Extracted from the 
TRANSACTIONS OF THE COLLEGE OF PHYSICIANS OF 
PHILADELPHIA. 
THIRD SERIES, VOLUME IV. ON THE RELATION OF SEWER GAS TO 
TYPHOID FEYER. 
GEORGE HAMILTON, M.D. 
By 
[Read March 5, 1879.] 
The subject of the paper for this evening cannot 
but be regarded as one of much importance, as well 
in relation to medicine as in reference to the public at 
large. As you are all aware, the attention of the com- 
munity, in general, has for a few years past been 
drawn in an unusual degree to the subject of sewer 
gas as an agent in the production of typhoid fever, 
and recently it has been declared by several writers 
to be the most potent and common cause, not only of 
this fever, but also of scarlet fever, and, in a special 
degree, of diphtheria. As a consequence of these 
declarations, a feeling of anxiety and alarm has mani- 
fested itself, greatly disproportionate to what an un- 
biassed and calm consideration of the subject will 
admit, or an examination of the reports of the Board 
of Health will justify. That those members of our 
profession who have endeavored, so earnestly and per- 
sistently, to impress upon the mind of the public, as 
well as of the practitioner, that sewer gas is the most 
potent and common cause of typhoid fever in Phila- 
delphia, have acted conscientiously, no one need doubt. 
To their excellent standing in the profession, and to 
their zeal in promulgating the views alluded to, is, in 176 
HAMILTON, 
great measure, due the success that has attended their 
efforts in this direction. So successful, in fact, have 
these efforts proven that probably one-half of the pro- 
fession in this city, and a still larger proportion of 
the citizens who may have given some attention to 
this subject, have been induced to accept the views 
so urgently pressed as a finality. It is, however, to 
be remembered that very little in opposition to the 
opinions stated has been attempted, and it may be 
that the present will prove a futile effort to stem the 
actual current of professional and popular feeling 
upon this subject. Nevertheless, we feel quite as- 
sured that a large majority of practitioners who have 
had, at the bedside of patients, the most frequent and 
abundant opportunities for the study of typhoid fever, 
will reject the evidence hitherto offered to prove that 
sewer gas is the most potent and common cause of 
typhoid fever in Philadelphia, or elsewhere, as utterly 
untenable, and as in direct antagonism with the facts 
and figures pertaining to that malady. 
An observation or two, in reference to the more 
acute aspect of disease as it occurs in the country, 
compared with what is seen in city practice, may here 
be admitted, bearing more or less directly upon the 
subject before us. The late Dr. Joseph Parrish, eminent 
in citizenship and as a practitioner, when lecturing, in 
1830, before a summer class of students upon bilious 
remittent fever, narrated his sad experience of this 
disease, as witnessed in consultation with country 
physicians within a circuit of about seven miles of 
the city (sometimes in Pennsylvania, at other times in 
New Jersey), by declaring that, in frequency in pro- 
portion to population, and in violence and fatality, it RELATION OF SEAVER GAS TO TYPHOID FEVER. 
177 
greatly exceeded anything he had ever met with in 
Philadelphia. The same remark was made by him in 
regard to dysentery, and was fully verified by the 
writer when, a few years later, he began practice 
thirty miles distant from the city. The accounts re- 
ceived from time to time from country physicians 
regarding the disastrous epidemics of the diseases 
mentioned, and, in an especial degree, of diphtheria, 
are doubtless familiar to you. 
