NATIONAL LIBRARY OF MEDICINE Bethesda, Maryland KAXITAPiY SCIENCE AS APPLIED TO THE Public Health OF SIOTTSZ P^.LLS, by =5. .A.. 33E,OTXTiT. 2x£- 3D. 1'IW.IPHKD BY THK nUMBOLDT CUB. SIOUX FALL?, I). T. leader Print, Kioux Falls, Dak. MUSEUM ofHYCi^t,! J Rec'd JUL 13 J885j_ I The .'>!;•< ng paper was first read as an ossay before the Humboldt Club of this city on the evening of the 27th of April, 1885. The club deeming the pap^r a very timely as well as able one on a matter of general public concern, passed a resolution, in accordance with which a committee was appointed to attend to its publication. Acting under that resolution, the committee has issued the paper in pamphlet form, and hopes that it will secure the attention to which the subject and the carefulness of treatment entitle it. Sioux Falls, May 15, 1885. W. J. Skillman, E. G. Smith, FI. T. Root, Committee. SANITARY SCIENCE As Applied to the Public Health of Sioux Falls, By S. A. BROWN, M. D. Mr. President:—Sanitary science lias been defined by Dr. Mapothersas "An application of the laws of physiology and pathology to the maintenance of the life and health of communities, by means of those agencies which are in common and constant use." This department of science has of late years received so strong an impulse that many suppose it to be a new invention, but hisbry tells us that ant lently the health of the general population was often the subject of i«_■ yi-•! ttion. Among tne Jews the preserva- tion of the physical well being of the nation was, of old, a part of tho religion; and nowhere can we find a better sanitary code than that of the Bible. The Greeks were unite alive to the necessity of sani- tary legislation; and the ruiiiB of Roman sewers are still a wonder. In the Roman Empire a medical council was appointed in each town, whose duty it was to attend to the public health. As Christianity spread in Ivirope, however, if came, by some misconception of doctrine, to be believed tli.t ai1 diseases were sent by God as a scouige, either to punish the wicked or to purify the good—and that any scientific effort to prevent disease was directed cuti-vly in opposition to the will of God. While the good monks and iriars devoted themselves to feeding the hungry, clothing the naked, and instituting hospitals, they entertained no idea of the possible prevention of disease. They never at- tempted t... impress upon their followers the importance of drainage, ventilation, pure and abundant water, etc.; but when an epidemic arose it was supposed to be a man- ifestation of God's special anger; and it would have been (3) impossible to make them understand that it was the natural .esultof prolonged disregard of the lavs of nature. Tiiere can be no doubt that the frequency and fatality of epidemics, in the middle ages, were in a great measure. due to unhealthy habitations. The houses were usually closely packed in crowded streets, and were often built for purposes of defence at a sacrifice of ventilation, drain- age, lighting, etc. Hiey builded high their ramparts, they made strong their battlements, their gates were bravely guarded against the human foe, but grim visaged Pestilence stalked boldly through those narrow streets, and laid low a hundred victims where one was destroyed by the hostile army. Their onlv hope in those days was to live in the open country, ft might be in hovels, but these wen- built so open that the wind played freely through them, their excretions were scattered upon the earth like that of beasts and birds, and the earth absorbed and purified them; their water was from a spring; but when they crowded into cities and towns they illustrated clearly how men poison themselves and each other. Dr. Farr has given an account of the death rate in England and Wales twenty years ago, and he has found that it is in direct proportion to the density of the popula- tion. Where the number of inhabitants per square mile was: 166 the annual death rate per 1000 was - IV 18H " " - - 19 379 " " " - 22 1 178 " " " - - L'o 4,409 " " " - 2S 12,:t57 " " " - - 32 nvi.S2:; " " " - 39 The nearer people live to each other the shorter is the average duration of life. Where the average proximity of residents is: j-/ 147 yards, the mean duration of life is ~f vears. 137 '• " " 45 " " Vi7 " " " 40 " 46 " " " 35 " 2S " " " 32 " 17 " ' " '* 2!> " 7 '• •' " 26 " But sanitary science has demonstrated that by means >>f proper measures vigilantly enforced, the duration of life can be brought up in the most crowded cities to a level with that of the open country. "God made the country," healthy, ".Man made the . town," and he is guilty of a crime if he do not have it also healthy. The first steps in Christian lands, for the improvement of the public health, appear to have been taken-in England (4) during the eighteenth century. Under a proper system of soil drainage ague was eradicated from extensive marshy districts; scurvy was by the use of lime juice -almost blot- ted out of the list of diseases which proved most fatal to sailors; and vaccination, incomparably the greatest dis- covery yet made in this department of science was the crowning achievement of the century. In the last forty years, or so, people in many lands have begun to see the importance of prevention of disease, and have adopted measures directed to that