Epidemic Intestinal Diseases 
in Albany and Vicinity. 
JOSEPH D. CRAIG, A.M., M.D., 
ALBANY, N. Y,, 
Lecturer on and Demonstrator of Anatomy 
in the Albany Medical College. 
Semi-Annual Address delivered before the 
Medical Society of the County of 
Albany, May 12, 1891. 
Reprinted from The Albany Medical Annals, May, 1891. Epidemic Intestinal Diseases 
in Albany and Vicinity. 
BY 
JOSEPH D. CRAIG; A.M., M.D., 
ALBANY, N. Y„ 
Lecturer on and Demonstrator of Anatomy in the Albany Medical College. 
Semi-Annual Address delivered before the Medical Society 
of the County of Albany, May 12th, 1891. 
ALBANY, N. Y.; 
Taylor & Roberts, Printers. 
1891. EPIDEMIC INTESTINAL DISEASES IN ALBANY 
AND VICINITY.* 
BY JOSEPH D. CRAIG, A.M., M.D., 
ALBANY, N. Y. 
Lecturer on and Demonstrator of Anatomy in the Albany Medical College. 
Mr. President: 
I desire to offer in this address, in fulfillment of my obligation 
as vice-president of this society, the results of a collective investiga- 
tion into the causes of epidemic intestinal diseases, which have 
prevailed in Albany and vicinity during the months of December, 
1890, and January, February and March, 1891. In response to a cir- 
cular letter (see appendices Nos. I and 2) sent by me to known mem- 
bers of the medical profession in the counties of Albany, Rensselaer, 
Schenectady, Columbia, Greene, Schoharie, Saratoga, Herkimer, 
Fulton and Montgomery and to others living in the counties of 
Clinton, Essex, St. Lawrence, Erie, Onondaga, Oneida, Otsego and 
Washington, one hundred and eight replies were received. 
From the information contained in these replies and from 
information obtained by means of personal investigation and inquiry 
from other sources the conclusions formulated in this address have 
been derived. It was also my purpose to tabulate the answers 
returned, but owing to the difficulty in deciding upon a convenient and 
simple basis of classification this has been found to be impracticable. 
A number of facts, concerning like epidemic diseases occuring in 
England, which pointed very strongly to contaminated water as an 
efficient cause, have been excluded from consideration. Investiga- 
tions in other places contributing to the support of other theories 
of causes have also been excluded as foreign to the purposes of 
this paper. It has not been my object to study either abstract 
propositions or general theories of causes, but the more simple 
*Semi-annual Address delivered before the Medical Society of the County of Albany, May 12,1891. 4 
purpose, of considering only those facts which gave indications of 
the sources of disease in the epidemic just past, has alone engaged 
my attention. 
I have sought for an expression of professional opinion and have 
endeavored to make what seem to me to be reasonable inferences 
therefrom. It is an estimation of probability only, and it is reason- 
ably certain that no method of scientific investigation into a subject 
of the character of the one to which our attention is drawn to-night 
can do more at this present time. At least, I do not know of any 
records which show with the exactness of science the relations of 
cause and effect in any epidemic like unto the one through which 
our people have just passed. Bacteriological studies and chemical 
analyses have contributed many valuable facts to the elucidation of 
the problem of the relation of water to the public health, but have 
failed, so far, to do more than to indicate the probabilities of the 
case. Such studies and analyses do not fall within the limits of this 
paper. Others are working along these lines and in due time will 
make public their results. By any method of investigation then, at 
preset available, we can do no more than estimate probability. As 
the inductive method more often than the scientific one is, from 
necessity, the clinical method and produces valuable and approxi- 
mately correct results, it is practicable for the purposes of this paper. 
It has sometimes seemed to me as if the greater number of the 
profession had committed themselves to some one theory of cause 
of the epidemic just past, whereby they had become partisans and 
biased in their belief and had lost sight of the fact that either the 
severe gastro-intestinal inflammation or the typhoid fever might owe 
their origin in different cases to any one of a number of independent 
or contributing causes. It is, by reason of the multiplicity of these 
independent or contributing causes, acting separately or in combina- 
tion, that this problem has become so complicated and so difficult 
of solution. 
I think it is fair to say, so far as the purposes of this paper are 
concerned, that we have had prevailing in Albany and vicinity 
during the past winter 
i. Typhoid Fever: 
(a) Running a typical course, the proportion of these cases being 
to the whole number less than the average in other epidemics. 
(£) Running an atypical course with one or more of the prominent 
symptoms of the disease absent. These cases comprise the greater 
number. 5 
The case of Miss T. illustrates this type. In this case the fever 
wave of the first week was not typical of typhoid fever. There were 
no petechiae; neither was there gurgling nor tenderness in the right 
iliac fossa. She died between the third and forth week, and at the 
autopsy well-marked ulcerations of the patches of Peyer and enlarge- 
ment of the mesenteric glands were found. 
(^) Of abortive forms, with fairly typical onset and fever wave, 
but quickly receding about the second week. 
2. Malarial Fevers : 
Almost exclusively prevalent in places away from the Mohowk 
and Hudson river centres of population, 
3. Other Fevfrs: 
Not typhoid-probably due to sewer gas poisoning the specific 
cause and course of which are unknown. 
4. La Grippe : 
The abdominal form of which principally concerns us in this 
address. 
5. DlARRHCEAS: 
With or without gastric or hepatic symptoms ; of all grades of 
severity ; owing their origin to well known causes, being 
(a) Irritative-due to improper food, impure water, etc. 
Symptomatic-particularly of typhoid fever, acute enteritis 
and Ih grippe. 
f) Vicarious-from exposure to cold and wet and from sudden 
changes in temperature. 
