I THE 
PROBABLE CAUSE 
OF THE 
XpideJmig of* Typhoid FrveJr 
IN 
SAVANNAH, GA., IN 1892. 
HOW TO AVOID IT AND OTHER FILTH DISEASES 
IN THE FUTURE. 
By R. J. NUNN. Kl. D. 
Reprinted with Notes from 
SAVANNAH MORNING NEWS, 19tii MARCH, 1893. 
SAVANNAH, GA.: 
The Morning News Print. 
189 AJ THE 
PBOBABLE C-A.TTSIE] 
OF THE 
EPIDEMIC OF TYPHOID FEVER 
IN 
SAVANNAH, GA.. IN 1892. 
HOW TO AVOID IT AND OTHER FILTH DISEASES IN THE FUTURE. 
R J. NUNN, M. D. 
Reprinted with Notes from Savannah Morning News, 19th March, 1893. 
At a recent meoting of the sanitary board 
a letter was read from Dr. R. J. Nunn in 
reference to the sanitary conditions of the 
city, dwelling at length upon some of the 
causes, which in the minds of leading sani- 
tarians are productive, to a great extent, of 
much of the sickness in Savannah, and 
which, if permitted to continue, are likely 
to result more seriously than most people, 
by whom the causes and effects of a lack of 
sanitation are given little thought, imagine. 
The letter was written in reply to the in- 
vitation to Dr. Nunn, among others, to be 
present at the meeting of physicians oalled 
by the mayor last December for the pnrpose 
of locating the causes of the fever which 
prevailed in the city last year. The three 
days intervening between the invitation 
and the date of the meetiug, in which the 
physicians were expected to obtain the in- 
formation asked for by the mayor, was re- 
garded by Dr. Nunn too short to permit of 
sufficient investigation upon which to base 
any reliable statement, and in consequence 
he did not attend the meeting. His subse- 
quent investigations reach a different result 
than that reached by the physicians who 
did attend, as stated i.i the resolution 
adopted at the meeting. 
The resolution referred to is as follows : 
Whereas, After a full and free discussion of 
the medical gentlemen, by invitation of his 
honor the mayor, concerning the question of a 
better preservation of the public health ; and 
Where is, We are of the opinion that an ex- 
aggerated idea now prevails in regard to a 
greater extent of fevers—malarial and typhoid 
—than in former years; and 
Whereas, We cannot assign any local cause 
for the existence of these fevers; be it there- 
fore 
Resolved, That we earnestly recommend to 
his honor the mayor and the sanitary authori- 
ties the observance of the best known sanitary 
measures for the still better preservation of the 
public health, such measures as thorough drain- 
age, flushing of sewers, removal of privy vaults, 
etc., etc. 2 
From careful, personal inquiry of twenty- 
five of the forty-nine practicing physicians 
in Savannah Dr. Nunn found there were 
136 cases of true typhoid fever in the city 
last year distinct from the other classes of 
fevers,sometimes called typhoid. Allow- 
ing the same percentage of cases to the 
other twenty-four physicians gives an esti- 
mated total of 266 cases of true typhoid in 
Savannah during 1892. Following the sta- 
tistics Dr. Nunn dwells at length upon the 
causes productive of typhoid and other kin- 
dred diseases which exist in Savannah and 
which threaten the health and commercial 
prosperity of the city. 
The letter was read at a recent meeting 
of the Citizens’ Sanitary Association, and 
has received the hearty indorsement both 
of the sanitary association and the Board of 
Sanitary Commissioners. Mayor McDon- 
ough is strongly impressed with the facts it 
contains, and has authorized its publica- 
tion. The letter is as follows: 
Savannah, Q-a., Feb. 14, 1893. ) 
119 York Street, j 
To His Honor the Mayor of the City of 
Savannah: 
Dear Sir—On Dec. 9, 1893, I received 
from his honor the mayor, through the 
clerk of council, an invitation to be present 
at a meeting of physicians, to be held Dec. 
12, which was called to locate the cause of 
the fever whioh prevailed in the city dur- 
ing the summer of that year. 
The interval of time between the receipt 
of the invitation and the date set for the 
meeting was altogether too short to admit 
of a thorough investigation of the subject, 
and all the information I have sought has 
not been received even yet, but there is 
enough at hand to enable conclusions to be 
drawn whioh may be valuable as guides in 
some of the future sanitary workings of the 
city government. 
But before entering upon this inquiry, I 
desire to draw a dear distinction between 
two olasses of minds which are not unfre- 
quently mistaken for one another. These 
are the pessimists and the precautionists. 
The former see nothing but evil as the out- 
come of all occurrences. The latter, when 
danger* and disaster are ahead, do not 
ignore the fact of their existence, but seek 
to avoid them by every legitimate means. 
With the former class I have no sympathy; 
but I hope always to be permitted to count 
myself as enrolled in the ranks of the latter. 
