750 THE WATER SUPPLY OF LEAVENWORTH. of the water with organic matter. In 1884 water drawn primarily from the Missouri river and 1885 however, typhoid fever became more and rendered presentable to the eye by the common, and in 1886 and 1887 it assumed the processes of subsidence and decantation, proportions of an endemic. The next year About one-fourth of the population use the the number of cases fell off markedly but the city water in their homes. About threenumber was still large. This was undoubted-fourths therefore use either cistern or well ly due to the efforts of physicians to induce water, and as most people prefer well water for people to desist from the use of questionable drinking purposes, it is probable that the mawater, or where they were compelled to use it jority of these use well water in their homes. to adopt methods of purification. There was It must be remembered however that in all a great outcry against the well water, as it was business houses and public buildings, almost found that almost every case of typhoid was without exception the city water is used, this among people who made use of well water. includes Fort Leavenworth and the Soldiers Physicians unhesitatingly recommended pa- Home and increases the number of people tients to drink hydrant water or cistern water using city water very greatly. and in any case to adopt methods of purification, to avoid drinking water from any well, no matter how clear and cold and sparkling it might be. But of course there was a large number of people who knew that their well was all right; there could'nt be anything the matter with their well. a The cisterns need very little consideration at our hands, as manifestly the water cannot be contaminated from the surrounding soil unless the cistern is cracked and leaky. The only other sources of contamination are the atmospheric air through which it passes in descending as rain and such organic matter as it may collect from the roofs. The latter is the most important source of impurity in consequence of the large number of English sparrows and other birds that befoul the roofs, but notwithstanding these sources of impurity a chemical examination shows our cistern water to be by far the purest water we have at our command. Excluding therefore cistern water as not liable to general contamination we take up hydrant water. About this time "winter cholera" made its appearance also, and the number of cases was very large. It was not a grave disease at all but the symptoms were sufficiently distresssing to keep physicians very busy. In 1888 and '89, and during the present year there has been steady decrease in the number of cases of typhoid, but it still remains an ever present factor to be considered by the physician in diagnosis. The allied enteric diseases while they have diminished greatly have scarcely While our hydrant water is not all that the kept pace with the diminution of typhoid. I water company hope to make it, it compares refer to dysentery, summer complaint and very favorably with that of any city in the those disorders of the stomach and bowels Missouri valley, I am told. A sample drawn which in children especially are so frequently referred to indigestion and fermentation as a cause. It is susceptible of proof by experi. ment that the fermentation and indigestion are an effect and not a cause, except in a secondary manner. Give the patient pure water and sterilized food and the fermentation disappears. Render the stomach and intestine aseptic and normal digestion is re-established. Enough has been said to show the status of affairs that leads to a consideration of the water supply of Leavenworth. This supply is from the usual three sources found in cities-cisterns, wells and hydrants; the last named being simply points of issue for from one of our hydrauts was sent by our local board of health to the chemist of the State Board of Health, Dr. Reid Alexander, and an analysis made with a view to establishing either its purity or impurity. Dr. Bidwell, Secretary of the local board kindly gave the writer access to the letter of the State chemist and we give the analysis in full : Grs. per U. S. gallon Organic matter.. Total solids. .300 .500 6.960 1.392 4.833 5.628 1.383 20.994 THE WATER SUPPLY OF LEAVENWORTH. 751 Chlorine. . Free ammonia . . parts per million. .835 fever may be disseminated by well waters that .280 contain only traces of free ammonia and the .170 albuminoids, but in these instances the nitrates Infusoria and chlorides are usually in excess." If well Concerning this water and its analysis Dr. waters containing only traces of free ammonia Alexander remarks in conclusion: "This and the albuminoids may generate the baccilwater is condemned by the best standards, for lus of typhoid fever why not a river water. drinking purposes, owing to the amount of The Leavenworth hydrant water with free free and albuminoid ammonia found to be ammonia present to the amount of 0.280 parts present." per million, and albuminoid ammonia to the This would be perfectly true if we are amount of 0.170 produces no typhoid fever; guided entirely by the conclusions of Prof, and