6. Catarrhal Enteritis : 
With or without gastric symptoms-especially prevalent in 
Schenectady and in other places among people who had contracted 
the disease in Schenectady. 
The type of this variety of enteritis is somewhat different from 
the ordinary form. The disease is more chronic, more angry, more 
severe than usual. I have called it for convenience the Schenectady 
type. In these cases, as a class, there are these peculiarities: 
1. Subnormal temperature. 
2. Resistance to the treatment usually effective in this class of 
cases. 
3. Marked tendency to persist. 
4. Liability to recurrence, and 
5. Perhaps spreading by contagion. 6 
The following cases, briefly reported, will illustrate this type: 
I.-Fred D., of Albany, age eighteen, a strong, healthy young 
man of good habits, went to work for the Edison Company in 
Schenectady on January 12th, 1891. He secured board first on 
Union Street and afterwards on Nott Terrace. Drank copiously of 
the Mohawk river water at both places, but especially drank the 
Mohawk water at the Edison works. This water was always dirty 
and of bad odor, and increased rather than diminished thirst. Had 
more or less diarrhoea until January 21st, when he was suddenly 
attacked with marked and severe gastro-intestinal symptoms, suffered 
great pain, was greatly prostrated and had almost constant vomiting 
and purging. The discharges were thin, mucous, and very offensive. 
Reached home the same day in a state of profound collapse. From 
this date to January 27th, just about a week, it was impossible for 
him to retain even a few drops of water on his stomach. Remedies 
usually effective in these cases were useless with him. The temper- 
ature taken every morning and evening was subnormal during the 
entire time. On two afternoons there appeared to be a slight rise 
in temperature, but of this I am not certain. After the more acute 
symptoms had subsided and he began to get about again, his diar- 
rhoea still persisted and continued for weeks, marked by several 
periods of frequent and painful discharges. The stomach only re- 
sumed its full physiological activity after a period of several weeks. 
This case well illustrates the Schenectady diarrhoeal disease among 
those who drank of the Mohawk river water, irrespective of other 
conditions. 
II.-William D., Albany, age seventeen, also a strong and healthy 
young man, went to work for the Edison Company and drank freely 
of the Mohawk river water. Suffered from profuse, painful, long- 
continued and rebellious diarrhoea, but of less severe character than 
Fred D. in Case I. There was the same marked persistency and 
tendency to recurrence. All symptoms gradually subsided after a 
number of weeks following his return to Albany. 
III.-Ralph S., Albany, age seventeen, another perfectly healthy 
young man, went to work for the Edisons about February 1st, 1891. 
Boarded first on Union street and afterwards on Hulett street. 
Drank well water at Hulett street, none at all at Union street. 
Drank Mohawk river water at the Edisons on the same days on 
which he drank well water in Hulett street. States that the Mohawk 
river water was always dirty, and increased rather than diminished 
thirst. Two days after going to Hulett street was taken sick. Sick- 
ness began with headache followed by profuse and painful diarrhoea 
of very offensive substances. Had rise in temperature with 
accompanying thirst. The next day vomited greenish, bilious ma- 
terial. Acute symptoms rapidly subsided, but diarrhoea persisted 
for some time. With the exception of the rise in temperature the 
other characteristics of the disease were present. 7 
Cases I and II seem to point to the Mohawk river water drank 
by these young men as a cause. Case III is valueless in the esti- 
mation of causes. The Hulett street well was known to be infected, 
as a man living in the same house and drinking well water exclu- 
sively had been sick with typhoid fever for two months, and a wo- 
man also living in the same house, also using this well water, was 
taken sick shortly afterwards. There was no sewer connection in 
these cases. 
IV.-A large number of cases, reported verbally by Dr. Pear- 
son, of Schenectady, whose accuracy as an observer none of us 
will question, all showed the same tendency to persistency, rebel- 
liousness and subnormal temperature, and in one of which the pros- 
tration was so profound that death resulted. 
V.-A case reported at Broadalbin, imported from Schenec- 
tady, kindly furnished by Dr. Finch. "This case," to use the 
doctor's own words, " has been a very severe and protracted form of 
diarrhoea, with attacks of vomiting pnce or twice a week. He has 
had no fever during the attack. He drank the Mohawk river water 
at Schenectady." 
VI.-A case reported at Saratoga Spa.-■" A locomotive engin- 
eer, whose duty kept him between Saratoga and Whitehall, used 
drinking water at various stations. The diarrhoea was severe, also 
had pains in his bowels. Great prostration followed first attack, 
with a tendency to return of bowel trouble if strict attention to diet 
and rest was not adhered to. * * * This patient's wife also had 
a slight attack. No other cases in Saratoga." 
VII.-Dr. Rivenburgh, of Middleburg, reports three cases im- 
ported from Schenectady, " severe in form, with vomiting and 
purging. Cases of local origin, mild." 
VIII.-Cases reported by Dr. Chas. McCullock: 
1st. " J. S. W., employee on Schenectady branch of D. and 
H. C. Co., drank a large quantity of Mohawk river water and in a 
few hours was attacked with diarrhoea, which has persisted until 
February 2Oth, 1891, a period of two weeks." 
2d. " A large number of Italians, similarly affected from the same 
source, mostly acquired in Schenectady. In any event, all drank 
Mohawk water." 
IX.-Cases reported by Dr. J. C. Still: 
Mild cases of diarrhoea occurred in his practice of home origin 
and some imported from Schenectady. Every one of a number of 
young men who went to Schenectady suffered. Cases protracted, 
convalescence slow. 