Some statements, made by the writer during the 
discussion that followed the delivery of the paper of 
Dr. Keating upon the relation of sewer gas to typhoid 
fever, must here be repeated, as some who are now 
present may have then been absent. Centreville, my 
location in the country for more than ten years, was 
upon the ridge separating the Brandywine and Red 
Clay Creeks; distant seven miles from Wilmington, 
seven from Ixennet Square, four from Dupont’s, and 
eleven from West Chester. The surrounding coun- 
try, rolling or hilly, abounded in nearly every direction 
with springs of fine water. In this rural section be- 
gan my first bedside experience in typhoid fever, and 
the occurrence in my practice of four cases of intes- 
tinal perforation, in the space of twelve consecutive 
months, may but too well attest the character of the 
prevailing epidemic. It was not, however, until after 
five years’ practice in this vicinity that typhoid fever 
developed itself; the usual form of fever in earlier 
years of practice having been bilious remittent, which, 
like the typhoid, at times assumed an epidemic charac- 
ter, and proved nearly as fatal as typhoid, while in 
other seasons but few cases occurred, the local condi- 
tions remaining essentially the same from year to year. 178 
HAMILTON, 
The change from bilions remittent to typhoid fever 
was, naturally enough, not abrupt, some of the symp- 
toms of the former gradually giving place to those of 
the latter. In mode of progression there was a close 
resemblance between them; either disease showing 
itself upon an elevated plain, on the brow or slope of 
a hill, or in the vale below, with perhaps a slight pre- 
ference for the latter; while the mansion of the opulent 
farmer would, in turn, be visited with the home of the 
humble cottager. 
Two remarkable instances of typhoid fever, men- 
tioned in the discussion before alluded to, cannot, for 
the reason then assigned, be passed in silence. One 
occurred in the residence of a wealthy farmer, the 
family consisting of eight persons, of whom only one, 
the mother, escaped an attack. Six were severely 
affected — three of them dangerously—while the 
seventh, a colored servant, suffered but slightly. 
"Now the important point in the history of these cases 
is revealed in the fact that the disease did not orig-i- 
nate upon the premises. A son, about nineteen years 
of age, had been absent several weeks on business in 
Maryland, forty miles distant from his father’s resi- 
dence, and from thence was brought home sick, and, 
apparently from contagion, the others were in turn 
affected, giving rise to an attendance of nearly four 
months before the final recovery of the last patient. 
The second instance happened in a family of seven 
persons, four or five of whom were attacked; the 
death of a youth of eighteen years resulting from 
perforation. Here, again, the disease did not origi- 
nate on the premises; the mother, the first patient, 
who had been assisting in nursing a relative several RELATION OF SEWER GAS TO TYPHOID FEVER. 
179 
miles distant, was brought back to her own home 
suffering from typhoid fever, contracted apparently 
from that relative. The number of persons attacked 
in both of these examples was exceptionally large, yet 
the disease rarely appeared in a family, even of mode- 
rate size, without more than one of its members being 
affected. 
As to the origin of these widely diffused, destruc- 
tive epidemics, nothing could be said in explanation 
except that, as a rule, a warm, moist spring, and, as 
a sequence, excessive growth of vegetation, followed 
by a hot, dry summer, appeared to favor the develop- 
ment of typhoid; just as had been noticed in former 
seasons in regard to bilious fever. In relation to the 
influence of local conditions, it may be said that in 
an old, long cultivated section, changes in these con- 
ditions rarely occur, and certainly nothing of this 
kind did occur that could explain the ravages of fever 
in one year and its absence or slight character the 
next; and hence the physicians of that section, so far 
as I knew, were nearly of one accord in regarding 
atmospheric, hygrometric, electric, or telluric condi- 
tions as the sources of the presence or absence, and 
of the violence or mildness, of the epidemic. 
On returning to the city, thirty-three years ago, a 
location for practice was chosen at Sixteenth and 
Summer Streets, and has thus continued ever since. 
At that remote period, intermittent, remittent and 
typhoid fever prevailed to a considerable extent, espe- 
cially between Broad Street and the Schuylkill. Not 
one of these types can now be seen so often, in pro- 
portion to population, as during the earlier years of 
my practice in this locality. 180 
HAMILTON, 
Some years after returning to the city, Professor J. 
Iv. Mitchell was called to consult with the late Dr. 