It is proper when discussing a matter of so 
much importance to the city as is the one now 
under consideration, to proceed slowly and 
cautiously, examining carefully each step 
as we proceed, to the end that the conclu- 
sions reached may he the truth, or as near 
thereto as it is possible to arrive. To pur- 
sue any other course would be culpable in 
the extreme. It would be deceiving the 
public into a sense of false security; it 
would be jeopardizing the health of the peo- 
ple, and trifling with the lives iutrusted to 
the keeping of the authorities. 
Assertions upon one side and denials upon 
the other, unsupported by evidence, will 
never become fact, no matter how often re- 
peated. 
The first question to be asked is: Was 
there any unusual amount of sickness dur- 
ing the summer of 1892? To this. the 
answer invariably returned by physicians 
of whom I have inquired has been in the 
affirmative, and here it may be well to ob- 
serve that the mortuary reports are not 
sure guides to the amount of sickness pre- 
vailing in a locality during a season, for 
the reason that such reports show only the 
fatality; nor can more be done with them 
than to show the character of diseases caus- 
ing deaths, and the proportion of these to 
the population. But as to the prevalence of 
non-fatal diseases, such as dengue, or as to 
the proportion existing between the num- 
ber of cases of a disease, and the deaths re- 
sulting therefrom, the public mortuary re- 
ports can show nothing. 
2. Were the diseases prevailing duriug 
the summer of 1892 of an unusual type or 
types? Answer, from the same sources: 
Yes; the types were unusual, and chiefly of 
two varieties (a), continued fever, some- 
times called typho-malarial fever, and lo- 
cally erroneously called typhoid fever; (b) 
true typhoid fever. 
The mortuary reports are neces arily 
misleading and unreliable as to the exist- 
ence of true typhoid fever in Savannah, for 
the reason just pointed out, viz.: that con- 
tinued fever has been locally known as 
typhoid. 
Here it may be well to observe that the 
fever cilled here typho-malarial is com- 
paratively new in Savannah, the more 
virulent types of malarial fever which were 
usual in the early ’50s having gradually dis- 
appeared before the milder, but far more 
protracted, forms which are seen at present. 
The causes which brought about this change 
may be the sama which culminated in tho 
typhoid fever of last summer, but these I 
will not now discuss, because, according to 
the terms of the invitation, the investiga- 
tion is to be confined to typhoid fever. 3 
It is proper here to remark that the medi- 
cal profession in this city is much divided 
on the relationship existing between con- 
tinued fever and typhoid fever; one por- 
tion believing that our continued fever is 
in reality typhoid fever, and differs from it 
only in the milduess of the attack. A sec- 
ond portion looks upon our continued fever 
and typhoid fever as separate, independent 
and distinct diseases, and incline to the be- 
lief that our continue 1 fever is a disease 
ooming from the dec imposition of vege- 
table matter, but that typhoid fever is 
caused by decaying animal matter; while a 
third portion rejects the idea of the possi- 
bility of the existence of even a 
single case of typhoid fever in the 
city and would classify all forms of 
continued fever or protracted fever as ma- 
larial. Finally there are some physicians 
who believe that a malarial fever and a 
typhoid fever can coexist in the same in- 
dividual, and rua each its course independ- 
ently. 
The difference of opinion existing as to 
the pathology of these phases of disease can 
only be settled by autopsies, and to these 
the patients have a decided objection. 
While, however, doctors differ about the 
classification of these diseases, there is not 
the least difference of opinion as to the san- 
itary measures which should be put in prac- 
tice at once to prevent their origination or 
their spread. 
3. Was true typhoid fever present to any 
considerable extent in Savaunah during the 
summer of 1892? 
Answer: A copy of the following letter 
was sent to each physician in the city 
(forty-nine in all): 
Savannah, Ga., Jan. 28,1893. 
Dr. : 
My Dear Doctor—I desire to arrive at an 
approximation of the number of cases of true 
typhoid fever which occurred in Savannah in 
1392, and would be much obliged if you would 
aid me by letting me know the number of cases 
which came under your observation, Sincerely 
yours. R. J. Nunn, 
I have to thank twenty-five of these 
gentlemen who have had the courtesy to 
favor me with replies, some of whom have 
not seen any cases of typhoid, but 
the total number reported is 136 
cases, which would be an average 
of 5.44 for each of the twenty-five who re- 
ported. Allowing the same average for 
each one who did not honor me with a re- 
ply (24), would give a total of 266 cases 
of undisputed typhoid fever as having oc- 
curred here in 1892. 
From the tenor of the letters received it 
is safe to say that the number of doubtful 
cases would far exceed the figure just given, 
say by double at least, and these again 
would be comparatively few if compared 
with the number of cases of continued fever. 
Should any replies be hereafter received 
which would materially alter the estimate 1 
have made I will change the figures given 
so that they may then be equally as accu- 
rate as are the above.* 
4. Were the causes atmospheric? 
Answer: Under date of Jan. 25, 1893, 
Mr. P. H. Smyth, observer weather bureau 
in this city, was kind enough to furnish me 
with the maximum, minimum and mean 
temperature and the rainfall for April, 
May, June, July and August for the past 
seven years. From this table the following 
summary has been computed: 
AVERAGE TEMPERATURE. 