object with the happiest: results. It is shown by statistics that each time the cholera has left its native shores to make incursions into the less con- genial climate of Europe and America, its ravages have been less and less disastrous, and we know that during the last two years it has confined itself, or been confined to the tilthiest cities in Europe and Africa. This is a sig- nificant fact which should teach us to look with intelligent interest upon the advancement of sanitary science where- ever made, and also to watch with jealous scrutiny any and every attempt at encroachment upon our own sanitary condition, and make each of us, as a disciple of progress, an apostle to spread with religious zeal the gospel of clean- liness. To show the benefit of sanitary reform, it is stated in the Quarterly Journal of Science, January hSfiS, that Sandown in the Isle of Wight, which is thoroughly drained and well supplied with pure water, has an annual death rate of 11 per 1,000; while in contrast is taken the village of Child's Hill in the parish of llendon, in which there is no efficient drainage, and where -open cesspools, connect- ed with privies often overflow into the ditches and dis- charge their contents in the river Brent. Here out of a population of 1,000 there were 70 deaths, mainly from ty- phoid fever. 7.H the year lSiio, ihe English government employed Dr. Buchanan to ascertain the amount of benefit to public health, that had been derived from works of sanitary im- provement—especially in drainage and water supply—that had already been completed. From his report which is fraught with much valuable information we learn among other things that typhoid fever has very much diminished with the ample supply <>f good water, the abolition of cess- pools, by draining, etc. J. u Salisbury, Stratford, Crcyden and Merthyr the annual death rate from typhoid has di- minished 75, 07 (13 and 60 per cent, respectively, and in all Ihe towns examined there was great diminution ex- cept where the system was not properly carried out. In the town of Worthing there was increase of the fever, but it was ascertained that on the side of the water tower of that town is a shed containing the engine which perfoims (5) the double duty of distributing the water to the houses, and the sewage to the land. Tu enable this to be effected there are two well- within iifty feet of each oth r, sunk in a porous soil, one for the reception of the sewage, and the other for the drinking water. "No arrangement for the propagationof typhoid" says the doctor "'could have be-'-n more ingeniously devised." He had not of course seen the ingenious arrangement recently made in Sioux Falls. Dr. Buchanan found almost as much diminution in the death rate of consumption, in those localities where the soil had undergone any considerable drying by means c T the drains. "Cholera epidemic," says he "appear to have been rendered practically harmless in the towns examined." "It cannot" says Mr. Simon a high English sanitary authority, "be too distinctly undeis'ood that the person who contracts cholera in this country is ow /orfo demon- strated, with almost absolute certainty, to have been ex- posed 'to excreinental pollution; that what gave him cholera was the contagion of cholera disc hargea from an- otheis' bowels; that, in short, the diffusion of cholera among us depends entirely upon the numberless filthy facilities which are let to exist, especially in our larger towns forthe fouling of earth, and air,and water, and thus, secondarily, for the infection of man with whatever contag- ion may he contained in the miscellaneous outflowing of the population. "Cholera, ravaging here at long intervals," continues the same high authority "is not nature's only retribution for our neglect in such matters as are in question. Ty- phoid fever and much enedemic diarrhoea, {'\i is here called winter cholera) are, as I have often reported incess- ant witnesses to the same deleterious influence: typhoid fever, which annually kills from 15,000 to 20,000 of our pop- ulation, and diarrhoea which kids many thousands beside- . The mere quantity of this wasted life is terrible to contem- plate, and the mode in which the waste is caused, is surely nothing less than shameful. It is to be hoped that a.-edu- cation advances, this sort of thing will come to an en.J: that so much preventable death will not always be accept- ed as a fate; that for a population-to he tint- po'sont ' by its own excrement will some day be deemed ignominious and intolerable." Mr. Simon deals with the death rate alone; au:t to that the proportion of cases ol typhoid to its deaths, and we have a grand annual total of 200,000 persons who lie many weeks upon a bed of suffering, are put to incalculable expense and are unlit for any kind of employment for months. (0) Dr. Do Wolf, commissioner of health of Chicago, in a paper before the Public Health Association. Nov. i^:>, states that tin- town of Pullman, 111., where the ideal of sanitary science has been realized, in every respect except that of situation, the town lying in a low, marshy district almost jn a level with the water of the lake, has an annual death rate of less than seven per 1,000 population—a rate which if kept up would make the average duration of life there three score and ten! The water is