Remarks on the Recent 
Outbreak of Typhoid 
or Enteric Fever at 
Southampton, L I. 
BY 
F. K. BECKWITH, M. I)., 
NEW HAVEN. 
!*KKsfc OF O. A. DORMAN. 
1H*7. REMARKS ON TIIE RECENT OUTBREAK OF TYPHOID 
OR ENTERIC FEVER AT SOUTHAMPTON, L. I. 
THIS paper presents the facts in regard to the recent outbreak 
of typhoid fever at Southampton, points out sanitary defects 
constantly present, and urges the importance of absolute 
cleanliness in the management and disposal of all filth and refuse. 
It is only by individual effort that the water supply can be kept 
free from contamination, but, as appears in the sequel, this is not 
only possible but practicable. The sanitary suggestions which 
close the paper apply not only to Southampton but to every small 
seaside resort in a developing state where there are similar condi- 
tions of soil, surface of country, and water supply. 
Every physician can, in a desultory way, contribute a few 
facts to sanitary knowledge, but his opinion can never have much 
weight ; therefore, outside of the facts the analyses and the cases, a 
large part of what follows is made up of quotations from undoubted 
sanitary authorities. Dr. Hill (Lancet, October 20, 188V,) writes: 
“Every hygienist has deplored the non-existence of a physio- 
logical and pathological institute, properly furnished for the 
scientific investigation of many questions affecting public health. ” 
The village of Southampton lias a population of about twelve 
hundred, together with, in the summer, about a thousand visitors, 
composed largely of children and young adults. The summer 
population live in boarding houses, and cottages (of which there 
are about eighty), partly rented and partly owned by their occu- 
pants. All are subject to the same sanitary conditions and sur- 
roundings, and all drink water pumped fifteen or twenty feet from 
a common source—what may be called surface water. All live 
upon the same level, so that none can be said to drain directly 
upon his neighbor. The soil throughout is composed of sand and 
gravel, resting upon clay fifteen feet below, allowing of rapid 
percolation of rain water and other fluids to the impervious clay 
layer, upon which they collect and remain. 4 
-Remarks on the Recent Outbreak of 
All the village, including the eighty cottages, dispose of their 
sewage and waste independently, either upon the surface or in cess- 
pools, there being no system of drainage into the lake or ocean. 
Most of the cottage cess-pools, and those more recently constructed 
in the village, are from twelve to sixteen feet deep, made of brick 
lined with cement, and are water tight, while the rest, which have 
no brick or cement at the bottom, are in reality only wet earth 
pits. (l) The villagers more often drain their waste water upon 
the surface near their houses, and use for the reception of all 
excremental matter the old-fashioned privy, kept dry and odorless 
by the free use of earth, in this way getting along without cess- 
pools. A very few of the cottagers employ this method. (2) Some 
of the cottagers, possibly the majority, drain the waste water of 
the house and all excremental matter into the cess-pools, using 
water closets with a large amount of water, and emptying the 
cess-pools as often as once a week. (3) Others of the cottagers, 
and a few of the villagers, drain the waste water and fluid excre- 
ment into the cess-pools, and for other excrement use dry earth in 
boxes or pails, which are emptied daily. Of these three methods 
the first or village method, which is unsightly, is, when properly 
carried out, the safest; the second, dumping on the surface near 
the houses, is bad ; and the third, if used with care, is moderately 
good ; both the second and third methods are unsafe, if the cess- 
pool is leaky, has an unsound bottom, or none at all, for all 
drainage takes place into the sand at the level of the water supply, 
which can hardly escape contamination. The contents of all the 
cess-pools are pumped into a tight wagon and poured upon the 
ground in the immediate neighborhood of the houses, there being 
no common dumping-ground at a distance. The contents of the 
boxes or pails, are carried away daily, but where is dimly known. 
The emptying of the cess-pools is done at night by careless workers 
who, entirely contrary to orders, have been known to dump within 
less than seventy-five feet of the houses and upon the roadside. 
The stench attending the pumping and dumping is, if appreciated, 
unbearable, hence the selection of the hours of midnight and early 
dawn; a selection bad because carelessness is thereby undetected, 
and because the odors fall upon a sleeping community in the hours 
when vitality is at its lowest point. 