Gebhard and myself in a severe case of typhoid fever 
near my residence. This was at a period when bilious 
remittent was being gradually supplanted by typhoid 
fever. Dr. Mitchell then stated to ns that nearly all 
the cases of this disease seen by him were in consul- 
tations upon the suburbs of the city, as in the case 
in which he met us, for at that time the locality was 
but a suburb ; yet, in the suburbs at that period there 
were but few sewers or cesspools, and, as to water- 
closets, they were not to be found there ; whilst on the 
contrary, in his own vicinity (Eleventh and Walnut 
Streets) they existed in all directions, and yet, as he 
informed Dr. Gebhard and myself, he scarcely ever 
saw typhoid fever in the families under his immediate 
care. Again, the late Dr. Wm. W. Gerhard, promi- 
nent as an authority in typhoid fever, informed me, 
about six years before his death, that he no longer re- 
garded typhoid fever as either so prevalent or so fatal 
in this city as it had been in former years; that some 
modification of the disease, from unknown causes, 
had occurred, just as he had witnessed many years 
previously in Paris, where typhoid fever in some of 
the hospitals had gradually changed in character until, 
from a mortality of one in three patients, only one 
case out of seventeen attacked terminated fatally. 
With the statements and opinions thus expressed my 
own observations and experience fully accord. 
During thirty-three years of practice in the city, 
four cases of typhoid fever, occurring in one family, 
have come under my care; in two or three families, 
twro persons in each have been affected; yet, setting RELATION OF SEWER GAS TO TYPHOID FEVER. 
181 
these aside, one case only in any family coming under 
my observation has occurred. This is in striking and 
most favorable contrast with what, as before stated, 
often happens in epidemic typhoid in the country, 
where no sewer gas or obstructed drains are to be found 
in explanation of this difference. The increase in the 
number of sewers, water-closets, and cesspools, in 
Philadelphia, for some years past, has been simply 
enormous; and consequently the opportunities for 
contamination of the atmosphere, water, or milk, cor- 
respondingly augmented. If (as some have as- 
serted) sewer gas is the most potent and common 
cause in the production of typhoid fever, and if so 
large a proportion of the houses in the city are in- 
fected by it, would we not have, in a population of 
nearly nine hundred thousand inhabitants, cases al- 
most without number, and deaths in proportion, far 
more than quadruple the average number reported 
by the Board of Health ? 
Physicians have long differed in opinion in refer- 
ence to the conditions under which typhoid fever is 
likely to occur, and in regard to the influence exerted 
by the various agents known, or believed, to play a 
part in the production of this disease. While many, 
at the present moment, are disposed to accept the opin- 
ion that in an atmosphere contaminated by sewer gas, 
or effluvia arising from cesspools, or decaying animal or 
vegetable matter, is to be found the ostensible cause 
of the disease; others are more disposed to refer it to 
the use of milk or water infected by the agents just 
named, and, in addition, to the consumption of food 
partially decayed. On the other hand, there are those 
who, whilst admitting the possibility or probability 182 
HAMILTON, 
that certain limited outbreaks of typhoid may be 
referred to the local causes just named, are fully con- 
vinced that the widely spread and fatal epidemics 
witnessed at times in the country can be explained 
by no such agencies as those alluded to; neither do 
we think that a practitioner, who has had the experi- 
ence of a single season of epidemic typhoid fever in 
the country, can refer to these agents as the cause of 
such epidemic, without rejecting the evidence of his 
own senses. 
Dr. James Jackson, of Boston, long before Pet- 
tenkoffer, in explanation of certain erratic and very 
restricted outbreaks of typhoid fever, ventured to 
suggest that, in the absence of any visible agency, 
some emanation from the soil, obscure as to origin, 
might account for them. PettenkofFer, however, de- 
termined that in proportion to the elevation or depres- 
sion of the water level in the earth was the greater or 
less prevalence of typhoid fever, without fixing any 
limit as to the extent of its influence. When we call 
to mind that, as before stated, a hot, dry summer is, 
as a rule, the precursor of an unusual amount of fever, 
either remittent or typhoid, the view of Pettenkofler 
demands attention and earnest consideration; for, 
after laborious and protracted researches, he an- 
nounces, definitely, that in proportion as the water 
level becomes lower, typhoid fever increases. That 
many epidemics of the fever appear without the pos- 
sibility of assigning any special cause in explanation 
of their origin, is manifest, and no one is more pre- 
pared to admit this than the practitioner and medical 
writer of large experience. Whatever may be the 
cause or causes of the fever, when once established, RELATION OF SEWER GAS TO TYPHOID FEVER. 
