352 WATER AND DISEASE 



1. Nearly all of the cases were nearer a certain public pump 

 in Broad Street than any other source of water and most of them 

 gave a definite history of getting water from the pump. 



2. Of the few cases which developed outside of the area sup- 

 plied by the pump most of them were known to have drunk water 

 from the Broad Street well. 



3. The few scattered cases in distant parts of London were 

 individuals who had used water from the well. 



4. Right in the midst of the district was a workhouse with 235 

 inmates and a brewery with 70 employees, each having its own 

 well, and there were only 5 deaths in the workhouse and none in 

 the brewery. 



5. It was shown that a privy vault and cesspool in an adjoining 

 house discharged through a leaky drain which ran within two 

 feet of the Broad Street well. 



6. There were 4 fatal cases of cholera in the house at the time 

 of the outbreak and earlier cases which were probably cholera. 



It was not until 1880 that the typhoid bacillus was isolated 

 by Eberth and studied in detail by Gafky in 1884 that we had 

 definite information concerning the causative agent of typhoid 

 fever, the way in which it leaves the body, and the routes by which 

 it may reach drinking water. This same year Koch isolated the 

 cholera vibrio from stools of patients suffering with the disease. 

 He also isolated the organism from tankwater in India. We now 

 know that water is a vehicle for a number of infections such as 

 typhoid fever, cholera, dysentery and other intestinal diseases. 

 It may be the medium for conveying infections not now generally 

 regarded as water-borne. It may carry inorganic poisons such as 

 lead, or may be of such a nature as to bring about derangements of 

 metabolism resulting in goiter, or may lower resistance, so as to 

 favor infections not water-borne. It occasionally conveys animal 

 parasites, amebse and worms. 



Amount of Sickness due to Water. Water is probably responsible 

 for more sickness and death than any other article of diet except 

 milk. This is due to the facts: (1) That it is used raw, while 

 many other substances are rendered sterile by cooking; (2) water 

 comes in contact with numerous substances upon the earth's surface 

 and is a universal solvent; (3) it is used as the great vehicle for the 

 removal of waste, much of which may contain pathogenic organisms. 



It is difficult to obtain statistics to indicate accurately the mor- 

 bidity and mortality due to impure water, but Whipple states 

 that the average typhoid death-rate in American cities is about 

 35 per 100,000, while cities with a good water supply average 20. 

 He, therefore, attributes 40 per cent, of the typhoid fever of the 

 United States to infected water. Chapin, however, considers it 

 would be more conservative to place it at 15 per cent, for the whole 

 country rather than at 40. But even these figures show a large 