1886 ,.76F 1890 75F 
1887 .74 1891 76 
1888 74 1892 75 
1889 74 
TOTAL RAINFALL IN INCHES. 
1886 28.01 1890 19.12 
1887 22.16 1891 28.00 
1888 15.55 1892 18.06 
1889 26.15 
From this it will be seen that the temper- 
ature has been higher and lower, and the 
rainfall greater and less than in 1892; con- 
sequently the fever of 1892 cannot be at- 
tributed to atmospherio conditions. 
In view of the very popular impression 
chat the temperature and rainfall might 
have some connection with the prevalence 
of the fever under consideration, this dis- 
oussion would have been incomplete with- 
out an analysis of the meteorological ele- 
ments which are so often referred to as 
potent factors of disease. 
5. Was the fever of local origin, or was 
it general throughout the country? 
This is a most important question, because 
upon the reply depends the preventability 
of the disease in the future. 
To determine this point I wrote to Bruns- 
wick, Charleston, Augusta and Macon. The 
importance of the replies from Bruus wick 
induces me to attach copies of them for 
*1 regret very much to be compelled to 
state that even at this late date I have not 
received responses from all the physicians, 
seven having still failed to give me their 
returns. I am therefore unable to vouch 
for the absolute accuracy of the above esti- 
mate, but from what I can now see the ex- 
act number would not depart widely from 
the calculation given. 4 
your consideration, for although they make 
no mention of typhoid fever, they show 
conclusively that the same neglect of sani- 
tary laws which was seen in Savannah in 
1892 was also practiced in Brunswick. They 
show the same disregard of the public wel- 
fare; the same ignoring of public warning; 
the same transgression of city ordinances 
by the very officers who were sworn to en- 
force them; and, stranger than all, they 
show that like results followed these acts in 
Brunswick as in Savannah. 
But these letters show something more, 
which is of vast importance to our citizens, 
in that they point to the fact that the peo- 
ple are not entirely at the mercy of muni- 
cipal authorities in sanitary matters. That 
designing politicians or greedy money get- 
ters, blinded by avarice, cannot usurp the 
place of science and me their power for 
their own selfish ends regardless of the lives 
of the people, but that the courts will, upon 
application, graut a mandamus compelling 
those in charge of the sanitation of a locality 
to do their duty in this most important 
particular. 
From Charleston, Dec. 20, 1892, Dr. F. 
Peyre Porcher writes: “We have been 
singularly free from the prevalence of any 
special disease in this city for the last year.” 
Dr. Eugene Foster, president of the board 
of health of Augusta, writes Jan. 10, 1893: 
“There were cases of continued malarial 
fever, and of typhoid fever in our city dur- 
ing the summer and fall seasons, but not 
more than is usual with us. I feel satisfied 
that we had fewer of these cases in 1892 
than for any year in the past five years.” 
Dr. William F. Holt writing from Macon 
Jan. 4, 1893, makes no mention of the exist- 
ence of typhoid fever in that city during 1892. 
From this evidence it will be seen that 
typhoid fever is not general all over the 
country and the conclusion is inevitable 
that the cause or causes are local. 
This leads up to the question sixth. In 
what respect did the circumstances iu 1892 
differ from those of say, five previous years? 
Answer: In extensive 3treet grading and 
digging, and spreading of thousands of tons 
of oyster shells during the hot months from 
May to September, and repairing stone 
paved streets during the same period. 
7. The next important step in this investi- 
gation is to inquire if such work at such a 
season of the year would be likely to propa- 
gate or originate typhoid fever. 
To give to this inquiry an intelligent 
answer it is necessary to review briefly the 
theories of disease. 
presupposes the existence of germ3 as fungi, 
baoteria, bacilli and cocci of various kinds, 
which, finding within the body suitable re- 
quirements for their reproduction, rapidly 
multiply and produce the phenomena which 
we call disease, each variety of microscopic 
organism producing a different ailment. 
It will thus be evident that, according to 
this theory, what we call disease iB but the 
outward manifestation of the development 
of a crop of these microscopic bodies; in 
fact the germs of diseases are the analogues 
of the seeds of a crop, and, as the latter will 
not produce a crop unless the climate and the 
soil are suitabie thereto, so with the former, 
and therefore it follows that, to have a 
disease, there must be the seed, the soil and 
the surroundings. One can no more grow a 
crop of bacilli upon a clean plate than one 
could grow a crop of wheat in the same 
situation, even supposing one to have the 
seed to commence with. The keeping of 
the soil in such condition that the seeds or 
germs of disease will not germinate is called 
sanitation. 
DE NOVO THEORY. 
It must not be supposed for a moment 
that the germ theory is universally ac- 
cepted, although it is just now the most 
fashionable, but the"e are those who believe 
that diseases can and do originate “de novo” 
under suitable circumstances, and they can 
point to certain experiments of Pasteur 
himself, and of others, demonstrating the 
truth of their position. 
