s TYPHOID FEVER i 
AND 
LOW WATER IA WELLS. 
BY HENRY B. BAKER, M. D., LANSING, MICH. 
[Reprinted from the Annuai. Report of the Michigan State Board of Heaith 
for the Year 1884.] 
[Reprint No. 181. ] 
TRUTH. 
KMCmSAUJ STATE IBQAifffi ©F HEALTH 
SISAL. 
BY AUTHORITY. 
LANSING, MICH.: 
W. S. George & Co., State Printers and Binders. 
1 88 5. Compliments of 
Henry B. Baker, M. D., 
LANSING, MICHIGAN. THE RELATION OF THE DEPTH OF WATER 
IN WELLS TO THE CAUSATION OF 
TYPHOID FEVER. 
HENRY B. BAKER, M. D., LANSING, MICHIGAN. 
[ Reprinted from the Annual Report of tbo Michigan State Board of Health for the year 1884.] 
[ Reprint No 181. ] 
During the last six months of the year 1881, and the first three months of 
1882, sickness from typhoid fever was, I believe, much more than usually 
prevalent in the State of Michigan. The evidences of the truth of this state- 
ment are found in the Annual Reports of the Michigan State Board of Health ; 
and they consist of replies by regular correspondents to questions asked by the 
Board, f and of tables compiled from weekly reports of sickness, made by 
health officers and other prominent physicians in different parts of the State.J 
Of forty-three correspondents, eleven reported typhoid fever (and nine reported 
typho-malarial fever) unusually prevalent in 1881, while only one reported 
tvpho-malarial fever and not one reported typhoid fever as less than usually 
prevalent in that year. 
TABLE 1.—By year and months fur each of the six years 1S78-83, and on an Average 
for the Five Years 1878-82, stating on ichat Per Cent of the Weekly Deports of Dis- 
eases received Typhoid Fever was reported present. 
• YEARS. 
Year. 
Jan. 
Feb. 
Mar. 
Apr. 
May. 
June. 
July. 
Aug. 
Sept. 
Oct. 
Xov. 
Dec. 
At. 5 yr. 1878-82 
13 
12 
11 
8 
e 
C 
G 
8 
15 
22 
25 
23 
17 
1878 
10 
12 
9 
7 
4 
7 
G 
G 
10 
13 
18 
11 
12 
1879 
12 
6 
c 
8 
3 
4 
5 
14 
20 
24 
25 
17 
1880 
14 
8 
13 
7 
5 
C 
5 
10 
19 
26 
23* 
22 
17 
1881 
18 
13 
10 
7 
5 
G 
6 
12 
23 
35 
37 
32 
25 
1882 
14 
21 
16 
12 
8 
7 
9 
8 
11 
17 
23 
23 
16 
18S3 
11 
11 
7 
7 
7 
G 
7 
G 
11 
19 
21 
17 
14 
By the table (No. 1), which is here submitted, it may be seen that, begin- 
ning with July, 1S81, the sickness reported from typhoid fever was about fifty 
per cent greater than the average for corresponding months in the five years 
1878-1882, and it continued at this high rate until April, 1882. 
* This paper was read before the American Public Health Association, at St. Louis, Mo., October 
16, 18S4. 
t pp. 285-9, Report of Mich. State Board of Health, 1882. 
i p. 568, Report lor 1882, and p. 241, Report for 1883. DIAGBAMATIC TABLE No. 2.—Exhibiting Correspondence in Time and Place 
Between unusually Low Water in Wells and the Occurrence of Typhoid Fever, in Mich- 
igan in 1SS1. Data obtained from Replies by Correspondents and from Weekly Reports 
of Diseases. 
PLACES. 
z 
< 
FEB. 
MAR. 
APR. 
MAY. 
z 
3 
~3 
JUL. 
o 
3 
< 
SEP 
OCT. 
N OV. 
—H 
o 
u 
Q 
Ground water... 
rani 
Esmhsw. . 
Brock way 
Ground water .. 
St. Clair | 
Ground water... 
Typhoid fever... 
J 
Dc Witt.... j 
Ground water .. 
Typhoid lever .. 
t 
= 
■ f' 1'- 
== 
Otisvillc | 
Ground water... 
Typhoid fever... 
= 
F—-= 
st. Johns 
Ground water... 
~ 
Stanton j 
Ground water... 
Typho-mal. fever 
mil 
ill 
m 
Weliberv’le j 
Ground water... 
Tvr>ho| ! fcv»r 
==SXS?9 
Ty pho mm. level 
iiitti 
■ 
Niles | 
Ground water... 
m 
Ty pho mat. fever 
wd 
pi 
Pokagon ...j 
Ground water. 
Typhoid lever. 
== 
= 
r 
Typho-mal. fever 
liiMlfllliiiiliM 
St. Joseph., j 
Ground water... 
SnSiv 
Ty pho mal. fever 
Hillsdale... j 
Ground water... 
Typho-mal level 
Mill, 
Kalamazoo, j 
Ground water . 
- 
Typhoid fever . 
11 
==33 
Typho-mal. fever 
I I 
pm 
Ini 
Manchester. 
Ground water... 
m 
i 
Mention j 
Ground water... 
Tvphnid fever . 
=3=3= 
Typho-mal. fever 
J| 
illllllll 
Ifli 
Union City.j 
Gr >und wa ter . 
m 
Typhoid fever... 
r 
~ sa 
Tvpho-mal fevei 
il 
Vicksburg 
Ground water... 
Dearborn... j 
Ground water... 
t¥i 
Typho-mal. fever 
ill 
Northville j 
Ground wafer 
l y plum l lever .. 
Typho-mal. fever 
la 
ill 
j lilll 
m 
ill 
Pontiac j 
Ground water... 
Typhoid lever .. 
Tv pho mal. fever 
ill 
\\ ynndotte . 
'l'vphoid fever .. 
Water low. 
Typhoid fev. 
Typho-malarial 
fever. 
.V u.M>t‘go|i pas a general water-supply from a ravine on I he banks of which are privies. 91 
TYPHOID FEVER AND LOW WATER IN WELLS. 
For this increased prevalence of typhoid fever, a variety of supposed causes 
were alleged by the physicians who reported, but, taken altogether, the alleged 
causes seem at first sight nearly to negative each other, the number alleging 
excessive rainfall, wet soil, etc., at some time during the year, about equaling 
the number who alleged unusual drouth as the cause of the sickness. But by 
a careful study of the evidence relative to the condition of the soil and of the 
ground-water, immediately preceding and during the prevalence of sickness 
from typhoid fever, it is found that it was one of unusual drouth and low 
water in wells, in quite a number of different parts of the State, beginning 
with July, 1881, and that, although the rainfall later in the year was sufficient 
to make the surface-soil moist, the water in wells continued unusually low. 
It was especially low in July, August, and September, 1881. From reports 
by meteorological observers for the Michigan State Board of Health for the 
summer and autumn months in 1881 I quote as follows: Dr. J. S. Caulkins, 
M. D., of Thornville, says, “July has been a very hot and dry month. * * 
* Crops are badly injured by the drouth. August has been a dry, hot 
month. Vegetation has suffered beyond all record. At a short distance a 
pasture cannot be told from ploughed field. * * * The crops are 
almost a total failure.” Dr. Jas. S. lleeves says, “The driest ever known 
here.” For October, Dr. Caulkins says, “In spite of the heavy rainfall, 
water has not risen in the wells and springs, and below the wet there is a 
stratum of dry earth one or two feet in thickness.” At the close of the year, 
Dr. Caulkins reports, “ December has been a warm, open month, with scarce 
any snow, and very bad roads. There is no frost in the ground worth speak- 
ing of as the month closes. No ice in the lakes and streams. Water is still 
low in spite of all the rains we have had.”* 
I submit herewith a diagramatic table (No. 2) in which is summarized the 
evidence which seems pertinent, that was contained in replies by regular cor- 
respondents of the Michigan Board of Health, relative to the months in the 
year 1881, in which the ground-water, as observed in wells, etc., was unusu- 
ally low, and the months in that year in which typhoid fever occurred under 
their observation. It may be seen that in quite a number of localities observ- 
ers have made records which show either a coincidence between the low water 
and sickness from typhoid fever, or that the fever occurred in months suc- 
ceeding the low water. 
I have shown that the sickness from typhoid fever in Michigan was unsu- 
ally great in the last part of the year 1881 and first part of 1882 compared 
with other years, according to reports extending back to 1876. I submit 
herewith a table 3) showing that the deaths from typhoid fever were 
also unusually numerous in the year 1881, compared with other years. The 
mortality statistics extend back to the year 1866. 
I have compared reports of the meteorological and other conditions in the 
years 1881-82 with those for other years; and I find no condition, concerning 
which we have records, that varied in such manner as to explain the unusual 
prevalence of typhoid fever in those months, except the condition of the 
ground-water, as indicated by the lowness of water in wells. The tempera- 
ture of the atmosphere was unusually high during those months; but to high 
temperature of the atmosphere the causation of typhoid fever has never been 
directly traced; the disease occurs in cold as well as in hot climates, and 
* Dr. N. S. Davis reports a very dry summer in 1881, with an exceptionally high typhoid death- 
rate in Chicago {(.hicnyo Med. Jour, and Examiner, Feb., 1882, vol. 44, pp. 113-117); and a very 
destructive drouth appears to have prevailed during the summer of 1881, over a largo portion of 
the eastern United States (II. U. Clayton, Jr., in Am. Meteorolooical Journal, Aug., 1884). 92 
STATE BOARD OP HEALTH,—REPORT OF SECRETARY, 1884. 
TABLE 3.—Deaths Returned as having occurred from Typhoid Fever in Michigan, in 
each of the 16 Years 1S6T-S2, by Sex, and by Months. 
Months and Teak. 
SEX. 
Jan. 
Feb. 
| March. 
April. 
cC 
a 
June. 
P 
to 
p 
Sept. 
Oct. 
>■ 
o 
Dec. 
Unkno’n 
Month. 
Tear. 
Tears. 