“In the night and early morning there is no breeze to keep 
the air in motion, and the density of the air and the deposition of 
dew prevents a free admixture of the impure with the higher Typhoid or Enteric. Fever at Southampton, Ij. I. 
5 
strata of pure air.”—“Sanitary Examinations of Water, Air and 
Food.” Fox, p. 230. 
“Families, visiting the seaside for the benefit of their health, 
do not desire to inhale the exhalation from hundreds of cess-pools, 
however much they may be diluted by the sea breezes.”—“Sani- 
tary condition of Margate.” Lancet, July 30, 1887. 
Other sources of stenches are the pigstys in the village and 
elsewhere, and a few heaps of rotting manure. The cess-pools, 
especially those used for all excremental matter as now managed, 
are a nuisance, and perhaps this term may justly be applied to the 
pigsty and the manure heap. 
“All unpleasant smells are to a certain extent deleterious, 
although infinitesimally so perhaps.”—Fox. 
The summer of 1887 was characterized by periods of intense 
heat followed by heavy rains, during which every form of soluble 
filth was washed into the source of the driven wells, to wit, the 
surface water. 
On the other hand, Southampton, which is near the open sea, 
enjoys the benefits of broad spaces, strong sea breezes and uninter- 
rupted sunshine. There is no crowding of houses or cottages, and 
no mobs of transient visitors. Its food supply is good, fish, meat 
and vegetables, arriving in excellent condition and in abundance. 
The milk, while not rich, is good, and carefully and promptly 
served. 
In a summer resort one looks for first rate health, and if it be 
only second rate the attention is at once aroused to search for the 
explanation or causes. Second-rate health may be said to exist 
when diarrhoea, digestive ills, general debility, and attacks of 
lassitude with headache occur ; such disorders indicating that the 
sanitary conditions of a place are unsatisfactory and approaching 
the danger line, while the occurrence of one or all of the graver 
disorders—dysentery, diphtheria, typhoid fever—indicates the 
crossing of the danger line. Now, preceded by the minor evils 
referred to, toward the close of the summer, typhoid fever made 
its appearance in Southampton. In contrast with this, the summers 
of the preceding two years presented an almost entire absence of 
these lesser evils and freedom from every grave disease. 
The history of the outbreak is briefly as follows : 
Dr. John Nugent writes: “I was called to see Mr. Waters 
(near the Shinnecock Reservation about three miles from 
Hildreth’s) about August 25th. lie died September 12th, after 6 
Remarks on the Recent Outbreak of 
an illness of five or six weeks. My notice was called to his 
daughter September 6th. Mrs. James A. Hildreth was taken sick 
September 20th. I was called to see Mr. George Folk, the water- 
mill man (about two miles from Hildreth’s), October 4th. He had 
been sick a week then. I had another case about two miles west 
of Pond Quogue lighthouse. I was called there September 22d, 
finding patient had been sick about a week. There have been 
quite a number of cases up that way since, and two or three deaths. 
I have not had a case of low fever in the past year that I can 
recall.”—Extract from letter November 10th, 1887. 
Dr. P. Brynberg Porter, in the latter part of August and Sep- 
tember, attended Miss E., sick with typhoid fever of a moderately 
severe type, at Mr. Hildreth’s. 
On the 16th of July I was called to see Mr. G. C. at James 
A. Hildreth’s boarding house. He had been sick a number of 
days, and after a week’s observation I concluded he had not, as I 
had feared, typhoid fever, but remittent fever, with sharp rises and 
falls in the temperature, and constipation, and cured by brisk 
cathartics and quinine. Mr. C. was in perfect health when taken 
sick, was subject to attacks of remittent fever, and had been in 
Southampton two weeks Avhen he was suddenly taken sick in the 
way described. This case, which is out of place here, is described 
and included for the reason that many erroneously assumed it to 
be typhoid fever. 
On the 11th of August I was called to see Miss de L. (at Mr. 
Hildreth’s), who was suffering with fever and headache. On the 
third day pneumonia (croupous) developed in the upper lobe of the 
left lung and ran a course of fourteen days, masking the typhoid 
fever present, which gradually became characteristic, until it was 
evident that it was the chief malady, the pneumonia being a com- 
plicating or intercurrent affection ; and from the two diseases, but 
chiefly from the typhoid fever, death occurred on the 11th of 
September. 
