Report on the Origin and Prevalence of Typhoid 
Fever in the District of Columbia. 
INTRODUCTION. 
The prevalence of typhoid fever in Washington has long been a 
matter of concern to the inhabitants of the District of Columbia. 
The transient visitor to Washington, seeing only the broad boule- 
vards, handsome structures, and the general air of beauty and clean- 
liness of the city, obtains the impression of a particularly healthful 
city. It is often a matter of surprise, therefore, to learn that Wash- 
ington has a comparatively high death rate, especially from typhoid 
fever, which has generally been considered a filth disease.” 
Why Washington should pay such a high tax to typhoid fever has 
been the subject of frequent investigation. All such studies have, 
as a rule, been focused on the water supply, although such conditions 
as pollution of the soil, infection through milk, oysters, and other 
articles of food, the importation of cases, the contamination of shallow 
wells, and more recently the danger of communicating the disease 
through direct contact, and indirectly by means of flies and other 
agencies, have also received attention. 
The Potomac water has long been regarded as polluted, both by 
the large majority of the medical profession and by the public at 
large. The muddy character of the water has doubtless exaggerated 
its unwholesome qualities in the public mind. From time to time, 
therefore, engineering projects to improve the quality of the water, 
such as subsiding basins, have been conceived and carried out. 
These improvements, however, did not materially affect either the 
turbidity of the water or the typhoid-fever situation. Congress, 
therefore, provided for a further purification of the water supply by 
means of slow sand filtration, appropriating for this purpose the 
sum of $3,468,405. The filters were constructed under supervision 
of officers of the Engineering Corps, United States Army, and, so 
far as general principles of construction are concerned, they embody 
the best conceptions that modern sanitary engineers have to offer. 
Advantage was taken of the experience in slow sand filtration gained 
in actual practice in this country and abroad. 
The work was rapidly pushed to completion, so that by November, 
1905, the city was supplied with filtered water. During the follow- 
Manuscript submitted Feb. 16, 1907. 
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