brought from five miles awav, and is placed in every house. The sewage is removed to a farm near by, and itself returns (1 per cent, on the cost of the sewage system. Amongst all the diseases to which, we in this region are liable, there is probably none so clearly preventable and so confessedly rrenu (liable, as typhoid fever, and I desire to show how' it is caused 10 the end that,at least in epi- demic foim, it mav be kept from here in future. I will begin with extracts from Dr. Harley's article in Reynold's System of Medicine. "Dr. William Budd most stronglv insists that the essence" of typhoid fever is con- tained in the bowel discharges of the patient. "The occupants of a farm house are attacked with ty- phoid fever, and the only discoverable e use is an over- flowing cesspool from which putrescent rm -ugs sink into,. and saturate the soil in whi'b the well supplying the house j- excavated. •The accumulated or pent up sewage of a town, es- capes ueo the subjacent soil, within and about it, soaking into the wells and defiling the drinking water, and an out- break of tvphoid fever follows. "D-. I.oel, editor of the Medical and Surgical Journal reports the ease of a village where out of :i1s. 157 inhabi- tants were attacked, and he savs that the cause of the dis- ease wjis the entire waut of good fresh water, and the use of cmrupted water. In 1850 a severe outbreak of typhoid fever occurred in Bedford, and there was every reason to believe that it was due to fa-cal matter soaking into the ■•■ells from the numerous cesspools of the town. Simon, report, to privv council 1S6S. Earlv in October. 1817. ty- phoid i'ewar broke out almost simultaneously in thirteen houses in ae. rtain terraee in Clifton. The houses were far apart in the terrace and there was little or no intercourse between their inmates. The inhabitants of these thirteen houses drew their drinking water from a well situated at one end of the terrace. The remaining 2! houses were supplied wit!: water fiom another source and- all escaped. Dr. Win. Budd, Lancet, 1859. Other instances of the direct association of typhoid fe- ver with contaminated well water may be found in the sixth report to tlie privv council in 1863. (7) Dr. Ballard and others have reported several instances in which outbreaks of typhoid fever in London and else- where have been traced to a close coincidence v ith the distribution of milk furnished to a number of famili ^sfrom the same dairies. The contamination of the miik by foul water has been inferred, and the existence of typhoid fe- ver near the inculpated dairies has been shown. British Medical Journal 1870; Lancet, April 1373; August, 1873." F. T. Roberts, M. D., B.'Sc., M R. C. P.: "There is abundant evidence that typhoid fever is infectious. It is most important to understand clearly how the disease is conveyed. There is very little danger from merely coming into the vicinity of typhoid patients. Indeed the' probab- ility is that the malady cannot be transmitted in this wav, and medical men or nurses rarely take it from attending a patient. It is in the bowel disci arges that the poison is chiefly contained, and by their agency the disease is propa- gated. The atmosphere may become impregnated with the emanations from the excreta, either because the latter are thrown into some open space, or because the water closets, privies, sewers, etc., are imperfect, and they may thus find their way into the system. "Water is, however, the great channel by which the poison is conveyed, and numerous epidemics and endem- ics as well as sporadic cases ol' typhoid fever have been traced to some special water supply. The materials may soak through the soil from cesspits, or from being merely thrown upon the ground, and thus obtain access into wells the water of which is used for drinking purposes, or they may find their way into cisterns through waste pipes. Within a recent period it h.is been clearly proved, also, that milk is not uncommonly the vehicle by which the ty- phoid poison reaches the system." Dr. Burdette, of the Sanitary Institute of Great Brit- ain, in his excellent work on Cottage Hospitals, says: "At the village of Tollesbury, in Essex, bad drainage, im- Eure water, and other insanitary evils had existed for years tit the returns show few cases of fever prior to the out- break to which I refer. In autumn 1877 a case of typhoid fever was brought from a neighboring town. What fol- lowed? Several other cases soon appeared in the same block of houses where the first case occurred. It was no- ticeable that the children were the chief sufferers, and a .careful investigation which we made on the spot convinced us that the new cases were caused by.the absence of dis- infectants, and by the careless casting of the stools into an open pit at the back of the cottages. Although a country village the garden space was very limited, and the children were in the habit of playing around the pit and well at the back of the cottages. Stools, for the most part not db.n- • fected, by being cast into the open ash-pit practically con- (8) vet I el typhoid in this instance into an infectious dis- ease. It is the stools which are highly dangerous to healthy persons. No one we believe disputes this fact at the pres- ent day " Prof. Hartshorn of Philadelphia, in an artiele on Wat- er Supply (Our Homes'* says: "At one of the New Jersey watering places, a few years ago, there occurred a number oi cases of typhoid fever. .Ml those attacked w< re resid- ing in houses supplied by driven wells from the ground water. All those who used rain water for drinking es- caped. Of the danger of injury to health from polluted wtiter," says the distinguished writer, "it is hardly peb- ble to sav too much. In one cholera epidemic in London, six: bundled deaths were traced to the use of a single pump. Tvphoid fever has been repeatedly, nay, mam- times known to affect whole families who resorted to a well for a common supply while otheis in the same neigh- borhood using different water were not attacked. Worse yet, perhaps, seems to be the subtlety with which organic poison mav be conveyed by water through milk in dairy- men's supplies. Several times this has happened in Lon- don and elsewhere in England. In one instance, so far-as appeared, the onlv mode of contamination was by the milk pans at tic dairv being washed in water from a stream into whieh. 1 -akage had occurred from a neighboring privy. At another time, several well-to-do families, one of them a physician's, were affected with typhoid fever. It was found out that thev were all supplied with milk by a-com- pany \ ! 'eh furnished milk from several dairies. At last it wab \scertained that cases of fever occurred only in those families to whom had been sent milk from one par- ticular dairy, and a local cause of contamination of its wat- er supply was also traced." 'Streams and rivers,'' proceeds the pr .■lessor, ' furnish the world over to the greater number of mankind then drinking water. They have the advantage of copiousness. facility of access, and movement, which faw-rs agitation with the air. But thev are liable to contamination on ac- count oi Iheir exposure to solid and liquid refuse and waste of ail kinds. Worst for this danger are small shal- low, slow streams, running throuch. or by large towns oi villages. Organic matter constitutes the really serious 1111- purhy of -tt earns and riven*. , Worst of all is excretory material, sewage from human habitations. Since t >e,oois- ou causes of human diseases are very subtle, whether, they consist of 'disease germs' or not, what we know of the morbid transporting power o! water should make us very cautious about using water for drinking or cooking into which drainage or sewage from human habitations can ever enter." , . Dr. Henry B. Baker ot the Michigan Board of Health, has made a valuable report "On the Relation of Typhoid Fever and Low Water in w<;Us," w.iich is based upon statistics laboriously gathered from all parts of the stat>. The facts are graphically laid before the reader in a se-irs- of diagrams: "Exhibiting correspondence in time and place between unusually low water in welis, and the occur- rence of typhoid fever in Michigan during the years 1S78- s2 inclusive." Of 21 towns rtited in the diagrams for isKl, but one shows typhoid fever unaccompanied by low water in the wells. Having clearly established a causal relation between these facts, tbe author proceeds to show how wells that contain but little water are most likely to have it contaminated by sewage from adjacent, 'cesspools and privy vaults, while "the small amount of water contained in the wells renders the poisonous solution all the more con- centrated and dangerous. Many facts are stated to prove that the disease is caused by bad drinking water rather than impure air; and the author believes that the typhoid genu is one that can- not thrive except in solutions of decaying organic matter. It is stated that the town of Muskegon in I SSI was af- flicted with the scourge during every month in the year, and that on investigation it was found that the water sup- ply was derived from a ravine on the banks of which many privies were located. A case was cited by Dr. Baker, wdiere one hundred and seven cases of typhoid fever were traced to a dairy, and it was there found that the outbreak was immediately preceded bv infection of the water, used at the dairy, by typhoid stools. He states that there were reported in Michigan 7,957 deaths, f>om 1867 to 1882 and says: "nearly every one of those s.o.iO lives were sacrificed either through ignorance or culpable neglect; for there is nothing more clearly proved in relation to disease than that typhoid fever is entirely preventable." "On the 4th of February last," says the British Medi- cal Journal, of May 3, 1870," ''representations were made to the local government board that a sudden outbreak of typhoid fever had occurred at Caterham. The >irxi day Dr. Thorne commenced his inquiry, finding that up to that date forty-Seven cases of the disease had occurred within a fortnight. They were found to be spread over a very wide area, and the houses attacked belonged to no special class, bot-lin'rich and poor having suffered. It was at once appar- ent that the disease could not have heen conveyed to the affected houses bv means of any general system of sewers common to the "district, for by far the majority of the houses were found to drain into separate cesspools excavat- ed into the chalk. There was also no possibility that there could have been any common cause of infection in connec- tion with the prevailing means of excrement disposal, be- (10) cause there was nothing common with regard to such dis- posal. Most of the houses in which the disease appeared were provided with water closets, a considerable number of which were apparently well trapped and ventilated. tHbers hud closets which were fitted with a trap and pan, and emptied into cesspools; and though these closets were at times a source of nuisance, owing to the absence of any iUishing apparatus, yet they were all situated out of doors. Others, again, were provided with common privies, and a few with earth clorets. "The possibility of the infection having been commu- nicated by means of a milk supply was next inquired into and 't v.