Total 
36 
28 
16 
24 
22 
9 
3 
13 
19 
9 
10 
18 
6 
21 
13 
8 
42 
22 
60 
28 
32 
84 
43 
41 
79 
40 
39 
48 
24 
24 
31 
15 
37 
18 
19 
49 
29 
20 
38 
20 
18 
52 
*2 
361 
) 
Males 
21 
13 
ii 
1 
186 
V 1867 
Females __ 
15 
12 
11 
ii 
17 
8 
6 
14 
8 
6 
11 
20 
72 
1 
] 
175 
Total 
36 
28 
16 
24 
45 
27 
18 
51 
25 
26 
64 
430 
) 
Males 
21 
13 
37 
35 
70 
36 
40 
230 
V 1368 
Females 
15 
12 
11 
9 
6 
4 
12 
16 
1 
200 
Total 
17 
8 
18 
31 
18 
27 
16 
11 
16 
8 
21 
437 
) 
Males 
10 
19 
11 
10 
25 
228 
V 1869 
Females 
9 
8 
12 
8 
ir 
20 
209 
Total 
10 
17 
33 
12 
17 
17 
34 
106 
60 
117 
69 
94 
1 
574 
Males 
7 
11 
9 
6 
6 
18 
32 
38 
27 
25 
270 
1S70 
Females 
3 
6 
24 
6 
10 
u 
16 
32 
56 
58 
56 
1 
304 
Total 
16 
26 
25 
23 
25 
21 
15 
37 
18 
59 
41 
34 
32 
17 
15 
3 
357 
) 
Males 
8 
15 
8 
9 
13 
8 
9 
37 
22 
25 
23 
2 
192 
> 1871 
Females 
8 
11 
J7 
14 
12 
13 
6 
19 
16 
11 
i 
165 
Total 
15 
25 
26 
40 
25 
24 
14 
39 
106 
129 
97 
78 
39 
2 
620 
) 
Males 
6 
12 
13 
20 
15 
15 
7 
22 
59 
75 
54 
1 
340 
1872 
Females 
9 
13 
13 
18 
10 
9 
7 
17 
47 
54 
43 
39 
1 
280 
Total 
39 
45 
32 
39 
22 
24 
36 
62 
103 
144 
77 
50 
4 
677 
Males 
23 
22 
17 
24 
12 
14 
16 
37 
56 
83 
45 
34 
2 
385 
Females 
16 
23 
15 
15 
10 
10 
20 
25 
47 
01 
32 
16 
o 
292 
Total 
33 
23 
22 
24 
31 
13 
24 
30 
50 
104 
123 
92 
61 
3 
610 
1 
Males 
12 
16 
12 
16 
12 
13 
26 
59 
62 
46 
30 
317 
V 1874 
Females 
21 
7 
10 
8 
18 
12 
17 
24 
45 
61 
46 
21 
3 
293 
Total 
30 
16 
21 
23 
17 
22 
22 
29 
92 
63 
40 
3 
433 
) 
Males 
12 
10 
9 
16 
8 
15 
12 
15 
31 
50 
32 
22 
232 
V 1875 
Females 
18 
6 
12 
7 
9 
7 
10 
14 
24 
42 
31 
18 
3 
201 
Total 
18 
18 
19 
20 
17 
19 
29 
54 
82 
66 
49 
34 
1 
426 
Males 
8 
10 
11 
13 
8 
11 
13 
33 
34 
42 
29 
21 
233 
1876 
Females 
10 
8 
8 
7 
9 
8 
16 
21 
48 
24 
20 
13 
1 
193 
Total 
14 
13 
25 
18 
24 
9 
18 
54 
83 
85 
58 
43 
2 
446 
) 
Males 
8 
5 
10 
11 
11 
5 
11 
29 
44 
44 
32 
22 
O 
234 
V 1877 
Females 
6 
8 
15 
13 
4 
7 
25 
39 
41 
26 
21 
212 
Total 
11 
13 
16 
14 
21 
13 
21 
42 
54 
52 
41 
31 
329 
) 
Males 
3 
10 
14 
9 
9 
22 
28 
25 
25 
17 
176 
V 1878 
Females 
8 
3 
9 
7 
4 
12 
20 
26 
27 
16 
14 
153 
Total 
15 
24 
24 
23 
13 
11 
18 
48 
53 
61 
55 
52 
397 
1 
Males.. 
7 
11 
14 
10 
3 
10 
26 
26 
26 
27 
24 
190 
£ 1879 
Females 
8 
13 
10 
13 
6 
8 
8 
23 
27 
35 
28 
28 
207 
Total 
22 
13 
22 
28 
20 
19 
35 
73 
92 
87 
58 
44 
513 
Males 
9 
6 
10 
17 
13 
11 
23 
38 
58 
43 
31 
26 
285 
[• 1880 
Females 
13 
7 
12 
11 
7 
8 
12 
35 
34 
44 
27 
18 
228 
Total 
20 
15 
23 
34 
27 
35 
45 
99 
150 
178 
149 
108 
1 
884 
) 
13 
9 
14 
21 
14 
23 
26 
49 
79 
83 
93 
67 
491 
y i88i 
) 
Females 
7 
6 
9 
13 
13 
12 
19 
50 
71 
95 
56 
41 
1 
393 
Total 
31 
34 
30 
18 
35 
30 
20 
* 27 
52 
91 
53 
40 
2 
463 
) 
Males 
19 
20 
17 
11 
19 
15 
9 
13 
26 
54 
36 
28 
o_ 
269 
y 1882 
) 
12 
14 
13 
16 
15 
11 
13 
26 
37 
17 
12 
193 
Total 
363 
3.56 
397 
373 
344 
308 
395 
795 
1,289 
1,489 
782 
1,044 
675 
779 
25 
7,957 
4,258 
) 1867 
Males 
185 
199 
196 
213 
181 
169 
201 
424 
682 
441 
10 
> to 
Females.. 
178 
157 
201 
160 
163 
139 
194 
370 
607 
707 
469 
338 
15 
3,698 
11882t 
) 1878 
Total 
99 
99 
115 
117 
116 
108 
139 
289 
401 
469 
356 
275 
3 
2,586 
Average 
20 
20 
23 
25 
23 
9.0 
28 
53 
80 
94 
71 
55 
517 
f to 
; 1882f 
* Includes one " 
unknown sex.” 
t Inclusive. TYPHOID FEVER AND LOW WATER IN WELLS. 
93 
in cold as well as in hot seasons of the year; and although in Michigan it 
follows the hot weather of summer, in some other countries it follows the 
cold season. On the other hand, the disease has many times (hundreds of 
times, I suppose) been traced directly to the use of contaminated drinking- 
water. 
There is one other closely-related physical condition that it would seem 
may have influence in the causation of typhoid fever, namely, the temperature 
of water in wells, and of the fluids in privies. The temperature of water in 
wells is recorded and reported each month from some localities in Michigan; 
and some study has been given that subject in the preparation of this paper; 
but the changes in the temperature are so slight that it is difficult to see how 
they can have great influence. Moreover, any effect this may have is so 
hidden in the greater changes in the quantities of water in wells, usually 
coincident with if not one cause of the changes of temperature therein, that it 
is difficult to distinguish separate influences, if such there are. 
From the foregoing it appears that in Michigan there is a relation between 
low water in wells and the prevalence of typhoid fever; that this relation is 
found to hold by seasons of the year,—those months in which the water is 
lowest (or the months immediately following) being the months in which 
typhoid fever is most prevalent; and the unusual year 1881-2 when typhoid 
fever was more prevalent than ever known before, was also unusual because 
of the exceeding low water in wells. 
A relation of low water in wells to the prevalence of typhoid fever being 
considered established, several questions arise 
1. Is there a quantitative relation? That is to say: Is the amount of sick- 
ness from typhoid fever proportional to the amount of water in wells? 
2. Does the drinking-water cause the typhoid fever? 
3. What constituent of the drinking-water causes the typhoid fever? 
4. How can typhoid fever be prevented? 
5. What need is there for the prevention of typhoid fever in Michigan? 
IS SICKNESS FROM TYPIIOID FEVER INVERSELY PROPORTIONAL TO QUANTITY OF 
WATER IN WELLS? 
At first glance in may seem to be impracticable to measure and compare 
quantitatively such dissimilar things as water in wells and sickness from 
typhoid fever. Yet whenever we can get the statements of the facts such 
comparisons aro now not difficult. We have only to construct diagrams on 
the proper principle, and accurately drawn according to definite scales. It 
may be well to say here, that the way to do this is to so plan the diagrams 
and the scales by which the two or more things to be compared are to be 
shown that the extremes of the two or more things to be compared (the high- 
est and lowest statements in the diagram) shall be the same distance apart,— 
in which case the greatest range of the statements for each will appear to be 
the same. In a diagram prepared in accordance with this principle, if there 
is a fixed and definite quantitative relation between the things compared, it 
will be apparent; because the greatest ranges of the several things compared 
being made to coincide, the minor fluctuations will also coincide in the amount 
of space they occupy on the diagram. This will be true as regards the amount 
of the fluctuation, even though the fluctuations may not exactly coincide in 
point of time,—even though one of them, for instance, be constantly in 
advance of the other in time. 
This principle, just stated, has been held in mind in the preparation of the 
diagrams which I present to you, and which show the relation of the depth of DIAGRAM A.—Exhibiting, for a Period of Five Years (1878-82) the Average Monthly 
Oscillations of Ground-water in Michigan, the Deaths from Typhoid Fever, and what 
Per Cent of the JVeekly Repoi'tsTof Sickness Deceived Stated the Presence of Typhoid 
Fever. 
* Inches of earth above water in wells. 
t Of all weekly reports received, per cent stating presence of typhoid fever. 
Note.—The sickness-curve should rise and fall later than the curve for its cause by about the TYPHOID FEVER AND LOW WATER IN WELLS. 
95 
the earth above the ground-water in wells in Michigan, and the prevalence of 
sickness from typhoid fever in Michigan by months in each of the years J878, 
1879, 1880, 1881, 1882, and 1883, also an average for five years,—1878-82, 
this diagram also including statements of the deaths in Michigan from this 
cause during the same five years. In these diagrams, statements of the 
“depth of earth” above the water in wells, have been employed; because if 
statements of the “depth of water” in wells were used the scale would, if 
upright, have to be the reverse of that used for the statements relative to the 
sickness, and therefore would not bo as easy of comparison. In studying 
these diagrams, one will need to bear in mind that whenever the “depth of 
earth” over the water is great, the depth of the water in wells is low, and 
vice versa. 
WHAT THE DIAGRAMS SHOW. 
Iii the several diagrams which I present, the statements of the sickness from 
typhoid fever relate to the State of Michigan as a whole,—being summarized 
from weekly reports of physicians in many parts of the State. The wells 
measured for these diagrams are not the same in number in both years; and 
they are not the samo wells in both years; so that from the diagrams alone 
no comparison can be made of one year with the other as to the exact height of 
the water during the year as a whole, or of one month with the corresponding 
month in another year. The comparisons intended to be shown are of one 
mouth with the others in the same year. The number of wells was very few; 
but an examination of the subject seems to show that it is sufficient to fairly 
indicate for each year the rise and fall of the ground-water throughout the 
State,—the curves are as nearly alike as one would expect them to be in 
different years. 
From the diagrams it may be seen that, beginning with June in each year, 
the sickness from typhoid fever follows more or less closely the curve repre- 
senting the average depth of earth above the ground-water. If the sickness 
is caused by the low water there is a good reason why the curve of the sickness 
should folloiv the curve representing the lowering of the water; because the 
statement of the sickness is: What per cent of weekly reports received stated 
that typhoid fever was under observation during the week for which the report 
was made; and as the disease lasts for about three weeks, and as cases taken 
sick in preceding weeks will remain under observation until death or convales- 
cence and be reported together with those just taken sick, the curve for 
sickness would, when rising or falling, necessarily lag behind the curve repre- 
senting the cause of the disease, by about the average duration of the 
disease. As there is in this disease an incubation period of varying length, 
but which may be ten days, two weeks or even more, this would still further 
postpone the sickness, compared with a curve representing its cause. Usually 
a few days’ sickness pass before the doctor is called and the disease recog- 
nized and reported as typhoid fever. So that if low water causes the sickness, 
we would expect as a rule to find the changes in the amount of sickness to 
appear to lag behind the changes in the level of the water by about one month. 
This is very nearly what we do find shown by the diagram on page 94 rela- 
tive to the average for the five years, and with respect to each of the years 
length of the period of incubation plus about the av. duration of the disease; because the reports 
of sickness include all cases under observation, old cases and new cases. The time-unit of the 
diagram is so great (one month) that the interval between the two curves is sometimes greater and 
sometimes less than the interval between the supposed cause and its consequent sickness. DIAGRAM B.—Exhibiting the Iiise and Fall of Water in Wells, and of Sickness from 
Typhoid Fever, in Michigan, in each of the Four Years 1878-81. 
