June 14, 1889] 



SCIENCE. 



467 



round numbers, 14,000. The total number of children in the city 

 under fifteen years, at the census of 1885, was 34,592: it must now 

 be at least 36,000. Therefore, if we assume that the general death- 

 rate of those who have had scarlet-fever is the same as those who 

 have not, and the same relative figures are true for those who have 

 moved into the city, there must, by the most unfavorable estimate, 

 be one and one-half persons of fifteen years of age living in Provi- 

 dence who have not had scarlet-fever to every one that has. Or if 

 we take the more favorable estimate, which I think is nearer the 

 truth, there are at present four persons of that age who have not 

 had scarlet-fever to every one that has. The age of fifteen is 

 selected because scarlet-fever is rare after that ; for, out of nearly 

 a. thousand cases in this cfty, there were only twenty-four over fif- 

 teen. The chance, then, of a child's growing up without having 

 scarlet-fever, is even now very good. It can be made still better by 

 a proper observance of sanitary rules. In four cases where chil- 

 dren who had been removed at the inception of the disease were 

 taken sick on their return, they were absent from four to five 

 weeks, and were attacked within two or three days after their re- 

 turn. In the other cases the absence continued for from four to 

 six weeks in the majority, but was less than that in some instances, 

 and greater in others. We may, I think, fairly infer from them, 

 that, when a child is exposed to scarlet-fever in its own family, its 

 chances of escaping or contracting the disease are about even. 

 The figures also show that when not brought in such intimate con- 

 tact, but when merely a resident of the same house but in another 

 tenement, the chance of contracting the disease is much less, being 

 in fact one in seven. The recognition of this fact has made me 

 -somewhat more lenient than formerly in excluding children from 

 school. In houses where I am satisfied that there is no direct 

 communication between the families, I only exclude those children 

 in the family in which disease actually exists, allowing the other 

 -children in the house to continue their attendance. Of course, 

 where there is any doubt about the children mingling, as fhere 

 -always is in the crowded tenements of the poorer classes, it is 

 ■necessary to exclude all in the house. 



" In regard to fumigation, it is seen, that, in the 114 cases where 

 fumigation with sulphur was done as well as it could be in a private 

 house, the disease extended beyond the family where it first ap- 

 peared, to others in the house, ten times. This is less often than 

 when fumigation was not done, the ratio then being about one to 

 four, and in the latter case one to eleven. But how much credit is 

 to be given to the fumigation for this, I do not know. When 

 people attend to fumigation properly, they usually are careful about 

 isolation also, and the disinfection of soiled linen, etc., and they 

 are also more thorough in the application of inunction ; and it is 

 probable that all these things have as much or more to do with 

 the restriction of the disease than does the final fumigation." 



Dr. Chapin speaks doubtfully of inunction of the skin as a pre- 

 ventive of the spread of scarlet-fever. In cases where it was prac- 

 tised, out of 714 susceptible children in families where the disease 

 existed, 467 were attacked, which is a larger proportion than where 

 it was not done. This method was proposed by Dr. Jamieson, and 

 has given good results in Great Britain. Its failure in Providence 

 may be due to its improper performance, or the neglect of parents 

 to continue it long' enough. 



The number of deaths from typhoid-fever during the first eleven 

 months of 1S88, while in excess of the preceding year, was not 

 much above the average for the past few years. The autumn was 

 warm and rainy, and it was thought that the slight increase in this 

 disease might be due to these meteorological conditions. During 

 the last week in November, however, the disease increased greatly 

 and suddenly, and almost as suddenly diminished during the early 

 part of December. During the two weeks ending Dec. 15, 223 

 cases of typhoid-fever were reported at the superintendent's office, 

 139 being reported during the week ending Dec. S. This is the 

 largest number ever reported in one week, except during the epi- 

 -demic of 18S2, when 163 cases were reported during the week end- 

 ing Nov. II. The number of deaths in December from typhoid- 

 fever was 47, which has been exceeded only once, by 70 deaths m 

 November, 1SS2. The next largest number of deaths was 32. in 

 April, 1SS3. It will thus be seen that the epidemic, though short, 

 was severe. 