On the 17th of August I [was called to see Miss C. (at Mr. 
Hildreth’s), who in the best of health was suddenly taken sick with 
a chill followed by fever. At first I thought that she had remit- 
tent fever, but I soon learned that free doses of quinine had no 
beneficial effect on the disease, which became gradually a typical 
case of typhoid fever of moderate severity. 
In addition to these cases I saw at Hildreth’s in August three 
patients who suffered from digestive disturbance with complete Typhoid or Enteric Fever at Southampton, L. I. 
7 
loss of appetite and frontal headache, and recovered in from seven 
to ten days. 
From Mr. F. O. de Luze I received the following : 
“I have seen Mr. R. who also boarded at Hildreth’s. On his 
return he was ill with malarial fever for ten days, and is still under 
treatment (September 15th), and looks much pulled down. Ilis 
sister (the youngest) is ill now in bed and has been so since 
August 14th, and her doctor says that she has just escaped typhoid 
fever, and that both cases were contracted at Southampton. 
Mr. R. never used ice in the water, but drank much water 
and milk.” 
On the 25th of August Miss S., at the Fondey Cottage, on 
the lake, one half mile west of Hildreth’s, was taken sick with fever 
and constant frontal headache, with feeble and rapid action of the 
heart, ending in prolonged sickness in bed. The diagnosis, after a 
few days observation, was typhoid fever of mild type. Miss S. 
drank milk, and water from the basement well of the cottage, but 
no water from the Hildreth well or milk from his farm. There is 
no evidence that the milk, which was supplied by Goodale, was 
ever impure or in the least contaminated. 
Scattered about during August and September there were a 
number of cases of moderately severe and obstinate diarrhoea, 
which were attributed to the use of impure water, as no sufficient 
cause could be found either in intense heat (the latter half of 
August and September were cool), or improper diet. 
At Seamarge, one-quarter mile south-west of Hildreth’s, we 
suffered from digestive disturbance, with obstinate colic and 
diarrhoea, and persistent nausea, which could be attributed to 
nothing except the water, and this was finally sent to Dr. Martin 
for analysis. 
At Mr. Hildreth’s a cess-pool, without a bottom of brick or 
cement, receives all the waste water (a large amount), and allows 
of immediate drainage into the ground at the level of the water 
supply. Connected with the cess-pool, at the south end of the 
hall, there is a shallow sink into which waste water is constantly 
emptied. All fluid excremental matter is thrown upon the ground 
at a safe distance from the well, and all solid excremental matter 
is deposited in privies supplied with earth, which renders them 
dry and odorless. There being no leak from a drain directly into 
the well, its contamination, which took place, can be explained only 
by percolation through fifty feet of sand. As this occurred there 8 
Remarks on the Recent Outbreak of 
is no reason to doubt that contamination could extend further, and 
I learn that the analysis of the water from the new well, one 
hundred and fifty feet from the house, indicates similar impurity. 
“ Th e cess-pool at the Fondey Cottage has no cement at the 
bottom, only on the sides ; it stands a little lower than the house 
and the ground slopes from it to the lake. (The driven well is in 
the basement of the house.) Last winter the cess-pool was 
thoroughly cleaned and left open until spring. There is one water 
closet and bath tub on the first floor in the corner nearest the cess- 
pool, and one sink room on the second floor, these with kitchen 
sink and wash tubs drain into the cess-pool. There is also an earth 
box outside, as the water closet is only a small one, and we had 
only a small tank of rain water. New pipes were put in last 
summer. We never had any smell from the sinks, but had to pour 
pails of water down the closet when the water was low.” 
It is evident that contamination of the surface water from the 
cess-pool could easily take place, and, as the analysis of the base- 
ment well water indicates, it did take place. 
At Seamarge, the cesspool, one hundred feet from the house, 
is made of brick cemented thoroughly, and is water tight. It 
receives all the waste water and fluid excremental matter, but no 
other excremental matter, which is deposited in earth boxes and 
removed daily. In July the waste pipe became plugged, allow- 
ing leakage upon the surface of the ground twenty feet from 
the driven well. From this or some other source, as is shown 
by the analysis, the well water became impure. 