X.-Four cases reported by Dr. J. F. Wheeler, of Chatham : 
" These cases were imported from Schenectady among young 
men who went to work for the Edisons and drank Mohawk river 8 
water. They recovered rapidly under treatment and change. All 
returned to work again. Three drank distilled water from the 
exhaust and remained well. One drank the old water, relapsed and 
recovered again on returning to Chatham." 
XI.-Dr. R. H. Morey has observed in his cases "great 
weakness and lassitude and the unusual length of time in con- 
valescing." Three or four of his cases were imported from Albany. 
XII.-From Kinderhook the following was obtained: 
(a) " Mrs. Wof Kinderhook, visited Schenectady for two days. 
Came home and was confined to bed with diarrhoea." 
{b} a Mrs. H., from the West, stopped in some of the lower towns 
on the Mohawk, then at Hudson. Had profuse diarrhoea." 
(r) "Nephew of Dr. W. came from the West and stopped at 
Schenectady about the middle of September. Had diarrhoea, which 
persisted as long as he remained in Schenectady. Yielded rapidly 
on coming to Kinderhook." 
XIII.-Dr. Jesse Crounse, of Altamont, sends the informa- 
tion that in his cases the " type of diarrhoeal disease is different 
from the usual." " Several cases imported from Schenectady." 
It has been stated by several that this type of disease is con- 
tagious. The following cases point in that direction. The evidence, 
however, is not very strong. 
I.-Case 6 above. 
II.-Case reported by Dr. Ross Wilson, of Sandy Hill, to 
whom I am especially indebted for his great interest in this investi- 
gation. (Dr. Wilson sent out over two hundred circulars and his 
reply is of great value.) He reports the following facts as bearing 
upon the contagiousness of this diarrhoeal disease: "A son, his wife 
and child visited his mother here. The first three contracted a pain- 
ful diarrhoea in Albany. His mother was prostrated with the same 
disease a few days later." 
HI.-Cases of Dr. Rivenburgh, of Middleburgh: 
I. " Mr. B. contracted diarrhoea while on a visit to Schenectady. 
His whole family suffered." " The cases imported from Schenectady 
were the most marked." 
2. " Mr. O. went to Schenectady to seek employment, returned 
with diarrhoea and gave it to his wife, but of milder form." 
3. " Mr. A. contracted diarrhoea in Middleburg and his family 
escaped." 
In other words, cases that came from Schenectady were followed 
by other cases in the families of those affected. Cases of local 
origin did not spread beyond the persons originally attacked. 
There is one other fact which seems to bear out the theory of a 
specific contagious principle as the cause of this diarrhoea. When- 
ever the cases were treated with antiseptics, particularly bichloride 9 
of mercury, then there was the most rapid recovery. This was 
noticed by several observers. 
In considering the expressions of opinion contained in the re- 
plies, it is convenient to group the returns under the following 
heads: 
i. Direct contagion. 
2. Atmospheric influence. 
3. Drainage and sewer gas. 
4. River and other waters. 
I.-Direct Contagion. 
The question of the contagiousness of the Schenectady type of 
the diarrhcel disease has already been considered. The following 
has reference to the contagiousness of typhoid fever. 
If the replies received are at all an indication of professional 
opinion, it is certain that the great majority of physicians either do 
not believe in the propagation of typhoid fever by direct contagion 
or treat such a means of communication with great suspicion. Of 
the one hundred and eight physicians who replied, forty expressed 
an opinion. Of these, twenty-seven do not believe in direct conta- 
gion as a cause of typhoid fever, while two were doubtful. Eleven 
considered direct contagion as an occasional cause, but in as much 
as three of these were from Schenectady, a city which is now 
well known to be in an extremely unsanitary condition, some allow- 
ance must be made for the accuracy of the observation. From per- 
fectly reliable observers, however, information comes that some 
cases have been so traced. In one of these cases the patient had 
nursed a typhoid fever patient and was herself attacked with the 
disease. Causes other than direct contagion were excluded. It is 
very probable that in occasional instances typhoid fever may be thus 
acquired. A very few of the cases in the epidemic under considera- 
tion may be so accounted for, but direct contagion has not entered 
in any large degree as a causative factor. 
II.-Atmospheric Influence. 
The replies to the question of the influence of atmospheric con- 
ditions as a cause, do not furnish us much of interest or importance. 
Forty-nine expressed the results of their observation. Of these, 
eleven did not trace any connection between the atmospheric condi- 
tions and their cases, while two regarded such conditions as the 
sole cause. Two others regarded the atmosphere as loaded with 10 
miasma and believed such a condition to be the cause. The 
remainder, thirty-four in number, were fairly united in the belief 
that sudden changes in temperature, particularly from extreme cold 
to warmer weather, with falling barometer and much dampness or 
rain, were immediately followed, not only by an unfavorable course 
in those already affected, but also by a marked increase in the 
number of new cases. These observations apply to both the 
diarrhoeal disease and typhoid fever. As the action of such changes 
on the course and in the causation of disease is already well known, 
and as nothing especially new or conclusive was obtained on 
this point, it will hardly be profitable to spend more time in its 
consideration. 
III.-Drainage and Sewer Gas. 
The relation of drainage and sewer gas to the prevailing epidemic 
has excited considerable professional interest. Forty-three expressed 
an opinion. Of these, the physicians of twenty-three places in which 
there is surface drainage and the cesspool system, but no sewers, 
state that there was 
Diarrhoea alone in fourteen places. 
Typhoid fever alone in two places. 
• Diarrhoea and typhoid fever in three places. 
Neither diarrhoea nor typhoid fever in four places. 