Pasteur takes a poisonous bacillus and, by 
proper cultivation, he develops an innocu- 
ous one; but then he can take one of these 
innocuous bacilli and, by cultivating it in 
suitable s oil, he can redevelop its poisonous 
properties. 
Again, Dr. Dollinger, president of the 
Royal Microscopical Society, ha3 taken a 
bacillus which, growing vigorously at a 
comparatively low temperature, is killed by 
a slight rise of 5° or 10°, and by careful cul- 
tivation has so changed its nature that, 
from being unable to endure a temperature 
of 90° Fahrenheit, he was able to keep it 
alive and vigorous at 180° Fahrenheit. 
These experiments, it is claimed, demon- 
strate the immense power of adaptability 
possessed by these low forms of microscopic 
life, and they further show that the power 
of reaction upon the animal economy, so as 
to produce the phenomena which we call 
disease, can be modified in either direction 
of virulence or innocuousness, according to 
surrounding circumstances. 
THE GERM THEORY OF DISEASE 5 
The proper surroundings for the propaga- 
tion of disease germs, if the germ theory is 
adopted, or for the origination of disease, if 
the “de ncvo” theory is preferred, are pre- 
cisely the the same, viz,: Heat, moisture 
and a suitable soil, which latter, in the case 
of typhoid fever, is decaying animal matter. 
No better culture bed for the propagation 
of the germs of typhoid fever, or for its 
origination could be desired than miles of 
streets freshly shelled during the hottest 
months, faithfully watered by city water 
carts and heated by a midsummer sun.* 
In Brunswick, according to the letters ap- 
pended, it is not thought that the shelling 
of the streets did any harm, but there, be it 
observed, the shelling w-as done in winter, 
while in Savannah summer was selected for 
that purpose. 
A letter from Dr. S. P. Dupon upon this 
subject gives the result of his experience 
when digging out shells as far back as 1848, 
when he lost four of the hands engaged in 
that work from fever, which he could trace 
to no other cause and which disappeared 
when the work was stopped. 
From all this I am forced to the conclu- 
sion that the digging, grading aud shelling 
of the streets In midsummer seems proba.ly 
to have been concerned in the origin, spread 
or continuance of typhoid fever in Savan- 
nah in 1892. 
8. If the germ theory is adopted the 
probable habitat of the germ must be 
sought out. 
In a city like Savannah, in which are 
travelers from every part of this continent 
and of Europe, the germs of disease are not 
likely to Le wanting. Palling on a paved 
street they would be carried under the pav- 
ing stones by the rains, where they would re- 
main until brought to the surface, when, if 
they found suitable surroundings, they 
would quickly multiply. Such was the case 
last summer. 
Or falling upon a sandy street, they 
would be washed into the soil and would be 
exposed during the process of such work as 
pipe laying or street grading. 
But then it must not be overlooked that, 
according to the evidence of Dr. Dupon, the 
germs of disease may be in oyster shells pro- 
cured from localities in the immediate vi- 
cinity of the city, and the probabilities of 
this being a source of contagion is vastly 
increased when these shells are imported 
from a locality where typhoid fever is com- 
mon. 
So much for the immediate cause of the 
fever of 1892, but other sources of contami- 
nation have been suggested, as, for exam- 
ple, the mixture of a small percentage of 
river water with the artesian water, with 
which the city is supplied. 
To argue against the possibility of infec- 
tion from this source would be absurd, but 
it is safe to say that its probability' is in- 
finitesimal. 
The river water was used in the city from 
1853 until a few years ago, altogether for a 
period of say thirty-five years, and no such 
result obtained during all that time, yet 
during much of that time the source of sup- 
ply was much nearer to the city than it has 
been in the last few years. 
Of the other means of the propagation of 
disease germs, such as privy vaults, dry 
wells, improper sewers, damp and dirty 
lanes, unsanitary plumbing, want of house 
drainage, the Bilbo and Ogeechee canals, 
the drinking of sewage by cows, the bath- 
ing of children in the water of sewers, the 
raising of the level of the lanes above that 
of the adjoining lots, the filthy cellars, cat- 
tle marts and stables, the dirty houses of 
some sections of the city, the crowded lodg- 
ing houses, the uudrained lauds around the 
city and other.things of like character, I can- 
not now speak. They have all been brought 
to the attention of the authorities frequently 
for years, but although all of these, and 
other like conditions are elements of danger, 
they do not seem hitherto to have been pro- 
ductive of any positive results of a serious 
character, but they may have been the steps 
which led up to the fever of 1892; or, in 
other words, prepared the soil for its intro- 
duction. 
What has been or will be the effect of 
covering up the vast filter bed upon which 
*The following streets haye been paved 
with oyster shells during 1892: Jefferson 
Btreet, from Charlton to Henry street, 
83,422 bushels; length 3,751) feet by 27 feet 
roadway. 
