-■',] -.d IF"— 1 t V^ 1 1 1 1 1 1 P mV IIMJ CO ^E . :j|:: Ih ,_ .a ff ,:.= . 3 1 M E = = = = = = = = ■====;===;; 1 an gg B t .. -. ^ ■L . .,., a ... .. "l^jf^ K . . . . . . -- 5 ^ F ::: :::::::::::;= : . , : I C =;- ■ -^ m C :. .2. ] m if ° 5 ; ■ ■ ■ ;' ^ -|-rf| '-" lt 41- E ; = S ? % i 1 i i 1 1 o o z H i S> m to Q CD 3 W O -0 o 5 s ii > o H o z > I PRECIPITATION IN MILLIMETERS- - - GROUND WATER IN A WELL ON GROSSEN yV leCHAFERKAMPF BELOW THE SURFACE OF THE GROUND, 1863-92. >nj' GROUND WATER IN A WELL ON BOGEN-. STRASSE, 1802-5. FIVE-DAY MEAN OF THE TEMPERATURE OF THE AIR, 1883-95. w Fig. 3. — Dr. Reincke, in Paper before Hamburger Aerzt. Verein, June 2, 1896. Pub. in Vierteljahresschrift filr Offentliche Gesundheitspflege, vol. 28, part 3, i8g6. ETIOLOGY AND PROPHYLAXIS OF TYPHOID FEVER. 9 Figs. 4 to 45 show the typhoid-fever death-rates and the annual precipitation for the years 1 890-1 895, inclusive, for many American cities. The data from which they are compiled will be found in Appendices A and C. In Boston, Cleveland, Columbus, Detroit, Louis- ville, New York, Paterson, Pittsburgh, San Francisco, and Toledo there is a remarkable parallelism between the typhoid curves and the rainfall curves: in years of high rainfall typhoid was high, with but one or two exceptions. These cities represent many classes of water — supplies drawn from impounding reservoirs, lakes, small surface gathering-grounds, large normal rivers, and sewage-polluted rivers — and follow a law directly opposite to that followed by Munich, Ham- burg and Altona. I will call attention to the fact that it is possible for all these supplies to be polluted by the washings from the surface,* or by percolation towards the water- supply sources; that is to say, the more rainfall the more polluting matter is washed into the source of supply. An interesting case of this occurred in the valley of the river Tees in England. f In the drainage area of * An excellent paper on the bacteriology of river-waters, and treating of the fluctuation of the bacteria in river-waters with rainfall, is published in vol. vii., Memoirs of Nat. Acad, of Sciences, by Dr. John S. Billings, detailing the investigations of Dr. J. H. Wright, Scott Fellow in Hygiene, Univ. of Penn., 1892-3. f Barry, Report on Enteric Fever in Tees Valley. Thirty-first Annual Report of Local Gov't Board, 1890-91. Report of Med. Officer for 1891. London, 1893. lO WATER AND PUBLIC HEALTH, TYPHOID FEVER DEATH RATES PER 100,000 DEATHS PER 100,000 PER ANNUM ^ |_i 1^ H> t-l M — — — — — — — — — — OOOOO ANNUAL RAINFALL IN INCHES, e o o o ANNUAL RAINFALL IN INCHES, ETIOLOGY AND PROPHYLAXIS OF TYPHOID FEVER. II TYPHOID FEVER DEATH RATES PER 100, _fe;SK!fc22 000 TYPHOID FEVER DEATH RATES PER 100,000 1890 r RAINFALL IN INCHES. 12 WATER AND PUBLIC HEALTH. TYPHOID FEVER DEATH RATES PER 100,000 TYPHOID FEVER DEATH RATES PER 100,000 ANNUAL RAINFALL IN INCHES. ETIOLOGY AND PROPHYLAXIS OF TYPHOID FEVER. I3 this river are numerous villages, some, with a total population of 219,435, drinking the water of the .Tees, which is polluted with surface drainage and sewage; the rest, with a population of 284,181, have other sup- plies, not polluted. It is shown that in those cities using the Tees water the typhoid fluctuates syn- chronously with the rainfall, and in the rest, not using it, there is no connection or similarity between the rainfall and typhoid curves. Dr. J.J. Reincke says on this point regarding the river Elbe at Hamburg:* " Whether the river-water carries typhoid bacilli in any considerable quantity in suspension from surface washings after rainfalls and the melting of snow is not positively known; never- theless it is worthy of record that the Landrathsamt of Winsen, in a public proclamation issued in Septem- ber last year warned the people against the use of the waters of the Ilmenau, because of the simultaneous existence of typhoid fever along the whole length of the river. In Liineburg, which lies on this river, there was a very extended epidemic. This little river empties into the Elbe above Ha;mburg,f opposite the ZoUenspieker. " Baltimore, Md., is the only large city in the United States of which I have records where the typhoid fever becomes consistently high with low annual rain- falls, similar to the conditions which formerly existed * " Zur Epidemiologie des Typhus in Hamburg und Altona" (see note, page 3.) ■)■ About 10 miles above the intake of the Hamburg water-works. —J. H. F. 14 WATER AND PUBLIC HEALTH. at Munich, Hamburg and Altona. Baltimore has as yet no sewerage, and the house-drainage is disposed of largely into cesspools and outhouses, giving condi- tions for a polluted subsoil. All the other cities shown on these charts, except New Orleans, have sewerage, and in them the typhoid-fever death-rate does not seem to show any correspondence with the rainfall rate, excepting at Baltimore and certain cities where the pollution may be occasioned by the surface washings into the reservoirs or streams furnishing the sources of supply. This state of affairs is not apt to be the case in smaller cities * not