A comparison of the analyses of these three waters shows a little 
difference in the degree of contamination only, and in each case 
the impure water produced sickness, so that it is probable that the 
boarders at Hildreth’s would have suffered equally severely if they 
had been either at the Fondey Cottage or at Seamarge. 
At the Waters’ place there is no cess-pool proper, tapping the 
ground twelve or sixteen feet to the water level, and the drinking 
water comes from a spring. The analysis indicates very little or 
no drainage into the source of the spring, which may be protected 
by the trend of the clay layer between the primitive cess-pool and 
the spring, being away from instead of towards the latter. It is 
worthy of note that there are no surrounding sources of conta- 
mination, in the shape of cess pools, as in the other cases. 
I know nothing of Mr. George Folk’s sanitary surroundings 
or the condition of his drinking water, or of the sanitary sur- Typhoid or Enteric Fever at Southampton, X, 1. 
9 
roundings and water supply of the Pond Quogue lighthouse case, 
or of the more recent cases, referred to by Dr. Nugent, in that 
neighborhood. 
Lake Agawam receives no drainage and is subject to conta- 
mination only from leaky drain pipes or cess-pools, which surround 
it, and surface filth washed into it by heavy rains. 
The life saving station has no cess-pool and uses an old- 
fashioned privy. The contamination of the water comes from 
leakage from surrounding sources of impurity, the drains and 
cess-pools. 
The water from D. Burnett’s well at Wickapogue, a little east 
of Hildreth’s, was analyzed by request of Dr. Nugent, who refers 
to the well in the following words : “There are willow trees not 
far from the well, and in summer the water smells so bad they can 
not use it; the roots grow into the well.” 
Having briefly related the cases and described their sanitary 
surroundings, where shall the explanation or causes of the fever, 
around which the lesser evils probably also cluster, be sought for? 
(1.) It did not spread from the first case by contagion, for it is 
universally believed to be not contagious from person to person. 
“But the most remarkable fact is what follows: Since 18G1 
for nine years 3,555 cases of enteric fever have been treated along 
with 5,144 patients not suffering from any specific fever [in the 
London Fever Hospital]. From 1871 to 1882, 1,795 cases of enteric 
fever have been admitted and treated in the same wards with 982 
cases of other diseases, no special precautions being taken, and not 
one of these became infected.”—Murchison : “ The Continued 
Fevers of Great Britain,” p. 462. By contagion none of the cases 
outside the Hildreth’s house could be explained. 
(2.) There is no evidence that it, originated from the use of 
contaminated food or milk. 
(3.) Its origin and spread has been briefly and simply explained 
by saying that Mr. G. C. had a low fever with diarrhoea, contracted 
in New York ; that by his dejecta the Hildreth well became 
polluted ; that upon his linen the poison or germ was carried to 
the Waters family (who took in washing), draining with the waste 
water into their spring ; and that it was carried in Goodale’s milk 
from Hildreth’s to Miss S. in the Fondey Cottage. 
This explanation, attractive from the fact that it limits the 
water pollution to Hildreth’s well and implies importation of the 
disease, has been eagerly accepted, but it is unfortunately at 
variance with the facts. 10 
Remarks on The Recent Outbreak of 
The nature of Mr. G. C.’s illness is stated in the history of 
hi s case. lie writes: “My linen was never washed by the 
Shinnecock Indian” (Waters). 
Mr. Jas. A. Hildreth writes : “I have never sold milk to the 
Goodales. They have not washed cans from my well nor used the 
water in any way.” 
“ The fever is occasionally believed to be introduced into a 
house by a newlv-arrived person, when it really has a local origin 
from which the stranger naturally suffers first.”—Murchison, p.364. 
(4.) It could have arisen from the use of water contaminated 
with sewage containing typhoid poison from unrecognized cases 
occurring during the preceding winter and spring, the germs 
living on and doing no harm until carried into the water supply 
by the rains of the middle and late summer. It is impossible 
to exclude the occurrence of contamination in this way and 
equally impossible to trace it. Dr. Nugent says that he had 
no doubtful cases of typhoid or low fever and knew of none 
in the winter and spring. Owing to the grave illness of the 
late Dr. llallock it was impossible to get an expression of his 
experience. Possibly doubtful cases did occur and it is perhaps 
possible that the typhoid poison, be it a bacillus or animal matter 
in dry form, is endemic here as in most country towns, and that, 
after very hot weather or prolonged drought, it is by heavy rains 
washed into the water sources, or else slowly leaks in from defec- 
tive drains or cess-pools. 