* Inches of earth above the water. 
t Of all reports received for the given month, the per cent stating the presence of typhoid fever. 
t Well-water high, but not protected by frozen ground; organic matter decomposing. 
§ Depth of earth above the water least,—water highest; least sickness from typhoid fever. 
|| Depth of earth above the water greatest,—water lowest; most sickness from typhoid fever, 
if Well-water low, hut protected by frozen ground. TYPHOID FEVER AND LOW WATER IN WELLS. 
97 
1878, 1880, 1881, and 1883,* namely, that the rise or fall of the disease 
appears to be greatly influenced in any month, after May or June, by the level 
of the water in that same month, but that the influence extends over into the 
succeeding month. 
The comparison between the depth of water in wells and the sickness from 
typhoid fever being so close for every month after June, what is the reason 
for the want of correspondence in several years from January to June ? By 
the diagram for the year 1881 it may be seen that the earth above the water 
increased from January to March and decreased from March until June, while 
the sickness seemed to decrease because of the low water in wells in March, 
and to increase in consequence of the rise of water in April. In considering 
this subject, it seemed to me that the cause of the low water in March, 1881, 
might be the great depth to which the ground was frozen ; and that the rea- 
son why the sickness was decreased might be that the privies and other sources 
of typhoid contamination were also frozen, and the liquid therefrom prevented 
from descending to the water in the wells. The water in the wells would then 
be derived in greater proportion by percolation from a distance, in some cases 
from streams not frozen. In either case, whether the water in wells came 
* It the diagrams were made by weeks instead of months it might be found that the relation is 
more definite and constant than appears by these diagrams; but this remains to be ascertained. 
DIAGRAM C.—Exhibiting the. Eise and Fall of Water in Wells, and of Sickness from 
Typhoid Fever, in Michigan, by Months, during each of the Years 1882, 1888. 
* Inches of earth above the water in wells, 
t I’er cent of reports of sickness from typhoid fever. 
j Well-water high, but not protected by frozen ground; organic matter decomposing. 
II Well-water low, but protected by frozen ground. 98 
STATE BOARD OF HEALTH,—REPORT OF SECRETARY, 1SS4. 
from a distant stream above ground, or from the general level of the ground- 
water, the ground above being frozen deeply, the water which enters the wells 
would be filtered much more slowly through the deep strata of the earth 
than is the case when rain passes freely down to wells through foul surface- 
soil. To learn whether this supposed explanation accorded with the facts, I 
have turned to the reports by the meteorological observers for the State Board 
of Health of Michigan, and I find they reported relative to the weather in 
the first part of the year 1881, as follows:— 
January.—“January was a very cold month. Ice about 25 inches thick; 
ground deeply frozen.”—JohnS. Caulhins, M. D., Thornville. “January 1881 
was the coldest, judging from its mean temperature, of any January since 
1875. The mean temperature was 14 degrees.”—Sergt. Jan. A. Banviclc, 
Alpena. 
February.—“Nights of February 23 and 24 were the coldest recorded since 
the first opening of the signal office in this city, minimum thermometer regis- 
tering-270.”—Sergt. Jas. A. Barwich, Alpena. “The month has been stormy 
and quite variable in temperature, which is below the mean of several years.” 
—JohnS. Caulhins, M. I)., Thornville. “Ground frozen four feet deep.” — 
Lee S. Cobb, Winfield. “ Frost four feet deep in the cemetery, soil, sand, and 
gravel.”—Francis D. Parmelee, Hillsdale. “Thickness of ice put up in ice- 
houses, 26 inches. Average depth of frozen earth in cemetery, 3 feet.”—Edwin 
Stewart, At. D., Mcndon. 
March.—“Ground frozen to the depth of 18 inches.”—Sergt. Jas. J. Fitzger- 
ald, Alpena. “ About five inches of snow on the ground as the month ends. 
Frost in the ground is not deep. The lakes and ponds are still frozen. A 
very wintry March,”—John S. Caulhins, M. D., Thornville. “Ice began to 
move in Grand River March 28.”—Lansing. 
April.—“Ice in bay beginning to crack in many places; will soon be 
gone; navigation not yet open.”—Sergt. Chas. Bill, Escanaba. “ Frost dis- 
appeared from the ground about the 25th. Navigation opened on the 29th.” — 
Sergt. Jas. J. Fitzgerald, Alpena. “April has been a cold, backward month, 
and closes with the prospect not improved. Remains of snow drifts were seen 
as late as the 22d.”—John S. Caulhins, M. D., Thornville. “Depth of ground 
frozen, three and one-half to four feet. Time of disappearance of frost from 
the ground, about the 25th.”—H. Peters, M. D., Tecumseh. 
The great depth to which the ground was frozen in February and March 
will, I think, explain the great freedom from typhoid fever in Michigan in 
March, 1881. If this is the true explanation, it indicates that the condition 
of the low water in wells is generally not productive of typhoid fever when the 
comparatively low water is protected by a deep freezing of the privies, cess- 
pools, and the general surface of the earth. We have previously seen, and 
it is apparent from several of the diagrams, which I present, that from June 
to December loio water in wells is not favorable to freedom from typhoid 
fever. 
Turning now to the diagram representing the relation of water in wells to 
typhoid fever in Michigan in the year 1880, it is noticeable that in the early 
months of that year the water was high (the depth of earth above it was not 
great), and that the typhoid fever was also high. The reasoning adopted 
relative to the early months in 1881, where the deeply-frozen ground was 
believed to have prevented typhoid fever, would lead us to suppose that the 
well-water was not protected by frozen ground in 1880. Inspection of the 
records (in the Annual Report of the Michigan State Board of Health) shows TYPHOID FEVER AND LOW WATER IN WELLS. 
99 
that this is true, that in Michigan the earth was not as deeply frozen as usual 
during the months of January and February, 1S80. In January, the average 
temperature for 15 stations in different parts of Michigan was above the freez- 
ing point, being 34.00° F. In February, the average was 27.93°, and in 
March, 31.00° F. Dr. Stewart, observer at Mendon in southwestern Michi- 
gan, reported: “Considerable plowing has been done in this county during 
the month of'January;” Dr. Caulkins, observer at Thornville, reported for 
January, 1880: “There is no snow, no ice in streams and ponds, and 
scarcely any in the ground.” Dr. Peters, of Tecumseh, reported for Febru- 
ary: “Frost all out of the ground February 28. Streams froze up and 
thawed out three times during winter, ice at no time more than six inches 
thick. Not more than half the usual amount of ice was put up.” Dr. 
Caulkins reported for February: “The ice crop is a total failure. February 
has been very mild for this latitude, and so much freezing nights and thaw- 
ing days has materially injured the clover.” 
The unusual prevalence of typhoid fever in Michigan in February, 1880, is 
probably fairly attributable to the unusually mild weather in January and 
February, and to the lack of protection usually afforded by the frozen ground 
at that season of the year to the water in wells, which water, by reason of the 
injury to vegetation by alternate freezing and thawing, was probably unusu- 
ally contaminated by decomposing organic matter, in addition to the leaching 
from privy-vaults.* 
From the evidence in the tables, diagrams, and comments in this paper, it 
may be seen that not only in the spring of 1880, but in the early part of other 
years, typhoid fever was prevalent coincidently with an unfrozen surface of the 
ground. The year 1882 is another example of high ground-water and high 
rate of sickness, during the first few months of the year. By reference to the 
reports of meteorological observers for the Michigan State Board of Health it 
is found that February and March, 1882, were unusually mild months. The 
observer at Lansing records for February : “Frost Feb. 9. River opened Feb. 
13, closed Feb. 21, and opened again Feb. 25. Robins came back Feb. 22.” 
Dr. Caulkins writes at the close of February: “Nights that no ice formed, 7, 
12, 13, 1G, 27, 28. A warm and pleasant month for the season, with no sleigh- 
ing, and noteworthy for the six days without freezing. Wheat seems not to 
be in the least injured by the freezing and thawing and the lack of snow, but 
looks excellent. As the month goes out there is not a particle of ice in sight, 
*In this connection tlie following from the Massachusetts'Board of Health Report for the 
year 1871 is of interest:— 
“A large house in this village [Sutton] is supplied with water from a well in the front yard, 
three rods from the house. Connected with the house is a barn without cellar, some three rods 
from the well. In December, 1868, a trench three or four feet deep was dug from the well to a 
point near the middle of the barn, where a pump was set and a pipe connecting it with the well 
was laid in the trench; after which the earth, which was in large frozen chunks, -was filled back 
into the trench. In the house was kept a boarding-school for boys, of whom there were ten or 
twelve. Three little girls were also there, aged twelve, eight, and three years, belonging to the 
family of the owner of the house; there were therefore fourteen or fifteen children who drank 
from the well. The oldest boy was seventeen or eighteen years old, while the others were of 
ages from ten to thirteen. Everything went well until after the thaws in February and March, 
1869, when the water had a decided taste and smell of stable-manure. March 26, one of the boys, 
thirteen years old, was seized with typhoid fever; another, twelve years old, on the 31st of March; 
another, eleven years old, April 2; another, ten years old, April 4; and another, twelve years old, 
April 9. April 20, one of the little girls (eight years old) was seized. Each of these six children 
<all of whom finally recovered) drank water with their meals from the well in the yard. Some of 
the older boys drank coffee in the morning and tea at night. The manner in which these children 
were attacked, and the fact that this house had been free from typhoid fever for many years, and 
the water heretofore known to be very pure and wholesome, leads me to the conclusion that the 
use of the water thus impregnated was the cause of the disease occurring where and just at the 
time it did. My theory is that while the ground, manure, etc., under the barn were frozen, the 
water was all right; but when it thawed, and the previously frozen filth leached through the soft 
and loose earth along the track of the pipe into the well, the effect of the poison was felt most 
perceptibly by those who used the polluted water most freely, while those who used it less freely 
escaped entirely.” 100 
STATE BOARD OF HEALTH-REPORT OF SECRETARY, 1884. 
and little frost in the ground. Robins came back as early as Feb. 22, and blue 
birds soon after. Blue flies and mosquitoes have been seen.” Dr. Oaulkins 
writes again at the close of March : “ March in spite of some cold weather, 
has been a warmish month. As it closes there is scarcely any ice in the ground. 
Wheat looks uncommonly well, but the last year’s seeding pt clover is pretty 
much all killed by the repeated freezings.” 
We thus reach the conclusion that, in Michigan at least, the relation of the 
depth of water in wells to typhoid fever is not the same in summer as in win- 
ter; that in summer when vegetation is active and not decaying, a lowering 
of the water is uniformly followed by increased prevalence of typhoid fever; 
with the advent of colder weather, there is a rise in the water-level which is 
uniformly followed by a decreased prevalence of the fever; that this decrease 
continues through the winter and spring, even though the level of the well 
water is lowered, provided the surface of the earth is deeply frozen ; that on 
the contrary, high water-level in wells in winter and spring, coincident with 
ground not thoroughly frozen, is followed by increased prevalence of the 
fever. Briefly stated, the typhoid fever follows low water in summer, and 
high water at that season of the year when the ground is usually thoroughly 
frozen. (Although I find little evidence of it as yet, we may expect to find 
that high water in winter and spring may not necessarily be followed by 
increased prevalence of fever, if it is coincident with a deeply and continu- 
ously frozen surface of the ground.) 
