Rural Hygiene

by Henry N. Ogden

To make sure of the quality of the water proposed for a water-supply, it is wise to have such water examined by a chemist. The chemist will make certain determinations of ammonia and other chemical combinations, and will report his findings with an interpretation or explanation of the result. What he finds is not the presence or absence of disease or disease germs, but substances that suggest or involve the presence of organic pollution. A test is made for the number of bacteria, and a well of spring water which contains more than about fifty in a cubic centimeter is a suspicious water. Surface water, on the other hand, may contain two or three hundred without being necessarily bad, the types of bacteria being harmless. Generally, a chemist will also determine the presence of the colon bacillus which is found in the intestinal tract of man or warm-blooded animals. Wherever this is found, in even such a small quantity as one cubic centimeter of water or less, there is strong presumption that the water has been polluted by human wastes and is therefore not fit to drink.

Dangers of polluted water.

Since no evidence of the danger of drinking polluted water can be so graphically expressed as by a direct reference to epidemics caused by the unwise use of such water, it will not be out of place to refer briefly to some of the instances in which a direct connection has been traced between a specific pollution of a certain water and disease or death resulting from it.

Although, as has already been explained, an infected water causes various kinds of intestinal disorders, particularly among children, the most characteristic evidence of pollution occurs when the noxious material comes directly from a typhoid fever patient, so that this same disease can be recognized as transmitted to another individual or family. This transmission of typhoid fever, while in some cases very plainly due to other agencies than water, as, for example, milk, oysters, and flies, yet, by far the largest proportion of the transmitted cases comes through the agency of polluted drinking water, and there are many examples both of contaminated wells and streams which emphasize this possibility beyond all question.

Two historic investigations of epidemics which have thoroughly convinced sanitarians that typhoid fever is a communicable disease and that water is the vehicle for its transmission may be briefly cited.

In 1879 Dr. Thorne reported an epidemic in the town of Caterham, England, which he had investigated, and disclosed the following facts: The population of the village was 5800. The first case of fever appeared on January 19. Others followed in rapid succession, until the number reached 352, of whom in due time 21 died.

The possibility of infection was carefully looked into. The influence of sewer air was ruled out because there were no sewers. The milk supply was proved unobjectionable. No theory of personal or secondary infection could account for the widespread prevalence, particularly as only one isolated case had occurred during the preceding year, and this had been imported.

Of the first 47 persons attacked, 45 lived in houses supplied with the public water-supply, and the other two were during the day in houses supplied with public water. Further, in the Caterham Asylum, with nearly 2000 patients, not a single case appeared, their water coming from driven wells. Investigation of the water-supply showed the undoubted cause of the epidemic. The public water-supply was derived from three deep wells, connected by tunnels in the chalk. In one of these tunnels, from January 5 to the end of the month, a laborer worked, who, though unattended by a physician, was evidently suffering from mild typhoid fever, the symptoms of the disease being carefully detailed by Dr. Thorne. The laborer at the time of his going to work had a severe diarrhœa, and while in the tunnel was obliged to make use of the bucket, in which the excavated chalk was hauled to the top. He admitted that at times the bucket, in being hauled up, would oscillate in such a way as to spill part of its contents and thereby pollute the water of the well below. Two weeks from this accidental pollution the epidemic began, and there can be little doubt of the relation of this mild case of typhoid to the epidemic which followed.

A second illustration may be cited at Butler, Pennsylvania, which occurred in 1903. The water-supply of Butler, a borough of 16,000 people, comes from a reservoir on the creek which flows through the phase. On account of the gross pollution of the water at the pumping-station, a long supply pipe has been laid from the reservoir directly to the pumps. The water also was filtered through a filter of the mechanical type. Through some accident the filter was thrown out of service for eleven days, between October 20 and 31, 1903, and unfortunately, on account of the failure of the reservoir dam, the water was at that time being taken directly from the creek at the pump well, and had been since August 27. Only ten days after the filter was shut down, the epidemic broke out in all parts of the town. Between November 10 and December 19 there were 1270 cases and 56 deaths. In the subsequent investigation it developed that not only was the stream generally polluted by the sewage at various points above the intake, but that there had been several cases of typhoid fever on the watershed, some on a brook that enters the creek within one hundred feet of the filter plant. As at Caterham, the inference is patent that the introduction of some specific infection into the drinking water was the direct cause of the general epidemic.

The occasional outbreaks of typhoid fever which occur in single families are not so easy to explain, particularly since the small number of persons affected does not usually call for a widespread interest on the part of those experienced in such epidemics. In the Twenty-seventh Annual Report of the New York State Department of Health, the following description of an outbreak in a small hamlet, where the cause seems to have been the use of a pond for a wash tub by some Italian laborers, thereby transmitting the disease germs from their clothes to the water afterwards used in a creamery, is given. The diagram, Fig. 37, shows that the creamery secured its water for the purpose of washing cans from a small pond by means of a gravity pipe line. The foreman of the creamery, who boarded at the residence marked A, first contracted typhoid fever. A week later an employee at the creamery also contracted the fever, the residence of the latter being marked B on the diagram. About six weeks later the railroad station agent, living at the point marked C, contracted the fever, and two weeks later his wife was attacked with the same disease. The residences at B and C are only about three hundred feet apart, both families taking their water-supplies from a spring between the two, but nearer B. During the summer previous to this outbreak a gang of Italian laborers, engaged in double-tracking the Central New England Railroad, were housed in box cars standing on one track of the railroad. One of the members of the gang was reported to have been taken ill with a fever and was at once removed, it was supposed, to a hospital in New York. It was the practice of the Italian laborers to bathe and wash their clothes in the upper of the two ponds from which water is supplied to the creamery by the pipe line. All the persons who contracted the fever were supplied with milk from the creamery. The foreman, who was the first to contract the fever, used water from the creamery and from the well at the house where he boarded. The other families, as already mentioned, used water from the spring. The conclusions, therefore, are that the creamery in some way became infected with typhoid fever, probably through the water-supply from the pond, and that the first two cases were due directly to this cause; that the station agent and his wife contracted the fever because of the infection of the spring, either from some small stream which is the outlet of the ponds or from some infection due to the illness of the owner of the house B near by. The report concludes as follows: "The use of water for creamery purposes from a pond exposed to such unwarranted and unchecked pollution as is shown here, or the permitted abuse of a water-supply for a creamery, appears little less than criminal negligence on the part of those responsible for the management of the creamery."