Of thirteen places in which there were public sewers, there was 
diarrhoea alone in one place. 
Typhoid fever alone in one place. 
Diarrhoea and typhoid fever in seven places. 
Neither diarrhoea nor typhoid fever in four places. 
These figures mean practically nothing, and from them practical 
deductions cannot be made. 
In addition the following facts were obtained : 
i. In Little Falls, where the sewers are new and privies abound, 
there has not been an unusual amount of either typhoid fever or 
diarrhoea. Almost every case of typhoid fever was imported from 
Albany or Schenectady. The drinking water is obtained from 
springs. 
2. One case of typhoid fever is reported from Gloversville as 
caused by an untrapped sewer emptying into a creek. 
3. One case of typhoid fever out of seven in Greenwich was due 
to a country drain. 
4. Dr. Willard, of Catskill, reports " one case of typhoid fever in 
a family in which a broken sewer was found under the house." 11 
5. Dr. Nellis reports two cases of typhoid fever as due to sewer 
gas. 
6. Dr. Burton, of Troy, "has found that whenever the streets of 
that city are torn up to relay broken sewers, along the line of such 
sewers much typhoid fever always prevails." 
7. Dr. Hennessey reports two cases in which defective drains 
were apparently the cause, while on the other hand he also reports 
five cases in houses in which there were no sewer connections at all. 
From this information it is reasonable to infer that some of the 
cases, at least in the epidemic we are considering, were due, directly 
or indirectly, to sewer gas. I do not know that attention has ever been 
drawn to one strong argument against the theory of sewer gas as a 
prime factor in the causation of the epidemic. It has been abund- 
antly substantiated that wherever there is a broken drain or improp- 
erly trapped or ventilated, or in any way defective system of plumb- 
ing, there there will be found a vitiated and poisonous atmosphere. 
Any human being inhaling such contaminated air will suffer in greater 
or lesser degree from its debilitating influence, and a proportion of 
these will be in such a non-resistant condition as to readily acquire 
any of the specific diseases, from whatever source derived, when 
brought within the range of their influence. I believe, in view of the 
strong evidence which follows, pointing to the drinking water as the 
great causative factor, that this is the best explanation of the fact 
that in so many houses in which typhoid fever has been found, the 
inspectors of our board of health have discovered incompetent 
drainage systems. 
IV.-Water. 
The facts obtained in relation to water supply are of vastly more 
importance. There were fifty-nine returns in all, which can be fairly 
classified as follows: 
i. Wherever spring or lake water was used exclusively (ten 
places in all), irrespective of sewerage system or drainage and irre- 
spective of atmospheric conditions of the most diverse kinds, in 
every one of such places there was neither diarrhoeal disease nor 
typhoid fever. 
2. Wherever the water supply was derived from wells, there there 
was found either diarrhoea or typhoid fever or both. 
3. Wherever river water was used from head waters, or only 
slightly contaminated as shown by chemical tests, there there was 
neither diarrhoea nor typhoid fever. 12 
4. Wherever there were centres of population placed near 
together, using river water contaminated largely with sewage from 
places above, there there was both diarrhoea and typhoid fever. 
Three other factors in the water problem were also developed 
from this investigation. 
ist. That rivers, and particularly wells, filled with the water that 
had been washed from the surface after abundant rain, the soil being so 
thoroughly frozen as to prevent absorption, were most active agents 
in causing an irritative diarrhoea. This diarrhoea was of the ordinary 
character and was not of that severe, chronic and rebellious nature 
which distinguished the Schenectady type. The water contami- 
nated with the decomposing animal matter of barnyards and fertilized 
and manured farm lands, was a more active agent than water polluted 
simply with the products of vegetable decomposition. Diarrhoeas 
thus caused made their appearance in January, immediately after the 
warm weather and heavy rains of that time. Through December 
the weather was continuously cold enough to prevent thaws. The 
Schenectady type of diarrhoea began about the first of December and 
continued until about the middle of March, and did not seem to be 
influenced in any marked degree by any atmospheric changes. 
2d. That the statement that rivers, filled to overflowing after 
heavy rains and great thaws, contain the germs of disease diluted in 
a great degree, is found to be fallacious. These rivers do not con- 
tain large volumes of water with a proportionately less number of 
germs, but as shown in ist, above, are filled with large volumns of 
water, polluted with a proportionately larger number of germs, 
washed from the soil. 
3d. That rivers contaminated with sewage and covered with ice, 
were more dangerous as sources of water supply, through insufficient 
aeration of the contained water, than when open. Among men 
engaged as boatmen during the summer and as ice cutters during 
the winter, and drinking river water at all seasons, it was distinctly 
observed that such men were free from diarrhoeal disease in the 
summer, but were largely affected in the winter. 
Imported Cases. 
One other important factor deserves careful but brief considera- 
tion before gathering together the facts obtained from the returned 
circulars. In very many of the places reporting cases of severe 
diarrhoea and typhoid, there were none, or few, of home origin, but 
all, or nearly all had been imported from other places. The cases 13 
of diarrhoea of home origin were of ordinary and mild type. The 
cases of diarrhoea from Schenectady, Albany, Cohoes and West 
Troy were of that severe and angry form which characterized the 
Schenectady type. Thirty-six physicians reported such cases. The 
figures are decidedly suggestive. There were imported from 
I. Albany, seventeen cases, with two others reporting some 
(number not stated). 
2. Schenectady, .forty-four cases, with seven others reporting 
some (number not stated). 
3. West Troy, three cases. 
4. Cohoes, three cases. 
5. Hudson, one case. 
In addition, cases were reported 
1. Among railroad men using water at Albany, Schenectady or 
Cohoes. 
