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REPORT OF THE DIRECTOR.
UNITED STATES MARINE-HOSPITAL SERVICE,
Washington, D. C., November 1, 1898. SIR: I have the honor to submit the following report of the transactions of the Hygienic Laboratory for the year ending November 1, 1898.
SPECIAL INVESTIGATIONS. In my previous report, submitted August 15, 1897, a preliminary note was made on the infections caused by the pneumococcus. This investigation has been further continued in the direction of producing a preventive and curative substance for the infections caused by this micro-organism.
This work has been beset with many difficulties, principally due to the fact of the varying susceptibility of a given animal at different times to this organism. These have in a great measure been overcome, and it now appears that this inquiry will be completed in the near future.
A report of progress is to be made on another subject. In 1895 a culture of the pseudo-diphtheria bacillus was received from Dr. Park and W. H. Beebe, of the New York health department. This particular culture figured in their report of that year on diphtheria. Dr. Austin O'Malley, of the health department of the District of Columbia, who was then acting as an assistant in the laboratory, was first assigned to this investigation.
The primary object was to determine whether this micro-organism was a variety of the true diphtheria bacillus. On Dr. O'Malley leaving Washington, the investigation was continued by Dr. Elgin, another assistant, who has brought it to a successful termination.
When this inquiry was undertaken the bacillus of pseudo-diphtheria had no virulence, even to animals most susceptible to diphtheria.
Attempts to raise its virulence were made after the plan as proposed by Bardach, by passing this organism through the bodies of animals (those susceptible to diphtheria), with the result that after two years the cultures began to show virulent properties, and a year later a toxin was extracted, which would kill guinea pigs. During these three years of experimentation the bacillus became more pleomorphic. Many times its morphology was almost identical with the
true bacillus, requiring a most careful study to differentiate from the diphtheria bacillus.
After the successful separation of the toxin, lethal doses were mixed with diphtheria antitoxic serum and injected into guinea pigs with negative results. The experiments proved that this particular microorganism is distinct from the bacillus diphtheria. A full and detailed report will be rendered on this subject.
Early in 1897 a study of the bacillus typhosus was begun, and is now in progress. While the observations made have been in a great measure confirmatory to those of others, a number of new features have been developed in special lines, which are believed to be of value. It is anticipated that a preventive and curative substance can be evolved which will do away with the objectionable features of vaccination, as proposed by Professor Wright, of Netley.
INVESTIGATION REGARDING ETIOLOGY OF VARIOLA. The investigation concerning the etiology of variola and its modified form is progressing slowly. This is due in most part to the fact that I have not had sufficient time to devote to it continuously. It is hoped that this subject can claim our undivided attention in the near future and something of a definite character be obtained. Already a mass of material has been collected concerning the methods, both in Europe and in this country, of propagating, preparing, and applying vaccine lymph, which will form a special report.
BACTERIOLOGICAL EXAMINATION OF POTOMAC WATER SUPPLY. My colleague, Passed Assistant Surgeon Sprague, was assigned to investigation of the pollution of water supplies, and on July 1 of last year began a systematic bacteriological examination of the drinking water of the city of Washington.
A report of observations on the Potomac water supply was submitted in March last, in response to Senate resolution of January 22, 1897, and is published as Senate Document No. 211, Fifty-fifth Congress, second session. This report is as follows:
WASHINGTON, D. C., March 21, 1898. SIR: In response to your instructions to prepare a report on the subject of the bacteriological examinations of the Potomac River, I have the honor to submit the following synopsis of the investigations which have been conducted in the hygienic laboratory:
The inquiry was commenced as early as 1891, when a bacteriological study was made of the Potomac River water, for the purpose of classifying the bacterial flora.
During this examination a certain group of bacteria, known as the colon group, was observed, which persisted with some degree of regularity, although not in considerable numbers. This was especially noted in the months of the summer and fall.
In the following years investigations of the same character were made in connection with other laboratory subjects, and with identical results.
It is now regretted that the inquiry then undertaken could not have been made continuous, thereby enabling us to reach positive conclusions earlier.