having sewers and depending upon wells for water. Among such it is very probable that a large proportion will follow the same law as Baltimore, although Baltimore uses no well-water. III. Effect of Pure Water and Sewers upon Typhoid-fever Death-rates. In order to show the correspondence between the decrease in death-rates from typhoid fever and the gradual introduction of sewers and pure water, I have plotted in Figs. 2, 46, 47, and 48 the statistics of Munich, Frankfort on the Main, Warsaw, and Danzig. The diagrams do not need explanation. Undoubtedly other circumstances may have had something to do with this reduction, such as better care of the sick, *See Reports of Mich. State Board of Health; also paper by Prof. W. P. Mason on " Rainfall and Typhoid Fever," Jour. Franklin Institute, Sept. 1895. ETIOLOGY AND PROPHYLAXIS OF TYPHOID FEVER. Ij TYPHOID DEATHS PER 100,000 _ ] -I J J 1 - r -T, —1 js. y4 ^ " r / ' ' I V fe ' ^ / 7^ ~Jf 3 z. -^-'sj- I ' . ' O en K^ CO » > . 9 e O PERCENT o o o o o ■ 5 ISSG a i WATER FROM RADAUNE KANALE: POLLUTED AT TIMES. 4^ 00 X -i r N D Ho* o (D a 2<3 a S "n * So:! :3s TYPHOID DEATHS PER 100,000 osggsggsgsis III *" m O ii 1 i8ei 1 2 1 ^l"^ 5 3 1 T X ^ Z 1 isi^ UrO 1 D ra » ■< O 1 60 1 ss S 1 |-„ 1 1 5| "^ 1 1 1 1 1 \ 70 1 1 ' 1 1 /' J 1 ,> > 1 / p^ J 1 1 } / Al/. 80 1 / ".'I"' / ,'^' / ,• ,' J 8 ,' 9 90 1 '( 2 : 3 ''' 1891 I ei en tp> w I Diagrams showing reduction in typhoid-fever death-rates follow- ing introduction of pure water and sewers. 1 6 WATER AND PUBLIC HEALTH. '.ue to more knowledge of the nature of the disease md improved methods of treatment; but the effect is marked and positive in each case. IV. Effect of Pure Water alone upon Typhoid-fever Death-rates. The reductioa of the death-rate from typhoid fever following upon the improvement in the quality of water supplied, in cities which are fully sewered and drained, is shown in many places in this country and Europe. Immediately after the change to the " four- mile intake" at Chicago in 1893, Fig. 49, there was a great reduction in typhoid. The city of Newark, Fig. 50, shows a great improvement when the new supply was introduced from the Pequannock, April 12, 1892. Hamburg, Fig. 3, shows an improvement with the placing of the filters in operation in May, 1893. Lawrence, Mass., Fig. 51, shows a great im- provement with the setting of the filters in operation in September, 1893; fully half of the deaths in 1894 were among persons known to have used the unfiltered canal-water. In Zurich, Fig. 52, with the intelligent operation of the filters since 1885, the typhoid death- rate has been almost constant and very low. Dr. Reincke says, in regard to Hamburg,* that the evidence that the reduction of typhoid in that city has been the result of an improvement in the water, is *"Zur Epidemiologic des Typhus in Hamburg und Altona" (see note, page 3). ETIOLOGY AND PROPHYLAXIS OF TYPHOID FEVER. 17 5 p- o 5' ><5 3' cu ffq fP I p p ■ n p • a o 5' w p s 3 J2 c p_ >< o DEATH RATE FROM TYPHOID FEVER PER 100,000 OF POPULATION. 1890 1 1 OS " 4 1 ' Ml -E NT AKE 1 188C 1 1890 1 ^1 m PE QU \Nh OC K RIVER J ^i 1895 1890 1 Cl 1 «2 1 "S3 FIL if,i i 1 1895 DEATH RATE FROM TYPHOID FEVER PER 100,000 OF POPULATION. ^ o5oooooooooooooe> 3 i 6 N C6 07 X J D FILTERS NEW FILTERS, CAREFULLY OPERATED i8 WATER AND PUBLIC HEALTH. substantiated by the typhoid among the shipping interest in the harbor, where the raw water is used, remaining as great as it was before, whilst in the city, where filtered water is used, it has fallen from 90 per 100,000 in 1887 to 6 in 1894 and 9 in 1895. He also reasons that the typhoid-fever infection has always come through the same channels that have brought the cholera, and shows by a tabular statement, quoted below, that the maximum of typhoid fever has fol- lowed two to three weeks later than the maximum of cholera. In 1892 and 1893 there were sick — In the week from Aug. ( IC (I <. I H 11 <( ' " " Sept. t i< tC ( ( ' (( tl t( On. Nov. Dec. Jan. 14 to 20 21 to 27 28 to Sept. 3 4 to TO II to 17 18 to 24 25 to Oct. I 2 to 8 9 to 15 i5 to 22 23 to 29 30 to Nov. 5 6 to 12 4 to 10 u to 17 18 to 24 25 to 31 I to 7, 1893 8 to 14 15 to 21 The same phenomena were observed in 1893, when the raw water of the Elbe broke into the pipes deliver- - ing the filtered water; and he concludes that the lapse ETIOLOGY AND PROPHYLAXIS OF TYPHOID FEVER. I9 of the two or three weeks in each of these cases repre- sents the difference in the periods of incubation of the two diseases, and that if the cholera comes from the drinking-water, the typhoid fever also does. V. Effect of Waters know^n to be Polluted UPON THE Typhoid-fp:ver Death-rates. Some of the large towns on the Mohawk and Hud- son rivers have an interesting history in the light of these statistical studies; they have already been re- ported on in connection with local epidemics. There is, however, another side of the question that has not, to my knowledge, received attention heretofore, and that is the yearly fluctuations of the typhoid-fever death-rates. In Figs. 53 to 62 are given the death- rates of Amsterdam, Schenectady, Cohoes, Green Island, Troy, Albany, Greenbush, Catskill, Hudson, and Poughkeepsie, cities on the Mohawk and Hudson rivers, from 1887 to 1894, inclusive. The distances between the towns are approximately as follows: Amsterdam to Schenectady, 17 miles; Schenectady to Cohoes, 17 miles; Cohoes to Troy, 3 miles; Troy to Albany, 6 miles; Albany to Catskill, 31 miles. By observing the yearly rates for Amsterdam and Schenectady, it will be seen that they have varied in the same direction since 1887, Schenectady exhibiting the most violent fluctuations. Schenectady drinks the Mohawk River water polluted with the Amster- dam sewage. Also, the curves for Cohoes, Green 20 WATER AND PUBLIC HEALTH. .»