well accomplished (although many even now are still in doubt) the Potomac river, by reason of an ever-increasing population in the towns, villages and settlements located along the banks and within its watershed, had become itself a dangerous source of infection.

My suspicions that typhoid fever germs might travel all the way from Cumberland, a distance of 134 miles, and infect the consumers of Potomac water in Washington, were confirmed as early as the winter of 18891890 by studying the effects of the typhoid fever epidemic at Cumberland upon the prevalence of the disease in Washington. The records of the health office show that during this epidemic, from December, 1889, to April, 1890, the deaths from typhoid fever amounted to 74, as compared with 42 for the corresponding months of the previous year. Indeed, we had almost double the number of typhoid deaths during these months than for any corresponding months either before or since this epidemic. Cumberland had about 45 deaths and 485 cases. Washington had 74 deaths and about 800 cases, and yet the starting point of all was the excreta of one patient washed into a little run which empties into the Potomac river 300 feet above the pumping station of the water supply for Cumberland. In the face of this fact and the almost constant presence of intestinal bacteria in Potomac water, the writer had no hesitation in declaring that the excessive typhoid fever rate of the National Capital was largely due to contaminated Potomac water, and urged, with other members of the profession, the speedy purification by means of sand filtration as well as the prevention of river pollution.

FILTRATION OF THE POTOMAC WATER.

In 1901 and subsequent thereto Congress appropriated sufficient money for a complete system of slow or natural sand filters. This filtration plant was completed under the supervision of United States engineer officers, with Allen Hazen as consulting engineer, in the fall of 1905. It covers twenty-nine acres and is the largest in America, and in many respects the most modern and scientific in the world. It handles about 75,000,000 gallons a day and eliminates ninety-eight to ninety-nine per cent of all the bacteria; and we have at least the comforting assurance that a corresponding percentage of disease-producing germs will also be removed. The effects of filtration upon the typhoid fever rates are shown by the fact that the rate reached as high as 104 in 1890, and was still 60.3 during the five-year period 1896-1900, but has fallen in 1907 to 34.6 per 100,000. As a result of the installation of filtration plants elsewhere, not only a reduction of eighty-one per cent in the deaths from

typhoid fever has been noted, but also a marked reduction in the general death rate. Computations by Hazen clearly indicate that where one death from typhoid fever has been avoided by the use of a better water, a certain number of deaths, probably two or three, from other causes, have been avoided.

It is a difficult matter to explain how water is connected with the deaths other than those from water-borne diseases, yet when we consider that water enters into the composition of the body to the extent of about sixty per cent, we are in a position to appreciate the sanitary acumen of Aristotle when he wrote in his Politica: "The greatest influence upon health. is exerted upon those things which we most freely and frequently require for our existence, and this is especially true of water and air."

INFLUENCE OF SEWERS UPON THE HEALTH OF THE COMMUNITY.

According to D. C. McComb, superintendent of sewers, "the first action. materially affecting the drainage of the city was the construction of the Washington canal from the Potomac river at the foot of Seventeenth street west, to the Anacostia river at the foot of Second street east. The sewers constructed by the city prior to 1871 emptied into the canal. * * * After the introduction of the Potomac water supply in the year 1859 the demand for and the construction of sewers increased, and it was not long before complaints were made of the nuisance caused by the foul materials brought by these sewers to the canal. *** It was not until the act of the legislative assembly of August 21, 1871, that the discharge of solids into sewers was permitted, although in point of fact water closets with direct sewer connections were in use for many years prior to the passage of this act.”

As a result of these conditions, the Board of Health, in 1871, found not only over 30,000 privy boxes, "many in bad condition and overflowing," the contents of which were emptied, according to Dr. Tindall, upon the commons of South Washington, within less than one mile from the best residence and business section of the city, but also that the Washington canal, which L'Enfant had hoped to preserve as a natural waterway, had become, in the language of Prof. Henry, of the Smithsonian Institution, "an open cesspool, a fruitful source of discomfort and disease, receiving the sewage direct in its midst, and inconsistent with the intelligence of the age.' ." This great nuisance, passing within a few hundred yards of the White House, the War, Navy and State departments, through the Agricultural, Smithsonian and Botanical gardens, almost to

the very gates of the Capitol, was abated in 1871-1880, upon the demands of the Board of Health.

It is safe to say that the District prior to 1871 spent less than $100,000 for sewers. We now have 103.2 miles of main sewers and 365.2 miles of pipe sewers, constructed at a total cost of $13,613,932.38. Provisions have never been adequate, however, and the records of the Health Department show that even now in about 4,100 houses sewer connections cannot be made, because of the absence of branch sewers.

A summary of the evidence reveals the significant fact that the cities, both at home and abroad, in which there has been the most marked decrease in typhoid fever are those in which a pure water supply has been substituted for a pre-existing contaminated one, and the effects are still more marked when combined with a good sewerage system.

