PRACTICAL HYGIENE, 
AS IT RELATES TO 
A PROPER WATER SUPPLY, 
AND 
THE DEFECTIVE SEWAGE OF CITIES AND 
TOWNS, HOSPITALS AND ASYLUMS. 
iby j\ nsr. im:. id., 
Member of the State Medical Society of Wisconsin and Permanent Member of the American 
Medical Association. 
REPRINTED FROM THE CHICAGO MEDICAL JOURNAL AND EXAMINER, 
For August, 1879. 
Chicago : 
Bulletin Printing Co., 113 Madison Street. 
1879. PRACTICAL HYGIENE, 
AS IT RELATES TO 
A PROPER WATER SUPPEY, 
AND 
THE DEFECTIVE SEWAGE OF CITIES AND 
TOWNS, HOSPITALS AND ASYLUMS. 
IB-sr J". ItT. ID e ZEE .A. IE?; T, IMI. ID., 
Member of the State Medical Society of Wisconsin and Permanent Member of the American 
Medical Association. 
REPRINTED FROM THE CHICAGO MEDICAL JOURNAL AND EXAMINER, 
For August, 1879. 
Chicago : 
Bulletin Printing Co., 113 Madison Street. 
1879. PRACTICAL HYGIENE.* 
The importance of the observance of the laws of hygiene, as 
they relate to a proper supply of pure water, and the imperfect 
sewerage of our large cities and towns, hospitals and asylums, is 
only receiving, at the present day, but a small share of the public 
attention which they so urgently demand. 
This paper will allude to some of the impurities that are found 
in water, as revealed by the microscope, and the diseases produced 
by them, together with the bad effects resulting from defective 
sewerage. 
The want of a good supply of pure water for domestic pur- 
poses leads to many bad results, not only in a private residence, 
where the wants of a family are not very great, but also in large 
communities where many persons reside, and in hospitals and 
asylums where many hundred patients are collected together for 
the treatment of diseases. It not only gives rise to impurities of 
all kinds, but the person and clothing are not properly cleansed, 
or are washed repeatedly in the same water; water for cooking 
purposes is used scantily ; houses are not cleansed, streets become 
dirty, and sewers are clogged ; and in these various ways a lack 
of a proper supply of pure water gives rise to impurities in the 
air itself. As a result of the facts just stated, we have an im- 
♦This paper was read before the Wisconsin State Medical Society, at the annual meeting in 
Milwaukee, June 5,1879. 4 
pairment of the health of the population. The deficiency of 
water in the cleansing of sewers causes the development of typhoid 
fever and choleraic diarrhoea, and our records show that epidem- 
ics of the latter have been checked by a heavy rainfall. The 
supply of water is a matter of the most urgent necessity, where 
persons are undergoing great muscular efforts, and it is very im- 
portant and proper that it should be furnished in small quantities 
and quite frequently given. 
It may be true that water containing a small quantity of or- 
ganic matter may be used for a short time with but slight ill 
effects, but its continued use has caused the development and 
spread of diseases in many communities. 
In some of these cases, very little attention has been paid, or 
inquiry made into the state of health of those using the water, 
and that most fallacious of all evidence, a general impression, 
without a careful collection of facts, has often been the only 
ground on which the opinion has been based. 
This much is certain, that as correct investigations are carried 
on, and careful microscopic examinations are made, a continually 
increasing class of cases is found to be connected with the use of 
impure water, and it seems only reasonable to infer that a more 
rigid inquiry will further prove the frequency and importance of 
this mode of origin of some diseases; animal organic matter, 
especially when of fsecal origan, vegetable organic matter, when 
derived from marshes, and some salts are the principal noxious 
ingredients of the dangerous substances; the suspended animal 
matter and especially fiaecal matters, are probably the worst. 
This is shown in outbreaks of diarrhoea and typhoid fever. 
This fact makes the chemical examination of the color and 
turbidity so important. The thoroughly dissolved organic matter 
appears less hurtful. 
Probably, also, the more recent the faecal contaminations, the 
more injurious, since it has been observed, that the most poison- 
ous attacks occur near wells into which, after slow percolation 
for some time, a sudden gush of sewage has taken place. . 