=..„.„, 150 100 60 ^ 1 i 4 i i i ■ 5; 160 5 50 s 0-250 SCHENECTADY. 1 n- U 150 a. 100 cr ^ 60 a ▲ A ■ j^ ■ L COHOES. DIAGRAMS SHOWING THE SYNCHRONOUS FLUCTUATIONS OFTHETYPHOID FEVER DEATH RATE IN CITIES ON THE MO- HAWK AND HUDSON RIVERS, WHICH ARE SUPPLIED WITH DRINKING WATER FROM THESE RIVERS Figs. 53 to 62. P0U9HKEEP5IE, ETIOLOGY AND PROPHYLAXIS OF TYPHOID FEVER. 21 Island, Troy, Albany, and Catskill show a very re- markable parallelism. Troy drinks the water of the Hudson opposite Waterford, but West Troy drinks the Mohawk water taken at a point above Cohoes. Cohoes drinks the Mohawk water taken just above the town, and Albany and Catskill drink the water of the Hudson. The Troy water should be comparatively free from sewage contamination, and therefore cannot be blamed for this unusual typhoid mortality; the probable reason why Troy reports so many deaths being, as Dr. John H. Cipperly, health ofificer, sug- gests, that many cases of typhoid from West Troy, Cohoes, Green Island, and other neighboring places are sent to the Troy hospitals, and the deaths may thus be reported from Troy. The high typhoid death-rates in Amsterdam and Schenectady in 1890 were caused by a sharp epidemic lasting from July, 1890, to April, 1 89 1, having its greatest severity in the latter part of 1890, while during the same epidemic the greatest severity in Cohoes and the other cities down the river was in the early part of 1 89 1. This, I think, explains why the curves for Cohoes, Troy, and Albany are apparently a year after the curves for Amsterdam and Cohoes, and makes it possible to recognize the similarity in all of them. In view of this explanation, and of the possibility of the bacterium of typhoid fever retaining its vitality in water, even at the temperature of freezing,* for a ♦Mass. State Board of Health, 1890. Typhoid Fever in its 22 WATER AND PUBLIC HEALTH. much longer time than would be necessary for its transference from any of these towns to the one below through the medium of the river; of the fact that all these cities drink the waters of the Mohawk and Hudson rivers, polluted with the sewage of the cities above ; of the fact that their typhoid-fever death-rates have fluctuated synchronously year by year, while cities on the other side of the river below Troy, where the effect of the large volume of pure water from the upper Hudson is felt, do not fluctuate synchronously with those polluted by the Mohawk waters; of the fact that the bacteriological analyses* of the river- water have shown a large increase in bacteria below each city, the number decreasing with the dispersion of the sewage by down-stream flow, but remaining above normal as compared with the water above Rome, I think we may safely conclude that we have here an undoubted case of the propagation of typhoid fever through the drinking-water. VI. Relation between the Quality of Water Supplied to a City and the Death-rate FROM Typhoid Fever. If the drinking-water supplied to cities is an index of their healthfulness as measured by the typhoid- fever death-rates, v^e should expect__t!>-fiflti""some sort Relation to Water-supplies, Hiram F. Mills, A.M., C.E., pp. 525- 543. Prudden has shown that they can retain their vitality in ice for 103 days. * N. Y. State Board of Health, 1892, p. 533. ETIOLOGY AND PROPHYLAXIS OF TYPHOID FEVER. 23 of relation existing between_ the quali t 37 nf tVip water and the typiEio]3"3eath-rates. Of course it is unreason- able to expect to find such an exact relation that there would be no variation from the rate for each different classification ; there must be overlapping, as local con- ditions may make a certain water more subject to pollution than another. As a general thing, we should expect to find that cities whose water is kept perfectly secure from contamination, such as use spring-water secured in mountains where no pollution is possible, would have the lowest death-rates, and the range of fluctuation would be very small, comparatively speak- ing. Next we should expect to find that water properly filtered, as is done extensively in Europe, would show a low rate and one without much fluctuation, provided the operation is carefully and intelligently carried on. Next in purity we should expect to find ground- waters, and in these there might be accidental pollu- tion that would cause considerable fluctuation. Then follow, in the order