notwithstanding there has been no diminWanklyn, the author of Wanklyn's method of ution in the amount of that water used for estimating albuminoid ammonia; for Wank- drinking purposes there has been a steady lyn says distinctly that "albuminoid ammonia decrease in the number of cases of diarrhoea, above 0.10 parts per million begins to be a dysentery, and such diseases up to the present very suspicious sign; and over 0.15 parts per time, and during the last six months the city. million ought to condemn a water absolutely." has been very healthy. But in direct contravention to this, please notice the remarks of Dr. Chas. Smart of the U. S. A., in his elaborate monograph on water in the "Reference Handbook of Medical Sciences." He says in speaking of this very conclusion of Wanklyn's: There is little doubt that the endemic of winter cholera, so-called, was caused by the defective system of subsidence and decantation then in use by the water company, as the vast majority of cases were in hotels and public institutions where the city water was used exclusively, and in addition to this large numbers of people by the advice of physicians used. hydrant water for drinking puposes, in order to escape the danger of typhoid fever which threatened them in drinking well water. "Most of the rain waters of the United States, collected in clean dishes as they fall from the clouds would be condemned by the Wanklyn's dictum. Most of our river waters which are in daily use would be condemned on similar grounds. In the experience of the But the fact that there has been a steady writer, while Wanklyn's limit of allowable decrease in the occurrence of enteric and gasimpurity may be accepted in cases of wells tric diseases, not to overlook the effective where the danger of infiltration from privies work of physicians in inculcating methods for is great, it should be extended to 0.20 parts the purification of well water, would argue per million in the case of our river and other that there has been a corresponding increase surface waters, as it is not until the albumin- in the purity of the city water. This is unoid ammonia reaches or exceeds this quantity doubtedly the case. that a taint becomes developed in the water during warm weather, and that diarrhoea, dysentery, or febrile conditions are connected with its use." Of course there is still room for improvement, but the recent completion of a new primary settling resevoir has added wonderfully to the facilities for furnishing pure water. This resevoir is a remarkable structure in the completeness of its appointments and was constructed at an enormous expense. sults however will fully justify such an expenditure if it is used with the effect that might be expected. Its re This shows that careful and exhaustive as were the experiments of Prof. Wanklyn, and valuable as were his conclusions, they must be revised very materially if Dr. Smart is correct. And the facts as they have occurred in Leavenworth seem to corroborate the opinion of Dr. Smart. Among the scores of cases of typhoid The defect of the old reservoirs was in the that occurred, not a single case so far as the fact that owing to their constant use and the writer was able to learn was traced to the hy- manner of their construction, they could not drant water. But Dr. Smart says: "Typhoid be cleaned of their accumulating sediment. oftener than once in six months and then matter and the chlorides in half an ounce only in a hasty and ineffective manner. The were saturated by two drops of the test soluresult of this condition of affairs is very clear- tion. These tests were afterwards supplely shown by a series of experiments instituted mented by the permanganate of potassium by the writer previous to the completion of and oxalic acid test in order to obtain a roughthe new reservoir. ly quantitative idea of the amount of oxidizable organic matter in each specimen. The rela to fifteen, that is, it required fifteen drops of the acid to neutralize one drop of the permanganate in one half an ounce of distilled water. Dr. Edmond A. Parkes, in his excellent work on practical hygiene says with reference tive strength of the test solutions was as one to the meaning of qualitative tests in determining the potability of water: "The coincidence of easily oxidizable organic matter, of ammonia and of chlorine in some quantity, would be in favor of an animal origin" of the contained impurities. Acting upon this as a basis, a sample of very nice looking hydrant water was tested for those substances, using Messler's solution for ammonia, the chloride of gold for oxidizable organic matter and the nitrate of silver and potassium chromate test for chlorine. The sample showed the presence of both ammonia and oxidizable organic matter, and the chlorides in half an ounce were saturated by four drops of the test solution of nitrate of silver. The first sample showed an amount of organic matter measured by ten drops of the oxatic acid solution; the second about ninety drops, the third nine drops and the fourth eight drops. In other words, previous to the completion of the new reservoir, the hydrant water contained just twice