183 
contagion, especially when aided by the concurrence 
of certain indefinable, elemental, and local influences, 
lends its all-powerful aid in its extension; this, at 
least, is the opinion of Bretonneau, Trousseau, Louis, 
Gendron, Chomel, and many other investigators of 
the disease in France, England, and the United States ; 
among the latter, Drs. Nathan Smith, James Jackson, 
Elisha Bartlett, and Austin Flint, Sr. 
Of the writers quoted, nearly all recognize that 
very frequently the disease arises spontaneously, and, 
while some of them admit that a limited number of 
cases may be due to emanations from sewers or cess- 
pools, others, regarding typhoid fever as specific in 
character, claim that a specific cause is necessary to 
develop the disease; and that they find no sufficient 
evidence of such cause either in the respiration of the 
effluvia alluded to, or in the consumption of unwhole- 
some food. Trousseau, the medical genius of France, 
declares “that in Paris, or other large centres of pop- 
ulation, it is impossible to determine the origin of 
the malady; and that this can only be done by 
physicians wTho practise in limited spheres, when it 
can generally be ascertained where the first attack of 
the disease was noticed.” Than this, nothing could 
be more certain in relation to contagious disease in 
general; for in the street car may be seated by your 
side the washerwoman, whose bundle upon her lap 
may contain the clothing of a patient affected with a 
malignant disease. 
When, from time to time, on meeting with physi- 
cians of this city who have formerly practised in the 
country, the inquiry has been made as to the origin 
of typhoid fever, the answer has been, without excep- 184 
HAMILTON, 
tion, that only in an occasional case conld even a 
hypothetical local cause be assigned. The late Dr. 
Gallagher, of West Philadelphia, once informed me 
that, from 1839 to 1842, he was nearly broken down 
in attending to cases of typhoid fever occurring in 
the fine rural section four or five miles west of this 
city. If typhoid is a specific fever, and has as a 
definite, specific cause, sewer gas, what can be said 
in explanation of its great prevalence and fatality at 
the distance of a few miles only from the city, where 
no sewer gas exists? All writers and practitioners, 
however, do not accept in toto, perhaps not at all, the 
sewer gas theory; but on the contrary refer to the 
emanations from decomposed vegetable and animal 
substances, and from cesspools, as frequent sources 
of the disease; in addition to which, a third class of 
observers insist that food, liquid or solid, contaminated 
by these agents, must be taken into account before a 
solution of the grand problem, the causation of 
typhoid fever, can be accomplished. But these various 
hypothetical or assumed causes, have been for years 
under serious and earnest consideration, yet, so far 
from solving the difficulty, we are, in many respects, 
little further advanced than when Montaigne, three 
centuries ago, in his amusingly furious tirade against 
doctors and their prescriptions, said, quoting the 
language of Pliny: “That the most important sci- 
ence in use with us, that which has our preservation 
and our health in charge, is unfortunately the most 
uncertain, confused, and disturbed by the most fre- 
quent changes,” and then, giving utterance to his 
own thoughts, exclaimed: “There is no great danger 
of our being mistaken as to the altitude of the sun, RELATION OF SEWER GAS TO TYPHOID FEVER. 
185 
or in the fraction of an astronomical calculation, but 
here, where it concerns our very existence, it is not 
wisdom to expose ourselves to the mercy of so many 
contrary and agitated winds.”1 
Attempts have often been made to explain away 
the difficulty of accounting for the extraordinary pre- 
valence and fatality of typhoid fever in the country, 
as compared with the city, by alleging that the water 
is, probably, contaminated by the well being too near 
to where is located the family necessitude, or otherwise 
that the drainage is from the latter to the former. 
Again, it is said that the effluvia, arising from decayed 
vegetable matter stowed away in vaults or cellars, are 
a fruitful source of the disease. That such a condition 
of things may obtain among families in some of the 
manufacturing towns of England, or other places in 
Europe, or in certain localities of this country, may be 
granted; but that it characterizes any considerable 
portion of the rural sections that have come under my 
own notice cannot, in truth, be admitted ; and certainly 
the charge of negligence and improvidence, implied in 
the above allegation, can have no application to the 
circle of my former practice in the country, nor to the 
region adjacent. 
A most significant reference must here have place. 