During the years 1892 and 1893, when cholera prevailed in Europe and this country was seriously threatened thereby, special attention was given to the subject of the polution of water supplies, and that of Washington in particular. I was soon convinced that in the event of cholera gaining a foothold in this country, particularly east of the Allegheny Mountains, the water supply of Washington might be seriously threatened, if not infected, with the germs of cholera, and that the possibility of having a repetition of the Hamburg epidemic was not remote. This fact was doubly emphasized in 1894, when an immigrant just landed was reported to have died of cholera in Cumberland, Md., just 125 miles above. Fortunately, the case was not cholera, but it demonstrated how easily a condition might arise under certain conditions which might jeopardize the water supply of Washington.
It is now a well-known fact that Washington has for many years enjoyed an unenviable notoriety in the number of cases of typhoid fever and diarrheal diseases which annually occur. This condition had at last become so persistent and grave that the medical profession had, by its long experience with the disease, become authorities on its treatment. On account of the gradual and persistent increase from year to year, the profession compelled action to be taken with regard to its cause and prevention.
Accordingly in 1894 the Medical Society of the District of Columbia appointed a committee to investigate and report on the cause and prevention of typhoid fever in the District of Columbia
This committee, after an exhaustive and painstaking investigation, made its report to the society in June of that year, and subsequently presented it to the Congress and it was printed.
The conclusions were as follows: “1. The immediate abandonment of all wells within the city limits, exception only to be made in case of the absence of the Potomac supply, and where the wells, after repeated chemical and bacteriological examinations, have been found to be free from all possible sources of danger; but even these to be abandoned as rapidly as possible.
"2. Purification of the sewerage system already existing, by replacing as rapidly as possible all damaged or defective drains.
"3. The introduction of new sewers in advance of other improvements in parts of the city not now supplied with drainage, and the extension of the system as far outside of the city limits as the rapidly growing population demands, so as to prevent soil contamination.
“4. The adoption of some system by which the lower sections of the city can be more completely drained and the risks arising from the backing up of tide water and sewage prevented.
“5. The final and safe disposal of the sewage.
*6. To make all existing privies, vaults, or other receptacles of human excreta water-tight and, by rigid inspection and penalties, to prevent the danger from leakage and overflow.
"7. The early completion of the plans recommended by Colonel Elliot, in charge of the Washington Aqueduct, and now in course of execution, which have in view the sedimentation of the Potomac water and ultimately the completion of works for filtration, the only proper method of purification.
“8. The suppression of all privies and the enforcing of the law to make sewer connections.
“9. Careful inspection of all dairies in the District from which our milk supply is drawn and the enactment of a law by which no milk shall be sold in the District without a permit from the health office. The inspection should cover an
examination at the dairies of all possible sources of infection, including the water supply."
Special stress was laid on the box-privy system and the shallow surface wells as being responsible for the majority of the cases of typhoid fever and diarrheal diseases.
Aid was given to this committee in its investigations by making a bacteriological examination of water from several wells and springs which were suspected of being infected. The result of the examination showed that the suspicions were well founded, and the majority of these wells were found to contain the intestinal bacteria.
The following is the memorandum furnished the committee, which explains itself:
Location of well.
Result of examination.
East side of ith street be- Sewage bacteria; colon Bad
Well should be tween M and N streets bacillus isolated.
lus isolated. 5 16th and Corcoran streets Ordinary forms usually Good Should be kept un. NW. found in water.
der observation. 6 17th and K streets NW... Ordinary forms usually Suspicious Do.
found in water, but
Should be closed. Cstreets NE.
bacillus isolated. 8 3d street and Indiana ave Sewage bacteria.