-as ascertained that thirty-three of the houses af- tec'ed received their milk from at least five different and completely independent dairies, and that at the remaining two private cows were kept. "It was also evident that personal infection could not in any way have led to the outbreak. Further there was no history <•(' any recent prevalence of typhoid fever at Caterh.im. '* was stated that the locality for s .me years had been icniarkably free from the disease, and during the twelve months preceding the outbreak, only one, isolated, imported case could be heard of. "With regard to the water supply, it was ascertained that out of a total of 558 houses in Caterham 419 were pro- vided with water from the mains of the Caterham Wider- works Company, the remaining 139 derived their supply from local wells, or from rain water tanks and barrels. Of the !7 persons attacked from January V.) to February 2, 4~ resided in houses where the water of the Caterham Water- works Company was in use, a circumstance, which, having regard to the other points already ad- ert< 4 to, indicated a likelihood that this water had been die means by which the infection had been conveyed. This view received con- firmation when it was ascertained that the two remaining patients who resided on premises where private wells were in use, had, owing to the nature of their employment, not onlv been in the habit of spending the day at houses to which the company's water was laid on, but had admittedly us<>d this water. Moreover, at the Caterham lunatic asylum with two thousand inmates, and at the Caterham barracks, where five hundred soldiers were quartered, the water supply for hoth of v hich was a deep well belonging to the Metropolitan Asylums board, not a single case had oc- curred or did occur during the whole course of the epi- demic. Whilst these inquiries were going on information was received of a i-iuiilar epidemic at Redhill, which is about eight miles distant from Caterham, and differs from it in several material respects, lying on the lower green sand instead of on the chalk, and being provided with a modern and efficient system of seweis. Here the epideui* (11) ic had commenced at the same time as that at Caterham, and it was found that during the first fortnight qf the out- break, 91 out of 90 persons attacked drew their tfater from the mams of the Caterham company, which also supplied Redhill. Reigate town which forms a part of the sanitary district in which Redhill is situated, but which'has a dif- fer* nt water supply, entirely escaped. And this and oth- er circumstances detailed by Dr. Tborne point clearly enough to the water supplied by the Caterham Company as the source of the mischief. " "This being so the next step was to discover in what way the poison of typhoid fever could have had access to the water. Here Dr. Tborne met at first wjtl£$feine dilfi- julty, until he made mquiry as to any illness amongst the workmen who were engaged in making an adit from one of the two existing wells of the company up to a new bore. which was being sunk about ninety feet distant. It was there found that one of the men had been ailing while at work, and a lengthened examination of him made it ap- parent that, during the time he was engaged in the adit lie was suffering from a mild form of typhoid fever. For the purposes of his argument, Dr. Tborne finds it neces- sary to give in considerable detail the symptoms of this man's illness especially as to his copious diarrhoea; but it will be sufficient for us t ■ say that the man's evacuations passed into the water in the adit, and were thus dis- tributed all over the company's system and that this is* so is amply borne out by the .occurrences which followed. If the stools of this man, who-began to be ill on January 5th and continued at work till the 20th, could by any means have found their way into the water of the well in which he had been working,and being typhoid stools, could have led to the development of the poison of the disease in the well the effect on the water consumers ought to.have been noticed within about ten days to two weeks after the date when the diarrhoea first came on. And this, in effect is' precisely what did take place, the epidemic having com- menced on January 19th and 20th, in Caterham and Redhill respectively. Now, we know, from ample experience that typhoid fever is produced, and that with the maximum of certainty when the specific evacuations of the disease are consumed by a population. Again,it is a ma'ter of ex- perience that where typhoid fever has been conveyed through water, about a fortnight has to elapse between the distribution of the water and the