the amount of chlorine that was contained in the water from the open river taken anywhere above the Cherokee street sewer, and at least two-fifteenths more oxidizable organic matter. Only one possible explanation of this suggests itself and that is the one which has been given. The water was pumped from the open river through a pipe that extends out into the river about forty feet. It was pumped directly into the first settling reservoir, allowed to settle, drained off into a second reservoir,allowed to settle again and then pumped into a third reservoir, from which it was distributed to the city, the post and the Soldier's Home. No provision had been made for flushing the bottom of these reservoirs, and not being able to clean them oftener than once in six months the accumulations of sediment became very large, and the pumping in of the new supply each day kept this sediment in a constant daily agitation. These samples of water were then taken from the open river, and after allowing them to stand until all insoluble matter had settled to the bottom and the supernatent liquid was perfectly clear, they were subjected to the same tests. The first sample was taken from near the bank of the river between the two sewers that empty at the foot of Cherokee and Choctaw streets respectively, and furnished very nearly the same reactions as that from the hydrant. The reason that the reactions furnished by this specimen were so slight is that the sewer at Cherokee street which is the one furthest up stream is a very small one, a mere branch. Whereas the second specimen, taken from opposite the Choctaw street sewer, This condition of affairs is largely remedied furnished marked reactions for ammonia and by the new reservoir. It is provided with two oxidizable organic matter, and an amount of chlorides so enormous that we did not attempt to estimate it. The third sample was taken from the mid-current of the river on the pontoon bridge, and the fourth from near the bank of the river opposite the pumping engines of the waterworks. These two samples furnished exactly the same reactions; faint reactions for ammonia and oxidizable organic large exit pipes and sluices by which the whole fifteen million gallons can be turned into the Missouri again in a few hours, carrying all the sediment with it, and as the bulk of this sediment falls in the primary reservoir, in this way the evil is largely remedied. But an examination of the water of the Missouri river opposite the pumping engines shows the presence of organic impurities. which though small in amount demand an Chlorides were present in excess in all the explanation. If they arise from contaimina- specimens examined, and nitrates present in tion with animal matter as seems probable, the majority. the source of such contamination must be How then is it that our typhoid fever has sewage entering the river at some point above. diminished to such a marked extent, that to Competent authorities have stated that the casual observer it has almost disappeared? sewage diluted with twenty times its volume The answer is, by adopting methods of purifiof running water is completly destroyed in cation. The methods of purifying water for running nine miles. Other authorities pre- drinking purposes are so well understood that sumably quite as competent flatly deny that it is hardly worth while mentioning them, such is the case. We are therefore driven except to remark that the simplest methods back upon the facts at our command for argu- are the best. Not only because the best ment. We know that the sewage of Fort methods happen to be the simplest, but beLeavenworth enters the river nearly two miles cause it is an unfortunate fact that a vast above the city; and we know that the current number of people will not take the trouble to of the Missouri river runs at the rate of about adopt any but the simplest possible method four miles an hour. It is therefore only about even to escape typhoid fever. It is therefore half an hour after the sewage of Fort Leaven- advisable to recommend only those methods worth enters the river that it is carried down that are easily carried into effect, such as boilto a point opposite the pumping engines. ing the water and the use of alum for the precipitation of impurities. The majority of people have a singularly blind and abiding faith in ordinary filters. It is often necessary to explain to people in the most careful manner the apparently self evident fact that filters cannot possibly extract any but the insoluble impurities. and unless they are frequently cleanse 1 are liable to become sources of contamination. Charcoal filters especially inspire the utmost confidence. These of course are better than ordinary filters because the charcoal absorbs the free amonia with great When we consider these facts, it is little less than marvelous that the amount of organic impurities found at this point should be so small, and it shows that if this one source of contamination was removed we might well be proud of old Missouri as a source for our water supply. It is understood the water company is making strenuous efforts to accom. plish and no