(5.) It could have arisen from the use of water polluted with 
sewage only, the pollution being limited to no one locality. 
“Although in large towns it may be difficult to exclude the 
possibility of contagion, on turning to the history of circumscribed 
epidemics in country districts, it is found to be often impossible to 
attribute the first appearance of the disease to contagion. It is 
not uncommon for the inmates of an isolated country-house to 
be seized with enteric fever, although no case has occurred within 
many miles, and there is no evidence of importation of the 
poison. 
“ In the admirable report of the medical officer of the Privy Coun- 
cil it will be found that the experience of many years repeats again 
and again the general lesson that enteric fever denotes ‘ excre- 
mental poisoning while the president of the Society of Engineers 
has recently declared that, having examined many hundreds of 
houses in which enteric fever had occurred, he had in every Typhoid or Enteric Fever at /Southampton, L. I. 
11 
instance been able to trace the outbreak to some unlooked-for de- 
fect in the drainage, lint there is not the same unanimity of 
opinion as to how the poison appears in the sewage. Many adopt 
the view taught at Munich for more than thirty years by 
Prof. F. von Gietl that the poison, although contained in sewage, 
is always derived from the excreta of an individual already suffer- 
ing from the disease, a drain being merely the vehicle for its 
propagation or, in fact, a direct continuation of the diseased in- 
testine ; while others believe that the poison may be generated in 
the sewage independently of typhoid excreta. The solution of 
the question is undoubtedly beset with many difficulties. 
“ During the last fifteen years, however, I have met with few 
examples of enteric fever, which, on investigation, could not be 
traced to defective drainage, the explanation of which was often 
unknown to the inhabitants of the infected locality. Enteric fever 
is constantly appearing where decomposing sewage is present, but 
where every effort of acute observers fails to trace the presence 
of typhoid excreta. 
“An increased rainfall sweeps away the impurities to which the 
origin and spread of the disease are in drained towns mainly due ; 
but in undrained places it may conduce to an outbreak of the 
disease, by washing these impurities into the wrater used for 
drinking purposes, as happened at Festiniog in 1863 and in Dun- 
dee in 1864.”—Murchison, p. 449, et. seq. 
“The waters of wells are greatly influenced by (l) height of 
the subsoil water, which is always varying ; (2) by the amount of 
water that is passing through the subsoil of a country ; and (3) by 
heavy downfalls of rain or periods of drought. I have many 
times found a water pure at one time and impure at another, and 
this occasional pollution of a water is often due to the periodical 
washing of filth into a well by heavy rains. The disagreement 
in the opinions of able analysts respecting the purity of samples 
of water, taken perhaps within a short interval of time from the 
same well, is often due to these causes, which are not sufficiently 
recognized.”—Fox, p. 01. 
“ The experience of Lausen (where filtration through a mile of 
earth occurred) seems to prove bejond a doubt that the poison of 
typhoid may undergo what appears a very efficient natural filtra- 
tion without losing its activity. 
“It is more than doubtful whether there is any absolute safety 
in obtaining water from deep wells. The Dudlow Lane well, near 12 
Remarks on the Recent Outbreak of 
Liverpool, having a total depth of 443 feet, was fouled by percola- 
tion from cess-pools, and percolation from a defective sewer would 
certainly prove equally disastrous. Surface wells are not now re- 
garded as at all safe, but our suspicions with regard to them were 
not aroused until after the introduction of the plan of mixing 
water with putrescible matter. There was no soakage from an 
old-fashioned dry pit. There must be soakage from a cess-pool or 
f dead-well.’ The only way of securing pure water is to make 
sure that there is no fouling of water sources.”—Lancet, July 23, 
1887. 
“ Some may triumphantly observe that they have been endanger- 
ing their health during a great many years, and are not, to their 
own knowledge, at all the worse for the filth that they have taken 
with their water. They conclude, therefore, that impure water, 
like tea which the old woman of ninety was informed was a 
stealthy poison, must be exceedingly slow in its action. 