occurrence of the dis- ease in the community served by it. But a fortnight after January 5th is the very day when the first case of fever oc- curred, and during the fortnight following the disease be- came widely spread throughout Caterham and Redhill; the distribution of the fever being limited, as litis been shown t* the houses supplied by the Caterham company. Up to the 20th of February the disease continued to attack ex- clusively those exposed to the water. After ibis it became more diffuse as might have been expected. "The total number of cases was 352 with 21 deaths. That such a total should be the consequence of the act of one. man is, it must be confessed, not a very encouraging subject for thought; but there is some comfort to be got from the fact that the exciting cause was temporary, and unforeseen, ami that every possible remedial measure wj- at once taken." SIOUX FALLS EPIDEMIC. Now, a few words in regard to the epidemic of typhoid fever recently prevalent in Sioux Falls. There had been, to my knowledge only a few cases of typhoid fever in the city during the twelve months before the time to which I refer, and most of them were imported. During the months of November and December, 1884, much com- plaint w:is made of a severe and persistent form of diarrhoea which had settled particularly upon the people in certain hotels. It was so general and so severe as to be- come the subject of constant remark, and to be frequently mentioned in the local papers. The name Winter cholera" was givf.t to it. Daily on the streets :'nd in the I otels we were asked to account for it. i endeavored to clear up its ciuse, and particularly questioned the water supply; but 1 could get no sufficient data of a reliable character upon which to base a conclusion, although all my cases were in persons who habitually or occasionally drank the hydrant water. Many of them said that when- ever they touched the hydrant water it made them ill. On the 18th of December, 1884, a case of typhoid fever occurred in tie* Commercial House, the patient remaining there one week and being removed on Christinas day. This patient's dejections went at once through the sewer into the river, and as we now know were pumped into the water mains regularly. About the first of January, just two weeks from the date of the beginning of this at- tack cases of fever began to be developed in those houses which used the hydrant water. The disease spread rapid- iv. By the end of January we could no longer iYtii to see that it had become epidemic There were cases at many of the hotels, at the jail and elsewhere, but no new cases could be heard of where people drunk only from wells. On the third day of February, growing alarmed at the rap- id spread of the disease, and finding by the method of exclusion that the only agency, capable of spreading the, disease, common to all the cases was the drinking water (13) furnished by the water works, an agency which, as we have seen, has been the usual—nay, almost exclusive me- dium of diffusion of typhoid epidemics that have hitherto keen traced to their origin, the conviction was forced up-e: me that the source of supply of the water works bad o> some way become polluted. F published my conclusions in the daily paper, with the grounds on which I based them, and no one will siy. in view of.the foregoing facts, that 1 could have acted differently. Notwithstanding the magnitude of the interests in- volved, and the efforts made by the superintendent of the water works, not one item of proof was advanced to assail my position. There were physicians in the city who ridiculed the idea, but the} had no rebutting evidence to bring. If they had can anv one believe that the water company would not at once have published it and thus vin- dicated the purity of its'supply? Meanwhile citizens, becoming alive to the importance •of clearing up a charge so terrible, investigated the matter, and men of the highest standing boldly declared that al- though the company had published it in the papers that they derived their supply of watei from a large well in which there was a living spring of pure water, they found i hat no water had been taken out of the well belonging t > the waterworks since w inter began, and thai there ap- peared to be no connect; m between this well and the sys- tem whatever. And finally the superintendent of the water works adjni'.ted in my presence to the .city council that the company was in the constant habit of pumping water into its mains and distributing it for drinking pur- poses to the unsuspecting people of Sioux Falls, from a point in the river on the same side and a few yards below the open mouth of a sewer which drained a hotel where typhoid fever was raging fiercely; thus corroborating my judgment in a manner appalling to contemplate. I have collected an account of the cases in this epi- demic as far as I conveniently could, and the result of my investigation has amply borne out my first conclusion. Out of forty-two cases that have come under my profes- sional observation there is only one in which the patient did not either live, or work, or often visit where the water of the company was habitually used. This is also true of all but nine of the cases, one hundred and twenty-nine in number, about which I have definitely learned." Of the remaining