doubt they will succeed. is a limit even to the capacity of charcoal to absorb ammonia, and when the limit is reached the filter is just as useless as any other. But it is when the hydrant water is compared with the well water of Leavenworth that its purity looms into very magnificence. The water from fifteen different wells from avidity, but it must be remembered that there as many different portions of the city was examined and in every case there was found from one to twenty-four times the amount of chlorides found in city water. In almost every specimen was found ammonia, in all but one a distinct reaction for oxidizable organic matter. In two were marked reactions for nitrates, several being doubtful; and the majority showed the presence of nitrates by the bricine test. Such facts speak in no uncertain terms. It will be remembered that Dr. Smart says: "Typhoid fever may be disseminated by well waters that contain only traces of free ammonia and the albuminoids, but in these instances the nitrates and chlorides are usually in excess." And here we find the explanation of the fact that all of our typhoid fever cases were traceable to well water and none to hydrant water. The conclusions to be arrived at from this study are: First-The cistern water where the cistern intact is the purest water in Leavenworth. Second-That the hydrant water stands next in purity and is undoubtedly improving. Third-That the maximum amount of albuminoid and free ammonia allowable in river waters used for general potable purposes should be placed much higher than has heretofore been thought; and the opinion that the Leavenworth city water should be condemned for drinking purposes according to the best standards is one from which we entirely dis sent. Fourth-That a swiftly running current ed that in all ages it has been recognized locallike that of the Missouri river, destroys organ- ly and described. ic impurities arrising from sewage much more But it was reserved for modern medicine to rapidly than an ordinary current, and instead mark out its peculiar nature, its contagion, its of requiring a flow of a greater distance, re-association with puerperal fever and other quires a flow of a much shorter distance to septicemias, and for the medicine of our own destroy such impurities. day to point out its prevention. Fifth-That the water of all wells not more Erysipelas is defined by Stille as "an acute, than two blocks outside the area drained by specific and contagious fever, tending usually the sewers is either grossly impure or of towards a typhoid type, and characterized by questionable purity, and should not be used a peculiar inflammation of the skin or mucous without adopting some method of purifica- membranes." tion. Its specific cause is a poison, probably due Tabulated list of well water, under chlorine. to the presence of certain micro-organisms, The city water is taken as unity. which is introduced into the blood. The poison may be communicated directly by the affected subject, or it may be carried in clothing or other material-especially on instruments of the surgeon and fingers of the accouchers. The disease is associated with the filth diseases, and its virus, as in that class of diseases, may under favorable circumstances, be [Probably generated in the decompositions of organic wastes; hence it is frequently communicated by escaping gases, from leaking sewers, &c. contam inated with veg etable or- For its introduction into the system it seems to require a solution of the continuity of some surface-a pimple, an abrasion, an ulcer, or jects are specially susceptible to the contagion whilst others are nearly exempt. "I FIND that the action of Ponca Com-wound slight or great-at all events such subpound is very favorable for inflammation of the cervix uteri and for irritation of the ovaries. "E. BRINKERHOFF, M. D., "Bristolville, Ohio." Erysipelas. It is in the light of these facts that the conscientious physician dreads to meet with a case of erysipelas. It may be simple and trivial in its type, yet the moment he touches it he becomes a source of danger, possibly of death, Read before the Lyons County Medical Society, to others who look upon him, and trust him. September 2, 1890. BY DR. L. D. JACOBS, A. M., M. D. [Reported for the KANSAS MEDICAL JOURNAL.] The subject which has been assigned to me is not a new one; it is old and its history runs cœeval with the history of medicine. Erysipelas was well recognized and accurately described by Hypocrates in all its forms -cutaneous and phlegmonous, traumatic and idiopathic. for relief and health in their distress. The connection of erysipelas with puerper-. al fever is so well established and recognized that I need not refer to the literature, but to emphasize what I have said, I will only quote the following cases from Dr. Dutcher (quoted from the International Encyclopedia of Surgery :) "A physician while attending a case of phlegmonous erysipelas was called to a case of confinement. The patient died of puerperal fever. In the course of four weeks he attend Its general characteristics are so well mark- ed seven cases of labor, and in every instance |