As regards bronchitis, pneumonia, and other diseases caused by cold weather, 
it does not seem to be true that they are more prevalent in a mild than in a 
severe winter. But as regards typhoid fever in its relations to contamination 
of ground-water, as herein set forth, there seems to be a partial explanation 
of the old saying, “A green Christmas makes a fat graveyard.” 
WIIAT CONSTITUENT OF TIIE DRINKING WATER CAUSES THE TYPHOID FEVER? 
Typhoid has been known to occur after the drinking of water contam- 
inated by decomposing vegetable matter (turnips in one instance*); by 
decomposing animal matter (a turtle in one instancef); also in the autumn 
succeeding a hot summer in which diarrhea had been unusually prevalent; 
and the unusual fouling of the water-supply by the extra quantity of fecal dis- 
charges under these circumstances has been supposed to have causative rela- 
tion to the typhoid fever which succeeded it. All this receives explanation if 
we accept the doctrine that typhoid fever is caused by bacteria; because 
bacteria require for their growth and multiplication a nutritive solution,— 
either mineral (such as Pasteur’s), or vegetable, or animal, very few, if any, 
of the many species of bacteria being able to reproduce themselves in great 
numbers in pure water. This last statement seems to me to be evident to 
those who have used the microscope much; yeti may quote from a high 
authority as follows: Dr. Robert Koch, in his recent address on cholera, 
before the Imperial German Board of Health, is reported to have said: “I 
would not certainly assume that the multiplication of the comma-bacillus 
outside of the human body takes place in well-water or in river-water without 
any assistance, for these fluids do not possess that concentration of nutritious 
substances which is necessary for the growth of the baccilli.”J Dr. Koch 
was, however, able to reproduce the comma-bacillus in meat juice, and other 
* Sanitary Record, London, Jan. 29, 1876, vol. iv., pp. 81-82. 
t Annual Report Mich. State Board of Health, 1876, pp. lxii-lxiv. 
$ British Medical Journal, Sept. 6, 1884, page 456. TYPHOID FEVER AND LOW WATER IN WELLS. 
101 
nutritive solutions. After mentioning the growth of bacteria in stagnant 
water, and that “ the continuous flow of water prevents the formation of a 
local concentration of nutritive substances in the liquid sufficient for patho- 
genic bacteria,” Dr. Koch further says:* “The connection between the 
falling of the subsoil-water and the increase of several infectious diseases, I 
would explain as follows: that when the subsoil water falls, the current that 
takes place in the subsoil-water is much less significant. Besides, the quanti- 
ties on the surface are much diminished, so that those concentrations, which 
I assume to be necessary for the growth of the bacteria must much sooner 
take place.” I venture to suggest that the evidence we now have of the 
causation of typhoid fever renders it necessary that we substitute for Dr. 
Koch’s diminished quantities of fluids “on the surface,” diminished quanti- 
ties of water in wells as more directly causative of typhoid fever; because that 
disease is not frequently traced to transmission through the air, but is fre- 
quently traced to the use of bad water; so that aside from such evidence as 
that which I present to you at this time,—we have good reason to believe that 
in some wav typhoid fever is frequently caused by the drinking of contamin- 
ated water. The cases recorded are exceedingly numerous. References to a 
few of them are as follows:— 
A mild, extensive epidemic or typhoid fever occurred in Neuchatel, Switzerland, in the fall of 
1882. There were six hundred and twenty-three cases between September 14 and October 20, and 
the total cases in the period covered by the epidemic, included 5 per cent of the entire population. 
All classes were taken and the outbreak occurred in all parts of the city at the same time. The 
water drinkers suffered most, and, so far as reported, those who drank only beer escaped 
entirely. 
The city water supply is brought by an aqueduct from the Seyon, a mountain stream, torrential 
in spring and during rains, but small in summer. This stream with its affluents drains the Val-de- 
Ruz, and on its banks above Neuchatel are many small villages. A careful investigation author- 
ized by the government, showed the following condition: The drinking water is taken from the 
Seyon directly below the town of Valangin; there are twenty other little villages higher up the 
valley. Slaughter-houses, pig sties, cess pools, sewers, and privies were found in close proxim- 
ity to the stream, and with liquid contents oo/.ing in some cases directly into the stream. A 
public laundry much used by several villages is also situated on the banks of the stream and the 
wash water flows directly into it. Ordinarily the water of the Seyon is pure, but during heavy 
rains tlio filth from above mentioned sources is washed into the stream in large quantities and 
gives to it a turbid aspect. A committee which examined the condition of the Seyon below Val- 
angin and above the point from which the Neuchatel water-supply is taken, immediately after a 
heavy rain, declared the stream to be “ nothing but a vast drain, the water being absolutely unfit 
for alimentation.” Some weeks prior to this outbreak at Neuchatel, there had been cases of 
typhoid in nine of the small villages above Neuchatel, and also about fifty cases of an infectious 
gastritis, thought by some to have been a mild typhoid. These cases were followed by a series of 
heavy rains, and these in turn by the typhoid outbreak at Neuchatel. In the fall and early win- 
ter of 1875 after continued heavy rain there was an analogous outbreak of typhoid fever in Neu- 
chatel preceded some weeks by sporadic cases of the fever in the Val-de-Ruz. (L’Eau du Seyon 
et La Fievre Typhoide a Neuchatel. Par Dr. Guillaume. Neuchatel, 1882.) 
NEUCHATEL OUTBREAKS. 
NEUCHATEL R. R. STATION OUTBREAK. 
Dr. Favarger relates (Feuilles d' Hygiene, November, 1879) that being called in the early part of 
1878, as physician to the railroad company, to care l'or a series of more or less grave cases of 
typhoid fever (14 cases, 3 deaths), confined exclusively to the employees of the railroad station at 
Neuchatel, he made an investigation and found that some weeks previous the son of an engineer 
in charge of the water-works had been taken with the fever, and had been cared for in the build- 
ing which contained the hydraulic ram used for forcing water from the lake into a reservoir from 
which the station eating-house and the locomotives were supplied; he found that a portion of the 
excreta of this boy had passed into the lake near where the water-supply was taken and had 
undoubtedly been pumped into the reservoir, and then consumed by the employees of the station. 
—(Cited by Dr. Guillaume, as above.) 
* British Medical Journal, Sept. 6, 1884, page 456. 102 
STATE BOARD OF HE ALTH—REPORT OF SECRETARY, 1884. 
At the college of Branham, Yorkshire, Eng., two pupils were taken with typhoid fever in Feb., 
1869, the discharges being thrown into the water closet. Toward the end of the next month there 
was, all at once, an outbreak of 16 cases of fever in the school. Investigation showed (1) that all 
the pupils ate the same food, while only a part were stricken; (2) that the beer drinkers were 
regularly spared by the disease; (3) that the disease seemed to single out the water-drinkers. 
These facts threw suspicion on the drinking water. Further investigation showed that a defect- 
ive soil-pipe had allowed the typhoid excreta to pass from the water-closet into a reservoir of 
fresh water, and that the well water had been polluted by infiltrations from this reservoir. The 
fact that the food was cooked in this water would go to show that heat destroyed the typhoid 
poison.—(Dr. Anker, as quoted by Dr. Guillaume.) 
BRANHAM SCHOOL OUTBREAK. 
UPPINGHAM OUTBREAK. 
During the month of Oct., 1875, fifty-one cases of typhoid fever occurred in a school at Upping- 
ham, England. There had been one case of this fever (terminating fatally) in this school in the 
preceding June, and no sanitary precautions had been taken. The lad died at the commencement 
of the midsummer holidays. Two cases occurred between Sept. 21 and Sept. 28; and twenty-eight 
others between this date and Oct. 12, up to which time no sanitary precautions appear to have 
been taken. The excreta from these cases went into large, full, and extremely foul cess-pools 
in proximity to the wells,—afterwards shown to be polluted. The contents of some of these cess- 
pools was pumped upon the garden for fertilization purposes, and drained into a stream in the 
polluted water of which, the boys were accustomed to bathe. The sewer-gas from these cess- 
pools, into which the typhoid excreta were thrown, penetrated almost without hindrance, not only 
the water-closets, but also the living and study rooms of the school. It will thus bo seen that, 
whether the cause of the fever was gaseous or particulate, given a first case in this school there 
was apriori every reason to suppose the disease would spread as it afterwards did. This outbreak 
was carefully investigated by Dr. A. Haviland, Medical Officer of Health, who considered the out- 
break to be the result of gross neglect on the part of the school authorities and the physician in 
charge.—(The Late Visitation of Typhoid Fever in the School and Town of Uppingham. London. 
E. & F. Spon, Publishers.) 
ARMLEY OUTBREAK. 
In an epidemic of typhoid fever occurring at Armlcy, in the Borough of Leeds, England, which was 
investigated by Dr. Ballard, of the Local Government Board (Reports of the Med. Officer of the Privy 
Council and Local Gov’t Board, New Series, No. II., London, 1875, Pg. 79-91), one hundred and seven 
cases occurred between July 7 and Sept. 7, 1873. The milk supplied by a certain dairyman, who had 
himself been 111 of this disease in May, was shown to be the cause of the outbreak. “ The manner in 
in which the fever picked out the customers of the dairyman in various rows and blocks of houses, 
sparing other families, was indeed remarkable. * * * * As to the mechanism of the dis- 
tribution of the fever from the dairyman’s premises, there arises at the outset a question which it is 
desirable to answer, but to which, in the nature of things, a direct answer can hardly be expected. 
Was it water added to the milk that produced the enteric fever among families supplied from the 
dairy ? No one knows anything of enteric fever being propagated by cow’s milk per se, while there 
is very ample knowledge about the spread of such fever by means of water. The following consid 
erations lead one to believe that it really was not through milk, but through water added to 
milk, that the customers of Hall Lane dairy got their infection of enteric fever. Houses occupied 
by families supplied from this dairy were invaded freshly, one after another, almost every day 
up to July 27; on that day three houses so occupied came freshly under medical notice; and from 
that day the epidemic, as such, was at an end. In the whole of the next week only one family 
dealing with the Hall Lane dairy applied newly for medical aid. This sudden cessation of the 
fever epidemic among this section of the community on July 27, means that the cause of the epi- 
demic had ceased for them a fortnight or more previously, since in enteric fever there are com- 
monly 11 days of incubation and several other days before medical advice for its symptoms is 
sought. July 10 would therefore be about the time when the cause of the epidemic among custom- 
ers of the diary suddenly ceased to operate. Now, on July 10, Dr. Robinson had the handle of the 
pump at the Hall Lane dairy chained up, and thenceforth it was kept chained. There was coinci- 
dence therefore between the cessation of the fever and the cassation of the opportunity that the 
dairy had to supply a particular water; while there was no suggestion that the cows or their milk 
had undergone any change.” Did subsequent investigation of the water supply (in which the 
milk cans were known to have been washed) show it to be contaminated ? Dr. Ballard leaves no 
doubt on this point. He says that the entire premises were in a filthy condition. Close to the well 
was an old urine tub in use; a very large dung pit full of filth and manure was situated about 15 
feet from the well in one direction; and the privy used by three cottages (and full of liquid excre- 
ment) was only a little farther off in an opposite direction. This well was 36 feet deep, loosely TYPHOID FEVER AND LOW WATER IN WELLS. 