nine, one was the principal of the Baptist col- lege; two were laborers; five were young persons who were in the habit of frequenting the skating rink, and are said often to have gone to the restaurants when warm from skating, and taken refreshments, presumably drinking the hydrant water which was there in use. One case was im- ported. ,14) l'rofess,,] Bartholow, Practice of Medicine, page 730, says "The average delation of the incubation period [the length of time between taking the poison into the system and the development of the disease], of typhoid fever, may be stated at Ibree weeks, although it may be a short as one, and as long as four." Now just two weeks after the day on which the case in the Commercial house, to which 1 have referred, began, the first case to occur in this ephlemic v !ich was seen by me, was attacked at the Mer- chant- hot I hi New Year's day, and just four weeks after the day on which my warning appeared in the daily paper the last new case in .ny practice occurred on the fourth of Mneh. That is, two weeks from the time the poison be- gan to he consumed by the people the fever begin to be developed, and four weeks after the poison cjas«d to be consumed the fever ceased to be developed. In view, then, of the foregoing facts, shall we permit water to be foisted upon us, if it is not entirely above sus- picion? Shall we be content to accept the simple assurance that we are to ha\ e pure water, and again receive it from a point in a mill yond, ii our little, slow, shallow river, just below a host of privies and sowers? Shall we not doggedly insist that only pure and whole- some water can be distrinuted to our population? Shall we not doggedly insi,-t that no water about which there is a shadow of dotibt, shall ho served to the quests of the city at the hotels which entertain them? Shall we not dog- gedly insist thai the works shall be so constructed as to make it impossible for the company ever to get water in- to its mains that could in any way, in the smallest degree, be infected by human excrement? No one can possibly readze, more fully than I, how entirely essential to the perfection of our sanitary condi- tio! i- an efficient water works system, which shall at all t.iees supply us with an abundance ol wholesome water; and if we but do our duty by positively and peisistently demanding water from the host attainable source only. soon the community, the authorities and the company will yield to us, and obtain the best water within reach. 1 need not discuss the question of obtaining^ for do- mestic use, water fnun Ihe Cascade mill pmd. It is fouled by numberless privie^and sewers, and its motion is only just enouuh to carry all polluting material to theuani. If all the sewer- and'privies wcje removed from its banks, there would still be the local ground water from a large portion of the eitv which empties into the mill pond, where there is no"motion to purify it, so that unwhole- some water woold still be the certain result. The water in the liver above the mill pond, where it tlows rapidly and freely might be used in preference to that of the w'-ells in many, part- of the town, and if it were (15 not possible to obtain pure water, then I should certainly advocate this source; but I am sure that \ou will all agree with me when I say that water with a" maximum of purity can assuredly he obtained by sinking lj well art the foot of the ridge which separates the populous portion of the city from CoveH's lake. Bore deeply, excluding the surface water and the local ground wiaer. until you reach a line drawn from the level of the water in the river to that of Covell's lake, and there, or thereabouts you will reach tne general ground water of the region, and will obtain an in- exhaustible supply which is always pure and is uninflu- enced alike by rains and droughts Let there be no com- promise of the right way. Let no interests affect our minds but the interest of Sioux Falls. Her enemies are sick- ness and death, her friends are health and life; pure water gives the one, corrupted watei the other. It has frequently been repeated in the course of this lecture that the great means whereby men poisen them- selves and each other is the excrement. I will therefore proceed, briefly, to outline the dangers from this source which appear to threaten this community, and endeavor to point out the methods by which these dangers may be averted. The mode of excrement disposal, as practiced by it large body of house-holders in this 'own, is to dig a hole in the ground a short distance from the drinking well and the cellar, and place a privy over it. In this hole accumu- lates, from year to year, a putrifying mass of the most poi- sonous kind known of organic matter, and putrescent leadings from thi.i mass saturate the earth of the building lot, earning, besides the poison which is inseparable froin all excrement, all the contagions that may be com.lined in the stools of such persons as may have been suffering from infectious diseases, and thus fouling the drinking well, and also often the cellar, and through it the air in the house. There are many parts of the town, on the hills as well as on the levels, where the local ground water lies so near the surface that whenever there is a rainy season, the earth becomes so water logged, and dropsical