THE MILLS-REINCKE PHENOMENON 353 



unnecessary mortality and morbidity when we remember there 

 were 25,000 deaths in the United States in 1910, representing at 

 least 250,000 cases. 



Dysentery and diarrhea, although not as fatal as typhoid fever 

 or cholera, are not to be neglected, for when we consider the sick- 

 ness and economic loss resulting each year in the United States 

 from these causes, much of which is due to infected water, we 

 find that they are not negligible. Moreover, the better care of 

 drinking water has resulted in a marked decrease in the ravages 

 of dysentery, for it is estimated that the mortality from dysentery 

 in England toward the end of the last century was but a fraction 

 of a per cent, of what it was in the middle of the century. More- 

 over, the reduction of dysentery in the United States has kept pace 

 with the advancement made in water protection and purification, 

 as seen by the fact that the death-rate from dysentery in this 

 country in 1850 was 6.32 per cent.; of the total mortality in 1860, 

 2.65 per cent.; 1870, 1.6 per cent.; and in 1880, less than 1.5 per cent. 



The Mills-Reincke Phenomenon. Mills, of Lawrence, Massa- 

 chusetts, and Reincke, of Hamburg, Germany, in 1893 noted 

 that the purification of the water supplies of their respective 

 towns was followed by a decline in the general death-rate w r hich 

 was more rapid than could possibly be accounted for by the death 

 from typhoid fever. This condition was later searchingly studied 

 by Sedgwick and MacNutt who gave to it the name of the " Mills- 

 Reincke Phenomenon." Later (1904) Hazen, a sanitary engineer 

 formulated a numerical expression for the comparative effect of 

 purified w r ater upon the typhoid fever and total mortality as fol- 

 lows: 'Where one death from typhoid fever has been avoided 

 by the use of a better water, a certain number of deaths, probably 

 two or three, from other causes have been avoided." This propor- 

 tion varies greatly in different instances. It was 1 to 16 in Ham- 

 burg, in Lawrence 1 to 4.4, Lowell 1 to 6, Albany 1 to 4.4 and 1 

 to 1.5 in Binghamton. Hence, in all of the cases studied by Sedg- 

 wick and MacNutt it appears to be sound and conservative, but 

 in some of the American cities more recently studied it does not 

 appear so exact. 



The cause of this decline in mortality is not clearly understood. 

 It may be due to the exclusion of specific pathogenic organisms, 

 to increased vital resistance resulting from the use of a better 

 water, or in some cases the appearance and taste of the water 

 may be improved with the result that greater quantities are used, 

 and hence a better condition of the body in general. Probably 

 many factors are at work and these studies have revealed a remark- 

 able relationship between polluted water and infant mortality. 

 Rosenau considers that it bids fair to assume a causal importance 

 in gastro-intestinal disturbance of children second only to that of 

 contaminated milk. 

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