103 
bricked up without cement for upper 22 feet, the lower 14 feet being in shale. “For the iirst four 
feet from the top of the well the outside of the brick work was padded with clay, but not lower. 
All the way down below the place where the pudding ceased there was observed an oozing of black 
matter between the bricks, and below the spot where the brick work ceased the oozing was con- 
siderable, as shown by the staining of the stony portions of the soil, and by a black stain, 12 inches 
wide, on the side next the dung-pit, reaching to the water two feet lower down. There was a 
deposit of mud and filth at the bottom of the well which gave off abundant bubbles of gas on being 
disturbed.” Analysis of the well-water showed much contamination from fecal matters. There 
had been considerable rain in the last part of May, toward the close of the dairyman’s sickness.— 
The excreta had been thrown into the privy and also, in all probability, owing to the slovenly 
habits of the family, into the dung pit and the urine tub, which were very near the well. 
LAUSANNE (SWITZERLAND) OUTBREAK. 
“The case in which the poison of typhoid fever mixed with drinking water was transmitted 
through nearly a mile of porous earth, and which was mentioned in the abstract of my discourse 
o the Fellows of the Chemical Society (Nature, Vol. xiii, p. 331), is fully described (in German) in 
lhe Cth Report of the Rivers Commission on the Domestic Water Supply of Great Britain. It will 
shortly appear, in English, in the Monthly Journal of the Chemical Society. Meanwhile perhaps 
I may be allowed to trespass upon your space with the following remarks:—The outbreak of 
typhoid fever occurred at the village of Lausen, near Basel, Switzerland, and it was exhaustively 
investigated by Dr. A. Hagler of Basel, who has given a full account of it iD the ‘ Deutsches Archiv. 
f. Klin. Med. xi.’ The source of the poison was traced to an isolated farm house on the opposite 
side of a mountain ridge, where an imported case of typhoid, followed by two others, occurred 
shortly before the outbreak. A brook which ran past this house received the dejections of the 
patients, and their linen was washed in it. This brook was employed for the irrigation of some 
meadows near the farm house, and the ellluent water filtered through the intervening mountain 
to a spring used in all the houses of I.ausen, except six which were supplied with water from 
private wells. In these six houses no case of fever occurred, but scarcely one of the others 
escaped. No less than 130 people, or seventeen per cent of the whole population, were attacked, 
besides fourteen children, who received the infection whilst at home for their holidays and after- 
wards sickened on their return to school. 
“ The passage of water from the irrigated meadows to the spring at Lausen was proved by dis- 
solving in it, at the meadows, 18 cwt. of common salt, and then observing the rapid increase of 
chlorine in the spring water; but the most important and interesting experiment consisted in mix- 
ing uniformly with the waterfiOcwt. of Hour, not a trace of which made its way to the spring, thus 
showing that the water was filtered, through the intervening earth, and did not pass by an under- 
ground channel. * 
“ These are the main features of the case, according to the works above cited. It affords a clear 
warning of the risk attending the use, for dietetic purposes, of water to which even so-called puri- 
fied sewage gains access; notwithstanding that, as at Lausen, such water may have been used with 
impunity for years, until the moment when the sewage became infected with typhoid poison. E. 
FRANKL AND." Quoted from Public Health, April 14, 1876, page 266. 
SYRACUSE (N. Y.) OUTBREAK. 
The history of this outbreak is very clearly set forth in an article on “Typhoid-Fever Poison,” 
(.Popular Science Monthly, N. Y., Feb. 1879,) by Dr. Eli Van de Warker. Sixteen cases of the fever 
were traced to one previous case, and the subsequent defilement by excreta from this case of one 
of the neighborhood wells by overflow of privy duringa heavy rainstorm. People living on the 
same block or across the street, and under similar conditions except as to the water which they 
drank, escaped entirely, although many of these same people were up night and day caring for the 
affiicted families. 
GERMAN TROOPS AT WITTENBERG. 
In some respects one of the most interesting outbreaks of typhoid fever ever recorded occurred 
in the summer of 1882, among the troops of the third Brandenburg Infantry-Regiment, garrisoned 
at Wittenberg, Germany. 
A full and admirable report of this outbreak by Staff Surgeon Dr. Gaffky, is given in the last vol- 
ume of the Report of the Imperial German Board of Health (Mittheilungen aus dom Kaiserlichen 
Gesundheitsamte, Band II., Berlin, 1884), pages 403-420. 
Between June Hand July 12 there were ninety cases of the fever. This outbreak occurred very 
suddenly, and was confined almost exclusively to the troops of one battallion of the Regiment.— 
Citizens upon whom part of these soldiers were quartered escaped, as did also the officers. This 
sudden and severe epidemic at once attracted government attention, and the investigation which 
followed is very characteristic of the thorough way in which the Germans do things. Dr. Gaffky 
was detailed to make the investigation, with the approval of the Minister of War, and under the 104 
STATE BOARD OF HEALTH,-REPORT OF SECRETARY, 18S4. 
direction of the Imperial Board of Health. By a rigid induction, every step of which is clearly 
detailed, Dr. Gaffky reached the conclusion that some weeks previous to the outbreak the well in 
the yard at the barracks had been infected by innumerable “typhoid seeds” from a neighboring 
privy, and that the use of the water of this well was the cause of the sickness. The citizens, offi- 
cers, and soldiers not attacked escaped because they did not use the water of this well. 
Two wells supplied the water used by the troops. Chemical analysis and careful inspection 
showed both wells to be badly contaminated, but in different ways. One well was situated in the 
yard of the barracks, near a privy. The water of this we 1 was used for dish-washing, washing 
canteens, and scrubbing purposes, and to some extent for drinking purposes, but was not used for 
this purpose by the officers nor by many of the troops because the water was not so good as that 
brought from the street well. Into the privy typhoid excreta had unquestionably been thrown 
in the months immediately preceding this outbreak. The strata between this privy and the well 
were for the most part coarse sand and gravel, easily permeable. The privy vault had two open- 
ings in its walls and through these its liquid contents had oozed into the surrounding soil. Its 
subsequent movement into the ground-water ana thence into the well was facilitated by three 
factors, (1) the lowness of the water in the well, (2) the increased amount of water which was 
drawn from the well at that season of the year, and (3) the movement of the ground-water itself 
which was found to flow from the privy toward the well. 
The other well, much used by the citizens as well as by the troops on account of the better 
appearance and taste of the water, is located in the middle of the neighboring Burgomaster street. 
No cases of fever resulted from drinking the water of this well, although it was very foul. The 
manner of defilement of this well was as follows:—The horse-dung anil other filth and rubbish of 
the street was supposed to be washed by rains along a pavement gutter to the northward away 
from this street well; but owing to a settling of the pavement there was a sag towards this well, 
and during rains the wash of the street actually poured into the well, and was pumped up and 
drank. This was not all,—beneath the pavement there was found a well-defined little gutter 
leading directly into the well. This befouling of the well had apparently occurred during every 
rain, for along time, and yet no typhoid fever resulted from drinking this water, because no typhoid, 
germs had ever found their way into this well. If typhoid dejections had at any time been cast into 
the street they would in all probability have been washed into the well during the next rainstorm. 
The author thinks there is no reasonable doubt that in such an event an epidemic such as was 
traced to the well in the yard at the barracks would also have resulted from drinking the waterof 
tho Burgomaster street well. 
In the fall and winter of 1883-4 an outbreak of typhoid fever occurred at Adrian, Michigan, in 
which there were fifty-three cases, witli eight deaths. Over one-third the cases were pupils at a 
German Lutheran school in the house of the teacher, which house had for many years been used 
as a hotel, and at which was a well (in use by the family, the pupils, and others) very near which 
(from 25 to 56 feet) were an overflowing privy-vault, several old filled privy-vaults, two other 
privy-vaults in use, and a barnyard; there was also a drain or sewer (laid in June, 1883) in which, 
six feet from the well, was a leak from which the contents of the sewer flowed toward the well, 
forming a little cess-pool in the gravelly soli only 3 feet from the well-wall, which was of brick 
laid up without mortar,* and from which cesspool the contents undoubtedly leached into the well. 
The well was 36 feet deep, with four feet of water at time of examination, October 24. Exam- 
ination of the water with a microscope revealed vibriones and other organic matter, animal and 
vegetable. Analysis of the water showed sewage contamination. Twenty-one (of about eighty) 
pupils were sick, all of whom presumably drank of the water. Thirteen other persons who used 
water from the well were sick. Of the other nineteen cases eighteen were in the families of 
pupils or of persons who used the water and were sick, and but one was not traced thus directly 
or indirectly to this well, and he attended another German school in the neighborhood of this 
well. 
The first case was a son of the teacher (about six years old), and was taken sick September?. 
Discharges from this patient were thrown into a catch-basin three feet from the well, connecting with 
the drain or sewer, and into which catch-basin passed the overflow from the pump. Because of 
the leak above mentioned, if not otherwise, these typhoid discharges without doubt reached and 
infected the already foul water of the well. September 24, seventeen days after the first case was 
taken sick, the second case occurred. The third came down September 27, both in persons using 
water from this well. The fourth case attended a German school on a lot in the rear of the lot 
where the bad well was, and cornering with it, but it is stated did not use water from this well. 
He came down October 1. Cases from the fifth to the thirty-fourth, inclusive, came down from 
ADRIAN OUTBREAK. 
* According to another statement, the wall of the well had been relaid in water-lime in June before 
the sickness, at a time when it hail been found necessary to have the well cleaned, the water hav- 
ing been reported as bad, pieces of dead earth worms having been brought up by the pump, at 
which time the drain or sewer was laid. Whether all or part of the wall was relaid in water-lime 
does not appear. TYPHOID FEVER AND LOW WATER IN WELLS. 
105 
October 2 to October 22 .is follows: Two, October 2; one, October 5; one, October 6; three, October 
7; six, October 8; four, October 9; one, October lb; two, October 11; one, October 14; one, October 
15; one, October 16; two, October 17; one each, October 19, 20, 21, and 22; ar.d one ntadate not so 
definitely ascertained. Of these 30 cases 20 were pupils of the school, 9 were other persons who 
used water from this well, and one (a brother of one of the pupils taken sick Oct 9) was a pupil at 
a third German school, across the street and about 12 rods from the one where the bad well was, and 
was himself taken sick Oct. 9, but is said not to have drank from the bad well. 
'1 he physician who treated the first and third cases was called to the third (his second) October 
4, which day, at his request, the. use of the water from this well was discontinued; but before the 
use of the water was discontinued the 30 persons (pupils and others who used the water) who 
were taken sick from October 2 to October 22 had an opportunity to become infected from this 
water. 
After October 22d there were no morejnew cases till November 5th; then began a second series 
of 19 cases, all but two of them in the families (mostly in two families) of previous cases, which 
19 cases were taken sick at dates as follows: One each, November 5, 7, 8, 13, 19, 21,24, 27, 28, Decem- 
ber 1, 4, 13, 15, 19, 25, January 1 (1834), 4. 7, and April 1. Of these, 8 were in one family (and its near 
and neighboring relatives), the first case in which was one of the pupils taken sick October 7, the 
second case being taken sick November 24; and four were in a family, the first case in which was 
the pupil taken sick October 15, and the second case was taken December 1; two (taken Nov. 13 and 
Nov. 21) were in a family in which two cases (one of them a pupil at the bad well) were taken sick 
Oct. 9; three were in three families in which had been sick pupils, taken sick October 8, October 
9, and October 8, and in which ihe second cases were Nov. 8, Nov 5, and Nov. 19, respectively; one 
of the other two was a near neighbor of a family in which were five cases; and one attended the 
German school across the street from the bad well and drank from that well. Two of the second 
series of cases were users of water from the bad well, one of them being a pupil at the school 
where t at well was. Concerning these it does not appear whether they used the water after it 
was infected by discharges from the first case (taken Sept, 7). The interval is so great between 
the discontinuance of the wTater (Oct. 4) and the coming down of these two cases (Nov. 7 and Nov. 