Jones street, from Tattnall to East Broad 
street, 118,334 bushels; length 3,350 feet by 
40 feet roadway. 
Bolton street, from East Broad to W est 
Broad street, 90,684 bushels; length 3,220 
feet by 30 feet road way. 
Summarizing the above figures, which 
are official, it will be seen that there were 
290,440 bushels of shells, some of which were 
brought from Baltimore where typhoid 
fever is prevalent, spread over a surface of 
over 7% acres (7.61) during 1892, and further 
I have been Informed that many of the 
shells used were live shells. 6 
the city stands with impervious pavements, 
and of the destruction of the shade trees, it 
is impossible to say; but the possibility of 
these being sources of danger was pointed 
out in my pamphlet, “A Medical History 
of Savannah,” in 1887.* 
Here I may be permitted to suggest that 
the method of cleaning the asphalt pave- 
ment by scraping only is, in my opinion, 
dangerous to health, as it leaves germs of 
disease and irritating matter to Pe blown 
into the air and inhaled by the people. 
These pavements should be thoroughly and 
frequently washed. 
This is a suitable ooeasiou to dra w atteu - 
tion to the extraordinary sanitary advan- 
tages conferred upon this city by the im- 
mense sand bed upon which it is built. For 
more than a century the whole of the con- 
tents of the vaults were buried in the sand 
of the streets, and during all this 
time the people drank drainage water 
from wells sunk In the same soil 
without knowing anything of typhoid 
fever, scarlet fever, diphtheria (see 
letter of Dr. Morel in “Medical History 
of Savannah”). So thoroughly was the 
magnificent work of this grand filter done, 
that although the presence of the salts com- 
ing from the vaults and dry wells (which 
were also permitted) was plainly demon- 
strable in the drinking water, vet the dis- 
ease germs were always excluded. In vari- 
ous ways, we in these later days, are shut- 
ting off this great filter and interfering 
with its usefulness, and the results do not 
seem to be to our advantage. 
From this careful analysis of the causes 
and conditions which precede! the out- 
break of typhoid fever in 1893, I am satis- 
fied that it was direotly due to a neglect of 
proper sanitary precaution and a disregard 
of those local traditions touching summer 
street work, which now amount almost to 
scientific certainties, but indirectly to a 
mass of other causes which have been ac- 
cumulating for years. 
To prevent the recurrence of an epidemic 
of like character would, I am convinced, be 
no difficult task in a city so hygtenioally 
favored as is Savannah,and the 8 ime meas- 
ures would undoubtedly have the effect of 
freeing the community from typho-malarial 
fever, from diphtheria, scarlet fever and 
other filth diseases. The same fearlessness 
and energy displayed by the executive in 
stamping out small-pox after it had been 
permitted to spread, will, if turned in this 
direction, show equally as satisfactory re- 
sults. 
Systematize the health department, evoke 
the aid and advice of the most experienced, 
professional sanitarians; inaugurate a 
system of house 4 drainage with 
closed drains to the point of discharge,* 
which should be as far from the city as pos- 
*The passage referred to reads as follows 
(R. J. N.): 
“There will probably, during the coming 
generation, be ample opportunity to judge 
as to what extent the immunity from dis- 
ease enjoyed by Savannah has been the re- 
sult of her porous soil, wide, unpaved streets, 
profuse forest growth and numerous squares. 
“For in the march of improvement,it is in 
contemplation to pave the streets, and pav- 
ing the streets has, so far, carried with it 
the total, unsparing, destruction of the 
shade trees. 
“Then, too, some of the citizens loudly de- 
nounce what they are pleased to call the 
waste of ground given up to wide streets 
and open squares, and would willingly see 
buildings located in the squares and some of 
the streets closed up a ad appropriated to 
the same purpose; in fact, so great has been 
the pressure brought to bear that the mu- 
nicipal authorities, in laying out an exten- 
sion of the city, felt forced to abandon the 
old plan, which has proved so good, and 
have adopted a more compact desigu. 
“Whether or not this is bast the irrefuta- 
ble logic of events must determine; the 
facts of the future will be the basis of the 
verdict; but, unfortunately, should it be 
on the wrong side, there will then be no 
redress, it will be too late to retrace the 
steps taken or undo the injury inflicted. 
“How much wiser would it have been to 
have adhered to the plan which has already 
borne the test of time and been found to be 
all that could be desired.” 
*The bottom of the new Casey canal will 
present an exceptionally cheap and prac- 
ticable bed upon winch to lay a pipe 
through which the house drainage may 
reach salt water six miles from the city,and 
at the point of exit it may be mixed with 
all the fresh water coming from the drain- 
age of the southeastern swamps, in which 
it would be lost, so great would be the dilu- 
tion. 