of their liability to contamination, large impounding reservoirs, where legal measures are taken to restrict pollution; large rivers, either normal, or where great volume and absence of any considerable evident place of pollution within a great distance, coupled with dispersion, sedimentation, and nitrifica- tion, may have brought a previously polluted river back to its normal condition. Then follow great lakes, whose waters at great distances from polluting sources are pure, but which are liable to pollution near the shores (in this class, from the relative positions of the intakes, we should expect to find rates varying from 24 WATER AND PUBLIC HEALTH. those of a very healthful city to those of the most infected); upland streams and small gathering-grounds where no special precautions may be taken to restrict pollution of the watersheds; and, finally, rivers and sources known to be polluted with sewage. In cities using such supplies we should expect to find high typhoid-fever death-rates, and a considerable variation of rates from year to year. In order to investigate this, I have collected and tabulated the typhoid-fever death-rates of a great number of cities, both in Europe and America, for the years 1 890-1 895, inclusive when possible, with a total population of about 33,300,000. For the six years these statistics would therefore represent the typhoid-fever mortality of nearly 200,000,000 people. Many cities which I wished to add to this list, I regret to say, have been unable to furnish me with the desired information. I have not included any cities in the United States of less than 50,000 inhabitants, and in Europe I have selected only large well-known cities. Doubtless many more could be added to the list, but I have considered that for the purposes of this study the data presented are sufificient. In some respects it might be of advantage to use the sick-rate, rather than the mortality-rate, but it cannot always be obtained, and the latter has some merits not possessed by the former. The different qualities of water I have placed in the following classes: Class A. Mountain springs with sourcQ§ un- doubtedly beyond the danger of pollution. ETIOLOGY AND PROPHYLAXIS OF TYPHOID FEVER. 25 Class B. Waters properly purified by slow sand- filtration. Class C. Pure ground-water supplies. Class D. Surface-water supplies with large im- pounding reservoirs and legal provisions against pollu- tion. Class E. Large normal rivers, or rivers in which the pollution may be considered to have greatly van- ished through the agency of sedimentation, dilution, and other causes. Class F. Large inland lakes, which may be more or less subject to pollution. Class G. Upland streams and small lakes with limited watersheds which are more or less inhabited. Class H. All rivers and public and private wells which are known to be polluted with sewage and other infectious matter to varying degrees. In order to distinguish between the different classes of water it was necessary to establish arbitrary standards which would with more or less definiteness afford a means of deciding in doubtful cases. In the cases of spring-waters, filtered waters, ground-waters, im- pounded waters, large-lake waters, and upland streams there was no difficulty; but to make it possible to decide whether a river should be classed as normal or as polluted, it was necessary to have a standard. The classification which I have made is based upon the following considerations: For a water to be classed as normal it is necessary that— I. The intake of the water-works should be so 26 WATER AND PUBLIC HEALTH. located as to be above the influence of the discharge of either sewage or surface drainage from the urban or suburban districts of the city. II. Thei^e should be no city up-stream discharging crude sewage into the river within such distance that the sewage would not be thoroughly and completely dispersed throughout the cross-section of the river before reaching the water-works intake. This distance I arbitrarily fixed at 10—30 miles, according to the size and character of the river. III. The proportion of sewage from the whole watershed above the city in question to the ordinary dry-year flow of the river should not be more than about as 2^ to 1000. This dilution at low water will give a water containing probably several times as many bacteria per cubic centimetre, after thorough dispersion by several miles of flow, as would be con- sidered advisable for a drinking-water, but for the aver- age floiv of the stream it might not be considered unfit for use. The average of seven authoritative German standards* makes the dilution required to render urine safe for potable uses 2 parts in 1000. The effect of the sedimentation of the bacteria by their adherence to heavy particles would tend to reduce the number in suspension, particularly if the water should be drawn off from the surface. Only towns on the rivers or their tributaries are considered in these calculations, the strictly rural population being neglected. All the sewage from * Baumeister. ETIOLOGY AND PROPHYLAXIS OF TYPHOID FEVER. 