TYPHOID FEVER AND DRINKING WATER.

TYPHOID FEVER AND DRINKING WATER.

ALL advocates of pure water for domestic purposes start from the stand point of water being the carrier of the typhoid bacillus and other pathogenic bacteria; and especially with reference to typhoid fever. It is held by the champions of potable water that this is a water born disease, and that it is due to sewage pollution of drinking and other domestic waters, the bacillus typhosus coming into the water from sewage sources, and finding its way into the human system through the dietary channels.

It is not universally admitted that the typhoid baccillus is the cause of typhoid fever, neither is it universally admitted that typhoid fever is a water born disease. Therefore, proof of either proposition is at present very desirable, and while the writer must leave the defending of the first to the medical fraternity, he has some information to offer on the generally accepted belief that polluted water is the cause of typhoid, whether that cause be found in the bacillus itself, or in the toxic properties which it may elaborate in the water before it is drunk, or after if has gained access to the human system. Conceding that the baccillus typhosus itself may not be the cause of typhoid, this would not affect the proposition that the infection is transmitted through drinking and other dietetic waters.

The fact is well established that In those cities where the public water supply is known to be polluted with sewage and generally used without attempt at purification, that the typhoid death rate is high, and in those cities where the water is obtained from sources not exposed to serious sewage pollution, or where careful filtration is practiced, the typhoid death rate is low.

With reference to the transmission of typhoid fever by milk, butter and other articles of diet which may have been inoculated with the typhoid bacillus or infected by contact with a polluted water, while this method of transmission may be operative in sporadic epidemics, it probably has no place in the continuous case and death rate from this disease prevailing at all times in all of our large cities; or, if any portion of the prevailing typhoid is due to infected milk, etc., this as a cause will probably operate quite uniformly In all the cities of the country. Thus, if. as Dr. Cyrus Edson declares, ninety-nine per cent, of the typhoid cases are chargeable to on Infected drinking water, and one per cent, to other causes, then this one per cent! will be applicable to the typhoid case and death rate of London, as well as New York. Considering then the general typhoid which we have always with us, and admitting that by far the larger percentage of the case and death rate is due to some other cause or causes than an infected milk or other article of diet, let us set’ what, if any, part polluted water plays in the matter.

I have before me the typhoid fever statistics from the principal cities of the United States for the past flveyears, and from the principal cities of Europe for the four years ending December 81st, 1888, from which are taken the following typhoid fever death rates per 100,000 of population living;

Of these cities, Vienna, Manchester, Liverpool, Glasgow, New York. Boston and Newark obtain their water supplies from natural or artificial reservoirs at high elevation and beyond the possibility of contamination by city sewage. This may not be wholly true for Boston, but is practically so for the other cities. Berlin has a divided supply, part of the water coming from Lake Tegel and part from the River Spree, from both of which the water is filtered before delivery. London is almost wholly supplied from the rivers Thames and Lea, the waters of which are filtered before delivery to the consumers, and Brooklyn derives part of its supply from impounded water, and part from driven wells.

Taking now a few cities for which the water supply is derived from rivers or lakes open to sewage pollution, with no attempt at purification, we have the following results in deaths from typhoid fever per 100,000 of population living;

The average death rate from the first list of cities, is for the several years;

From this we see that in those cities where the public water supply is known to be sewage polluted, the typhoid fever death rate has been as an average for the past five Sears, over three times as great as in those cities where the supply is obtained from sources not exposed to contamination from city sewage, or in which the water is filtered before it is supplied to the public. If the excess of typhoid fever in the second list of cities is not due to the inferior quality of the water supplied in all of them, to what other cause can it be assigned? In this query Newark, N. J., is not included because of the improved supply which it has enjoyed since April, 1893.

Despite the many references of health officers and water boards to the influence of the quality of water supply on typhoid fever rates, and the numerous special investigations by experts, showing typhoid fever to rise and fall with the impairment or improvement of the quality of our drinking waters, there are many intelligent people who are still to be convinced that typhoid fever is a water-born disease; and stranger yet, some of these skeptics are found in the medical profession. To my mind, if there be any fact in etiology clearly proven, it is that typhoid fever is as directly traceable to polluted or infected water as intoxication is to the use of alcohol; and to one who believes this, it ;s but a step to the conclusion that when we banish from our midst the infected water, typhoid fever will cease to exist. However, human nature is so prone to be perverse that it seems we prefer to wait on the discovery of an antitoxine to cure typhoid fever, rather than adopt the simplest of remedies to prevent it altogether. Meanwhile we lose, at the present time, enough souls each year by this one disease to make a city as large as Lawrence, Mass.

As further evidence that an infected drinking water is the cause of typhoid ’fever, reference is had to the city of Munich, where, it is said, that water is not generally used as beverage. Here the death rate from typhoid fever has been as low as three persons per one hundred thousand of population living (1892), but at the same time the consumption of beer has been as high as 128 gallons per capita per annum, an amount which, if properly distributed among the inhabitants throughout the year, will certainly quench a large thirst. The very low typhoid rate of this city cannot be attributed to the excellence of the public water supply, for the people generally do not use it for drinking purposes, but rather to prophylactic properties of the beer.

Typhoid Fever and Drinking Water.

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Typhoid Fever and Drinking Water.

JOHN W. HILL, C.E.

ANY city or community which has typhoid fever, whether epidemic or sporadic, can safely charge the disease to infection from a polluted water

supply. It may be that the local water supply is infected or the water used in connection with dairy operations or in the preparation of articles of diet which are eaten uncooked, but in all cases a source of water supply infected by the bacillus will be found at the root of the disease.

The water supply of a certain city may be free from the typhoid bacillus, and at the same time the disease be pervalent in such city.

In such case, if a careful examination of the drinking water supplied to the people of such city demonstrates the absence of the typhoid bacillus, then it will be found to have been brought into the city through some article of diet which has been in contact with an infected water at some other place. Thus the water used in washing milk-cans or bottles, or in the manufacture of butter, or in washing vegetables or meats, or in rinsing dishes, if it is infected with the typhoid bacillus, may be the cause of sjxiradic or epidemic expressions of the disease.

In brief, if the typhoid bacillus can be excluded from our domestic water supplies, it will not bo found in our milk and other articles of food.

During the past, few years I have taken pains to trace several cases of typhoid fever in some of the villages and towns of Ohio and Kent ucky, within fifty miles of Cincinnati, and invariably have found that tho original cases in any locality have, previous to the development of the disease, been in contact with tin* city water pumjM-d from the Ohio liiver, The Ohio River, before it reaches Cincinnati, has received the sewage of more t han 1,500,000 people, and at low stages is found by microscopic and chemical examination to be rich in the materials necessary to maintain bacterial life.

People from the surrounding villages visit Cincninati. drink the disease-laden water from the city taps, and return to their homes after laying the foundation for a siege of typhoid. If tho dejecta from these suburban sporadic cases is deposited in privy vaults dug into the ground, and the ground is of a porous nature, infection of wells and cisterns soon follow, and other cases of typhoid are often established The general physical frailty of t he typhoid germ is against its continued existence, and excepting its life is maintained by frequent transplanting in favorable soil, it would soon perish. Thus the infection of the water of a cistern or well by one typhoid patient would not mean the infection of others who might drink such water after the lapse of many months, but might mean the infection to any one who would drink the water within a few weeks, or even months, of the time of the original infection. The most favorable soil for the development of the typhoid bacillus is frequently found in the human intestine, and from this source it. obtains the energy essential to its continued existence.

Something should be done by cities now having a high death rate, from typhoid, to mitigate or entirely extinguish the evil.