The epidemic of typhoid fever at Ithaca, N. Y

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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.

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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.