At the distance of three miles from my location was 
situated, upon the Brandywine, the cotton factory of 
1 “ ‘ Que la science la plus importante qui soit en nostre usage, comme celle 
qui a charge de nostre conservation et sant6, c’est, de malheur, la plus incer- 
taine, la plus trouble, et agit6e de plus de changements.’ II n’y a pas grand 
dangier de nous mescompter k la haulteur du soleil, ou en la fraction de 
quelque supputation astronomique : mais ici, oil il y va de tout nostre estre, 
ce n’est pas sagesse de nous abandonner k la mercy de 1’agitation de tant de 
vents contraires.”—Montaigne, Essais, Liv. 2, chap. 37, Paris, 1834. 186 
HAMILTON, 
Mr. ¥m. Young, employing a large number of hands, 
of whom probablyr at least one-half were under my 
care; and yet, so far as memory serves, only two 
cases of typhoid fever there, ever came under my 
charge. At the distance of about a mile below are 
located the immense establishments of the Messrs. 
Dupont, where thousands of people live , in compara- 
tive proximity. As my practice did not extend to 
these works, a note was sent a few weeks ago to Mr. 
Henry Dupont, asking whether or not typhoid fever 
prevailed among his employes during the years 1840- 
1843. The note of Mr. Dupont in reply states that, 
while of so distant a period his recollection is not 
clear, his impression is that there were but few cases 
of typhoid fever at that time among the people, and 
that they are generally healthy. A note recently 
received from Dr. Jos. P. Chandler, of Centreville, 
who has had an extraordinary opportunity of investi- 
gating the disease, confirms the impression of Mr. 
Dupont, as he is well qualified to do, from the large 
practice he has had at the works. 
Dr. Chandler also informs me that, with the excep- 
tion of a few cases of the fever, where it seemed prob- 
able that local causes may have given rise to the dis- 
ease, the rule has held good that its origin is involved 
in obscurity. This statement is fully justified in the 
fact that the manufacturing centres, with their closely 
situated houses, do not suffer, as his letter informs me> 
in comparison with the rural sections, where the dis- 
ease will often appear in the best and most favorably 
situated dwellings, with nothing within or without 
to explain the cause. Yow when we call to mind that, 
in some seasons, typhoid fever has prevailed exten- RELATION OF SEWER GAS TO TYPHOID FEVER. 
187 
sively on the north and south side of the Brandywine, 
whilst the intermediate banks, with their dense popu- 
lation, have Buffered but little, is it not worth while to 
concede, at least, to such a statement, so full of truth 
and meaning, that measure of thoughtful consideration 
which its importance merits, and in fact demands? 
At the present moment, and during the last two or 
three months, Wilmington has suffered from an unu- 
sual amount of typhoid, yet the banks of Brandywine 
have had but few cases; and whilst the proverbial 
generosity of the Messrs. Dupont never flags, when 
the safety, the health, or the general welfare of their 
employes is in question, the fact is nevertheless ob- 
vious, that the local conditions must, of necessity, be 
in several points such as in the opinion of many phy- 
sicians would surely engender an epidemic of typhoid 
fever, vThich yet for a long series of years has not oc- 
curred. 
In the earlier part of this paper, it was stated that 
the reports of the Board of Health of this city did not 
warrant the anxiety and alarm that exist in relation to 
sewer gas, as the chief agent in the production of ty- 
phoid fever; and without going into details, a few 
points only will be adduced in reference to this matter. 
The reports show that very often the deaths from this 
disease are more numerous in the winter months than 
during the hot weather of the summer. For example, 
in January, February, and December, of 1878, the 
deaths in the order named, were 34, 32, and 33, whilst 
in July the deaths were but 23; yet this month, as 
shown by the record of the last ten years, is the hot- 
test of the year, and consequently is the period when 
fermentation, decomposition, and putrefaction are most 188 
HAMILTON, 
actively engaged in evolving effluvia from animal or 
vegetable substances. This record of facts and figures 
may, by some, be regarded as inconceivable and per- 
plexing, yet it finds its counterpart in the country, 
where during one entire winter the disease was unu- 
sually prevalent and fatal. Incidentally, it may here 
be stated that Dr. L. P. Bush, of Wilmington, during 
that winter, made, at my request, the examination of 
the body of a young man who died, apparently from 
perforation, and this was verified by his careful post- 
mortem search. To Dr. Bush, in fact, was I first in- 
debted for the intimation that Dr. J. P. Chandler and 
myself were probably having to do not any longer 
with remittent, but with typhoid, fever, for his attend 
tion had, if I remember, been especially drawn to this 
change of type by Dr. Wm. W. Gerhard, and the work 
of Dr. Elisha Bartlett. 