“Mr. Simon, who rightly insists upon a high standard of purity 
for drinking water, in his second annual report to the city of 
London, observes that: ‘ We cannot expect to find the effect of 
impure water always sudden and violent. The results of the 
continued imbibition of polluted water are indeed often gradual, 
and may elude ordinary observation, yet be not the less real and 
appreciable by close inquiry. In fact it is only when striking and 
violent effects are produced, that public attention is arrested ; the 
minor and more insidious, but not less certain eviis, are borne 
with the indifference and apathy of custom.’ 
“ All waters, even the purest, contain some organic matter. The 
excess is alone objected to ; and especially that of animal origin, 
which is especially prone to pass through certain putrefactive 
changes. 
“ Thousands are still to be found who believe that if a water is 
bright and clear, and not unpleasant to the taste, it must be good ; 
whilst it has been proved, over and over again, that such a water 
may be polluted with unspeakable filth, and that an excessive 
brilliancy of a water is a suspicious sign.”—Fox. 
The following analyses were made by Dr. Edward W. Martin, 
of the School of Mines, Columbia College, and Prof. Herbert E. 
Smith, of the Medical Department of Yale University. Typhoid or Enteric Fever at Southampton, L. T. 
SCHOOL OF MINES. 
Columbia College. 
New Yoke. 
Results of Analyses of Samples of Water from 
Southampton, L. I 
(Figures indicate grains per U. S. Gallon of 231 cubic inches.) 
2294 
2323 
2306 
Appearance, etc 
j Clear 
1 Greenish. 
) Clear 
'( Blueish. 
j Clear 
( Greenish. 
Odor, heated to 100° F 
Faint Musty. 
None. 
None. 
Chlorine in Chlorides 
1.4993 
1.5978 
1.5990 
Equivalent to Sod. Chi 
2.4726 
2.6365 
2.6365 
Phosphates 
Traces. 
Traces. 
Traces. 
Nitrites 
None. 
Traces. 
FaintT races. 
Nitrogen in Nitrates and Nitrites .... 
0.1888 
0.3265 
0.1440 
Free Ammonia 
0.0005 
0.0017 
Traces. 
Albuminoid Ammonia 
0.0029 
0.0040 
0.0005 
«<Hardness” Equiva- l before boiling 
2.0411 
3.7900 
1.5162 
lent to Carbonate 
of Lime f after boiling. 
1.8952 
3.5689 
1.5162 
Organic and Volatile (loss on igni 
tion) 
2.9159 
1.9828 
1.7495 
Mineral Matter (non-volatile) 
20.1197 
6.9981 
4.0822 
Total Solids (by evaporation) 
23.0356 
8.9809 
5.8317 
The samples were marked as follows :— 
No. 2294—Hildreth, September 19, 1887. 
No. 2323—Fondey, November 1, 1887. 
No. 2306—Seamarge, September 28, 1887. 
No. 2294. This sample of water appears to be contaminated 
with sewage and is not suitable for domestic uses. 
No. 2323. This sample of water cannot be considered as satis- 
factory in quality. I should recommend boiling before using it for 
drinking purposes. 
No. 2306. This sample of water must be regarded with sus- 
picion. If necessary to use it for drinking purposes I should 
recommend boiling the water. 
Edward W. Martin. 14 
Remarks on the Recent Outbreak of 
YALE UNIVERSITY. 
Department of Medicine. 
New Haven, Conn. 
Results of Analyses of Samples of Water from 
Southampton, L. I. 
Received from Dr. F. E. Beckwith, November 9, 1887. 
(Figures indicate milligrams per litre, 
or parts per million of 
water.) 
1 
2 
3 
4 
Total solids (by evaporation) 
122. 
95. 
84. 
39. 
Loss on Ignition 
53. 
31 
24. 
17. 
dhlorine of Chlorides 
41. 
31. 
30. 
10. 
Free Ammonia 
0.56 
0.12 
0.01 
0.02 
Albuminoid Ammonia 
0.44 
0.07 
0.06 
0.02 
Nitrogen of Nitrites 
0. 
0. 
0. 
0. 
Nitrogen of Nitrates 
0.25 
1.09 
0.08 
0.33 
Oxygen consumed (from permanganate 
in 30 minutes at 100° C) 
6.59 
0.09 
0.12 
0.05 
The samples were marked as follows :— 
No. 1—Lake Agawam. 