2^ towns with sewers, and 30 per cent of the sewage from towns without sewers, is assumed to ultimately reach the river. The amount of sewage generated is assumed for American towns to be equal to 60 gallons per capita per diem. These arbitrary assumptions are not offered as models for absolute standards; they are intended only to furnish a means of making a classification of waters as they are found, which would be based upon extant and comparable conditions. There are so many com- plex phenomena met with in cases of river pollution that probably no definite standard can be adopted, excepting to consider all natural waters as polluted to greater or lesser degrees, mountain spring-waters and properly filtered waters being the least so. Cities supplied with the water of lowland rivers, but having a large or considerable population supplied with public and private wells, are classed with polluted supplies. Among the cities so classed are Washing- ton, Louisville, and Atlanta. Applying the conditions stipulated above to certain doubtful cities, the results are exhibited in the follow- ing tabulation. These figures are not considered to represent the actual amount of sewage discharged into the various streams, but they afford a means of making a com- parison between them. There is great probability that in all the streams quoted the pollution is greater than I have estimated it. No allowance has been made for the disappearance of bacterial pollution, because there is good reason to 28 WATER AND PUBLIC HEALTH. Name of City, Albany Atlanta ... Camden . . Columbus, GrandRapids Indianapolis. Jersey City. . Louisville.. . . Newark Paterson . . . Philadelphia. Pittsburg- ... Richmond . .. Toledo Trenton River forming' Supply. Hudson Chattahoochee. Delaware.... . . Scioto I Olentangy . J Grand White Passaic Ohio Passaic Passaic Delaware Schuylkill Allegheny James Maumee. Delaware T3 > Is 1 bo nl □ i^. i6 1." 1- .S a| £<" .^u •Eh. tn'tJ^ < s w w" 8,2ooi 2.0c 0^ 3,000' 5O0j00O 37 2,000^ 50u6 1,000' 10,000 I S,jcx)2 1,500* 2.000^ igo,ooo iS 1,139* S47* '5* 2,51,0= 375= 500' 25,000 1-5 1,500 300" 400' 40,000 2.0 950S 225« 400' 400,000 37 91,000' 7,750' 1,250,000 74 9506 225« 400' jgo,ooo 18 800B 150* 287» 18,000 ■ ■; S.ioo" 1,500' 2,000' igo,ooo 18 i.Sooll 35°' 600' 120,000 11. 11,1071= 1,330!'' 2,000' 170,000 13 6,8ool3 i,30ols i,7Soi' 80,000 5 6,723'* 1,000' 3,000' 120,000 7-5 6,9.615 i,ooo'« 2,7001' 144,000 4 Parts of Sewage per 1000 parts of River- water. Min. Flow. 18.5 2.0 12.3 4 6.7 166.7 9 5 83.3 3.3 12.3 31.3 10 3.8 7-5 4 Dry- year Flow. 12.3 2.0 9.0 3 5 90.9 45.5 1-7 9.0 18.2 6.5 2.8 2-5 1.5 1 N. Y. State Board of Health, Rep't 1892. ' Geolog-ical Survey of N. J., vol. III. 1894, a. 58. ' Geological Surv. N. J., vol. iii. 1894, p. 309. * Tenth Census U. S., Water Power, vol. 11. p. 476, (This gauging taken 60 years ago No recent gauging. With this minimum flow a population of looo above Colum- bus would pollute beyond the limits established.) 'Estimate. 'Tenth Census U.S , Water Power, vol 1. p. 650. ' Tenth Census U S , Water Power, vol. 11. p. 440. " Geol. Surv. N. J. 1894, vol. iii. p. 103. » Tenth Census U. S., Water Power, vol. i. p. 650. 11 Allen Hazen, Report on Filtration of Philadelphia Water- supplies, i8g6. 11 Geol. Surv. N. J. 1894, vol. in. p. 104. 12 Tenth Census U. S., Water Power, vol. 11. p. 442. i' Tenth Census U. S., Water Power, vol i. p. 536. 1* Tenth Census U. S , Water Power, vol. i. p. 495. i' Geol. Surv. N. J. 1894, vol. III. p. 229. 1" Geol. Surv. N J. 1894, vol. in. p. 241. i' Tenth Census U. S., Water Power, vol. 1. p. 613. believe that usually the effect of sedimentation and oxidation have been largely overestimated, and that what has been attributed to these causes has more generally been due to perfect dispersion. The com- plete sedimentation of all bacteria* by gravity is an * N. Y. State Board of Health; Report of C. C. Brown on Ex- periments on Sedimentation of Bacteria in St. Louis Settling- tanks. ETIOLOGY AND PROPHYLAXIS OP TYPHOID FEVER, ig impossibility in any finite period of time; in flowing streams, even when carried down by precipitants, the bacteria may soon rise again when freed from their weighted envelope by currents in the liquid. The currents in rivers * induced by the rugosities of the bottom, differences of temperature, and other causes are sufficient to maintain in suspension or keep in motion bodies of far greater weight than these; and under even very adverse conditions they may be transported by flowing waters to very great distances without losing their vitality. As before stated, probably the most potent factor in the apparent dis- appearance of bacteria in large reservoirs is the more perfect dispersion of the inflowing water throughout the whole mass of impounded water than could take place in many miles of flow in a stream, because the motion of water in rivers is filamentary to a certain extent. A very good illustration of the more perfect dispersion that takes place in a reservoir of quiet water than in a flowing stream is afforded by the river Rhone in Switzerland. Where