I had hoped to be able to give the esti- 
mates of the cost of this and other routes, 
besides other interesting data, but I have 
been unable to obtain them in time for this 
publication. 7 
sible; fill up all dry wells;* abolish privy 
vaults, and substitute either water closets 
or the pail system;+ restore and maintain 
the relative levels of the lots and the lanes; 
inspect plumbing; keep the sewer traps 
clean: suppress the canal nuisance; inspect 
all cellars, and the houses of the lower 
classes; drain all wet and sobby lands; iso- 
late cases of infectious diseases, and keep 
physicians informed of the location and 
character of all occurring in the city. All 
of this has been said time and again by 
others during the past decade or two, but 
without effect. 
As ignorance i3 no doubt the principal 
cause of sanitary mistakes, educate the 
people; let the principles of sanitation be 
taught in the public sohools and encourage 
private sanitary associations. When every 
person is a skilled sanitarian, and appreci- 
ates the danger, the anxiety and the suffer- 
ing resulting from sanitary sins, then there 
will be less use for constant watcnfuluess 
on the part of the authorities. This will 
be in the long run a vast saving to the city. 
A word touching the health of the com- 
ing summer (1893). 
Those who have made a study of the 
period of a cholera epidemic, put it at three 
years from the time of its appearance in 
the east to its ultimate disappearance. The 
epidemic which has touched our shores, be- 
gan in 1891 and has expended the violence 
of its second year in Europe, having barely 
shown itself in America, but having 
reached this side of the Atlantic, and 
*The number of dry wells is about 1,300 
(1891]. In October and November, 1891,notices 
were served on the owners of the properties 
on which the dry wells exist and executions 
were issued so that these dry wells could be 
filled up before the summer of 1892. but in 
or about December, 1891, a petition from 
the owners was presented to council asking 
that the ordinance be not enforced, and 
council thereupon ordered that the ordi- 
nance should not be enforced, and therefore 
the dry wells remain. (Condensed from a 
private letter which I am authorized to use. 
R. J. N.) The records of the city show that 
during the last five years, 1889 to 1893 in- 
clusive, there has been appropriated for 
house drainage $93,000, to which may be 
added #5,000 worth of sewer pipe on hand 
in 1889. The municipal reports do not show 
that any of this appropriation has been 
used in the construction of the worK for 
which it was intended. 
•(•That the public may fully appreciate the 
enormity of this danger I beg to sunmit the 
following calculation and comparison: 
The number of vaults in the city proper is 
about 4,400, and the average size is fully 5 
feet long by 4 feet wide, giving an area of 
twenty square feet. This will give a total 
vault surface of 88,000 square feet. 
An acre contains 43,500 square feet, so 
that the area of vault surface exposed to 
and contaminating the air of Savannah is 
over two acres, which again is about 
equal in extent to one of our squares. 
To this should b9 added another quarter 
of an acre for those vaults in the immediate 
vicinity of the city, add which, while not 
within its limits, aro contributing their 
share of poisonous, effiuvia to vitiate the 
atmosphere and to breed or invite disease. 
Surely this subject is important enough 
to provoke serious discussion and a rapid 
abatement of such a dangerous nuisance. 
It may be interesting to glance at the 
financial aspect of the vault question. 
The present cost of cleaning the vaults 
averages about #8.00 each, of which fifty 
per cent, is paid by the city. 
The capaoity of the O. E. M. department 
is about twenty vaults per week, or say one 
thousand per year. 
Now as there are about five thousand 
vaults in the city and its vicinity it is evi- 
dent that they cannot be cleaned oftener 
than once in five years and this at an ex- 
pense of (#8,000) eight thousand dollars a 
year, or in other words it oosts forty thous- 
and dollars (#40,000) to clean the vaults 
once. 
Now, if vaults are to be tolerated at al!, 
they should be cleaned at least once a year 
and that during cold weather, which would 
make the cost forty thousand dollars 
($40,000) a year, which in five years would 
give capital enough to pay for a system of 
house drainage. 
But a properly organized system would 
not cost anything like this sum annually 
and even the present expense of eight thous- 
and dollars ($8,000) a year would very 
nearly, if not quite, pay the interest on the 
cost of the house drainage, and then the 
work would be done continually and not 
once in five years. 
It is evident that a proper system of house 
drainage would result In a great saving of 
money, in the supression of the two acres of 
putrifying matter, which Is now pulluting 
the atmosphere and as a consequence the 
chances of disease infection would be cor- 
respondingly lessened. 8 
having another year to run, it is safe to 
say that it is exceedingly probable that it 
will spread in America in 1893. With 
measures to be adopted to keep out cholera, 
this letter has nothing to do, but I desire to 
say that the line of sanitation just indicated, 
thoroughly and intelligently carried out. 
while stamping out other filth diseases, will 
also place the city in the best possible con- 
dition to prevent the spread of cholera 
within its limits. 
The want of a properly organized health 
department as a portion of the city gov- 
ernment has been tho subject of so much 
comment on the part of the citizens that an 
explanation of the situation for the benefit 
of this generation may not be misplaced, 
although it might be fairly argued that in 
this respect the city is in advance of the 
state. 