No. 2—Life Saving Station. 
No. 3—Wickapogue Burnett’s. 
No. 4—Waters. 
No. 1 was turbid and somewhat yellowish ; No. 2, not clear ; 
but Nos. 3 and 4 were clear. No. 1 is impure to a high degree. 
No. 4 cannot be objected to from a chemical stand-point ; but with 
regard to Nos. 2 and 3, it appears that while the results do not in- 
dicate the presence of a quantity of organic matter which is 
necessarily objectionable as such, the waters should be regarded 
with suspicion and the question of their use be decided from a 
consideration of the probable source of the impurity : if this be a 
cess-pool or a privy, the waters should be condemned. 
Herbert E. Smith. Typhoid or Enteric Fever at Southampton, L. I. 
15 
One of these waters, No. 1, Lake Agawam, was analyzed in 
1885 and pronounced pure. 
Dr. G. V. Poore, in an address on the shortcomings of some 
modern sanitary methods, writes : “ The principal aim of sanitari- 
ans has ever been, and will ever be, the securing for the masses of 
the people the two chief necessities of life—pure air to breathe, 
pure water to drink. Whether or not we are able to secure these 
two necessaries depends very largely upon the method which we 
adopt for the treatment of putrescible refuse. 
“ It has been the wise custom in all ages of the world to dispose 
of putrescible matter by burial in the earth. Dead bodies in all 
ages have been buried, and the greatest of all law givers and 
sanitarians, Moses, gave most explicit directions that excremental 
matter should be treated in the same way. The latest advances of 
modern science seem to show that in this particular Moses was 
absolutely in the right. 
“The farmer may feel certain that if he buries his organic 
manure directly it is produced, it will not be wasted. It will not 
give off ammonia to the air, nor will the juices be washed away by 
rain to the same extent as when it is left above ground to be a 
nuisance. There seems to be no doubt whatever that all heaps of 
manorial matter which give off ammonia and other gases to poison 
the air, and perhaps do more serious mischief which we know not 
of, are allowing valuable matter to escape, which ought to be 
undergoing oxidation in the earth. There can be no doubt what, 
ever, that to the agriculturist stench means waste ; and it is to be 
hoped that when the bucolic mind has imbibed this great and 
important truth, the country will be more evenly pleasant than it is. 
Most of the shortcomings of modern sanitary methods are due 
to the fact that in our dealing with organic refuse we commit a 
scientific error—i. e., we pursue a course which is in opposition to 
natural law. When organic refuse is mixed with water, it under- 
goes changes which differ widely from the changes which it under- 
goes when mixed with earth. The most favorable amount is 
about 33 per cent., and if the moisture rise above or sink below 
this amount, the process of nitrification and the formation of car- 
bonic acid is hindered. 
“ In the treatment of putrescible refuse, so that it shall not be a 
danger nor an annoyance, what we have to aim at is nitrification 
rather than putrefaction, and it is certain that by mixing with 
water putrefaction is encouraged and nitrification delayed. It 16 
Remarks on the Recent Outbreak of 
seems to be almost incontestible that the proper course to pursue 
with regard to organic refuse—putrescible matter—is the very reverse 
of that which we do pursue. We clearly ought to encourage oxi- 
dation and make putrefaction impossible. 
“ Putrefaction is certainly a great cause of ill-health. It is the 
putrefaction of organic refuse mixed with water in cess-pools and 
sewers that causes that long list of ailments which we ascribe to 
the inhalation of sewer air. The opinion is held by many that the 
dejecta of typhoid patients and cholera patients do not become 
dangerous to others until putrefaction has set in, and such an acute 
observer as the late Dr. Murchison held the opinion that common 
putrescible changes taking place in dejecta were a sufficient cause 
of typhoid, independently of the admixture of any specific poison. 
The putrefaction of organic refuse, when mixed with water, has, I 
think, been the chief cause of the development of modern sanitary 
* progress.’ Our forefathers were not given to this method of 
treating putrescible matter. House slops trickled along open gut. 
ters, and excremental matters were deposited in dry pits. 
