220 
TYPHOID FEVER IN DISTRICT OF COLUMBIA. 
is expressed that many of these cases were really typhoid fever. 
Attention is called to the fact that as malarial fevers are diagnosed 
less, the diagnosis of typhoid fever has become more frequent. Also 
that the areas of the greatest number of deaths from malarial fevers, 
typho-malarial fever, and diarrheal diseases coincide with that of 
typhoid fever. 
Abundant water supply and efficient sewerage being so intimately 
associated, it was found very difficult to determine what effect sepa- 
rately these conditions had upon typhoid fever. Instances are cited 
to show that it has been necessary to combiue good water vdth effi- 
cient sewerage before there was any marked reduction in the typhoid 
rate. 
It was found that the greatest abundance of bacteria in Potomac 
water occurred in January and February, the season of least typhoid 
in Washington, while during August, September, and October, when 
typhoid was most prevalent, the bacterial counts were lowest. Also 
that turbidity and bacteria ran parallel, in accordance wdth the raiu- 
fall on the Potomac watershed. The conclusion is reached that the 
possibility of the introduction of typhoid bacilli into Potomac water 
is dependent upon the prevalence of the disease on the watershed, 
but that ^Tt is an unjustifiable conclusion that because fecal bacteria 
are found in Potomac water, therefore t}q)hoid fever is usually propa- 
gated by the drinking of Potomac water.” 
The authors show that the disease was more prevalent in that por- 
tion of the city occupying the low ground in the southeast and south- 
west, and attribute this fact to several causes, viz, a greater number 
of privies in those localities, resulting in greater pollution of the soil ; 
leakage from defective drains, and less efficient drainage on account 
of the flatness of the land and the backing up of the tidal currents into 
the sewers, even in times of flood, carrying the sewage into cellars 
and basements. 
On account of the greater soil pollution, it was found that the wells 
of this section were often contaminated. 
The authors did not investigate the milk supply sufficiently to 
warrant any extended remarks, stating that — 
it is safe to assume from the experience of many observers elsewhere that typhoid 
fever is to a certain extent propagated by milk; there is nothing in the condition of the 
dairies from which om’ milk supply is drawn to make us think that we are better pro- 
tected from this danger than other communities where epidemics have been traced 
to milk infection. 
The conclusions are reached that : 
1. Typhoid fever increases in proportion to the saturation of the soil with decom- 
posing organic matter, especially human excreta, and to the drinking of infected 
water. 
2. Typhoid fever decreases in proportion as a city is well sewered, and in proportion 
to the abandonment of the drinking of well water, and of all contaminated water. 