that the water in the well rises, until one can dip it out with a cup, and the cellar and privy ate flooded; ano thus the excrement in the privy well is dis solved, and i( soaks into the drinking well and the cellar. The physicians of the city ami the older resiaents can all testify that in these regions tvpho'd fever has been a frequent visitor for years'. In future it must become -more so. Lit no man deceive himself. Even if there were no privy pits on the premises, water in such places would be unwholesome, with them it he- comes a source of much danger: but. if a typhoid stool get into the privy the infection is certain, sooner or later,"to reach a victim through the drinking water. (10) In this city during the p-ast winter, hundreds of per- sons wirh typhoid fever have been pouring out, for weeks, a steady flow of highly inlectious discharges. We cannot hope that all these discharges have been completely disin- fected. The germ of this disease is so prolific in favorable soil, that one typhoid evacuation cast into a privy will speedily infect the whole mass therein contained. There ib every likelihood that a number of these privies will soon infect the adjacent wells, especially if shallow, and thus institute new sources of fever. Let us, then, drink no more water.from wells which may be corrupted by drainage from a privy! Let us no longer be parte s to" the fouling of earth and water with sewage! Let us no longer permit our families daily to visit a spot so vile, so loathsome, so treacherous, so abhorrent to decency, so dangerous to health! Let us rise up united and with one voice condemn the cesspitin every form; and baiush it, from the face of our fair land forever; and make • it a reproach, an offense, a disgrace to use it longer amongst us. What shall we do? We must drain. Wherever the earth is water logged drainage must be instituted, for, be- sides the great danger from excremental poisoning, we have other great dangers caused by wet foundations. Con- sumption, pneumonia, rheumatism and a host of other af- fections thrive on wet foundations. These foundations must be drained. There is scarcely any doubt that the city will adopt and enforce a system of sewers for the more populous portion of the town, at an early day. The neces- sity for it is so obvious that the newspapers have taken it up", and it seems that we now* only wait for definite plans before we begin. Undoubtedly if there is to be no drain- age provided for in the thickly populated portions of Phil- lips avenue and Main street we can expect nothing but sickness. But for those houses which are out of the reach of al! probable sewer connections, we must adopt the system which hitherto has proved to be the best of all, namely 11 i- infection and removal. Rich, arable earth, is for this purpose the best dis- infectant known. To be effectual the earth must be both rich and dry. Next to this in value is sifted ashes. Sand and clay are of little use. Much can be done with chemi- cal disinfectants, but nothing keeps the closet so free from odor as rich dry earth. Two pounds will suffice to deodor- ize one stool. Removal at short intervals should be pro- vided for by the city. The most approved plan, at present followed, seems to be to have a small light box under the seat of the privy, arranged so as to bo readily accessible and easily handled by two men, who empty it into a cart, disiafectand replace it. Persons who do not thoroughly disinfect being subject (17) to fine,and if necessary proceeded against as a nuisance. "Nothing" says Professor Hartshorn, ;'is more effec- tual in annulling the injurious influence of contaminated water than boiling it before using. M^iny a time it has hap- pened that, when bad water produced a local epidemic of typhoid fever, a'i those affected had been drinking the water cold, while those who only took it in the form of tea and coffee have escaped." This was f he ease, for example at Burlington, N. J., in 1875, where as stated by Dr. Le- Conte, thirty cases of typhoid fever occurred within two weeks, from contamination of the drinking res 1 voir by leakage from a privy vault. None of the servants of the house, who drank only tea and coffee, and almost never cold water were attacked, while the boarders, often thirsty drank cold water freely between me..is; and all the cases were among them. I should not have ventured to address you upon a sub- ject of such magnitude as that of sanitary science, were it not that it seems to me that there is an amount of indiffer-' ence in this community to many of its most emphatic pre- cepts, so great, that it canonty be explained by assu uing a want of knowledge of its principles.» I have, therefore, endeavored to place certain facts before you in such com vincing form as to demonstrate clearly the extreme- nece. sity of a wider knowledge of such matters in the commu- nity. And if I have succeeded in only lighting the ;-pai k uhich shall kindle an interest in the subject here 1 am abur. ntly naid. Wi' (IS) Book taken apart, leaves de- acidified with magnesium bi- carbonate. Leaves supported with lens tissue en both sides* New all-rag end paper signatures, unbleached linen hinges* Rebound in quarter linen with all rag paper sides* September 1975. Carolyn Horton A Assoo* MFr» Mk;t 1+30 West 22 Street w j New York, N.Y. 10011