2. Among broom makers, using river water at Schenectady. 
3. Among men engaged in ice cutting on the Hudson river in 
the neighborhood of the Abbey and Van Wie's point, both places 
being situated on the Hudson river just below Albany. Three 
physicians in three different places observed such cases. These 
men drank Hudson river water. At least forty per cent of the men 
cutting ice and drinking the river water at Van Wie's point had 
either typhoid fever or severe diarrhoea. The greater number had 
diarrhoea of the Schenectady type. 
From all other places only nine cases were reported as imported. 
At least one hundred cases, of which sixty-seven are actually known 
and the rest conservatively estimated, were from Schenectady, 
Albany, West Troy or Cohoes. Considering the entire number of 
returns, this is a very large number, and there is something very 
suggestive in these figures. 
The Fountain and Origin of the Epidemic. 
It has been suggested that Schenectady was the fountain and 
origin of the epidemic under consideration, and that the pollution 
of the waters of the Mohawk river, by the sewage of that city, act- 
ing with other contributory causes, was the source of the epidemic 
diseases prevalent in Cohoes, West Troy and Albany during the past 
winter. There are very many facts which point to the truth of this 
suggestion. 
Along the Mohawk river, Rome, Utica, Little Falls, Fonda and 
Amsterdam now use spring water almost exclusively as a source of 14 
public supply, except the city of Rome, which derives its supply 
from the head waters of the Mohawk, where pollution is not likely. 
In all these places there has not been even the usual amount of 
diarrhoea and typhoid fever. At Utica, Little Falls and Amster- 
dam the sewage empties into the Mohawk river. At Rome and 
Fonda the drainage is the surface and cess-pool system. Sewer gas 
and defective drainage has certainly not caused either of the prevail- 
ing epidemic diseases in these places. 
From Amsterdam, the city next above Schenectady, there could 
have been no pollution, as there have been but few cases of the 
epidemic diseases which have afflicted the lower cities. Moreover 
a flow of seventeen miles would be amply sufficient to purify the 
waters of the very slight sewage contamination through aeration, 
oxidation and precipitation. In fact, chemical analysis of the 
Mohawk river water, just above the city of Schenectady, has shown 
that it is comparatively free from chlorides and albumenoid am- 
monia. 
In this connection, an instructive lesson is taught by the history 
of the water supply of the city of Amsterdam, kindly furnished 
me by Dr. Charles Stover. The sewerage has not been of the 
best until recently. The surface water has collected in places, owing 
to the inequalities of the roads and inefficient grades, and the sewers 
have been broken and incompetent. There are also some cess- 
pools. In spite, however, of the sewage system, the waves of con- 
tagious disease, particularly typhoid fever, have risen and fallen 
with the changes in the water supply. During the use of water 
derived from the old water system, there were only a small number 
of cases of typhoid fever ; but there were some. The water so sup- 
plied was derived from a water-shed, and flowed along a natural 
creek, through pasture and farm lands. This water was analysed by 
Dr. Tucker and found to be polluted by animal matter, though not 
to a great extent. This water was not very pleasing to the eye, but, 
during its use, only a moderate amount of fever prevailed. In 1890, 
the reservoirs failed and the water commission shut off the' supply 
from that source. Old wells, known to be contaminated, were now 
resorted to, when there was an immediate and alarming increase in 
the number of cases of typhoid fever, amounting to an epidemic. 
Soon after water from a new source became available, and its intro- 
duction was followed by a steady and marked decrease in the num- 
ber of new cases until this fever became infrequent and, practically, 
disappeared. This new source is from springs supplied by the 15 
gravity system, in addition to which there is also a supply from a 
lake near Ballston Spa. This is a fairly conclusive history of typhoid 
fever due to contaminated water, the sewage system remaining 
practically the same during the entire time. 
The Mohawk river towns, as far as Schenectady, were thus found 
to be free from the epidemic diseases we are considering. The 
Hudson river towns from the north, as far as West Troy, now 
demand attention. 
Sandy Hill, Fort Edward, Lansingburgh, Waterford, Green 
Island and Troy have been free from the prevailing epidemic dis- 
eases. 
Fort Edward and Sandy Hill are supplied with water from 
springs. In both places the drainage is by means of the surface 
system. In neither has there been unusual diarrhoea or typhoid, 
except four cases which were imported to Sandy Hill and one to 
Fort Edward. 
Green Island (which is subject to the same atmospheric con- 
ditions as West Troy, lies contiguous to it, and is drained by the 
surface and cess-pool system) has also been free from prevailing 
diseases. This town derives its water from a basin on an island in 
the Hudson, after percolation, which practically excludes contamina- 
tion. 
Waterford and Lansingburgh, just above the city of Troy, have 
been also free from epidemic typhoid fever and diarrhoea. 
The sanitary condition of the city of Troy is well known and 
needs only suggesting in this place. The water supply is from the 
Hudson, immediately above the state dam. The sewers are of all 
conditions and kinds, while the house drainage is of the many 
degrees of perfection or imperfection found in modern American 
cities. The atmospheric conditions are, practically, the same as 
those existing in West Troy, directly across the river, and in Albany, 
six miles below. The Hudson, with overflowing banks, has fur- 
nished, part of the time at least, the same mechanical conditions for 
the forcing of sewer gas into the houses as found at Albany. Yet, 
with the exception of imported cases, there has been, practically, 
neither diarrhoeal disease nor typhoid fever in that city. 
The chain of cities and towns beginning at Schenectady and 
ending at Catskill present a suggestive history. 