19) as to make it seem likely that they were infected in someother way than by water drank before 
Oct.4. Concerning the two cases in the first series who are stated not to have used water from the 
bad well, it should be remembered that they attended schools near that well, one of them had a 
sister attending the school where the bad well was, and it does not seem unlikely that they may 
have visited the playground and drank at the bad well, as one pupil of the school across the street 
from the bad well is stated to have drank at that well. 
Where and how the first case in this outbreak contracted the fever is not known, but typhoid 
fever is known to have occurred in a house near the school the year previous to this outbreak. 
A longer report of this outbreak (not, however, including all the cases) is printed on pages 36- 
47 of the Report of the State Board of Health for 1884. 
It appears to be established conclusively that in this outbreak the fever resulted from the use 
of foul well-water, after it had become infected by the specific discharges from a first case. The 
facts developed may be summarized as follows: 
1. Filth conditions likely to contaminate this well (the nearness of the privy-vaults and the barn- 
jrard) had existed for a long time without, so far as known, causing a case of typhoid fever. It had 
been found necessary to clean the well in June before the sickness. The leaky drain laid in June 
became another source of contamination. Unless M. II. (the teacher’s son) was infected with the 
foul water, no case of typhoid fever resulted from the use of the foul water until excreta (con- 
taining the specific typhoid germs ?) from a case (M. H., the first case) of typhoid fever were intro- 
duced into the water. Then, after about the usual period of incubation, other cases followed rap- 
idly. If the teacher’s son, M. H., was infected by water from the well, it seems strange that of the 
large number of persons using water from this well, no one else should have been infected at that 
time, and that no other case occurred till 17 days after the first, especially as so many of those sub- 
sequently infected by the water were near the age of this first case, about six years. 
2. After the first case of the fever occurred (September 7), seventeen days elapsed before the 
second case (September 24). This may indicate that the period of incubation was, in that case, 17 
days; or if we call the period of incubation 11 days, it was six days after the first case was taken 
sick before his discharges were capable of causing the disease; or it took six days for the dis- 
charges to reach and so infect the body of water in this well as that it could cause typhoid fever. 
The third case occurred September 27, and the other cases followed rapidly (thirteen of them com- 
ing down on the three days, Oct. 7, 8, and 9) until October 22. 
3. The use of the we) 1-water ceased about October 4. . 
4. In tlie first series, new cases ceased to appearabout 18 days after the use of the water from 
the condemned well was discontinued. 
5. In the first series of cases, out of about 80 members of this school 20 had the fever, and all of 
these arc believed to have used water from the infected well. 
6. In this series, fourteen other persons, not members of the school, had the fever. All but two 106 
STATE BOARD OF HEALTH,—REPORT OF SECRETARY, 1884. 
of these used the water of this well, occasionally or habitually; one of the two was a brother of' 
one of the sick pupils. 
7. The lirst series of 34 cases, with possibly one exception, was confined to persons using the water 
from this infected well. 
8. The second series of 19 cases, beginning Nov. 5 and ending April 1, could not have been derived, 
directly from the school well (a) because but two of these persons used its water, and (b) because 
the first case of this second series occurred Nov. 5, 32 days after the use of the well water was dis«. 
continued. 
9. Most of these 19 persons might have contracted the fever from the infection of their own wells or 
drinking water (a) because this second series of cases all occurred in families whose children or near 
neighbors had contracted the fever at the school and had been nursed at home, and (b) because 
nearly all this second series of cases occurred in from 3 to 6 weeks after the first casein the family, 
and sufficient time after the first case in the family to allow for the infection of the home privy- 
vaults and the subsequent infiltration of thisinfection through the porous soil into the wells, which 
infection of the water-supply may have been continued by subsequent cases in the same family. 
An outbreak at Caterham, England, and a few other outbreaks are men- 
tioned on page 108. 
TABLE 4.—Inches of Earth above Ground water, from Observations of Wells in Mich- 
igan,by Months for the Five Years, and for each of the Five Years 1878-82, also for 
1883. 
TEARS. NUMBER OF 
WELLS. 
Jan. 
Feb. 
Mar. 
Apr. 
May. 
June. 
July. 
Aug. 
Sept. 
Oct. 
Nov. 
Dec. 
Av. 5 years, 1878-82... 
159 
139 
137 
131 
132 
139 
162 
171 
173 
176 
164 
157 
1878, at Elsie 
9G 
90 
84 
90 
90 
96 
102 
120 
132 
138 
120 
103 
1879, at Otisville 
60 
55 
42 
57 
63 
87 
91 
76 
71 
71 
52 
1880, Ay. at 4 stations'* 
231 
231 
230 
222 
226 
234 
244 
261 
263 
260 
253 
244 
1881, Av. at 3 stations! 
200 
201 
212 
194 
170 
162 
198 
232 
255 
249 
222 
215 
1882, Av.at 3 statlonsj 
108 
106 
104 
108 
116 
136 
180 
152 
140 
160 
156 
168 
1883, Av. at 2stations|| 
132 
132 
84 
48 
45 
45 
96 
108 
129 
120 
108 
111 
Note.—As the stations are different for different years, this table is useful rather for comparing 
months in the same year with each other than for comparing one year with another. The average 
line in Table 4 is represented in Diagram A, page 94; the lines for 1878 and 1879, in Diagram B, page 
96. 
* In 1880, at Thornville, Hillsdale, Mendon, and Union City. (Diagram B, page 96.) 
f In 1881, at Thornville, Linden, and Dearborn. (Diagram B, page 96.) 
t In 1882, at Brockway Center, Otisville, and Woodland. (Diagram C, page 97.) 
|| In 1883, at Brockway Center and Saginaw City. (Diagram C, page 97.) 
IS THE CONSTITUENT OF THE DRINKING WATER THAT CAUSES TYPHOID FEVER, 
SPECIFIC? MAY THE DISEASE BE CAUSED BY MORE THAN ONE SPECIES OF BAC- 
TERIA? BY THE ORDINARY BACTERIA OF DECOMPOSITION? 
The statistics show that in Michigan, typhoid fever in every year increases 
in prevalence in the autumn months, following the season of the year when 
there is most sickness from diarrhea. With the unusual prevalence of typhoid 
fever in Michigan in 1881, beginning in July of that year, we must note the 
unusual prevalence of diarrhea in that year, especially in June, July, and 
October. (There was most sickness from diarrhea in August, but compared 
with other years, the sickness in June, July, and October was very unusual).. 
Then again, in the year 1882, the greatest prevalence of typhoid fever occurred 
rather later in the season than usual, as did also the diarrhea, and as did also 
the highest monthly average temperature in that year. Whether the typhoid 
fever is very generally caused by diarrheal discharges getting into the drink- 
ing water, and whether the diarrhea is sometimes caused by bad water under 
conditions the same as, or similar to those which cause the typhoid fever, are 
among the many interesting questions in this connection upon which further 
evidence is desirable. TYPHOID FEVER AND LOW WATER IN WELLS. 
107 
With reference to the causation of typhoid fever by air and water contamin- 
ated with diarrheal discharges, wfe are indebted to Dr. W. Stewart, Honorary 
Surgeon to Beckett Hospital, Barnsley, for facts and suggestions as to how 
the fever may thus arise.* Speaking of a series of cases of typhoid fever, 
Dr. Stewart says:— 
“ After careful inquiry, I arrived at the conclusion that the cause of this outbreak was to be 
attributed to tlie fact that the slaughter-house of a butcher was situated at the end of the row, 
into the common sewer of which the blood from his operations was allowed to flow, there to 
remain and putrefy. The waste pipes from the sinks were directly connected with this drain 
without the intervention of any kind of trap, and the smell therefrom was often horrible. Here 
the putrefaction of a highly albuminous liquid, blood, in the drain, and a direct communication 
between it and the interior of the cottages, seemed to give rise to the fever.” Dr. Stewart gives 
other cases, and then says: “ In the experiments instituted by M. V. Feltz, and communicated to 
the Academie des Sciences, upon the effect produced upon dogs by the injection of putrid blood, 
and alluded to in a contemporary (Lancet, Vol. II, 1875, p. 460), the symptoms produced were very 
analogous to those we see in typhoid fever. 
Putrid blood which has stood for several months was dried and desiccated in the air-bath and 
mixed with a certain quantity of distilled water, and injected into the crural vein of three power- 
ful dogs. The animals immediatelj' exhibited marked depression. After a period of incubation of 
from four to five days,"febrile symptoms set in, accompanied by vomiting, loss of appetite, eleva- 
tion of temperature, bilious and bloody diarrhea, and biliary urine;’ and these symptoms were 
produced even when all trace of bacterial life had disappeared from the blood injected.” After 
referring to the typhoid condition in puerperal fever, attributed to decomposing blood, and refer- 
ring to other considerations, he says:—“The question may now be asked in what way is the origin 
of these cases, apparently arising from some component of putrefying blood, connected with the 
vast number of typhoid fever cases which appear to arise from the pollution of drinking-water by 
the excrement of human beings ? In this manner, by fixing upon the serum of the blood as the 
essential factor of the poison, we at once see how any severe case of diarrhea would be sufficient 
to produce the disease, because the liquid evacuation of severe diarrhea is principally composed 
of serum blood, and it is drawn from a source and placed in a condition highly favorable to the 
development of the putrefactive process. * * * This theory of typhoid fever, arising 
from the decomposition of the serous evacuations of severe diarrhea, accounts in a more satisfac- 
tory manner than any other for the extraordinary prevalence of the fever at a certain period of 
the year. It is a fact of universal observation that enteric-fever cases reach their maximum, in 
point of numbers, in the months of October, November, and December; and this ‘periodical dis- 
position ’ to the disease is accounted for by Liebermeister (who believes that ‘the real cause of 
every epidemic and every isolated case of typhoid fever is only the specific poison of typhoid 
fever ’ (Ziemssen’s Cyclopaedia, Vol. I, p. 61), in the following manner. He says (ibid, Vol. I, p. 65): 
‘The curves representing the frequency of typhoid correspond to the curves of average tempera- 
ture, only with this difference—the different points of the typhoid curve follow those of the tem- 
perature curve by an interval of some months; and in order to account for this discrepancy, he 
says it takes two or three months for the changes of temperature to penetrate to the breeding 
places of the typhoid germs.’ But, if it can be shown that typhoid fever may arise from the putre- 
.factive decomposition of blood-serum, then the abundant prevalence of summer cholera, from the 
end of July to the beginning of September, affords plenty of material for the elaboration of the 
poison, which afterwards percolates into the wells or is washed by the autumnal rains into the 
sources of our water-supply.” Dr. Stewart says: “I do not propose to enter into the discussion as 
to whether the disease can have an abiogenetic origin, although the facts upon which my theory 
is founded appear to favor that doctrine. Whether the fever arises only from specific typhoid 
germs, which (according to the advocates of this theory) have a nearly omnipresent existence, 
and have the property of preserving their vitality in a dormant condition for many years, ready to 
spring into active and vigorous life when introduced into a proper nidus for their development; or 
whether the poison is manufactured from the ordinary germs existing in all the putrefactive pro- 
cesses which take place in certain animal fluids, or is elaborated by some subtle chemical change 
in the properties of the substance itself, does not signify so much to those who have to deal prac- 
tically with the disease, so long as we can put our finger upon the factor, element, or pabulum 
without which these forces would be rendered permanently impotent. It is from the conviction 
that this pabulum will be found in albuminous liquids, such as blood, blood-serum, and the liquid 
discharges from the bowels in diarrhea, and that the poison of typhoid fever is elaborated from 
the putrefactive changes which occur in them after their expulsion from the body and subsequent 
exposure to the air, that I have ventured to draw the attention of the profession to what appears 
to me to be a probable explanation of the origin of this disease.” 