its gray glacial waters empty into Lake Geneva the whole end of the lake is discolored by the dispersion of the finely divided suspended matter in every direction. Where the river issues from the other end of the lake it is a beautiful clear blue color, and in the suburbs of the city of Geneva it is joined by the river Arve, whose muddy *A valuable article on the "Suspension of Solids in Flowing Water" was presented before the American Society of Civil En- gineers, Sept. 2, 1896, by Elon Huntington Hooker, Ph.D., C.E. 30 WATER AND PUBLIC HEALTH. waters issue from beneath the glaciers of Mont Blanc. These two large rivers then flow side by side in the same channel for a great distance without appreciable intermingling of their waters. The flow of discolored sewage in clear streams is also an illustration in point. I have seen the dark-brown water from one of the sewers in Munich form a stream 5 to lo feet wide in the clear Isar, and be perfectly distinguishable after a flow of nearly a thousand feet. Under the classification given on pages 15 and 16, the different cities quoted in Appendices A and B would be grouped as follows: Mountain Springs. — Munich and Vienna. Filtered Waters (slow filtration through sand, and not mechanical filtration or straining). — Amsterdam, Berlin, Breslau, Buda-Pesth (until 1894), Edinburgh, Hague, Hamburg (since May, 1893), Lawrence (since September, 1893, but the canal-water is still some- times used in the mills), London, Rotterdam, Warsaw, and Zurich. Ground-waters. — Brussels, Buda-Pesth (since 1894), Copenhagen, Dayton, Dresden, Frankfort on the Main, Lincoln, Neb., Lowell, Mass. (since February 22, 1895), Paris, Venice (since 1890). Impounding Reservoirs. — Baltimore, Boston, Brook- lyn, Cambridge, Fall River, Glasgow, Liverpool, Manchester, Newark (since April 12, 1892), New Haven, New York, Rochester, Sydney, Syracuse (since July 3, 1894; there are still many wells used in Syracuse), Worcester. Large Normal Rivers. — Minneapolis, Montreal, New ETIOLOGY AND PROPHYLAXIS OF TYPHOID FEVER. 31 Orleans, Omaha, Paterson, Quebec, St. Louis, Tok do, Trenton. Large Inland Lakes. — Buffalo, Chicago, Clevelana Detroit, Hamilton, Ont., Milwaukee, Toronto. Upland Streams, Small gathering-grounds and Springs in Populous Valleys. — Denver, Genoa, Hart- ford, Providence, Reading, Rome, San Francisco, Scranton, St. Paul, Syracuse (until July 3, 1894), Wil- mington. Polluted Rivers and Wells. — Albany, Alexandria (Egypt), Allegheny, Atlanta, Cairo (Egypt), Camden, Cincinnati, Columbus, Grand Rapids, Hamburg (till May, 1893), Indianapolis, Jersey City, Lawrence (until September, 1893), Louisville, Lowell (till February, 189s), Newark (till September 12, 1892), Philadelphia,- Pittsburg, Richmond, Troy, Washington, D. C. The typhoid-fever death-rates per 100,000 for all these cities for the years 1890 to 1895, inclusive, when obtainable, are given in Appendix A. In Figs. 63 to 68 I have shown graphically these death-rates per 100,000 for each of these cities for the years 1890 to 1895, inclusive. The different cities are grouped in classes according to the quality of the water supplied to them. I have f)referred to plot the statistics for each year separately, rather than to take averages for the six years. It will be noticed that there is a decided tendency toward high death-rates in the cities using supplies of a questionable character. The lowest rates are toward the pure-water end of the diagrams ; and while there is an overlapping of rates, as it were, they sub- 32 WATER AND PUBLIC HEALTH. stantiate entirely what has been premised would be the case. In Appendix D will be found a table containing a statement of the number of times a given death-rate from typhoid fever recurs in all these cities when classified according to the qualities of their water- supplies, and from this table it can be calculated — that in the cities using filtered water 94^ of the death rates per 100,000 are more than 3, 83^ are less than 20, and 'j'j'^ are between 3 and 20; that in cities using ground-waters 98^ of the death-rates per 100,000 are more than 5, "Ji^ are less than 32, and 75^ are between 5 and 32; that in cities using impounded waters g'/i of the death-rates per 100,000 are above 15, 80^ are less than 35, and y^i^ fall between 15 and 35 ; that in cities using the waters of large normal rivers 90^ of the death-rates per 100,000 are above 17, 85^ are less than 38, and 75^ are between 17 and 38; that in cities using the waters of the great lakes 93^ of the death-rates per 100,000 are over 18, 80^ are less than 54, and 73^ are between 18 and 54; that in cities using the waters of upland streams, etc., 92^ of the death-rates per 100,000 are over 29, 80^ are less than 58, and 72^ are between 29 and 58; that in cities using polluted waters 95^ of the death-rates per 100,000 are over 40, and only 6^^ fall between 50 and 100, the upper limit fre- quently exceeding 300. FIG. 63 DEATH RATES PER 100,000 INHABITANTS PER ANNUM FROM TYPHOID FEVER IN 1890. lU iO 30 40 00 60 70 SO 90 100 110 130 130 HO 150 160 170 L r>i JRE i„,. 