In York, within the past three weeks, there have appeared fortyfive cases of typhoid fever, none being present before the occurrence of th epidemic at Glen Rock. Allowing the usual time for incubation in this disease, it is readily seen that the cases at Glen Rock may have caused those in the city of York.

Glen Rock is a country village of 1,200 people. It contains eight factories, in which practically all the population labor. The closets at each and every one of these factories discharge their contents into the Codorus creek. There is one large hotel, four large livery and sale stables, and probably not less than fifty privies at private houses, all situated directly over the stream.

All the way from York to Glen Rock, a distance of eighteen miles, are to be seen many privies built directly over the stream, and numerous farm buildings so situated that practically all the drainage is into the stream.

We believe, and so report that all the conditions here exist for the production of an epidemic of typhoid fever, the experience of chemists and sanitarians being that wherever human dejecta enter the sources of water supply there is a possibility of fever occurring. It might, however, be thought that the distance between Glen Rock and the city of York is so great that the organic matter would all be oxidized and the bacillae perish before reaching the city. In this case, however, the fall from Glen Rock to York is so rapid that the time consumed in making the passage would be very short and both the organic matter and the bacillae would reach York little changed. This is shown by the microscopic and bacteriological examination made on March 10th by Robert Pitfield, Assistant Bacteriologist of the State Board of Health.

Dr. Pitfield reports: "The water in the new reservoir now undergoing construction was found to be contaminated with fecal matter, since in every c. c. the colon bacillus was found. In the same water drawn from the pipes in the Colonial Hotel the same organism was found. The presence of these bacillae is always sufficient to condem any water supply, since it is indicative of fecal pollution. Samples of water were obtained from the spring which at the time of collection was not supplying the reservoir, and from Hoke run, just above the town. The spring water contained an unusually large number of bacteria, but the colon bacillus was not found in it. In the reservoir water were found 1,390 bacteria per c. c. At the Colonial, in the same water, 1,190 per c. c. were found. In the spring water 2,810 bacteria per c. c. were found, and in Hoke run 1,700 bacteria per c. c.

were found.

"I believe that the water from the Codorus creek, polluted with sewage from the typhoid cases at Glen Rock, is the cause of the

typhoid fever in York. The Codorus creek water is undoubtedly contaminated with human feces, and is condemned."

To your inspector it was perfectly clear that this water was contaminated, as reported by the bacteriologist, before either chemical or bacteriological studies were made. The Codorus creek is throughout its course entirely too small to dispose of the sewage from Glen Rock and from the farms along its eighteen miles of course, before reaching York. The rapid fall of the stream guarantees that the organic matter and the bacillae will reach the city unaltered.

Previous to 1889, the valley of the west branch between Sunbury and Renova had for years been practically free from typhoid fever. Since 1889 this disease has been continuously present in all the towns along the river. After the floods of that year, a severe epidemic occurred at Lock Haven, a city of 12,000 inhabitants. In this epidemic a very large proportion of the inhabitants were stricken with the disease, some in the severe, others in the milder form. In very large part, the fecal discharges passed into the river and to the towns below, which, in greater part, draw their water supplies from the same. At Lock Haven, immediately after the floods of '89, there were a number of cases of fever in houses situated immediately below the reservoir, from which the city supply is drawn. This reservoir is fed by a mountain stream which passes through an uninhabited mountain district. In some way discharges from the patients living below the reservoir must have found their way into it, and thence have been disseminated throughout the mains and supply pipes of the city's water system. It was demonstrated through the course of the epidemic that these pipes were not regularly and systematically cleansed by flushing, and when opened were found to contain a large amount of filthy sedimentary material. The epidemic in Lock Haven apparently died out for lack of material to continue it.

In 1890 your inspector was called to examine a proposed source of water supply for the town of Muney, Pa. The stream which it was proposed to use was at first sight an ideal mountain stream, and the new reservoir in course of construction appeared to be in the primeval mountain forests, but tracing the stream a mile above the reservoir, a mountain cove was discovered, containing five small mountain farms. All the drainage of these farms necessarily passed into the stream, which was entirely too small to dispose of the same. The fall of the stream to the reservoir was very rapid; the distance to the town of Muncy not more than five miles. On the ground that there was insufficient water to dilute the sewage the supply was condemned. The company, however, went ahead and constructed works. The results which have followed have abundantly proved that the water is unfit for human use, and during the summer months it be comes exceedingly foul.

In 1892 there was an epidemic of typhoid fever confined to a single street in Sunbury, Pa. An inspection demonstrated that the people of the street in large part drew their drinking water from a well which was situated in the midst of the most unsanitary surroundings. Within a few feet of the shallow well were not less than six privies and a large number of pig sties, chicken houses and the waste from several kitchens drained directly toward the well. Not only were these unsanitary conditions observable, but the water was distinctly loaded with organic matter. On further investigation it was discovered that all the persons sick of fever at the time of the inspection were accustomed to drink water from this well. The water was condemned, the well ordered closed, and the epidemic promptly died out.