Up to tbe 5Is the necessity for a health 
department did not exist, so well did the 
immense filter bed just alluded to do its 
work. At tbe time alluded to three citizens 
in each ward were appointed by the mayor 
to see that the yards were kept clean, 
and that wa3 all there was to do. 
Nature did the rest. Closets were all on 
the lanes, forty or more feet from the 
houses. Sewers there were none, conse- 
quently there was no sewer gas laden with 
a dozen or more varieties of disease germs. 
There were no water works, and hence 
there was no plumbing to be defect- 
ive nor water mains to lay. The streets 
were not yet covered up with impervious 
coating of different kinds, and as a conse- 
quence there was no pavements to repair. 
The legislature had not yet given private 
corporations the right to dig up the streets 
when and where they desired, nor had it 
tben begun to out up the streets and dispose 
of them to private citizens or societies, and 
the importance and value of the shade 
trees was appreciated, and they were pre- 
served and cultivated. 
Savannah was a village then compara- 
tively, and may have had what would now 
be called primitive village ways, but they 
suited admirably to keep out filth diseases. 
Gradually, unconsciously this has been 
changed. Water works came, bringing the 
water closets into the houses with defective 
plumbing. Sewers came with their at- 
tendant sewer gas and filth diseases. 
Impervious pavements came, shutting 
off tbe filter. The odorless excavating ma- 
chine came with cemented vaults, again 
stopping filtration and courtiug disease by 
increasing the chances of fermentation. 
Tbe shade tree3 were cut down and the 
hot sun allowed full play, and so on. The 
hand of improvement is upon us, and the 
modern city with its typhoid fever, scarlet 
fever, diphtheria, membranous croup and 
other filth diseases is here before we know 
it, and, as a consequence, the organization 
of thb health department has not kept 
pace with tbe increasing requirements of 
the city. 
The experience of 1892 will perhaps change 
all this Filth diseases have invaded the 
houses of a class of citizens who will make 
themselves heard when they themselves are 
touched, but who have sat idly by for years 
nor heeded the warning of the coming evil 
until now it is beside them at their own 
hearths and firesides. Cassandra prohesied, 
but none gave ear to her prophecy. 
The fever of 1892 will surely eventuate in 
good to the people. Such a result is not 
unusual; in fact, it is always so. It is the 
law of compensation. 
But the history of the outbreak of filth 
diseases in 1892 has a-still deeper lesson to 
teach, which, if properly learned, may not 
be coo costly, even though it be at the ex- 
pense of many valuable citizens sacrificed 
to typhoid fever, of time lost, of suffering 
endured and of expense incurred by those 
who recovered, of numbers of innocent chil- 
dren made victims to scarlet fever, diph- 
theria and other filth diseases, of terrified 
mothers, and families driven from their 
homes, and business lost by rumors of dis- 
ease within our walls, which is, that the 
persistent negligence of sanitation on the 
part of the authorities is gradually intensi- 
fying the virule ice of filth diseases which 
they tolerate, and is preparing the people 
for a repetition of the experiences of 1876. 
Who are they who will then remai i to face 
the horrors of an epidemic? Who will then 
restore to Savannah her lost commerce? 
The experience of 1892 is but the distant 
rumbling of the thunder warning us of the 
approaching storm. The “little cloud like 
a man’s hand” is to be seen on the horizon. 
To the inexperienced these sigDs are mean- 
ingless, but to the educated seaman they 
are warnings to trim his sails to meet the 
coming stor n. 
Typhoid fever, scarlet fever and diph- 
theria are but the skirmish line of the ad- 
vancing army of filth diseases whose ad- 
vances have been ecu; ten and encouraged, 
rather than opposed and repelled. By all 
means let the responsibility for the death 
and disaster which v ill aecompany its ad- 
vent be placed where it belongs. It cannot 9 
This observation of cause and effect as to dis- 
turbing the soil during the heated term was 
continued by me in 1891 and the present year 
with the same unvarying results, clearly demon- 
strating to my mind the great danger of ex- 
tensive and injudicious disturbing of soil in our 
southern ciimate during the heated summer 
months (May to November). Our city govern- 
ment, in their zeal for public improvements 
(not seeing anything deleterious in disturbing 
pure sand) ignored the ordinance governing the 
turning of soil during the summer months, a id 
the board of hea'.th found it necessary to get 
out a restraining order from the court forbid- 
ding the city from further excavation, etc., and 
since that date our city has been remarkably 
exempt from severe forms of fever. In con- 
clusion I wish to say, in my close and personal 
observation of our summer fevers that they 
are intensified by extensive soil excavation and 
dimished by its cessation with as marked cer- 
tainty as the fall of a high temperature from 
an untipyretie. 
As to shelling streets, no ill effect has bee n 
experienced from that source, as all of the ex- 
tensive boulevards were done in winter months 
I might add there was much cutting away of 
chaparral and underbrush on the peninsula 
point of our suburbs in the summer of 1890. 
This was allowed to remain on the ground for 
some time before burning, and I observed cases 
of intermittent fever about that period which 
had not prevailed before. 