The city of Schenectady, in which endemic typhoid fever has 
prevailed for years, takes its water supply from 'the Mohawk river, 
immediately below the entrance of a tributary creek known as the 16 
Beinekill, the intake being situated just in front of the upper end of 
the city. This source of supply is used by only a portion of the 
inhabitants. A very large number of houses having no connection 
with the water mains are still supplied by the old wells, which are 
fearfully contaminated with sewage, and are in near relation to the 
privies. The soil surrounding these old wells is thoroughly satur- 
ated with decomposing animal waste. 
The systems of drainage are four in number: 
i. The " Memphis " system of sewers running through all the 
principal streets, and discharging their contents into the Mohawk, 
below the water-works intake. Only part of the houses, however, 
along the line of these sewers, drain into them. The system is 
flushed automatically at intervals during the day, and, as far as it is 
utilized, contributes largely to the public health. All evidence seems 
to point to the completeness and thoroughness of part of the sys- 
tem. Part of the system, however, unfortunately is incomplete, 
owing to irregularities in the grades theteby allowing the sewage to 
accumulate in places. In other places the sewers are reported to be 
broken. Houses draining into these sewers are relatively free from 
typhoid fever, though not from diarrhoea. 
2. The cess-pool and surface systems, largely used in portions of 
the city, a source of pollution of the wells, and, together with the 
old privies, a constant menace to public health. 
3. The sewage system of the Edison and Westinghouse compan- 
ies, which is common to the two works, is complete and thorough in 
itself, but discharges its sewage into Beinekill creek, above described 
as a tributary of the Mohawk, at a distance of half a mile above the 
intake of the Schenectady water-works. This sewer, together with 
Cow Horn Creek, presently to be described, is a direct and abso- 
lutely certain source of contamination of the Schenectady drinking 
water. It appears to me to be morally certain that it is just here 
that the source of the epidemic of last winter is to be found. 
It is only just and fair to say that the Edison Company is entirely 
free from responsibility for directly or indirectly contributing to the 
large amount of sickness among its employees. Through the kind- 
ness of Mr. Kreusi, superintendant of the works, I was permitted to 
inspect all the buildings of the company, and to study their sewage 
system. Of the thirty-six buildings, comprising the works at that 
time, only four have any relation to the drainage system. All their 
closets, except in the four buildings just mentioned, are outside the 
main buildings, and there are no sewer pipes running through or under 17 
any of them. These closets are trapped and ventilated, and flushed 
at regular intervals. The four buildings in which closets were 
found were those used by their female employees. Each of these 
closets is flushed automatically whenever used, and their waste pipes 
are trapped and ventilated. The sickness among their employees 
seemed proportionally large, but, when it is remembered that from 
a third to a half of the working population of Schenectady are em- 
ployed in these works, it is evident that the relative sickness was 
not larger among them than among Schenectady people of the same 
class employed in other places. Early in the epidemic, the Edisons, 
from necessity, supplied the same water to their employees as that 
supplied to the people of the city generally. This water was from 
the city water supply, drawn from the Mohawk, was dirty, of bad 
odor, positively contaminated with sewage, and was the certain cause 
of the severe diarrhoeal disease among their men. Now, these men 
are supplied with clear and comparatively pure water, from a system 
of driven wells. The Edison Company has done its full duty to 
its men and to the public, and should be free from all responsibility. 
4. The fourth system of sewage is the most dangerous of all. 
Running through the centre of the city, starting from the cemetery 
at Nott Terrace, in the western portion, is Cow Horn creek, which 
empties itself finally into the Beinekill, at a distance of only a quar- 
ter of a mile above the water-works' intake. Its course is winding; 
it is not covered in any way ; and into it flows the sewage of perhaps 
a twelfth of all the houses in Schenectady ; its water is contaminated 
and foul, shown to be charged with chlorides and albumenoid ammo- 
nia by chemical tests, and finds its way along the quarter-mile flow 
into the Mohawk almost directly above the Schenectady water- 
works' intake. It needs neither bacteriology nor chemistry here to 
prove a certain contamination. 
It is not possible for me to lay all the evidence before you within 
the limits of this paper. But whoever goes over the ground with ordi- 
nary care will, I think, find the statement of Dr. Duryee, of Schenec- 
tady, to be true ; that the Mohawk river water, polluted as above 
described, has been the cause of most of the diarrhoeas, while the old 
wells have been the cause of most of the typhoid fever. It is not 
to the discredit of Schenectady to make these statements now, as its 
people are actively seeking reform in sanitary affairs. 
Out of 85 cases of typhoid fever in Schnectady, in 84 well water 
was used. Among the Edison employees, who drank the river water, 
diarrhoeas were almost universal, irrespective of other conditions. 18 
Among five cases of the Edison employees who left Schenectady 
suffering from profuse diarrhoeas and who recovered, four, on return- 
ing to work, drank only water from the exhaust and remained well; 
while the fifth, who also returned, but drank of the Mohawk water 
again, was again afflicted with severe diarrhoea. This is fairly conclu- 
sive evidence. It has been also reported that in some of the houses 
having the most approved system of drainage, but using river water, 
many cases of diarrhoea occurred. Most of the cases of typhoid 
occurred in houses with no sewer or water connections and in which 
well water was used. 
As a still further proof of the firm conviction among all those 
who speak honestly upon the subject after a careful investigation, 
the following extract from the report of the water commissioners 
on the new or Van Slyke island supply is offered. 
" In view of the experience of the past few years, it would seem 
to be a work of supererogation to set forth the necessity of a change 
in the city's water supply. 
