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of the bacterial content. The quantity of chlorine was increased from day to day on the basis of an examination for free chlorine, and the samples taken on the twenty-second of September gave the first satisfactory bacterial analysis.
Watervliet's death rate from typhoid fever has been consistently high as shown by the following table. The upstate rates for the corresponding years are given for comparison.
The above rates are prima facie evidence of a polluted water supply. As a matter of fact, the disease is endemic in Watervliet and almost every year rises at some time or other to epidemic proportions. The death rate is in reality much higher as a considerable number of the severe cases are taken to hospitals in Troy or Albany for treatment. The records of the registrar of vital statistics at Troy show that since 1913 the following number of deaths from typhoid have occurred in Troy among residents of Watervliet:
1914, 4; 1915, 2; 1916, 2.
Prior to 1913, the certificates of death failed to show the usual residence of decedents and one can but surmise the actual loss of life from typhoid among residents of this community. Even this does not tell the entire story, for many residents of Troy, Albany and smaller places in the vicinity work in Watervliet and contract typhoid there.
The unusually high death rate of 1913, was due to a flood of the Hudson river which inundated a large part of the city lying east of the Erie canal and infected the wells lying in that locality. This flood also probably contributed to an increase in the infection in the general water supply itself.
Although the death rates above given are quite high and would be higher if the typhoid deaths attributable to Watervliet but occurring elsewhere were added, it is probable that even this “corrected” rate would be less than the truth, through failure to accurately diagnose atypical cases of the disease. Seemingly but few of the physicians of the city used a Widal reaction for the purpose of identifying their continued fevers and most of these failed to send more than one specimen of blood to the laboratory for this purpose. Instances were encountered of cases diagnosed as malaria, grippe, gastric ulcer, etc., which were in the imme diate families of cases of typhoid and recounted histories indicating that a Widal would have been of extreme interest.
The preliminary investigation by Doctor Duryee above referred to excluded milk and any common food product and the explosive character of the outbreak eliminated flies, contact, et cetera, from consideration except as minor sources.
Although few cases of typhoid were reported during early September from the northern and southern parts of the city - the latter known as Port Schuyler - in the latter part of the month there was a considerable increase in cases occurring in the district north of Nineteenth street and as far west as Fourth avenue. The public wells were blamed in the minds of a number of people for this increased incidence but it did not seem reasonable to believe that such a considerable number of wells could be simultaneously infected with typhoid organisms. It appeared much more plausible on the face of things to attribute this increase of infection to the city water supply.
In all one hundred and sixty-nine discovered cases were investigated, not including several cases reported from Troy as having received their infection in Watervliet. An analysis of the data collected by personal visits of representatives of the State Department of Health very clearly showed:
1 The presence of some unusual condition in the neighborhood of Thirteenth street, Second and Third avenues.
2 That milk, food, flies and contact were not responsible for the outbreak.
3 That but three explanations for the outbreak could be considered as solving the problem, namely:
(a) That the city water supply was the sole source of infection, and for some reason connected with the flow of water through the mains in the Second avenue and Thirteenth street district received a larger portion of the highly polluted Hudson supply than other parts of the city.
(b) That the three wells at Second avenue and Thirteenth street, Third avenue and Thirteenth street, and Third avenue and Fourteenth street had each been simultaneously infected with typhoid organisms.
(c) That one of these wells, probably that at Second avenue and Thirteenth street, had become suddenly infected and was responsible for the appearance of the large number of cases in this neighborhood, and that there had been superimposed upon this a general infection of the city water supply.
A study of the water supply system at first lent some color to the first possibility as cases were then occurring in the northern part of the city and seemingly followed a large main running along Broadway. The city map also showed a large main running off Broadway up Thirteenth street. Subsequently it was found that the map was inaccurate and that the actual size of the main on Thirteenth street was four inches smaller than that shown in the drawing
As to the second possibility, it was not impossible that a sudden storm, taxing the sewers to their capacity, should cause an excessive leakage in the sewers and result in a sudden large infection of the wells at Third avenue and Thirteenth street, and Third avenue and Fourteenth street, and that through some fissure this infection reached the well at Second avenue and Thirteenth street almost at the same time.
However, the third possibility seemed the most likely and reinvestigation of some of the early cases whose record cards stated they had obtained water only from the Third avenue and Thirteenth streeet and the Third avenue and Fourteenth street wells, verified the suspicion that the information was incomplete. As a matter of fact the Third avenue and Fourteenth street and the Third avenue and Thirteenth street wells were both out of commission at different periods during the latter part of July and through the month of August, and the latter was permanently