STUDY OF THE TYPHOID FEVER EPIDEMIC AT ELLINWOOD, KAN. The prevalence of typhoid fever in the city of Ellinwood, Barton county, for the past year, was the occasion of a visit by the secretary to that place on May 6, in order to determine if possible the cause of the continuance of this disease. The condition of affairs had not been made known to this office until a few days previous to the visit, but when the history of the cases was related by a Great Bend physician it determined me to undertake to find out the cause of the disease. One physician reports that he has had thirty-five cases during the past year, these cases being scattered at irregular intervals during this period of time, and other physicians report having a number of cases of continued fever, but were in doubt as to the real nature of the disease, one diagnosing it as malarial fever. However, the Weidal test, and the clinical history of a large number of cases, including intestinal hemorrhages in some, together with the analysis of the water, would seem to indicate this epidemic as being one of typhoid fever. Upon arrival in this city we found a town of about 1000 inhabitants, scattered over an area of one-half square mile. The location is in the Arkansas valley, but a short distance from the Arkansas river, the surrounding country almost as level as a floor, thereby making the drainage very imperfect. The soil is composed of a sandy loam. The water-supply of the city is gotten from wells, in most instances driven into the soil twenty or twenty-five feet deep, where the first water layer is encountered, from which almost all of the residents of the city are supplied. The absence of a sewerage system makes the disposal of sewage a matter of considerable concern, and I found, upon inspection, it was accomplished in two ways: First, the ordinary privy vault, most of them from four to six feet deep, and many of them without enclosures, and allowed to fill up before being removed to a new point; second, by the method of cesspools. The lay of the land dips from the west towards the east, and the underflow of water has been determined by the United States Geological Survey to flow from the west towards the east, in the same direction as the river. A number of modern houses have constructed cesspools for the disposal of sewage. Each one of these cesspools was discovered to have been dug to this water-bearing stratum and the contents of the cesspool allowed to drain off through this sand and gravel. Three of the cesspools are located immediately west of the principal point of infection, as will be noticed by the accompanying map. Six samples of water taken from wells at points where the disease occurred were submitted to the bacteriologist for analysis, which analyses are reported in the following letter: "Dr. S. J. Crumbine, Topeka, Kan.: 66 "MAY 15, 1906. 'DEAR DOCTOR-Following is the report of examination of samples of water sent by you: "Cultures made from three drops of water taken from bottles marked John Dunker, Henry Bennett, and Mr. Boodie, and kept in incubator at 37°C. for thirty-six hours showed a profuse growth, which covered the entire surface of the Petri dish. "Growth from samples marked A. H Shaeffer did not show so marked development of colonies, but a count could not be made, owing to the fact that the colonies ran together in places. "Samples marked City drug-store well and V. S. Muscil showed about 3000 and 4000 per c. c., respectively. "Bouillon cultures six days old made from all samples of water East 6 gave the indol test. Indol is an aromatic product, the result of the growth of certain bacteria. The Bacillus coli-communis is the principle indol-forming germ to be considered in water. The Bacillus coli-communis is closely related to the Bacillus typhoses. They develop under the same conditions, and where the one is the other is likely to be. "There was a marked odor H2S in the bouillon cultures, which were used in making the indol tests. H2S is from peptones by the growth of the Bacillus coli-communis. The Bacillus proteus vulgare, which is found in water that has been contaminated with sewage, also gives the indol and H2S tests; so it is safe to say that one and probably both of the germs, the Bacillus coli-communis and the Bacillus proteus vulgare, are in the specimens of water from Ellinwood. Evidence of contamination is sufficient to condemn the water. Very truly yours, S. E. GREENFIELD, Bacteriologist." In several of the samples taken from driven wells it was found that there was an excavation around the piping which might allow surface contamination by water following down the pipe during the time of the rainy season. In other samples taken from wells the conditions above surface were all that could be desired, in that they were covered over and surface contamination quite impossible. The analyses of the water showed a uniform contamination of all the wells, and would seem to indicate the general undercurrent of water to be polluted, rather than such contamination coming from the surface. The conclusions drawn, therefore, from the location of these cesspools, the location of the principal source of infection, the location of most of the cases of typhoid, would seem to indicate the necessity of the abandonment of all cesspools in this city immediately, filling them up with earth to above the water stratum; then, if desired to be used as cesspools, to require them to be cemented water-tight as a cistern, and be emptied as occasion required. There can be doubt that many cases of typhoid fever in towns of this size having no sewerage system and a common water-supply are occasioned by the pollution of the water current from the cesspools. County health officers should demand the abandonment of all cesspools that empty themselves in a water-bearing stratum from which people in villages obtain their water supply. The general prosperity over the state has shown itself in no greater manner than by the movement on the part of the people to make their homes modern, and this movement, requiring some disposal of sewage, in the absence of a sewer system, is one that |