Animal matters forming fatty acids produce salts which though 
not oxidizing into nitrous and nitric acid, are as hurtful as the 
more oxidizable substances. 5 
There have been a variety of opinions expressed in regard to 
the action of minerals in water, which is used for drinking and 
domestic purposes. While there are some mineral substances, 
such as sodium chloride or carbonate, or calcium carbonate, which 
within certain limits appear to do no harm, yet there are other 
mineral substances, such as calcium, and magnesian sulphates 
and chlorides, and calcium nitrate, which are undoubtedly inju- 
rious to many persons; a combination of impurities, and especially 
the co-existence of organic matter and calcium sulphate is hurtful; 
this has been proven by the analysis of water which contains them 
and which has produced disease. As far as at present known, 
the existence of infusoria of various kinds is not injurious, though 
their presence may indicate the existence of an abundance of 
organic impurities. 
That impurities of water do cause diseases by their action upon 
the membranes, with which they come in contact, may be proven 
by an enumeration of some affections of the alimentary mucous 
membranes, viz.: dyspepsia, diarrhoea, dysentery, etc. 
In the first mentioned disease, the use of large and frequent 
doses of magnesian salts, calcium sulphate and chloride in water 
may produce it. 
The latter diseases may be caused by suspended mineral sub- 
stances of clay, mud, etc., as the waters of the Mississippi and 
Missouri rivers,* also the waters of the Ganges and other rivers, 
at certain periods of the year, especially to persons unaccustomed 
to their use. The scales of mica are said to have caused diar- 
rhoea among the inhabitants of Dhumsala, India; also suspended 
animal and faecal matters and vegetable substances have been the 
cause of sudden attacks of diarrhoea. 
The former and latter when washed off the ground by heavy 
rains into streams and rivers which supply cities and towns, have 
caused an epidemic of catarrh of the alimentary canal, as is fre- 
quently observed in this country. 
In the summer of 1876, owing to the very slight rain fall, the 
Croton river which supplies the city of New York with water, 
became so nearly dry that there was great fear that the city would 
* Hammond’s Hygiene. 6 
lack a sufficient supply of water for ordinary use. During the 
following September there was a very heavy rain fall, and the 
vast water sheds which supply this river, were completely 
drenched; the decaying animal and vegetable matters which had 
been exposed to a long drought were carried down to the receiv- 
ing reservoirs, and immediately following this heavy rain-fall, 
there was an outbreak of typhoid and malarial fevers within the 
hospitals of the city, as well as an endemic of diarrhoea and dys- 
entery. 
It is a well established fact that dissolved and putrescent ani- 
mal organic matter, to the amount of 30 to 50 Ctm. per liter, 
may produce diarrhoea. Faecal gases will cause catarrh of the 
alimentary canal, especially if organic matter be also present. 
This was observed during the invasion of Mexico by the French, 
in 1861 and ’62. This army suffered from a peculiar dyspepsia 
and diarrhoea at Orijaba, which was attended with the disengage- 
ment of gas and eructation of food, after meals. This gas was sul- 
phureted hydrogen, and was traced to the use of water from 
sulphurous and alkaline springs. The symptoms of poisoning 
by water contaminated by sewage, are frequently similar to 
those already mentioned, viz., diarrhoea and dysentery, and 
sometimes irritations of the kidneys, liver, spleen and lungs. 
Pinel observed this fact 20 years since in the wards of Salpdtriere, 
and Duchaulet noticed that the water furnished the patients at 
St. Lazare contained a large proportion of sulphate of lime, and 
other . purgatives, which caused frequent attacks of diarrhoea. 
Nitrate of lime has a similar effect. Brackish water will also 
affect the mucous membrane lining the alimentary tract. 
Occasionally animal organic matter acts in an indirect way by 
producing nitrates which act on metals. In illustration of this 
fact, a German physician, who was called to see persons who 
were supposed to have been drinking impure water, and became 
sick, found on examining the water, that it contained a consider- 
able amount of copper. The cylinder of the pump was made of 
copper, and this had combined with some organic matter in the 
water and caused them to be poisoned. 
The effect of drinking impure water is also frequently shown 
in the dysentery which develops among the soldiers who encamp in the vicinity of swamps and marshes. In the late civil war, 
the Union army, while passing through the Chickahominy 
swamps of Virginia, suffered very much from dysentery. The 
water which they drank was mostly surface water. When a well 
was sunk, it seldom exceeded ten or twelve feet in depth, and 
the water always had a brackish taste, and frequently emitted a 
foul odor, especially if it had been allowed to stand in a vessel 
for a few hours. 