1 1 1 MUNICH ■ -SP|miNUt:>. VIENNA THE HAGUE ROTTERDAM BERLIN ZURICH -DDi^C ER rY- fiiIt-eIre 1 BRE8LAU 1 1 1 ' LONDON AMSTERDAM EDINBURGH ^~ ■ WARSAW BUDA PE8TH — DRESDEN ■GF -w \-T- -WEbL COPENHAGEN GUmu -S, DAYTON i_ -DRIVEN- W-E'tt i 1 Nd-Pi-PESrE BRUSSELS • PARIS ■ LINCOLN VENICE WORCESTER 1- NEW YORK l: BROOKLYN -SURF 111- GE l-M- =oi!jn[ €S LIVERPOOL L ER-y-UIK&y GLASGOW K r NEW HAVEN L- IDS -PRO-TEdr-E HH — 11 1 d-aga|ns;t-i 'Ot MANCHESTER K ^LU-TlOiN. ROCHESTER ■■r BOSTON 1 BALTIMORE 1 FALL RIVER -t\ir DAJ1_A 1 -Rl y-ERSr OR DIV/C =ts- N-WH 1 ich-t-|he Dr\ ON TRENTON OR ..,,.,- NEW ORLEANS -M A-V 3^ GO A-V e-\|an r-J^. r.A..^ PATERSON H^ 1 n rsuut r-Hi;. ST. LOUIS AnPNi'^v- -OF — T IMF ornirfl E-N- r A~rtr\ ,,J,^. . OMAHA L- •_.■» -J '■ ^i L^iuu r lUlM, CTl K. • MINNEAPOLIS E TOLEDO DETROIT HAMILTON ^^^^^^^^Mm LARG E-t A k'co _MODC -0 3 1 CdC >-SL JB-J EO T— T _ ,., MILWAUKEE ^^H ^^ i_o, BUFFALO 1 ] CLEVELAND TORONTO —T —l- SYRACUSE -UP -bA-ND -S-T^ RE- 4MS-A ND -SIV -AUb-y AK ESi wit-h- -tl^ A\-T- ED ROME, ITALY VV/A T£ ? c ■\S 3S^ MO RE rtR 1 c -SS -IN- H-A :irT READING 1 SCRANTON HARTFORD t ST. PAUL ■ ^1 ^1 WILMINGTON HAMBURG TROY PI Bb r AN-r ^ DD.iA, A^T ^v /EL bS -IN us- DIJ -T-R GRAND RAPIDS t-uuV^H {To /lice page 32.) 10 FIG. 65 CEATH RATES PER 100,000 INHABITANTS PER ANNUM FROM TYPHOID FEVER IN 1892. au 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 ■■■" ' ■ '■ PI D cr JJi (7\\ \Kt~r f UN- SP =lliN MUNICH VIENNA THE HAGUE ROTTERDAM BERLIN ZURICH -PROFFER -Y- FiL T-E RE LONDON EDINBURGH BRESLAU AMSTERDAM 1 BUDA PE9TH WARSAW DRESDEN FRANKFORT -w , -.r- ?-|-NGSj -W&bl COPENHAGEN ,,L. J) BRUSSELS WE bbSrGOtitEpT NG -PI ■ PARIS VENICE t DAYTON LINCOLN ^^^^BH^ NEW YORK BROOKLYN GLASGOW SYDNEY A& :-v\ /-AT -IM ^01 E-RVOIRSy CAMBRIDGE JNbiM MANCHESTER 1 LIVERPOOL ^0- 1 J D-AGAIN-4-T-poitt BOSTON > P PEC"^ 1 C TIC' -'l>). NEW HAVEN FALL RIVFR BALTIMORE ROCHESTER 1 WORCESTER ^ OMAHA _, t~\i-i HE- PO PATER80N - — -LU 1 lUIN- NEW ORLEANS ■L lVIAy_BE CONSIDERED TO HAVE VANISHED THRn Ifn H T HF TRENTON ■ ^^ L pn'— -1 -J., J „T„,i_ NT-ATI(DN -DI-tUTlJ puj. MINNEAPOLIS 1 U 1 1 Mvicy^o ;ui VI t iN, El o. TOLEDO 1 ST. LOU IS HAMILTON 1 MILWAUKEE -RG E-L AK ES^ ^O ^-lJ ESS-^SUB^ EG ^Ol -hi BUFFALO TORONTO 1 DETROfT ^ ^ ^ ^m ^ CLEVE1J\ND TV ^ ^ ^ GENOA U- .-^ ROME 1 SAN FRANCISCO ■ i-i-f ^IrA M-n o-r ^RE a-M n rt ND -s^ ■Ab l^t AK- ES- wi- r-H -bir /IhT ED- SYRACUSE L_ PROVIDENCE -W AT- :-R-SH- F-nc ? Ryir\D E-O R-l -ES Sir s|H, VBI TE[ WILMINGTON ED^ "■ READING ^^^^^^^^^^^^^^^^^^^^^^^^^^M _ DENVER 1 ■ HARTFORD ■ SCRANTON ^^^^^^^^V HAMBURG PHILADELPHIA CINCINNATI TROY l_ iiJ COLUMBUS PI JBU AN D-P RIV-A-7 E-V VEl Lbs -IN POD'- 1 /^ JS- ALBANY IC1 rs, CAMDEN E /i-MT 3-RIV-F RS \A/HI(^ Li-^ ,RE -K't' |./=\A VN- rr-A^D-C n/- M 1 u-tIe-d RICHMOND ■ E 1 1 WASHINGTON E \h IT-I- ^-s ~\A/-l^'5cr Aplin. r\T bJ c.r* i.K r-cT 1-tc'r LOUISVILLE tlr JERSEY CITY -w J.p.P-C \B 5-T-RAC T-E 3-POR -Ui V GRAND RAPIDS ■J ALEXANDRIA, EGYPT NEWARK ^^H ATLANTA LOWELL ^H LAWRENCE 1 PITTSBURG ^^^^1 H ^1 ^1 ^1 H CAIRO, EGYPT 1 (7> yace page 32.) FIG. 66 DEATH RATES PER 100,000 PER ANNUM FROM TYPHOID FEVER IN 1893. 10 20 30 40 50 80 ; 30 90 1(X) 110 120 130 140 150 160 ■ p 11 . 1 ^ 1 1 VIENNA IN-l-j^ri^ Ol-jTMIiNtlO MUNICH THE HAGUE — ROTTERDAM ZURICH BERLIN 1 BRE8LAU PRjbPERl ■~~: 1 1 , 1 EDINBURGH BUDA PE8TH 1— AMSTERDAM t LONDON E HAMBURG ■ WARSAW FRANKFORT VJD -ty , DRESDEN ^_ 1 1 1 1 ' wti_i.o, COPENHAGEN I'-EN W^i ' ■:'- GoIbbEG-TINb-PIPES, 'eT( PARIS L- """^' .'• VENICE L — BRUSSELS LINCOLN ■r DAYTON L BROOKLYN SYDNEY NEW YORK GLASGOW su D ET- A r'.c va/a t cld c ITI H-b OU-N diNG-RESERMOl F 1 1 1 1 1 ?S;- CAMBRIDGE 1 1 1 FALL RIVER BOSTON ~PRO-T EeiT-ED-F I r-io rj MANCHESTER 1 NEW HAVEN NEWARK WORCESTER ^^^^^^^^^^H^^H ^ ROCHESTER Lj BALTIMORE LIVERPOOL OMAHA -Ri^ /-ER VERS- N- NH lOh -pe ,-r ON NEW ORLEANS /k.hj, ' '^'^'^ MONTREAL ■ NU^ BEj :oj^.si D£:i?.ED TO HAVJEJ/ANIfihiFH' Th^ROIiriH tTH ~ TRENTON ■ rt p PMpv e^ -T-ir /IE- QCLrM.fcX.ET.M PAT-ION- 3IL .^ TOLEDO H I -• ' PATERSON MINNEAPOLIS HAMILTON 1 MILWAUKEE |_ \_ft, RH b L VKF« VI G he- OR _Le«Sj SUR IP CT ^TO P U-lLu: -10 M BUFFALO 11 ~ ' TORONTO CHICAGO 1 ■ CLEVELAND L- DETROIT SAN FRANCISCO UP. UA sjD^ ST RE-A'^'' AMD SMAI 1 LAKES \V_LT H- LI-MI TF.n VA/Ai TEp- ' PROVIDENCE ■ ROME GENOA Sh l-ED-'^ ^ /I OF ?E PR L-ESC -Nh AB'TE D READING ' HARTFORD Hh DENVER ■ SCRANTON WILMINGTON _- PHILADELPHIA w^ -P-U BL C-AN [>-P R lA/j AT- E-\A fEL LS l-N- POP-U -Ol JS- DIS T-R CT S-A MD CINCINNATI COLUMBUS RICHMOND 1 RI-V-ERS-V V.H.Cb AElE^KNOW- SI_lrO_3E^ ->() -Ll )-l-fc .D-\ N.a ["- TROY ALBANY -SE W-A'^f^ -Qp_A TH =R- INfi^FRTIPiic M-AXn ^EF CAMDEN v '■"p' I » — 1 LOWELL _ . BS T-R-. - J )R- JSE _ ATLANTA L VC TED r*. JERSEY CITY LAWRENCE 1 WASHINGTON _.. ALEXANDRIA LOUISVILLE GRAND RAPIDS ^ ^ ^ _ ^ ST. LOUIS* •This typ hoi 1 w as atti ribti ted to sei t Arag he e p int! olli tke itio wa n c s m om ove ng frc Pt m the le n di ew 3Ch wo irg rks e o ab f a ove lar th ; ci se^ ty- ver jus >t above the intake. In 189^ (.To /ace ^age 32.) \ FIQ. 67 DEATH RATES PER 100,000 INHABITANTS PER ANNUM FROM TVPHOID PEVER IN 18S4. 