* British Med. Jour., reprinted in “ Public Health,” March 16, 1877, pp. 192-193. 108 
STATE BOARD OF HEALTH,—REPORT OF SECRETARY, 1884. 
I agree with Dr. Stewart that a great practical point is gained when we know 
the materials and places in which the cause of typhoid fever is reproduced ; 
but we also need to know in what way the cause of typhoid fever usually 
enters the body,—whether, as he seems to think it sometimes does, with the 
air which is breathed, or whether it is generally with the water which is drank ; 
and I still think the question whether or not the disease is specific is an import- 
ant one to which we should seek the true answer. From the evidences of sta- 
tistics, from clinical evidence, and such evidence as to coincident conditions 
as those relative to well-water, etc., it may not be quite possible to decide 
whether the cause of typhoid fever is or is not specific; because, although we 
can say that the cause is associated with decomposing organic matter, of vegeta- 
ble and animal origin, in drinking-water, and that it appears to be capable of 
reproduction, thereby making it extremely probable that the cause is organic, 
and probably one or more of the bacteria,—many of such organisms are known 
to be able to reproduce themselves in meat juice, and other fluids consisting of 
water and animal products, also in vegetable infusions, and even in mineral solu- 
tions, not directly derived either from animals or vegetables, as for iustance in 
Pasteur’s solution. Yet it is probable that by proper effort we may soon learn 
the truth,—whether typhoid fever is ever caused by more than one species of 
bacteria, whether the cause of every case is derived from a previous case. 
Bearing upon the question of a specific cause for typhoid fever, are many 
well-known outbreaks, especially those at Caterham and Red Hill, England; 
at Lausanne, Switzerland* ; and Dr. Austin Flint’s cases at New Boston, N. Y. 
The history of the outbreaks at Caterhatn and Red Hill is substantially as fol- 
lowsf : In the towns of Caterham and Red Hill, England, ‘652 cases and 21 deaths 
from typhoid fever occurred in a period of six weeks in 1871). Dr. Thorne 
Thorne, of the Local Government Board, made a thorough investigation, and 
found that the cause of the outbreak could be very clearly traced to the defile- 
ment of the common water-supply of the two towns by the typhoid excreta of 
a workman employed at the water-works in the construction of an adit from 
an old well to a new bore which was being sunk. This man worked at the 
bottom of the adit, 455 feet below the surface, and was at the time suffering 
from a mild form of typhoid fever. The excreta of this man was hauled up 
to the surface in a bucket, and spattered over on the sides and the bottom of 
the adit, into which the water-supply was soon after admitted. The outbreaks 
occurred about two weeks after the infection of the water, and were confined 
entirely to those families using water from the pipe lines. The cases at Lau- 
sanne, stated on page 103, also strongly indicate that the cause of typhoid fever 
is specific; and the cases recorded by Dr. Austin Flint can hardly be explained 
on any other hypothesis; nor can the cases reported by Dr. Gaffky. See, 
in this article, “German Troops at Wittenberg,” page 103. The Adrian, 
(Mich.) outbreak, a synopsis of which appears on page 104, in this article, also 
supplies strong evidence that the disease was spread by the discharges from a 
first case infecting the drinking water. 
Klein,(J) Klebs,(||) and many other eminent histologists have thought that 
typhoid fever is caused by a specific bacterium, although they have not agreed 
as to which of several described forms should be considered the true typhoid 
bacterium. A recent view is that the forms seen by Klein and Klebs in the 
* Detailed on page 103. 
t Ninth Annual Report of the Local Government Board, 1879-80, pages 78-92. 
t Intimate Anatomical Change in Typhoid Fever: Reports of the Medical Officer of the Privy Coun- 
cil and. Local Oov’l. Board. London. 1875. Also, Public Health, June 10, 1876, page 463. 
|| Archiv furexper. Pathologle, 1881. TYPHOID FEVER AND LOW WATER IN WELLS. 
109 
diseased Peyer’s glands are secondary invasions, and that the real cause of the 
disease is a peculiar short, thick bacillus with rounded ends, found during the 
fever not only in the diseased Peyer’s patches but also in various other organs 
of the body, as the liver, spleen, and kidneys. This bacillus has been described 
by Eberth, Meyer, and Friedlander, and is believed by them to be specific. 
Koch has confirmed the statements made by these observers, and Ziegler says 
thia bacillus is “probably the exciting cause of the disease.”* The state- 
ments of Eberth, Moyer, and Friedlander have been again confirmed quite 
recentlyf by a series of very exhaustive and carefully conducted microscopic 
examinations by Dr. Gaffky, of the Imperial German Board of Health. These 
bacilli have been found by him in 27 out of 28 cadavers examined, and have 
never been found, either by himself or by the other investigators named, 
except in typhoid cases. It is believed that the failure to find this bacillus 
in the twenty-eighth cadaver was because death had occurred at a late stage 
or the disease, when the characteristic symptoms of the disease had mostly 
disappeared, and at which stage of the fever this bacillus is much less fre- 
quent than at an earlier stage. Dr. Gaffky cultivated this typhoid bacillus 
outside of the body on various nutritive substances, as nutrient gelatin, meat- 
broth, fluid blood-serum, boiled potatoes, and also in vegetable solutions, although 
in the latter they grew less vigorously. All Dr. Gaffky’s attempts to reproduce 
the disease in the lower animals proved futile, but inoculations of animals with 
cultures of typhoid bacteria are recently reported\ to have been successfully 
made by two French scientists, MM. Tayon and Mozioconacci. The descrip- 
tion of their experiments, however, leaves much to be desired by way of explan- 
ation and confirmation. 
HOW IS TYPHOID FEVER INDUCED BY LOW WATER IN WELLS? 
The evidence of the causation of typhoid fever by low water in wells will 
not be accepted by some persons, because they do not understand, at first 
sight, how the disease can bo thus caused. Several persons to whom I have 
piesented some of this evidence have replied that they could understand how 
dilution of a poison would lessen its effects; but that if typhoid fever is caused 
by a specific organism, they failed to see how the low water in wells could 
cause the disease. A study of the relations of privies to wells, and the state- 
ment of certain facts may aid such persons to an understanding of how it is 
possible to explain such mode of causation. 
' Herewith I submit a diagram, page 110, showing a privy and a well under 
two circumstances; in one case the water in the well is low, and in the other 
case it is high. It would seem that when the level of the water is the same in 
the well as in the privy, there would not be likely to be a mingling of the 
water from the privy with that in the well, unless the distance between them 
was small. But whenever and wherever the water in the well is below the 
bottom of the privy not far distant, there will be a strong tendency of the 
fluids cast in the privy to pass downward toward the water in the well; or, if 
not directly to the well, to the ground-water not far distant, which will pass 
into the well to replace that which is drawn. The quantities of solid and liquid 
filth deposited in privies probably do not vary much from month to month, 
except that because of diarrhea in the hot months of July and August, more 
* Pathological Anatomy. London, 1883, Part I, page 300. 
t Zur des Atulominal typhus; MtUheilungen aus dem Kaiserlichen Gesundheitsamle. 
Band II., 1884, pages 372-403. 
t Complex Renaus, Aug. 18, 1884, vol. xcix., pages 331-334. 110 
STATE BOARD OF HEALTH—REPORT OF SECRETARY, 1S84. 
fluid fecal matter probably enters them. The supposed causation of the regu- 
larly recurring increase of typhoid fever in the autumn, by discharges from 
persons suffering from diarrhea gaining access to the drinking water, is referred 
to in another part of this paper. That is only one way of rendering the water 
foul, or, as we might say, nutritive to bacteria; and it is quite in keeping with 
the other evidence referred to in this paper, as to outbreaks of typhoid 
fever after the use of water contaminated by decomposing animal and vege- 
DIAGRAM D.—Illustrating the Proposition that the Fluids Cast into a Privy bear a 
lielation to the Water in a Well Not Far Distant, which Relation is Different When the 
Water in the Well is High from What it is When the Water is Low. TYPHOID FEVER AND LOW WATER IN WELLS. 
111 
table matter. The explanation of all these lines of evidence would seem to be 
that either the ordinary bacteria of decomposition cause typhoid fever, or that 
the specific cause of the disease is quite generally distributed, and is capable, 
of self-multiplication outside of the body, whenever it falls into fluids suffi- 
ciently nutritive. But even if the cause of the autumnal increase of typhoid 
fever is the diarrhea which precedes it, and which is itself caused directly or 
indirectly by the high temperature,—even then, it would seem that under 
present circumstances the quantities of water in wells controls the rise and fall 
of typhoid fever; because the relation which the curve representing diarrhea 
bears to the curve representing the fever is not closer than is that borne by 
the curve representing water in wells ; and it is probable that it is only by pass- 
ing into the drinking water that the diarrheal discharges help to cause typhoid 
fever. 
In the early autumn, also, there is more than the usual likelihood of a spe- 
cific cause being introduced into certain wells, because then surface supplies of 
drinking-water, wash-water, etc., are diminished to such an extent that unus- 
ually large drafts are made on the wells. This increased use of well-water 
would lead to the drainage of an unusually large territory around the wells, 
with a consequently increased danger of contamination from privies infected 
by typhoid excreta. 
I think we may now safely assume that there is a greater dilution of the 
dejections from typhoid-fever patients, and of human excreta generally, when 
the water in wells is high than when it is low, except when the low water is 
caused by a frozen ground which locks up the excreta on the surface of the 
earth. It cannot yet be positively asserted that the specific cause of typhoid 
fever is reproduced outside of the body in nutritive solutions at the temperature 
of water in wells; yet this may be found to be possible, or, if not in wells, in the 
higher temperature of privy-pits, from which they may pass into the well, 
either at once in the form of mature bacilli, or after a time in the less perish- 
able form of spores; and if typhoid fever is caused by the ordinary bacteria of 
decomposition, as many seem to believe, then we must consider that lessening 
the quantity of wmter in wells would probably (except as just mentioned) lessen 
the dilution of the fluid derived from privies, and consequently increase the 
proportion of bacteria thus introduced into a given quantity of well water; and 
not only this, but the proportion of albuminoid matter suitable for the rapid 
reproduction of bacteria would then be increased; and, bearing in mind how 
rapidly the reproduction of bacteria occurs under such circumstances, we can 
well understand how in such a “culture fluid” there would soon be something 
of very much greater import than simply what would result from a lack of 
dilution of a fluid containing some organism or poison not capable of self- 
multiplication. Then, again, the ordinary bacteria are known to be frequently 
in much greater abundance on the surface than elsewhere in a liquid, because 
of their requirement of air; therefore a much greater proportion of bacteria 
would be likely to be drawn up by a pump reaching to the bottom of a well, 
when the top of the water falls to near the opening into the pump. 
