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disabled by a break in the pump on the twenty-first of August. It was the custom of the neighborhood to resort at such times to the Second avenue and Thirteenth street well for their water as this was a never failing source of supply and the water was cold and deemed of an excellent flavor.

A study of the chronology of the cases indicates that the permanent breaking down of the Third avenue and Thirteenth street pump, leading to the excessive use of the Second avenue and Thirteenth street well, was the immediate cause of the large number of typhoid cases which developed in the succeeding three weeks. The extraordinary drain upon the Second avenue well undoubtedly brought water to it from an unusual distance and with unusual rapidity. In consequence there was greater opportunity for pollution and for the survival of typhoid organisms, thus enhancing the infectivity of this source of supply. In a number of instances the relationship between the change of water supply and the onset of illness was remarked by the people themselves. One woman in commenting on the breakdown of the Third avenue and Thirteenth street pump said: That is what started all the trouble.”

About two weeks after the investigation started, a case of admitted but unreported typhoid was discovered in the house in front of which the Second avenue and Thirteenth street well is located. It was learned that a previous case of probable typhoid with onset on August 1 had occurred in this patient's sister. This sister's case was diagnosed as malaria (without a blood examination) and the stools were not disinfected but were thrown into a privy on the back of the lot about one hundred feet distant from the well itself. There is a pronounced slope to the yard of this house down hill to the well and the soil of this region is a loose shale permitting of rapid percolation through fissures from considerable distances. It is highly probable that this was the source of the infection of the well. The woman with the original case apparently received her infection through bathing in the polluted water of the Hudson.

It is not believed that the Third avenue and Thirteenth street and the Third avenue and Fourteenth street wells were infected, although, an analysis of the latter showed undoubted pollution and both are unquestionably exposed to it. The few cases which

CASES IN 13TH STREET DISTRICT. 2nd Ave. and 13th Street Well Water Users. Secondary Cases Not Included. By Dates of Onset.

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CASES IN ENTIRE CITY. By Dates of Onset.

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27

30 WULY

29

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15 17 AUGUST

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obtained their water from these supplies only, can be accounted for on the basis of the general infection of the city water supply, the failure to remember an occasional glass of water taken from the Second and Thirteenth street source, or an unwillingness on the part of some to admit their having drunk from that supply.

The record of the cases shows that of the 35 discovered cases having their onsets in the month of August, 22 primary cases were users of the Second avenue and Thirteenth street well. Two other cases were also users of this water but their ongets occurred a week or more after the beginning of the primary case. The remaining eleven cases were scattered over the entire city but principally in the region north of Nineteenth street.

The 169 discovered cases which were investigated (residents of Watervliet only) derived their water supply either solely or in part from the general water supply, from bottled water, or from one or more of 26 wells, six of which were located on private property. Of these the ones most frequently used were: The Second avenue and Thirteenth street well, as stated above; the Third avenue and Thirteenth street well; Third avenue and Fourteenth street; Fourth avenue and Twenty-fourth street; Sixth avenue and Nineteenth street; Twenty-second street and Broadway; city water and bottled water.

An analysis of the combinations in which these waters were used shows that 69 gave a clear history of having drunk water from the Second avenue and Thirteenth street well, while of four others there was greater or less doubt on this point. This is the largest single source from which the water supply of cases was obtained, and it was stated to be the sole water supply in 21 instances, outranking by nearly three to one its nearest competitor in this respect, bottled water.

The Third avenue and Thirteenth street well could practically be ruled out as it was used in conjunction with the Second avenue and Thirteenth street well in 26 admitted instanges, one doubtful, and with the city water supply and Second avenue and Thirteenth street well in two instances, and was the sole source of supply in but one instance. It was admittedly used by thirtyone of the cases, one doubtful, leaving three cases in which it was not used in conjunction with a pretty well established source of infection.

The Third avenue and Fourteenth street well was used admittedly by 27 cases, one doubtful. In 19 of these cases it was used in conjunction with the Second avenue and Thirteenth street supply, and in two instances with the city water supply, leaving six instances in which it was not used with one of the established sources of infection. Even these cases were not confirmed owing to inability to find a responsible person at home. From other cases it is probable that this number would be reduced through failure to ascertain that the Second avenue and Thirteenth street well water was used. The Third avenue and Fourteenth street water was said to be the only source of supply in three instances; a manifest error when it was generally agreed amongst the users of the well that it was dry at different times during the summer.

The Twenty-fourth street and Fourth avenue well was used by 21 of the cases, one doubtful,— the latter probably a contact case,— but in only one instance was it the sole source of supply. This well is located in the foreign district of the city and was used 16 times certainly, one doubtfully, in conjunction with the city water. It is very doubtful if the question were thoroughly understood in many instances, and one may be permitted to doubt the veracity of some of the informants. The analysis of this water showed it to be of fairly good sanitary quality although evidently it had been subject to past pollution, judging from the high chlorine content.

The Sixth avenue and Nineteenth street well was used by eight of the cases, four times admittedly in conjunction with the city water. As this water was very largely used by the residents of this district, the occurrence of but four cases among them who had not admittedly drunk from the infected river water would indicate that it was not a source of infection.

The Twenty-second street and Broadway well was used by 16 cases, seven of whom admitted drinking the city water. Five of them stated that this was their sole source of supply. This is a larger number relative to the probable number of persons using the well than is found in the case of most of the other sources of supply. However, since it was stated in five instances to be the only source of supply and three of those making this

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