5 10 15 80 35 30 ' 35 40 45 50 55 60 66 70 76 80 85 90 95 100 „,. ,^. N-S 'R-l-f QS:^ 1 MUNICH 1 VIENNA 1 THE HAGUE BERLIN ROTTERDAM BRESLAU PERtY- He -ER- rD-^A-T ERS HAMBURG ZURICH AMSTERDAM LONDON EDINBURGH WARSAW ■I ^H ^^^H LAWRENCE FRANKFORT COPENHAGEN )UN 3-W'/ >Rir QS7 WE DRESDEN BRUSSELS ■ -WE bUSpCC bbE C-T-IWQ-('IPEls-Er-0. VENICE 1 LINCOLN PARIS ROCHESTER L BROOKLYN ■ NEW YORK MANCHESTER L 'A-T- :rs U 1 AR<; NEWARK ■ wn ,.-^ BOSTON IRSy WA r.o -PRI GLASGOW 1 TER SH... JltO,^ NEW HAVEN ■ -AQ VI^Ni TpL. .J.,„ FALL RIVER TP CAMBRIDGE SYDNEY ■ WORCESTER BALTIMORE LIVERPOOL MONTREAL ■ NORMA u, 1 ^ QUEBEC /ERo, up n JBRf,-,.-.-.,. ~ TRENTON poJlu" "ION maV be CC NSIDERE.0 U h AVE OMAHA 1 1 1 iJ,,. l.QE|jeY . TOLEDO ■ HT nt. I Mil ' NEW ORLEANS 1 SF "IIMF NTATIC 1N T|i 1 TION, E rr,. ST. LOUIS ■ PATER80N MINNEAPOLIS HAMILTON TORONTO 1 tse ■qr- AK iS MOR ■ ni 1 F SS SLIBJ •OT MILWAUKEE L ^ DETROIT ■ CLEVELAND i_ CHICAGO ^^^^^^^H ■ m ^H |H ■ 1 BUFFALO GENOA ■■ ROME 1 ■UP AN )-ST RE^ MS- ^NC SM VLL UA( ES- DENVER ■ SAN FRANCISCO |_ ED- WA- -ER SHE WILMINGTON ■ SYRACUSE 1 DREOR- rlAE READING PROVIDENCE 1 .J^ HARTFORD ■WBV III ■pi 1 SCRANTON 1 RICHMOND ■ PHILADELPHIA JUG ATLANTA GRAND RAPIDS DIS rRIQTSAND rivIers Wh ICH ARE COLUMBUS -K-N 1 „: ". CINCINNATI ALBANY WITIH SEWAGE !ANC OT HEii: THOV 1 .L„L_1... JERSEY CITY PITTSBURG Wl EREABSTF AC1 ED LOWELL I T 1 CAMDEN ■ LOUtSVILLE 11 1 WASHINGTON ALEXANDRIA EGYPT ■ ■ ■ ■ ■ ■ ■ ■ ■ \,To / 42 Rhone 29 Richmond 3ii 48, $6, 60 pollution of supply of 28 River Elbe, bacteria in 13, 18 Rivers and wells, polluted 25 bacterial self-purification of 44 dispersion in 29 pollution by surface washings 27 proportion of sewage to stream-flow 26 Rochester 30, 48, 56, 60 Rome 31, 48, 56 Rotterdam 30, 48, 56 St. Louis 31, 48, 57, 60 St. Paul 31 San Francisco 31, 48, 56, 60 typhoid and rainfall fluctuate synchronously 9 Sanarelli 2 Schenectady 19, 20, 21 Schuylkill River, watershed, flow, and pollution of 28 Scioto River, watershed, flow, and pollution of 28 Scranton 31, 48, 57, 60 Sedimentation, effect of 28 Hooker 29 of bacteria 29 in storage reservoirs 45 overestimation of, in rivers 28 Self purification of rivers 44 Sewage from sewered towns 27 unsewered towns 27 Sewerage, Baltimore 35 Sewers and water, effect on typhoid 14 INDEX. 73 PAGE Shipping, effect on typhoid 45 in Hamburg i8 Sick-rate vs. death-rate 24 Simmonds, experiments on inoculation 2 Small cities, typhoid and wells 14 Solids, suspension of, in liquids 2g Spring-waters and typhoid 31 Standards for pollution 26 Storage reservoirs and rainfall 44 sedimentation of bacteria in 45 Stream-flow and sewage disposal 28 Surface washings and pollution 9 into lakes 44 reservoirs 14 rivers 27 storage reservoirs 45 Syracuse 30, 31, 48, 57, 60 Sydney 30, 57 T Tees River, typhoid in valley of g Thirlmere, Lake, owned by Manchester 42 Toledo 31, 48, 57, 60 pollution of supply of 28 typhoid and rainfall 9 Toronto 31, 48, 58 Trenton 31. 48, 58, 60 pollution of supply of 28 Troy 19, zo, 31, 48, 58, 60 Typhoid fever, at Cuxhaven 3 birds, etc 42 Typhoid, among shipping at H»mburg iS and Hudson River water 19 and polluted water 19 and quality 22 cause not proven to be B. typhosis i cholera in Elbe 18 death-rate for cities Appendix A •/4 INDEX. PAGE Typhoid, effects of filtration on 43, 46 pure water on , 16 sewage and water 14 from milk, food, etc 41 high with polluted water 34 Hudson and Mohawk rivers 19 influence of rainfall 42 in H amburg 18 largely due to water 41 low with pure water 34 LUneburg and Winsen 13 meteorological influences on 44 methods of infection 5 principal causes 35 rarity in Europe 41 reduction not due to ground-water lowering alone 35 U Upland waters, typhoid death-rates 31, 32, 45 V Value of pure water 4°, 43 waters of different classes 40, 43 Venice 30, 48, 58 Vienna 30, 48, 58 Vitality of B. typhosis in water 22 W Warsaw 30,48,58 effect of water and sewers. 14 Washington 31, 48, 58, 60 typhoid not dependent on sewers 6 well-waters 6, 27 Waters and sewers, effect of 14 classification of 24 polluted 25 Water power, U. S. Tenth Census 28 INDEX. 75 PAGE Water, quality of, and typhoid fever 22 responsibility for typhoid 41 Watershed and flow of Hudson, Chattahoochee, Delaware, Scioto, Olentangy, Grand, White, Passaic, Ohio, Schuylkill, Allegheny, James, and Maumee Rivers 28 Watersheds as sources of contagion 3> 42 Wells, and rivers polluted 25 in small cities 14 Syracuse 30 Washington, Louisville, and Atlanta 27 polluted 58 White River, watershed, flow, and pollution 28 Winsen, typhoid in 13 Worcester 30, 48, 58, 60 Wright, Dr. J. H., bacteriology of river-waters g Z Zurich 30. 58 improvement following betifr water 16 reduction of typhoid, and pure water 35 SHORT-TITLE CATALOGUE OF THE PUBLICATIONS OF JOHN WILEY & SONS, New York. London: .CHAPMAN & HALL, Limited, AERANGED UNDER SUBJECTS. Descriptive circulars sent on application. Boolcs marked with an asterisk are sold at net prices only. All books are bound in cloth unless otherwise stated. AGRICULTURE. 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