The same impurities which produce dysentery are closely 
allied to those which develop diarrhoea. The fact that dysenteric 
stools can propagate disease, render it quite probable that, as in 
the case of typhoid fever and cholera, the accidental passage of 
dysenteric evacuation into wells may have some share in spread- 
ing the disease. 
To the late Dr. Snowr, of England, are we indebted for valu- 
able researches relating to the dissemination of some diseases by 
the use of water for domestic purposes. 
Malarious fevers are very prevalent in the vicinity of marshes. 
It was Hippocrates who first asserted that those persons who 
drink the water of marshes suffer from an enlargement of the 
spleen. Other writers have not only confirmed this fact, but 
•claimed that it generated fevers. 
One very important circumstance is the rapidity of the devel- 
opment of malarious disease, and its fatality when introduced 
by water. We have the same result in the case of diarrhoea 
and dysentery. Either the fever-producing cause must be in 
larger quantity in the water, or what is equally probable, must 
be more readily taken up into the circulation and carried to the 
spleen, than when the same cause enters by way of the lungs. That 
typhoid fever may be developed by the use of impure water, as 
well as impure air, is a theory of quite recent origin; although 
as far back as the middle of the last century, one German phy- 
sician advanced a similar opinion. 
Dr. Flint in his clinical reports on continued fevers in 1852, 
alludes to an outbreak of typhoid fever, which occurred in North 
Boston, Erie county, N. Y., in 1843, and this was attributed to 
the contamination of the water by the contents of a sewer passing 
into it. That water may be the medium of propagating typhoid 8 
fever, has been proven by the evidence of many English physi- 
cians and German authorities, such as Profs. Budd, Jenner, Wil- 
kenson, Barclay, Seaton, Latham, Muller, Richter, Burkhardt 
and Wohlial. 
Profs. Clark, Metcalf, Loomis and others of this country, have 
fully corroborated the views of these distinguished English and 
German physicians. 
One English authority states that in cases where the poison is 
conveyed by water, the infection seems to be much more certain ; 
and he has reason to think that the period of incubation is ma- 
terially shortened. 
The question may sometimes be asked, what is the proportion 
of cases of typhoid fever that are disseminated by the use of 
impure water, as compared with those that are caused by the in- 
halation of impure air? While no positive answer has yet been 
given to this question, yet it has been observed that when the 
dates of attacks are given, the incubation period in those who 
have drunk impure water appears to be very short; while it is 
probable that it takes from eight to ten days after the typhoid 
poison has entered with the air before the early malaise comes- 
on ; yet in some cases of typhoid fever produced by water, only 
two or three days were observed to elapse before the symptoms 
are marked. Will decomposing sewage in water produce typhoid 
fever, or must the evacuations of a typhoid patient pass into it ? 
This is part of the larger and important question relating to. 
the origin and propagation of specific poisons. How often, 
everything is attributed to faecal matters merely, without search- 
ing for other causes, which may be as potent as this, in the- 
development of typhoid. 
