the reservoir, a very few hours might suffice for the transfer of typhoid bacilli from a human intestine in Ludlow to one in Chicopee Falls.

A single case will serve to illustrate the way in which the river was infected. A boy operative named Caissy, who lived in one of the company's tenements in Jenksville, was taken with severe. diarrhoea during the last of January, 1892. During the course of one day he was sometimes obliged to visit the mill water-closet (which leads directly to the river) four or five times, yet he kept at work for a week or more. The first week in February, however, he was obliged to take to his bed. The illness was of long duration and, as I was informed by the attending physician, was undoubtedly typhoid fever. The symptoms were typical, and included delirium and rose-red spots. It was not necessary to inquire as minutely into the details of every case which occurred during the period under consideration. Enough was learned to show that several operatives having typhoid fever had infected the river in a similar way between October, 1891, and April, 1892. Moreover, this infection was decidedly more extensive than anything which could be discovered in previous years, and was, I believe, sufficient in time, intensity and duration to account for the mild epidemic in Chicopee Falls in the spring of 1892.

The pollution of the river took place about seven miles above Chicopee Falls. (See plate above.) No other near infection of the river by typhoid germs is known to have occurred during these months. There is, however, a possibility that such an infection may have taken place, and at a point much nearer the intake than anything yet mentioned. Until after my visit there were in Chicopee Falls itself, between one-half and three-fourths of a mile above the intake of the water works and on the same side of the river, several privies which either directly overhung the Chicopee River or had vaults of such shape that a hard rain might wash a part of the contents into the river. The position of these privies is approximately indicated upon the plate given above, on East Main Street, nearly opposite Linden Street. Until the recent epidemic, no cases of typhoid fever have occurred in these houses or any near by within five years at least. The plate shows, however, that one of these dangerous privies belonged to a house in which a case of typhoid fever occurred in 1892. There were also cases in the two houses next west, but in these the privies,

although near the river, were so built that the contents probably could not reach the river. Inquiries showed that such excreta as were not thrown into the privy were carefully buried behind it, within a hundred feet of the river to be sure, but yet in such a way that nothing would be likely to get into the river. I was assured and, so far as I could learn by the most careful inquiry, the method of throwing slops directly into the river or on the sloping river bank, which I happened to witness at a house near by, was not in vogue in these cases. As already pointed out, the other river-bank case occurred in a house provided with a dangerous privy. Its contents were completely exposed on the river side, and a hard rain might wash a portion down the bank into the river, which was less than a hundred feet away. The patient in this house was a little girl of eight years, who went to bed about March 17. The physician feels sure that the illness was typhoid fever, and says that she had considerable diarrhoea. All excreta were thrown without disinfection into this vaultless privy. So far as I was able to learn, no severe rains occurred between the beginning of her illness and the date of my visit to Chicopee Falls, and it is probable that no considerable infection of the river had taken place up to that time. I at once drew the attention of the local board of health to these matters, and urged the immediate removal of this and all similar privies. I am very glad to be able to report that a day or two after, i. e., during the first week in May, this privy was cleaned, and boarded up so as to prevent its contents from washing into the river, while the other dangerous privies, also above the intake of the water works, were removed. Up to May 30 no more cases of typhoid fever at the Falls had come to the knowledge of the local board of health. This fact, and the others cited above, make it probable that little or no harm has been done by these privies, in spite of their extremely threatening position directly upon the river, above the intake of the water works.

In fine, all the evidence which I have been able to discover indicates that the mild typhoid epidemic in Chicopee Falls during the past winter and spring was due to some unusual infection of the public water supply. This contamination of the water supply may possibly have been due in part to cases of typhoid fever in Indian Orchard or Ware, or to cases on the river bank above the intake in Chicopee Falls itself; but was probably for the most part the result of an unusual prevalence of typhoid fever during the previous winter and spring among mill operatives at Ludlow and Jenksville.

AN INVESTIGATION OF AN EPIDEMIC OF TYPHOID FEVER IN THE CITY OF SPRINGFIELD IN JULY AND AUGUST,

1892, DUE TO INFECTED MILK.

BY W. T. SEDGWICK, Ph.D., BIOLOGIST OF THE STATE BOARD OF HEALTH,

AND

WALTER H. CHAPIN, M.D, CITY PHYSICIAN AND MEMBER OF THE BOARD OF HEALTH OF SPRINGFIELD.

(With Map, Plates and Figures.)

About the first of August 1892, it was noticed that typhoid fever was unusually abundant in a particular district of the city of Springfield. This city (of about 47,000 inhabitants) covers a large area extending north and south along the Connecticut River and, upon somewhat higher land, to the eastward. Its soil is chiefly sandy or gravelly, and the situation is regarded as salubrious. The particular district in which typhoid fever began to appear in such abundance as to excite comment and at length alarm is known as the "McKnight district" and lies upon a gravelly plateau of wide extent, such as often characterizes the terraces of the Connecticut valley. It may be located upon the accompanying map as that portion included between State Street and St. James Avenue. The district has been comparatively recently developed" by enterprising real-estate activity, and may fairly be described as having a refined and attractive suburban character; the houses, mostly of wood, standing somewhat back from the street, are provided with grassy yards or lawns and sometimes with gardens. The sanitary arrangements are in keeping with the exteriors; in brief, the district forms an inviting, wholesome and excellent suburban community. There are other parts of the city, similarly situated, some as good, some better, than this; but most of the city is far

66

less favorably situated, less inviting, less clean, and in parts, especiall along the river, crowded with tenement-houses; still other portion consist chiefly of shops or stores or offices, amongst which dwelle of a lower grade are crowded. But in none of these except th McKnight district did typhoid fever make its appearance in July

1892.

The perplexity of the people, therefore, was great, and, as usual in such cases, various theories were advanced to account fo the epidemic. Some of these were manifestly untenable; others although resting only upon vague conjecture, were soberly pro pounded and seriously discussed among the citizens and in th newspapers. Even physicians and the local sanitary authoritie were deeply perplexed. Attention was first drawn to well water a a possible cause of the disease, some of the people in the McKnigh district having resorted largely to well water in preference to th city water during the hot months. But it was naturally urged a sufficient objection to this hypothesis that many, indeed most, the victims had used only the public water supply for drinkin purposes. A similar hypothesis was advanced in respect to certai spring waters widely sold in the district, but the same objection w effectively raised in this case. Some turned to the drainage an some to the sewerage of the district as the probable source of th trouble. But it was immediately pointed out that the house affected were mostly new and the plumbing was generally in goo condition. With respect to the sewers, a stench from the man-hol in the neighborhood of Yale Street was said to be very noticeab at times, and we found that this was a fact; but the superintende of sewers showed that this was an incident of the hot season; th the smell was no worse this year than in previous years when the had been no fevers; that the fall of the sewers was unusually go and the system of flushing them excellent. Moreover, many of t houses nearest to the man-holes had no typhoid fever cases; so th the sewer-gas theory, also, proved to be inadequate to account f the outbreak.

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