Quoting again, after this digression, from the Health 
Office Reports, we find that in a series of years the 
weekly deaths from typhoid average but six or eight 
in a population of nearly nine hundred thousand; and 
it should be remembered that this includes the deaths 
in the almshouses, prison, penitentiary, hospitals, 
house of correction, and all other similar establish- 
ments, making at least one-fiftli to be deducted from 
the total reported. 
It is only a few weeks ago that, of our vast popula- 
tion, only two deaths from typhoid were reported for 
the week. When we reflect upon the number of inlets 
constantly evolving gas, at times very offensive; 
the thousands of residences, factories, etc., infected 
with it; the throngs of plumbers and gas-fitters who 
are daily compelled by their vocation to inhale the RELATION OF SEWER GAS TO TYPHOID FEVER. 
189 
gas in no diluted form ; is there not cause of rejoicing, 
rather than of the alarm that prompts to invert a 
tumbler over a small aperture, or fill a slight crevice 
in the washstaftd, with paper or cotton? Quite re- 
cently there appeared in the daily papers an account 
of an excursion through one of the immense sewers ot 
Paris, where the odor is said to be so offensive that it 
can never be forgotten. Is it not strange that this 
should be permitted if sewer gas was there regarded 
as the chief and common cause of typhoid fever? But 
sewer gas is also said by many to he the general cause 
of diphtheria and scarlet fever. By reference to the 
JSTew York Board of Health Report, for the week 
ending January 11, 1879, it appears that 274 cases of 
scarlet fever, and 65 of diphtheria, were returned, and 
only 8 of typhoid fever; nevertheless, the logical in- 
ference deducible from this statement will probably 
be contested. The deaths from scarlet fever, for the 
month ending Dec. 28, 1878, were, by the same report, 
228, from diphtheria 101, from typhoid fever 24, show- 
ing a fair correspondence with the number of cases 
returned. 
My own experience, and that of most physicians 
who have had much experience in typhoid fever, shows 
a larger number of cases and deaths among males than 
females; yet the latter, more domestic in town or 
country than the former, are far more exposed to the 
influence of what are now regarded by many as the 
almost exclusive agents in the production of the dis- 
ease. Practitioners and writers are generally in accord 
that the disease is most common between the ages of 
fifteen and thirty-five years; it will be found, however, 
that a very large proportion are between seventeen 190 
HAMILTON, 
and twenty-one years, the most fatal too of all periods, 
especially when the patient is large and has grown up 
rapidly; and it is just at this time that young men are 
prone to out-door life, even when business does not 
call. 
The readiness of some physicians to attribute to 
sewer gas an attack of typhoid, if any smell denoting 
its presence in a house can be detected, is surprising, 
when every physician knows that this is only an ex- 
ceptional event. To get over this difficulty it is now 
declared in some quarters that, although the smell 
be wanting, the gas is present, and capable of pro- 
ducing an attack. This is an unfortunate discovery, if 
it be a discovery; for it would follow from this, that, 
after much expense in the effort to banish gas where 
it was known to exist, from the sense of smell, it might 
still remain, although imperceptible, and keep the 
family in painful suspense. But have we any tangible 
and conclusive proof of this lurking, unforeseen danger, 
and, if it really exist, is it not remarkable that in the 
thousands of houses, where the odor is annoyingly per- 
ceptible, it appears to do so little mischief? Yet after 
all there is consolation and hope for the people; for it 
is announced that typhoid fever and, as may be sup- 
posed, with it, diphtheria and scarlet fever, can be 
stamped out. The whole system of existing sewerage 
is now discovered to be radically wrong, and it is de- 
clared that it ought to be torn out, root and branch. 