In 1897 an epidemic of typhoid fever arose in Lewistown, Pa. Until the early winter of '96 and '97 this town had been entirely free from this disease. In the early portion of the winter, a number of cases appeared in the outskirts of the town in houses beyond the control of the local board of health. Suddenly the disease invaded the town proper. An inspection was made. It was discovered that Lewistown had not less than four sources from which water could be pumped into its mains, and the water company was just ready to introduce a supply from a new source, the fifth, a mountain stream in an uninhabited district and, therefore, free from pollution. During the winter in which the epidemic appeared, the water from that source. considered to be most pure had been too small for the needs of the town, and hence it had become necessary to pump from the other sources which were open to suspicion. One of these sources was the Kishaquillas creek, a large stream and apparently able to dispose of a large amount of sewage. There had been from along the head waters of this stream cases of typhoid fever during the early winter. The other source of supply was a spring which in the early history of the water company had first supplied water to Lewistown, but because of the hardness of the water it had been abandoned. During this winter, however, water had been pumped from the spring into the mains. On inspection it was discovered that sewage was passing from the houses in which typhoid fever had occurred in the early winter directly into this spring, and had been passing from them when the water was pumped into the mains. The fever was especially bad on one street along which extended a main with a dead end. Several persons who saw the old main opened up declared that it was filled with offensive sedimentary material. Fortunately, the water company was just ready to turn a new supply of mountain water into the pipes. The old supplies were condemned. It was ordered that the pipes be thoroughly flushed and the dead ends opened and left

open until the pipes were completely cleansed. This was done, and the epidemic completely died out.

Lewisburg is situated on the west branch of the Susquehanna river. For twenty years previous to 1889 typhoid fever was unknown except in sporadic cases in the town. The water supply is drawn from the above named stream. The in-take pipe is located well out toward the centre of the stream, where the water appears as bright and sparkling as in the purest spring, and yet, from 1889, when the epidemic at Lock Haven occurred, to the present time, there has probably not in any year been less than 50 cases, and the town has a population of but a trifle above 3,000. It would seem in this case that there is an abundance of water to dilute and to oxidize the sewage from Lock Haven, Williamsport, Watsontown and the villages above Lewisburg, but the experience of ten years shows that this is not the case, but that the germs of disease in the sewage of the towns above retain their vitality in sufficient numbers to cause typhoid fever in volume sufficient to be a matter of grave concern to all.

Inspection shows clearly that the Schuylkill river from Reading to Philadelphia is little better than an open sewer. The drainage from thousands of farms and nearly a million people passes into the river, which is used as a source of water supply for Philadelphia, with the result which all know.

Chicago discharges its sewage into Lake Michigan, and then pumps the water and the sewage mingled into its reservoirs for distribution to its people. The result there is also well known.

Erie discharges its sewage into Put-in-Bay, a body of water covering a few hundred acres. Water and sewage are pumped into the city reservoirs and distributed to the people. The result here is also well known.

What is true of Erie and Chicago is true of all the lake cities, discharging their sewage into the lakes and drawing upon the same for their water supplies. In the case of Erie, Chicago and Philadelphia, or any other city which supplies its inhabitants with water mingled with sewage, chemical or bacteriological examinations are no longer necessary to show that these waters are dangerous. If the sewage has entered the waters, this is sufficient. The experience of thirty years shows that the organic matter and the bacillae remain active in sufficient volume and numbers to cause serious outbreaks of disease.

INSPECTION AT PACKERTON.

By J. B. Tweedle, Medical Inspector, on Account of Reported Diphtheria.

To the Secretary of the State Board of Health:

Sir: I have the honor to report that in compliance with instructions received from you March 19, 1898, I visited Packerton on March 20th, and found the following conditions to exist: I found a scattered settlement of three or four hundred people, living in a township without any board of health or any person in authority. Most of them living in rented houses, and where the cases of sickness were reported to have been, they were crowded pretty closely together. The water supply came from a dam, supplied from or by a mountain stream which at present looked pretty clean, but from reports when the water gets low is hardly fit to use. The water closets were in pretty good condition, with the exception of needing disinfecting. I found that there had been two deaths within the past two weeks, but the parties could not say they had died from diphtheria, as the bodies of both had been taken away on the train for burial, and if the physician's certificate had shown they had died from any contagious disease, they would not have been carried by the railroad. I found four children sick with bad colds, some sore throat and croup, but the parents did not think them serious or dangerous. I called the school board together and appointed them to act in my absence as a health board, and ordered all cases to be reported to the secretary. I furnished them with some placards and instructed them to placard all houses reported by physicians. I left an order to notify all physicians treating cases in the district to report to the secretary of the board, also to notify the undertakers in case of death to report at once, as in case of neglect or refusal to report to me we would proceed according to law. I also notified the owners of the premises, who promised to have them all put in good sanitary condition.