This was in May, 1890, and the excavation or 
grading of Windsor park was continued through 
the entire summer. The severe types of fever 
occurred in August and September in locality 
adjacent to park. 
Not being a statistician, I regret my inability 
to furnish you histories of these cases, which 
would require much time to run through my 
books, hunt them out and write them up. 
I hope these crude details may be of service 
to you. I remain, very truly and sincerely, 
— Hugh Burford. 
Office Health Officer, ) 
Brunswick, Ga., Dec, 17. 1892. ( 
Dr. R. J. Nunn. 119 York St.. Savannah, Ga.: 
My Dear Doctor -Yours or the 15th inst. to 
hand this morning, and the contents noted. 
I’ll endeavor to answer your questions in order 
in which you ask them, and as fully as possible. 
1. The fevers were of a distinctive form o f 
congestive malaria. The upturning of soil dur- 
ing the summer, with very heavy rains, I think 
was the cause. There were no active steps 
taken in the matter. Fortunately very shortly 
after we had cold weather, which prevented, I 
think, a great many cases. 
The shelling of streets is not detrimental to 
the public health. I think the danger is in pre- 
paring and grading of the streets, which neces- 
sarily requires an immense area of new soil ex- 
posed, which gives off sufficient malaria to en- 
danger the public health. 
I say the shells themselves do not, I think, 
occasion any trouble provided, of course, they 
be laid to the charge of the medical pr )fes- 
sion, whose warnings have always been un- 
heeded; and I pray the present city admin- 
istration to so act that the blame may not 
be laid at its door. Your obedient, servant, 
R. J. Nunn, M. D. 
This letter has been submitted to Dr. J. 
B. Read for his criticism. He, being a 
native of this city, the oldest physician in 
active practice, with a local medical expe- 
rience of nearly fifty years, is the best 
qualified to express an opinion as to the sci- 
entific and practical value of the views just 
given. Here is his reply: 
Savannah, Ga , Jan. 30, 1893. 
Dr. R. J. Nunn: 
My Dear Doctor—I agree with you in all 
that you have written in your statement in re- 
gard to the origin and increase of the typhoid 
diseases that have prevailed in this city during 
the last summer, and that still exist at this 
time. 
I hope the candid statement you have made 
of these causes, and the method of avoiding 
such; diseases for the future, will be carefully 
studied by the citizens of Savannah. Respect- 
fully, J. B. Read, M. D. 
Brunswick. Ga., Dec. 29, 1893. 
Dr. R. J. Nunn, Savannah, Ga.: 
Dear Doctor—I must beg your indulgence for 
my procrastination in responding to your letter 
of tl’.e 15th inst., but, in fact, my professional 
duties have so absorbed my entire time, I have 
not been able to make out a tabulated state- 
ment of the malignant fever prevailing here two 
summers previous from my case book, and in 
lieu of same will submit in this communication 
the factors causing these summer fevers to as- 
sume such a fatal type from my observation 
and.experlence. 
We have, in common with other cities and 
towns, the mild type of remittent fevers, Tun- 
ing their course, in many cases, without serious 
complications, and ending with convalescence 
from fourteen to twenty-one and thirty days. 
During the summer of 1890 there was an ex- 
cessive rainfall for two months (July and Au- 
gust), saturating the soil, and causing a rapid 
and vigorous gro vth of vegetation. This condi- 
tion was succeeded in September by a very 
warm, dry period, causing decaying vegetable 
matter to disseminate malaria; producing dis- 
tinct types of intermittent fever. 
Our municipal government very ignorantly 
and unwisely permitted extensive upturning of 
“virgin soil’’ in Windsor park (the property of a 
private company), “booming” their real estate 
interests here. The result of such excavations 
here was cases of hemorrhagic and congestive 
fevers, terminating fatally in my practice, 
clearly and undoubtedly traced to this upturn- 
ing of saturated soil to the hot sun, eliminating 
all its paludal causes. 10 
contain no organic matter. Most of the shell 
that we have used have been dead shell. 
During May and June of this year wre had 
several severe cases of malarial fever of a re- 
mittent form, and in some instances the bowels 
would become involved, resembling typhoid 
fever. 
All during the winter, spring and far into the 
summer the city authorities continued to up - 
turn the soil, directly against an ordinance that 
they themselves had made, and against the 
earnest recommendation of the board of health 
and my written opinion against it. 
Finally, with the assistance of the board of j 
health, I succeeded in having a writ, or an in- 
I junction, restraining them from further up- 
turning of the soil until the time set apart in 
the ordinance allowed them so to do. 
Almost immediately after this ceased the 
forms of fever became milder and fewer, yield- 
ing more readily to treatment. 
In my opinion, the upturning of soil in any 
southern city, especially during the spring and 
summer, is one of the most potent causes of so 
much malarial fevers. 
I trust that I have furnished you the informa- 
tion that you desire and will esteem it a privi- 
lege to serve you in anv manner that I can. 
With great respect, I remain your obedient 
I servant, J. A. Dunwoody.