Many years since Chauveau* performed a series of careful experiments with 
vaccine virus diluted with constantly increasing quantities of water, when he 
found that the proportion of successful vaccinations was correspondingly 
decreased. Under these circumstances it appeared that whenever there was a 
lodgement of the virus the development of the case proceeded regularly to the 
* Comptes Rendus, lxviii, 1868, and lxxii, 1871. 112 
STATE BOARD OF HEALTH,—REPORT OF SECRETARY, 1S84. 
close; but with large quantities of water the proportion of such cases of suc- 
cessful vaccination was very small. I suppose that no one now doubts that vac- 
cinia is caused by specific particles which are reproduced within the body (it is 
now many years since vaccinia was shown to be due to a “particulate” cause, 
and those same experiments by Ohauveau had much todo with establishing that 
fact; however, Dr. Burdon-Sanderson’s experiments verified those made by 
Chauveau, and have been considered sufficient to establish this point). The 
two points just alluded to (the lessened chance of vaccination with diluted 
virus, and the fact that vaccinia is a specific disease) may serve to remind those 
who have not held these facts in mind, that dilution of a fluid containing the 
specific cause of a disease lessens the chances of communicating that disease 
when the fluid is brought in contact with the body. 
An objection has been offered, that the variations in the amounts of water 
in wells, as shown by the diagrams, were too slight to account for so great 
differences in the prevalence of typhoid fever as are shown to occur in Michi- 
gan in the months of June and October. The reply is that the variations 
shown in the diagrams are mostly averages of several wells, and that in one of 
the wells included in the average for the year 1881, the amount of the varia- 
tion was from twenty feet of water in the month of June, to no water what- 
ever, in the month of September. Besides this, the wells measured are not 
the wells the water of which actually caused the typhoid fever in Michigan, 
but they are only examples of how the water rose and fell, on the average; it 
is probable that many wells (besides one of those observed) were nearly dry at 
some period during or following the extreme drouth of 1881. 
An instructive inference from the evidence which I present is either that the 
cause of typhoid fever does not long remain in the well-water in an active 
form, or that the dilution is so great as to reduce very greatly the chances of 
its producing the disease. As the water lojvers in summer, the typhoid fever 
cause is apparently quick to act; and as soon as the autumnal rains filter into 
the wells, its action quickly disappears, although it must be admitted that at no 
time of the year is the State entirely free from typhoid fever; and it is quite 
possible that the rapid subsidence of typhoid fever after the autumn rains is 
simply because of the extreme dilution of its cause in the wells. 
THE CAUSE OF THE GENERAL ANTAGONISM BETWEEN INTERMITTENT FEVER 
AND TYPHOID FEVER. 
It would lead us too far aside to treat fully here of the controlling cause of 
intermittent fever; but it may be allowable for me to say here that we now 
have possession of facts which in my opinion enable us to explain the general 
antagonism between intermittent fever and typhoid fever; and that the 
nature of some of these facts may easily be inferred ; because high ground- 
water, with coincident high temperature of the air, is generally conducive to 
intermittent fever; and lent) ground-water is conducive to typhoid fever, when- 
ever the drinking-water is liable to be contaminated by typhoid excreta. The 
first-named condition is most frequently found in new countries, as yet 
undraiued; the last named in localities which have long been settled,—especi- 
ally in large villages which depend upon wells for their water-supply. 
WHAT NEED IS THERE FOR THE PREVENTION OF TYPHOID FEVER IN MICHIGAN? 
For the five years, 1878 to 1882 inclusive, there were returned as having 
occurred in Michigan, 2,58<3 deaths from typhoid fever (Page 92.) This is TYPHOID FEVER AND LOW WATER IN WELLS. 
113 
an average of 517 each year; but we have reason to believe that the deaths 
returned are about one-half of the number that occur; therefore we conclude 
that, on the average, over one thousand persons die in Michigan in each 
year from typhoid fever. The proportion is greater in Michigan than 
in other States.* 
HOW CAN TYPHOID FEVER BE PREVENTED? 
If the evidence which I have presented is conclusive, the reply to the above 
question may be stated in four words, namely : Stop drinking contaminated 
icater. This might not prevent all the typhoid fever; but it would appear 
that by far the greater proportion of it in Michigan may reasonably be expected 
to be thus preventable. How to prevent the contamination of the various 
water-supplies, cannot be so briefly stated ; but if people care enough about it 
to take the necessary trouble to do this, sanitarians can tell them how. So 
far as it relates to typhoid fever, it may be that all that is necessary is to 
destroy and keep out of the water all discharges from persons suffering from 
typhoid fever; but the difficulty of recognizing the disease early enough in its 
course is so great, that in order to do this it will be necessary to keep all human 
excreta, and perhaps the excreta of some animals, out of the 
Most people think they do this now, or probably we would not have a thous- 
and deaths a year in one State from this cause; but I think we have reason 
to believe that their confidence in the purity of the water they drink is mis- 
placed, and that consequently many of them sicken and die. The numerous 
instances where typhoid fever has apparently been caused by drinking-water 
contaminated by decomposing vegetable • matter, indicate that, even if the 
cause of the disease is specific, until such time as that the specific cause shall 
be so restricted as not to find access to water-supplies, it is important to pre- 
serve the water from contamination by vegetable as well as by animal matter. 
Henry B. Baker. 
Note.—In this paper the design has been to present one line of the evidence on this subject which, 
during the past ten years, has been collecting In the Annual Reports of the Michigan State Board of 
Health, in the office and library of the Board, and in the mind and manuscript of the writer; and 
in doing so, much of the interesting evidence which has been contributed by prominent physicians 
and others in Michigan, on the general subject of the causation of typhoid fever by contaminated 
water, has been omitted, in order to confine the paper mainly to the subject of the relation of low 
water in wells from which water is drank to the causation of typhoid fever. But, although in this 
paper no attempt is made to give the literature of the general subject of the relation of ground 
water to typhoid fever, the author cannot let the paper go without a reference to the work of one 
whose name is foremost throughout the wrorld in connection with this general subject. I refer 
to Max von Pettenkofer, of Munich. If I understand Pettenkofer’s view, it was in 1869, that with 
the recession of the ground water the air enters deeper into the soil, and stimulates into activity 
and multiplication disease germs which lay dormant when under water. These germs permeate 
this ground air, and whenever the barometric pressure is low, or other conditions favor its 
♦ There is reason to suppose that a large number of deaths attributed to other diseases than 
typhoid fever are caused by impure drinking-water. In a paper entitled: “Chronic Zymotic 
Disease Simulating Consumption,” in the Annual lteport of the New Hampshire State Board of 
Health for 1884, page 240, D. M. Currier, M. P., says: “Another instance in point where the effect 
lay between typhoid lever and consumption, with a decided preponderence in favor of the latter, 
and caused by drinking impure well-water, was reported and published in the report of the State 
Board of Health [N. II. | for 1883, in which the analysis of the water Is given (pp. 263-269) [The water 
was very foul, and was declared 1 neither lit for man nor beast.’] On this farm nine persons died, — 
two of typhoid fever,one of gall stones,and six of consumption, the lastof which was the onlyone 
that 1 had under personal observation. A general survey of the case would give one the impres- 
sion that he was suffering from tubercular deposit in the lungs, but upon thorough examination 
of the chest no evidence of tubercles could be found. There was equal resonance over both 
lungs, which were equally and fully distended by a forced inspiration. He had chronic laryngo- 
pharyngitis, with loss of voice. There was great and constant irritation of the stomach, as mani- 
fested by frequent nausea and vomiting of food, with progressive weakness and low vitality. 
This went on, and the man died, not, in my opinion, from tubercular consumption, but from what 
1 believe to be chronic poisoning by the lilthy water he drank.” 114 
STATE BOARD OP HE ALTH—REPORT OF SECRETARY, 1884. 
upward movement, the germ-laden air rises from the soil, and enters houses, and causes typhoid 
fever. That there is a causal relation of low ground-water (not necessarily in wells, but under- 
lying residences) Pettenkofer, from the great masses of statistics with which he dealt, long ago 
considered established, the chances being as 36,000 to i. (Boden und Grundwasser, etc., Pettenkofer, 
Munich, 1869, pages 16 and 137.) 
The interpretation of the most usual mode of entrance of the cause of typhoid fever into the 
human body, which pervades this paper, is very different from the interpretation which Prof. 
Pettenkofer seems to have adopted; yet, so far as relates to the fact of there being a relation of 
water in wells (ground-water) to typhoid fever, the evidence relative to Michigan is not materially 
different from the evidence relative to Munich, with which Prof. Pettenkofer dealt; except that 
it has been found that in Michigan a frozen surface of the ground prevents the low water from 
causing typhoid fever. Whether or not the interpretation which the author of this paper adopts— 
that the cause of the fever enters the body most frequently with the drinking water— will apply 
to the causation of typhoid fever in Munich at the time the subject was studied by Prof. Petten- 
kofer, the writer has no ready means of determining, not having at hand a reliable account of the 
water-supply of Munich during that period of time—1856 to 1869. But in this connection an account 
of the enormous reduction of typhoid fever in Munich coincidently with the construction of sew- 
ers, is interesting and suggestive. In an extract from an address by Capt. Douglas Gal ton, quoted 
from “ Proposed Plan for a Sewerage System, etc.,” by Samuel M. Gray, C. E., Providence, R. I., 
1884, pages 7-8, it is stated that “at Munich the enteric I typhoid] fever mortality per 1,000,000 of 
inhabitants for quinquennial periods, was as under:— 
“1854 to 1859, when there were absolutely no regulations for keeping the soil clean 24.2 
“1860 to 1865, when reforms were begun by cementing the sides and bottoms of porous cess-pits 16.8 
“1866 to 1873, wlien there was partial sewerage 13.3 
“1876 to 1880, when the sewerage was complete 8.7” 
There was thus, in Munich, coincident with sanitary work, a reduction of two-thirds of the mor- 
tality from one of the most deadly diseases. Whether this great reduction was due entirely to the 
work for complete sewerage, or whether that work was wholly or in part incidental, I am not now 
able to say; but it is reasonable to infer that during the years 1856 to 1869 when Buhl, Seidel, Pet- 
tenkofer, and others were collecting their evidence relative to ground water and typhoid fever, 
and when, as appears from what I have just quoted, there was little or no sewerage in Munich, 
there may not have been as good water supply as there was after the sewers were complete. If 
the water supply was in great part from wel Is, the evidence which Pettenkofer compiled, together 
with his statement of probabilities of 36,000 to 1, of the relation of low ground water to typhoid 
fever being a causal relation, holds as well in favor of the view that the mode of introduction into 
the body was with the drinking water as in favor of the view that its introduction was with the air 
inhaled. 
At the meeting of the American Medical Association in Detroit in June, 1874, during a discussion 
in the Public Health section, Dr. Foster Pratt of Kalamazoo, Michigan, remarked that typhoid 
fever became unusually prevalent in Kalamazoo in a certain year, in the autumn about the time 
the water in the wells became very low, some wells being dry. Dr. Pratt’s remarks at that time 
have had much influence toward the collection, during the past ten years, of facts bearing upon 
this subject, and toward the preparation of this paper. 
H. B. B.