Whether it is considered as a muddy liquid, unfit for drinking, 
washing or culinary purposes, filling up the mains and service pipes 
with sediment and lessening their capacity, or whether it is con- 
sidered in its sometimes tolerably clear and far more dangerous 
condition, contaminated to a greater or less degree by the sewage 
which is emptied into the Frog Alley river*-a constant menace to 
health, an injury to the prosperity of the city through the impres- 
sion which has gone abroad and is steadily gaining ground of the 
unhealthfulness of the city (and which impression will not be 
removed by mere denial) from whatever point of view it is regarded, 
the necessity of a radical and immediate change is generally con- 
ceded." 
Diarrhoeal disease and typhoid fever became epidemic in Schenec- 
tady about the first of December, and numerous cases appeared in 
Cohoes, West Troy and Albany a week or two later. It would 
seem probable from this sequence of time, together with the other 
evidence, that the river water, contaminated at Schenectady, reached 
the lower centres of population, and after the usual period of incuba- 
tion made itself felt. 
The sanitary condition of Cohoes, so far as it relates to the subject 
under consideration, is briefly told as follows: The water supply 
of Cohoes is obtained from the Mohawk river in the neighborhood of 
Crescent, two miles above the city, and is furnished to the public 
through two resevoirs, known respectively as Nos. I and 3. The water 
from reservoir No. I was examined by Dr. Tucker on February 26, 
* Frog Alley river is another name for Cow Horn creek, before described. 19 
1891, and found to be contaminated. The water from reservoir No. 
3 was also examined by the same analyst at the same time and 
found to be in such condition as to be positively unfit for use. As 
frequently happens when water is stored in reservoirs, in addition to 
any primary contamination, secondary pollutions from vegetable 
growths in the reservoirs themselves may occur. This happened in 
reservoir No. 3 in Cohoes. In addition to the original contamination 
of the Mohawk river water, still greater pollution occurred after this 
water had remained fora little time only in this reservoir. Clinically, 
also, it was observed that the portion of the city supplied from 
reservoir No. 3 was much more numerously affected with prevailing 
epidemic diseases than the portion supplied from reservoir No. 1. 
The sewers of the city of Cohoes are ventilated and empty 
into the Mohawk below the falls. Their mouths are exposed, 
except at high water. Some of the houses in which cases of fever and 
diarrhoea occurred have no sewer connections. Others are known to 
be well plumbed, trapped and ventilated. Of fifty-eight patients 
reported by Dr. Featherstonhaugh, fifty-seven drank unboiled water 
and the other drank boiled water. These cases following are of inter- 
est : (1) " Mr. J., of Cohoes, uses boiled water. There are three young 
people in his house.- One of these goes to school at Albany, drinks 
the water and promptly has typhoid. The others escape." (2) " At 
Northside, a suburb of Waterford, where there have been no cases 
of home origin, two imported cases occurred there, one, a boy, goes to 
school in Albany, and the other a school teacher, lives in Waterford 
but teaches in Cohoes. Both drink river water. Both have fever, 
their families escaping." Dr. Featherstonhaugh, who communicated 
the above facts, kindly furnished them during a very busy season 
and states that he could give more examples if he had the time. 
The facts from West Troy bearing upon this matter are few in 
number, but most decidedly to the point. West Troy has a double 
water supply-the Hudson above Troy, and the Mohawk at Duns- 
back Ferry. After the first fifty cases of typhoid fever had been 
reported, the Board of Health ordered the Mohawk river water to 
be shut off; within thirty days the disease almost entirely disap- 
peared. The superintendent of the water-works, at the end of that 
time, surreptitiously turned the Mohawk water on again. There fol- 
lowed a prompt and wide-spread reappearance of the disease. Ninety- 
five per cent, of all cases in West Troy, as reported by Dr. Van 
Vranken, used river water, and occurred irrespective of drainage of 
any kind. There are some sewers in West Troy, some cesspools, 20 
and some surface drainage; the sewers empty into the Hudson. 
The factors of the problem in Albany are well known, so far as 
local conditions are concerned. Albany has two sources of water 
supply-one from the Hudson, furnishing river water to all that por- 
tion of the city west of North Pearl street, and a second supply 
from Tivoli lake, the water flowing into which is collected through 
Patroon's creek. Arising from springs, Patroon creek is aug- 
mented as it flows through farm lands, by a water-shed. Almost 
all the cases of typhoid fever in Albany were found in the 
section of the city, west of Pearl street, using river water. The sec- 
tion east of Pearl street, using the Tivoli lake supply, was compara- 
tively free from the disease. Out of 406 cases of typhoid and 
symptomatic fevers occurring during this epidemic, as reported by 
the health officer of Albany, 334 used unboiled and unfiltered river 
water, while 72 used either boiled or filtered water. About eighty 
per cent, of the cases used unboiled or unfiltered river water. Of 
the returns from Albany, all but three expressed themselves as 
believing the river water to be the chief cause. Of the three who 
expressed themselves otherwise, one said he had no opinion on the 
subject; one said water is positively not the cause; and one said, 
frankly, he "didn't know." Two other statements were made in this 
connection, " St. Agnes' school, where plumbing and drainage is per- 
fect, and where the water has been boiled with great care (so that 
both the drinking water and sewer gas can be excluded as a cause), 
there were a very great many cases of diarrhoea, but there has not 
been a single case of typhoid fever. On the other hand, in the 
Albany Orphan Asylum, where the water was not boiled, there has 
been neither diarrhoea nor a single case of typhoid." 
The diseases under consideration did not appear in epidemic 
form in Hudson, Coxsackie or Catskill. These places are all situ- 
ated on the Hudson river. There is a flow of about twenty miles 
between Albany and Hudson. Catskill is still further down the 
river. In Coxsackie river water is not used generally for drinking 
purposes. 