In this announcement the dishonest contractor would 
surely have the largest share of hope and consolation, 
were it not that a lynx-eyed, intelligent, and fearless 
Reform Association confronted him. To this associ- 
ation, in fact, are due the thanks of the community RELATION OF SEWER GAS TO TYPHOID FEVER. 
191 
for having unearthed the nefarious acts of more than 
one contractor, and exposed to the light of day the 
wretched workmanship and worse material, that they 
fully believed had been forever concealed from human 
vision. Let the actual system, then, have justice done 
it, in material and construction, before entering upon 
the trial of another, involving the expenditure of 
untold millions still further to oppress the renter and 
tax-payer. 
But what is to become of the rural population who, 
without sewer gas, suffer more from epidemic typhoid 
fever than the residents of cities? Let them, we shall 
/ . 7 
be told, be more careful in regard to local filth, con- 
taminating both air and water or food. This advice 
appears to be tendered in all sincerity and charity; 
but whether the people of any well-ordered farming 
district in the counties adjacent to the city, where the 
Quaker element, proverbial for neatness and order, so 
largely prevails, will receive, with due humility and 
gratitude, the advice so generously proffered, remains 
to be seen. Admitting, however, that the charge is 
in some instances well founded, or indeed that every 
farm-house in the largest county adjacent to Phila- 
delphia has, within or without, the sources of infection, 
what would it all amount to, diffused over so large an 
area, when compared to the limited space on which 
the city is built, with its sewers, water-closets and 
cess-pools, aggregating, in number, tens of thousands, 
and many of the latter, too, in close proximity to the 
dwelling, in an offensive condition, and rendered more 
so by serving as receptacles for every description of 
putrefied and putrefactive substance? And, again, 
has the butcher never any unsalable, perhaps semi- 192 
HAMILTON, 
putrefied, meat on hand? has the green-grocer no de- 
cayed vegetables or fruits to dispose of? and have the 
hucksters nothing of a semi-putrid character to stow 
away, in barrels or boxes, in cellars or vaults, or to 
have covered up from sight in a filthy stable-yard or 
outhouse ? 
The sources, then, of local contamination would seem 
to be infinitely more numerous in the city than in the 
country, yet without discouraging those who promise 
to stamp out disease. The real difficulty is when an 
epidemic of a violent and extended character starts up, 
as it has been known to do, in certain mountainous 
parts of Virginia and Tennessee, in their almost pris- 
tine condition, without the semblance of filth to ac- 
count for its origin. It is evident then that, whatever 
cases of typhoid fever may have been traced to sewer- 
gas or local contamination, some other cause or causes 
must be sought to account for the frequent and dis- 
astrous outbreaks in the rural sections ; and this, it is 
clear, was in the mind of that sagacious observer and 
logical thinker, Dr. Charles Murchison, when he de- 
clared his belief in the origin de novo of typhoid fever, 
placing himself, in this point, upon the platform occu- 
pied by all the celebrities named in the earlier part of 
this paper. 
Directing our attention once more to the health of 
our city, as exhibited by the Board of Health from 
week to week, we see no rational cause for anxiety or 
alarm; for while the deaths from pneumonia, for the 
last five weeks, have been very numerous, exceeding 
by far the total number caused by typhoid fever, 
diphtheria and scarlatina, taken together, the city, as 
to general health, may still be, as it has been for many RELATION OF SEWER GAS TO TYPHOID FEVER. 
193 
long years, regarded as one of the most healthy of 
large cities. In the present Board of Health the peo- 
ple, we believe, may have entire confidence, composed 
as it is of gentlemen of exalted character, and fully 
interested in the important and responsible work they 
have in charge ; presided over, too, by a gentleman 
whose fitness for the post he occupies is acknowledged 
by every one who has examined the recent annual re- 
ports, in the preparation of which he is doubtless 
aided by the indefatigable Registrar. That nothing 
will be left undue by the Board for the prevention of 
disease, so far as that is possible, and for the removal 
of nuisances, even if not productive of disease, we have 
full confidence. The circulation of exaggerated re- 
ports, in relation to any disease, should be avoided, as 
the tendency is to engender a degree of anxiety and 
inquietude, whose only effect is to diminish vital force, 
and thereby render the system more liable to the in- 
fluence of a deleterious agent.