A recent number of the Berlin Klinische Wochenschrift con- 
tains an account of five cases in which infected w'ater was the 
undoubted medium of contamination. A miller living on the 
bank of a small stream, was attacked with typhoid fever. His 
excreta were thrown daily into a small pond which was connected 
with the stream by a ditch. This man recovered, but seven weeks 
afterward, his brother, who alone nursed him, became ill with 
symptoms of typhoid. The discharge from the bowels were very 
profuse, and were, as in the other case, thrown also into the pond. 9 
A few days afterwards four laborers, who were employed in a 
forge about one mile distant, were attacked with typhoid, and the 
medical attendant, anxious to discover the source of the mischief, 
found that all of these men obtained their drinking water from 
the stream in question, there being no well accessible. Another 
case also occurred, the patient being a farm laborer, who worked 
in a meadow near the forge, and also drank water from the same 
rivulet. No case of typhoid had occurred in this vicinity for a 
long time previously, and all the circumstances were in favor of 
the supposition that the disease had been transmitted through the 
medium of the water. There was no evidence as to the source of 
infection of the first patient, and the period of incubation was 
extremely long, particularly in the case of the brother. The 
history of this small epidemic tends to support Dr. W. Budd’s 
view, that a specific agent must be present, for the production of 
typhoid fever. No doubt the water in the rivulet alluded to, 
often contained more or less ordinary faecal matter. May we not 
infer from this, that the excreta of typhoid patients should be 
thoroughly disinfected, and when possible, as in country districts, 
should be deeply buried in places far removed from any source of 
water supply ? The London Lancet has quite a full account of an 
outbreak of typhoid fever, in Glasgow, Scotland, and the source 
of infection was traced to the supply of milk from certain dairies ; 
after the death of two prominent citizens, the sanitary officers of 
that city began an investigation which traced the contaminated 
milk supply to two large dairies. Though these circumstances 
were known, it was reserved for another medical officer conclu- 
sively to show that the two dairies in question were fed by a con- 
stant supply of water from an adjoining farm, where typhoid 
patients had lived for several weeks previous ; and that the sani- 
tary arrangements of this farm were very defective ; that the 
excreta of the patients were thrown into a channel into which 
the water ran that supplied the two dairies. 
The water with which the dairy vessels were washed was ob- 
obtained from the same supply. One hundred and sixty-three 
cases of typhoid were developed among the customers of these 
two dairies, and the death rate was about 10 per cent. Of seven 
students at the university who had the fever, three died. Should 10 
not these melancholy facts lead to the proper and periodic 
inspection of town dairies and their country feeders ? It is not 
a very pleasant thought to realize that disease may unwittingly 
be brought to our doorsteps every morning through the single 
medium of the most essential of all nourishing fluids for family 
use! 
In one of our Western asylums, which had been supplied with 
water from an artesian well and several cisterns, the rapid increase 
of the population required a more abundant supply, and an iron 
pipe was laid to connect with an inland lake. This lake was fed 
by a river which received its supply from an extensive marsh. 
The sewage of the asylum, State university and many private 
residences was discharged into this lake. 
The use of the artesian well and cistern waters were discon- 
tinued in the wards of the asylum about May, 1, 1877, and a 
very abundant supply of water was obtained from the lake. 
No malarial nor typhoid fevers had developed in the wards of 
the asylum, while the artesian and cistern waters were in use. 
About one month after the lake water was introduced, a case 
of well marked typhoid was developed in one of the male wards. 
The patient died on the morning of the 21st day from the attack, 
having had a haemorrhage from the bowels in the evening of the 
19th day. 
Other cases of intermittent, remittent, typho-malarial and 
typhoid fever continued to develop during the summer and fall, 
and also during the winter months. The fever appeared both in 
male and female wards, and patients and employes were alike 
attacked by them. 
Some cases of typhoid were accompanied with severe gastric 
symptoms, which seemed to baffle all remedies. In one case, 
that of an the gastric symptoms were very severe, and 
for about ten days both medicine and nourishment were rejected. 
There was also a persistent diarrhoea, with marked tympanitis. 
Subsultus was present, and during the third week there was a wild 
delirium. A haemorrhagic discharge from the bowels occurred in 
the evening of the 19th day, which had been preceded by a severe 
-chill. He died on the morning of the 21st day. 
In many cases of intermittent and remittent, as well as typho- 11 
malarial fevers, the patients had epistaxis and pharyngitis. All 
the cases of typhoid had a diarrhoea, and those of the male patients 
who had haemorrhagic discharges from the bowels, died. Petechia 
was present in all cases of typhoid. From June, 1877, till June, 
1878, there were in the male wards 30 cases of intermittent, 11 
cases of remittent; 4 cases of typho-malarial; 12 cases of ty- 
phoid. Total, 57. Population of male wards about 188. 
Two patients died of typhoid, and all the others recovered. 
In the female wards, there were about the same number of 
cases, but a slight increase of deaths. From June, 1878, until 
August, 1878, there were fifty cases. Six of these were well- 
marked cases of typhoid, and two of them died. At first it was 
thought that this endemic of malarial fevers was due to th 
marsh, which approached to within one mile of the asylum, at the 
point where the river emptied into the lake, but the continuance 
of the fever during the winter months, and its rapid devel- 
opment in the spring, naturally led to a microscopic and chemical 
examination of the water of the lake. From the large quantity 
of sewage matter that was being daily discharged into the lake 
from the asylum (and this was impregnated with the fever poison 
from the excreta of the patients), and the several sewers of the 
city of Madison, it was not surprising to find organic matter in 
the water. The sewer from the asylum discharged its contents 
into the lake about 900 feet from the end of the water pipe. 