At Hudson, river and well water are used as a source of supply. 
Drainage is good into sewers emptying into the Hudson river. There 
were diarrhoeas, beginning after the January thaw, but scarcely a 
case of typhoid fever. 
At Coxsackie, where cistern and well waters are used, there was 
neither unusual diarrhoea nor typhoid fever, except among the ice 
cutters drinking river water. 21 
At Catskill river water is mostly used, with some cistern and 
well water. Drainage is by means of public sewers in part, and in 
part by means of the surface system. There have been many diar- 
rhoeas following sudden changes in temperature, but no typhoid 
fever. 
From the foregoing statements of facts, together with other 
facts, for the presentation of which there has not been time in this 
paper, all largely contributed through the kindness of the profession, 
I am led to the following conclusions. Excluding from considera- 
tion the abdominal type of la grippe and the diarrhoeas caused by 
bad food and sudden changes in temperature, I believe the epidemic 
diseases prevalent during the past winter to have been due- 
ist. To the following contributing causes: 
(«) An ice-bound condition of the Mohawk and Hudson rivers, 
whereby contaminated water was not sufficiently aerated, and the 
destruction of such contamination by oxidation was prevented. 
Additional contamination occurring after thaws and rains, 
the earth being frozen and preventing absorption, and the surface 
accumulations of decomposing animal and vegetable materials being 
washed directly into rivers and wells. 
(r) Non-acclimated persons drinking for the first time water to 
which they had not been accustomed. 
(aO Polluted milk supply.-I am informed that a number of cases 
of typhoid Jever, in Albany, occurred among people using milk 
obtained from the same milkman. 
(^) Sewer gas acting as a debilitating agent, and, in occassional 
instances, as a direct cause. 
2d. And to the following as a chief cause : 
(«) Typhoid fever and diarrhoeas endemic in Schenectady, 
caused by the use of either the polluted city water or private wells, 
or both. 
(^) The water of the Mohawk contaminated by the city sewers 
of Schenectady, polluting the water supply of the city of Cohoes at 
the intake at Crescent above the Cohoes falls. 
(r) The water of the Mohawk again contaminated by the city 
sewers of Cohoes below the falls and polluting the drinking water of 
both West Troy and Albany. 
If I had any bias at all at the beginning of this investigation, it 
was in favor of the river water as a proper and healthful source of 
public supply. It is to me at least a most convincing argument 
that the above conclusions were forced upon me by the powerful 
logic of the facts obtained. 22 
I thank you, gentlemen, for your interest in and attention to this 
somewhat lengthy address. My thanks are also due to my pro- 
fessional colleagues, whose responses made this address possible, and 
to personal friends in Schenectady, Cohoes and Albany, who gen- 
erously supplied me with valuable information. 23 
Appendix I. 
No. 12 Ten Broeck Street, 
Albany, N. Y., February 16, 1891. 
Dear DOCTOR-There have been prevalent in Albany and vicin- 
ity, since the first of January last, many cases of severe irritative 
diarrhoea and catarrhal enteritis with or without gastric symptoms. 
The same intestinal disturbance has been called, in some places, 
" Winter cholera." This form of disease has become so frequent as 
to amount almost to an epidemic, and, as a consequence, there has 
arisen great public and professional interest in the subject. At the 
same time typhoid fever and an anomalous variety of fever, accom- 
panied by irregular chills, neuralgia, and gastric and intestinal 
symptoms, have become epidemic in this section of the state. 
It has become a matter of importance, both to the public and the 
profession, to ascertain, if possible, the causes which have produced 
such diseases. 
I have, therefore, volunteered to make a collective investigation 
of the subject and invite an expression of opinion from the profes- 
sion in this section of the state. Full information is particularly 
desired from places using potable water derived from other sources 
than the Hudson and Mohawk rivers. The opinions expressed will 
be properly tabulated and presented at an early date in a paper to 
the profession in Albany. A copy will be furnished you, if you 
desire. 
Your cooperation is desired, and the favor of an early reply to 
the questions in the enclosed blank earnestly requested. 
Very truly yours, 
JOSEPH D. CRAIG. 
Appendix II. 
COLLECTIVE INVESTIGATION AS TO THE CAUSES OF EPIDEMIC 
INTESTINAL DISEASE IN ALBANY AND VICINITY. 
A-1.-Do diarrhoeal diseases prevail in your practice to an unusual 
extent ? 
2.-What is the source of the drinking water in these cases ? 
River, well or other water? 
3.-What unfavorable atmospheric conditions have these dis- 
eases followed ? 
4.-Were any of the cases contracted in other places ? If so, 
where ? 24 
5.-What kind of drainage system have the houses in which 
these cases occurred, and into what does it empty ? 
6.-What is your opinion as to the cause of such diseases, 
particularly in reference to- 
(a) Drinking water? 
Atmospheric influences? 
(r) Other causes ? 
B-I.-Have you had, to an unusual extent, in your practice- 
(a) Typhoid fever? 
(£) Anomalous or other fevers? 
2.-If so, what cause did you assign? 
(a) Drinking water? 
(^) Importation from other places ? 
(c) Direct contagion ? 
(^) Local sources of infection, as privies, cess-pools, sewers, 
etc. ? 
3.-Is there any known relation in your cases, or do you suspect 
any relation to exist between drinking water and drain- 
age system ? 
C-Can you remember a previous epidemic of like intestinal disease, 
where like atmospherical conditions prevailed? If so, 
will you give particulars? 
D-Will you kindly report any case where the relation of cause to 
the disease has been POSITIVELY ascertained ? 
E-Remarks: 
From