do..... Do. nue NW 9 Tand 18th streets NW..... Ordinary water bac. Suspicious Should be kept unteria, but in large
bacillus isolated. 13 9th and H streets NW Ordinary water bac- | Good Should be kept unteria in small numbers. 1
In view of the fact that deaths from malarial fevers are of rare occurrence in the cities of Philadelphia, Baltimore, and Norfolk-at least, this has been the experience of the officers of the Marine-Hospital Service stationed at these places-it is remarkable that Washington should prove the exception. It was suggested in this report that both the deaths from malarial fever and typhomalarial fever were nothing more or less than typhoid fever given another name. In the main, I believe that the conclusions were correct, and my own observation on cases of malarial and other fevers, made in a marine hospital (the majority of these having contracted the disease in the vicinity of Chesapeake Bay) was to the effect that deaths from malarial fevers were exceedingly rare and that the disease known as typhomalarial fever was equally rare. In over 400 cases examined I found 4 cases of a mixed infection of malaria and typhoid. Professor Osler reports that in 600 examinations of cases of fever none had been encountered, and that the so-called typhomalarial fever was nothing more than typhoid fever.
It then appears that all agree that these diseases are in all probability typhoid and should be so classified. Another significant fact is that these cases occur synchronously with typhoid and always in the same ratio. If, then, these cases are typhoid, we would have a considerable increase in the death rate per 10,000, and instead of the death rate of 7 for the ten years ending January 1, 1897, it would really be 7.6.
Washington City stands among the foremost in the high death rate in a preventable disease.
In 1895 another serious and widespread epidemic of typhoid fever occurred during the summer and fall, and the disease was so severe that a special sanitary inspector, Dr. George M. Kober, was appointed to investigate into its cause.
At the commencement of this inquiry a request came from the health officer for the bacteriological examination to be made of samples of water submitted by Dr. Kober, in the hygienic laboratory, which request was complied with.
From September 24 to December 13 about 200 analyses were made of samples of water from about 70 different sources, with the result of finding practically the same condition as existed in the wells examined the previous year. Dr. Kober concludes that the infected shallow surface wells located near leaky sewers and leaky privy vaults formed the ideal conditions for their infection and the dissemination of typhoid fever from them. Quite a number of these wells which were found to be badly contaminated were those which had been recommended to be closed and had been so for a time until, by one pretext or another, they were again reopened and used. Out of the 70 original sources (wells, springs, etc.), 26 were found to contain sewage bacteria, and in 21 intestinal bacteria were found.
In my report submitted December 24, 1895, I state that,
“The Potomac River water has been examined, as will be seen, at intervals during the inquiry
“While the examinations on the whole make a better showing than do the same number of wells, it was not found free from contamination,
“On two occasions intestinal bacteria were isolated, and in several instances the sewage bacteria were found."
The direct results of the investigation of both the medical society and Dr. Kober were the closing of many of the wells which were undoubtedly concerned in the spread of typhoid fever and diarrheal disease. This was particularly noticeable in localities where the people had depended solely on these wells for their supply. There was a noticeable diminution in the number of cases after a new supply of water had been introduced. Unfortunately, this did not cure the evil; typhoid fever, while diminished in these localities, had not disappeared, but still lingered. Not only this; the closure of the wells and the abatement of nuisances did not diminish, or has not materially diminished, the death rate of typhoid fever. The disease now appears to be widely scattered, and there are no particular foci, as have heretofore existed.
The previous investigations have not been without their indirect benefits. The Potomac water has been heretofore considered by many to be in as good condition as any other water supply, and the idea prevails that, on account of the large quantity of water and the proportionately small quantity of sewage thrown into the river, long before it reaches Washington it has been purified by the efficient agencies of aeration and sedimentation.
Other causes have been assigned for the prevalence of typhoid fever, such as milk, imperfect sewerage, and pollution of the subsoil.
While these theories offer a plausible explanation for these conditions, it by no means follows that they are true; but when people are misled into this way of thinking it takes a long time to convince them of the error-ten times longer than they were falling into it.
Such a mass of evidence had been collected that it was thought sufficient to convince almost anyone that the public water supply was contaminated, and would in time become more so, as the history of the Potomac River was the repetition of that of other rivers which are used for like purposes; and further, that no chemical or bacteriological examinations should be necessary to prove the condition. Such, however, is not the case.
In order to settle this question once and for time to come, another examination of the Potomac River water was commenced on July 1 last. These examinations