For this outbreak there must have been some peculiar and local 

 exciting cause. General meteorological conditions must be ex- 

 cluded, for they would have operated over the neighboring country 

 as well as in Providence. There was, it is true, a very heavy rainfall 

 during the year 1888, and particularly in November, and the sea- 

 son was unusually mild ; but a local epidemic like this cannot 

 properly be attributed to any such general influences. The cases 

 were scattered very generally and very equally over the city. The 

 only district which had less than its due proportion was that on 

 the summit of the hill on the east side of the Providence River. 

 Local unsanitary conditions, acting only on the individuals at- 

 tacked, could not stand in a causative relation, as is shown by the 

 report of the medical inspector. 



The one cause which seemed most likely to act upon the whole 

 city for the production of this disease was the w.iter-supply. A 

 quite common and absolutely demonstrated cause of typhoid-fever 

 is the pollution of drinking-water with the stools of typhoid patients. 

 Knowing the danger of pollution to which the Pawtuxet River was 

 exposed, and thinking that the source of trouble might possibly be 

 found along its banks, Dr. Chapin proceeded to make a thorough 

 investigation of the river-valley. From inquiries he learned, that, 

 with the exception of one locality, there had been only two or three 

 recognized cases of typhoid in the valley of the river during the 

 autumn months. The exception was at Natick. Below Natick, 

 at Pontiac, is a dam. This is the only obstruction between the 

 pumping-station and Natick. At the latter place are several tene- 

 ments belonging to the Mill Company, situated from one hundred 

 to one hundred and twenty-five feet from the river-bank on a flat 

 only a few feet above the level of the water. These houses are 

 occupied by French Canadians, and it was among them that the 

 typhoid-fever occurred. The attending physicians — one of Natick, 

 and the other of Centreville — could not state how this epidemic 

 originated, but they assured Dr. Chapin that during the months of 

 September, October, and November there had been about twenty 

 cases of the disease in these houses, and that one or two of the 

 patients were only just convalescent when he visited the village on 

 Dec. 7. These people were ignorant, and no information could be 

 gained by questioning them. They were very careless and filthy 

 in their habits ; and the attending physician stated, that, as was to 

 be expected, they made no pretence of disinfecting the excreta of 

 the patients. These houses were all provided with water-tight 

 cemented vaults, situated within fifteen to twenty-four feet of the 

 water's edge, which had not been cleansed for two or three months 

 previous to Dec. i, and no night-soil had been applied to any land 

 near the river during that time. 



Openings had been left in the covers of the vaults, through 

 which it was supposed that the tenants would empty their slops ; 

 but the people chose, perversely, to throw them on the ground be- 

 hind and at the side of the privies. Places were seen on the banks 

 of the stream where these slops, mingled with fscal matter, were 

 slowly working their way into the water. Cases of typhoid began 

 to appear with unusual frequency in Providence about Nov. 23. 

 As there are good reasons for believing that the incubation of 

 typhoid-fever consumes from ten to eighteen days, and as two or 

 three days might elapse before the disease poison was distributed 

 at the house-taps, it is evident that the course of events was as it 

 would have been if the rain of the 9th of November had washed the 

 specific poison into the water.- 



Examinations were made of the water itself, taken from the dis- 

 tribution in the city, the river, and the two reservoirs. The bacte- 

 riological investigations of Dr. Swarts, the medical inspector, have 

 made it certain that the house-filters in common use collect filth 

 and microbes from the water, and act as incubators for the latter, 

 allowing them to rapidly propagate within the interstices of the 

 filtering material, and they are washed out in large numbers as 

 water is drawn through the filter. Such filters have been invari- 

 ably condemned ; for it seemed certain, that, in case there were 

 disease-germs in the water, the so-called filters, instead of remov- 

 ing them, would actually increase the amount of the poison, and so 

 increase the liability to disease in those who use them. During 

 this epidemic a large number of patients were found who had used 

 water thus filtered ; and it was especially noticeable that many of 

 the cases which occurred soon after the epidemic proper had 