“ Only the other day I visited a lone farm-house which a friend 
wished to take for the summer, and I found that the proprietor, 
having taking the soil pipe of a recently erected water closet into 
a cess-pool alongside a deep well sunk in the chalk, had rendered 
his house unlettable to any thinking person.”—Lancet, July 23, 
1887. 
If these analyses and the foregoing facts indicate that the sur- 
face or subsoil water of Southampton has become contaminated to 
such a degree as to render its use unsafe for drinking and domestic 
purposes, then the water supply which is, as has been stated, the 
chief or only marked cause of ill-health, must be protected in 
every possible way ; otherwise, when the town becomes large the 
following remarks of the Editor of the Lancet in reference to 
Margate, which recently suffered from typhoid fever, will apply to 
Southampton. 
“Nothing but the abolition of cess-pools, the provision of a 
proper system of drainage and of a safe water supply, will make 
Margate fit to be regarded as a first-class health resort.” July 23, 
1887. 
Fortunately these expensive improvements, which will inevita- 
bly come, are not now essential. They cannot be provided and for 
years the present methods of drainage and disposal of waste must 
suffice. Typhoid or Entric Fever at Southampton, L. I. 
17 
The flatness of Southampton, which is an obstacle to every form 
of drainage, renders the use of Waring’s excellent system almost in- 
applicable from the fact that the terminal distributing pipes, if 
provided with the necessary fall, would lie not near the surface 
where oxidation readily takes place, but far below in sand instead 
of earth and in dangerous proximity to the water supply. 
It also makes it impossible to provide drains over fifty feet in 
length with sufficient fall to the cess-pools to prevent the occurrence 
of stagnation and leakage. 
Possibly pure water might be obtained by using driven wells 
passing through the surface water to a deeper source, but then 
safety would not be attained (as is shown by the Dudlow Lane 
well); and what is worse this would be only dodging the sanitary 
evils instead of removing them. All the water might be boiled 
and in this way safety would be attained, but this is only another 
method of shirking a plain duty. Dr. Geo. M. Sternberg writes : 
“ We may then safely say that the thermal death point of the 
typhoid bacillus is 50 degrees C., or 132.8 degrees F.” 
Evidently wisdom lies in striving to remove all sources of the 
water contamination. 
Therefore in closing I would make the following suggestions : 
(1.) Decomposing manure heaps should be protected from the 
rain by simple roofs or else be stored in dry pits, thereby saving 
valuable fertilizing material and preventing soakage into the sur- 
face water. 
(2.) When old-fashioned privies are used they should be kept 
dry and oderless by the use of earth frequently renewed. 
(3.) If waste water is allowed to empty on the ground near the 
house the point of exit should be frequently changed to prevent 
saturation of the soil. 
(4.) All cess-pools without bottoms of cement, and so-called 
cess-pools, mere holes in the ground with a few large stones thrown 
in, should be abandoned. All leaky cess-pools and drains should 
be made water-tight as shown by the smoke test. There is a 
current belief in the village, said to founded on observation, 
that the contents of many cess-pools rise and fall with the tides, 
implying the existence of leaky cess-pools. 
(5.) If the contents are to be emptied as at present on the 
ground between the houses, the cess-pool should be used for waste 
water and fluid excrement only and emptied as often as once 
a week and always in a fresh spot. “Oxidation, in 18 
Remarks on Typhoid or Enteric Tever. 
other words the beneficial cleansing power of earth, does 
not continue for an indefinite period. Soil is liable to 
be in time overdone with filth, and is then unable to carry on 
this purifying action, so that animal matters pass through it un- 
changed. Its particles require rest and free exposure to the air, 
before it recovers its expended powers. Earth becomes relieved of 
the products of this dressing with filth by means of vegetation, 
which greedily incorporates them into its substance.”—Fox. p. 50. 
Other excremental matter should be deposited in dry earth in 
boxes or pails and removed daily. 
(6.) If the cess pool is used for all excremental matter, a bad 
practice, the contents should be carried far away and never 
emptied on the ground near the cottages and wells. 
(7.) For the reception and proper treatment of every form of 
waste requiring removal a sewage farm should be provided at a 
distance. 
Finally this outbreak of typhoid fever emphatically teaches 
that the only safe disposal of all organic matter is burial near the 
surface, where purification by chemical action rapidly takes 
place.