The water examined with the microscope was drawn from the 
tanks at 6| a. m., and after the water cocks had been open half 
an hour. It was pumped into the tanks at 5 a. m. The follow- 
ing, infusoria, animalcules, protozoa, rhizopods, rotifers, vibriones, 
and many microscopic forms of vegetable life, together with 
organic matter, were found in great abundance. 
Animalcules. — Tricoda Lynceus, 4; Vorticella Nebulefera, 5; Zo- 
ospores, 2. Protozoa.—Actinophrys Sal, 8; Amoeba, 15; Rhizopoda.—Cu- 
cella Acuminata, 10. Entomostraca.—Daphnia Pulex, 13. Rotifera.— 
Rotifera Vulgaris, 16. Vibriones.—Vibriones, 14; Oscillaria Lawes, 7. 
Tubular prolongation of pigment cells, 21. 
Microscopic Forms of Vegetable Life. 
Desmidiacea.—Pediastrum Granulatum, 1; Fungi, 12; Puccianii Gram- 
mi, 18. Diatomacea.—Surrilla Constricta, 6; Surrilla Striatula, 11; 12 
Mastoglia Smithii, 9; Cocconema Lanceolatum, 3. Organic matter, 20, 
Decaying vegetable matter, 17. Yolvex Globiator, 19. 
Infusoria or infusory animalcules are found almost universally 
in infusions of organic matter. 
Vegetable matter, portions of woody fiber, small bits of roots 
and parenchyma were found. Some of the vegetable tissue was 
more or less decomposed, and dark, opaque, structureless masses 
were seen. Sewage matters, having a darkish brown or reddish 
color, and very frequently seen in globular masses, and thus dis- 
tinguishable from the flattened vegetable matter were found in 
considerable quantity. Nitric acid applied to the sediment 
ncreased the redness of the deposit of organic matter. This is 
Hassel’s test for organic matter, who first recognized these little 
ocherous masses, and thought them to be muscular fiber tinged 
with bile. 
Vibriones or microzyomes are the terms applied to small points 
or jointed rods, which frequently move with great rapidity, and 
then become quiet or motionless. Some make a distinction 
between them, while others consider the terms as synonymous. 
Their presence indicates the existence of an organic, carbonaceous 
substance, a nitrogenous substance and a phosphate. Bacteria 
is a term also applied to the above. This latter may originally 
exist in the water or be introduced. Burden-Sanderson claims 
that they cannot be introduced from the air, and that they are 
sometimes so small as not to be detected by the highest micro- 
scopic powers, or by the test of Tyndall with the electric beam. 
While it has not been conclusively shown that bacteria or 
vibriones are in themselves hurtful (although some observers 
think they are), yet their presence indicate the co-existence of 
certain organic substances and putrefaction, and the latter is 
always dangerous. 
Rhizopoda and amoeba may indicate, like bacteria, the exist- 
ence of putrefying substances. 
The mere presence of diatoms should not condemn water as 
being impure on account of their presence. Entomostraca 
(water flea) are quite abundant in the spring, and being found in 
so many waters, are not regarded as dangerous. 
The rotifera (wheel animalcules) are frequently found, and although not considered as dangerous, yet their existence indi- 
cates an impurity of the water. The great number of micro- 
scopic objects found in water have led observers to look first for 
mineral substances, and ascertain by chemical tests their origin 
and quantity; then to examine the water, by aid of the micro- 
scope, for bacteria, fungi, amoeba and ova, and small worms and 
leeches. These latter indicate an impurity of the water, which 
makes it dangerous for drinking or culinary purposes. 
The various forms or kinds of infusoria, diatoms and algae 
are important in connection with microscopic evidence of decay- 
ing vegetable matters, and with chemical tests showing much 
dissolved organic impurity in water. Rl i' i A _ _ 1 11 1 WE are glad to receive contributions from 
iNOTICR TO I .OniTInl ITOPS every one who knows anything of interest 
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