The history of every sewered town shows a lessening of the typhoid death rate subsequent to the construction of the sewers, and that the typhoid rate is always higher in sections supplied with makeshifts. In 1895 the writer pointed out that typhoid prevailed in the city of Washington in one of 81 houses with privies, and in only one in 149 of those connected with sewers. The health officer of Nottingham, England, has since then presented similar evidence. The only reasonable explanation for this is that sewers carry away the filth that otherwise would contaminate the soil and ground water, but even if there were no wells these makeshifts are still a source of danger in so far as they favor the transmission of the infection by means of flies, nor can the possibility be ignored that the germs in leaky or overflowing boxes may reach the upper layer of the soil and, with pulverized dust, gain access to the system.

HAS HUMAN LIFE BEEN PROLONGED BY EFFORTS IN SANITATION?

Professor Finkelnburg, of Bonn, estimates that the average length of human life in the 16th century was only between 18 and 20 years, and at the close of the 18th century it was a little over 30 years, while today it is between 38 and 40 years; indeed, the span of life since 1880 has been lengthened about six years. No two factors have contributed so much to the general result as the improvement of the air we breathe and the water we drink. Indeed, we have ample evidence that, with the introduction of public water supplies and sewers, the general mortality in numerous cities during the past fifty years has been reduced fully one-half, the good effects being especially shown by a marked decrease in the number of cases of typhoid fever, diarrheal diseases and consumption. The

vital statistics of Great Britain furnish the proof,* and our experience with American cities confirms this conclusion.

The death rate in London has been decreased from 40 per 1,000 in 1780 to 15.1 per 1,000 in 1905; in Berlin from 32.9 in 1875 to 16.4 in 1904; in Munich from 41.6 in 1871 to 18 in 1906; in Washington from 28.08 in 1875 to 19.25 in 1907, and in New York from 38 per 1,000 in 1854 to 18.9 in 1906. The general mortality in the United States has been reduced from 19.6 in 1890 to 16.2 per 1,000 in 1905, which means a saving of over 290,000 lives in one year alone.

To demonstrate the beneficent effects of sanitary reforms, the following comparative illustration, which I gathered from one of the public addresses of my deceased friend, Dr. Busey, and have brought up to date, may be cited:

In 1872 the cities of Berlin and Washington were alike in primitive municipal methods of sanitation. Without adequate distribution of the water supply, the larger part of their population was dependent upon public and private wells. Without systems of sewerage both were alike supplied with makeshifts for the disposal of human excreta and waste waters. The unpaved streets were the common receptacle of garbage, ashes and house sweepings, and along the gutters the surface and house drainage were conducted to the neighboring water courses. Since the city of Berlin began the system of sanitary improvements, completed in 1890, at a cost of fifty-nine million marks, for a pure and ample water supply, and forty-two and one-half million for construction of sewers, the typhoid fever death rate has fallen from 143 in 1872 to 5 in 1896,

*The following table shows the death rate from certain diseases per 10,000 of population in English cities before and after the introduction of sanitary works (see Cameron, "A Manual of Hygiene," 1874, p. 129):

per 100,000 of its inhabitants; and the general death rate from 32.9 in 1875 per 1,000 to 16.4 per 1,000 in 1904, while our death rate from typhoid fever is still seven times greater than that of Berlin, our general death rate has been reduced from 28.08 in 1875 to 19.25 in 1907— results not so much due to climatic differences, but largely due to the fact that the German capital enjoyed superior advantages in sanitation and the housing problem, while we are still in the process of evolution, and are making slower progress on account of the mixed character of our population.

The writer, however, is not a pessimist as regards the health of this city, since a retrospect conclusively shows that the efforts of Senator Gallinger and other members of Congress, the Commissioners and the Health Department in the sanitation of the National Capital have been most fruitful and beneficent.

DECREASE IN DEATH RATES SINCE 1875.

When we recall the fact that, in 1875, the death rate for the white population was still 21.04 per 1,000, while in 1907 it was only 15.54, and that likewise a steady and most gratifying decrease from 42.86 to 28.21 per 1,000 of the colored population has taken place, we have reason to look hopefully to the future.

In discussing the healthfulness of the National Capital, it would not be just to the fair name of our city did we fail to emphasize the fact that the colored element is a potent factor in maintaining a high general death rate. For example, the mortality rate during the census year of 1900 in the larger cities of the Registration area in the United States, representing 10,000,000 of inhabitants, surrounded by modern influences of civilization, was 18.6 per 1,000; our own rate for the white population was 17.81, and for the colored 30.43, making a general high average of 21.74. Our population is composed of 231,417 whites and 95,018 colored, which means that Washington includes the largest colored city in the world.

CAUSES OF LARGE DEATH RATES AMONG THE COLORED RACE.

An analysis of the relative incidence of the most fatal diseases on the white and colored race shows that the excessive mortality is especially marked in Pneumonia (ratio 1 to 3.30), Tuberculosis of the lungs (1 to 3). Abdominal Tuberculosis (1 to 4.10), Pulmonary Hemorrhage (1 to 6.13), Diarrhea and Enteritis under two years of age (1 to 2.96) and Typhoid Fever (1 to 1.79), and is higher in all other diseases, even in malarial affections (1 to 4.32), from which they were supposed to enjoy