When we consider the many insalutary conditions now in existence at the institution, all of which were in operation at the time of the endemic under investigation, viz: overcrowding, imperfect, and irregular heating, impurity of the walls, floor, carpets, and chamber utensils, and general want of cleanliness, insalubrity of the atmosphere, the situation of the building being low and damp, partly surrounded by trees and shrubbery, preventing evaporation and obstructing light; and then, combine these influences with the restrictions and privations by confinement, depression, overawe and overtaxation in discipline, it is no wonder the inmates were rendered fit subjects for the ravages of disease.

Now, while it will be readily admitted that the causes enumerated are sufficient to depress, render anæmic and predisposed to disease those under their influence, it must not be forgotten that, as far as we can learn, they have been in operation long before and since the outbreak of disease, under special consideration-and as there was no epidemic prevailing in the outside community at the timeour attention must inevitably be directed to the existence of some local cause.

The committee agree with the opinion of Dr. Daly, in general, as expressed in his report to the Board of Managers of the Reform School, in which he says: "That typhoid poison in its most concentrated form must have been introduced in the drinking water, there can be no doubt whatever, and that the same danger exists in the use of the well water seems evident from the proximity of the privy vaults and sewers, which are constructed of brick, and are necessarily more or less defective." There is reliable evidence that well water has been contaminated with typhoid poison from vaults 300 feet distant, the poisonous matters leaking through crevices in the bricks and cement, and percolating through the earth to the water veins that supply the wells. Again, the Doctor says: "The water supply is obtained generally from two sources, but during the time of the endemic, the pumps which furnished the drinking water from two wells, were out of order, and the boys' pump not in use during January, February, and March, the girls' in February and March. The supply then for all purposes, including drinking, was obtained directly from the river immediately opposite the buildings."

The danger of organic matter consists in the fact that it is organic matter in a state of rapid putrefactive change, and that it may, and often does, contain (especially if derived from excremental matter) the poison of specific diseases which it is known may be disseminated in a drinking water to a population.

Now granting the possibility of the wells being contaminated by the escape of sewage matter from the privies or main sewer pipe, it would be reasonable to expect a continuance of the disease while the poisoning process still existed, and its effect would have been manifested in a more marked degree on the new inmates, even admitting the subjects for infection at the commencement of the endemic had been exhausted.

Although at present we are unable by chemical analysis to ascertain the exact nature of the poisonous element, it is none the less susceptible of demonstration, that analysis will give us evidence of previous contamination of water by sewage, or the introduction of decomposed organic matter in some other form.

Believing there was at the time of the endemic a special cause of contamination which had neither occurred before nor since, we were thereby induced to give special attention to the water supply obtained from the river.

It will be recollected that the sewer from the boys' privy empties into the river one hundred and eighty feet below and the girls' one hundred and eighty feet above the main sewer. The latter (girls') only six feet below the main water supply pipe which extends into the river 250 feet, and at the distal end has an angular or curved projection down the river ten or twelve feet. This curve brings the mouth of the water pipe below the point on the shore where the sewer from the girls' privy empties at high-water mark.

As previously stated, the shore at low-water mark gradually declines to the end of the water-supply pipe, and is a smooth, even surface. The engineer informs us that, when the river is low, the contents of the girls' privy, when forced out through the sewer, never reaches further than within 100 feet of the mouth of the water pipe. Now, suppose the river to be at such a stage as to allow the fecal matter to enter the water at a point, say fifty feet nearer to the shore, is it not reduced to a certainty that it would be carried much nearer to the mouth of the water pipe? Suppose, in addition, that at the proper stage of water calculated to carry the contents of the privy nearest the end of the water pipe, the privy was flushed, as is the custom, by pumping water through the supply pipe into the privy vault, would there not undoubtedly be a force exerted on the surrounding water by suction sufficient to favor the contamination at the point where the supply was afterward obtained for the tank on the top of the building?

It must not be forgotten that twelve hours are required to complete this flushing process, and during that time 500 cubic feet of

fecal matter are forced into the river in proximity to the end of the supply pipe, and that the tank is pumped full twice a day.

It appears reasonable to suppose that such a conjunction of cir cumstances might occur. For instance, a certain stage of river, flushing of privy and filling of water tank so as to result in the proper degree of contamination of the water supply, and thus account for the outbreak of typhoid fever-and it would just be as reasonable to suppose that it might only occur at long intervals. It may be well to remark that, in addition to the danger of polluting the river water used at the Reform School by emptying adjacent to the mouth of the water-supply pipe the contents of the privy, that from the location of the building, which is on the north bank of the Ohio, about two miles below the junction of the Allegheny and Monongahela Rivers, we unavoidably have the contamination of the water supply by sewage emptied into the river above, both from the cities of Allegheny and Pittsburg, and also the con- . tents of the night-soilers' vaults, which are emptied into the river at the "point" or junction of the two rivers just mentioned. We still place, however, the general contamination of the rivers in the same relation to constantly operating causes as that of the wells.

As the statistics of the institution do not show that any such endemic has occurred either before or since, one would naturally look for some such condition as existed in the outbreak at Guilford, where the water of a poisoned well was supplied to 330 houses for one day only, and the result about 500 cases of typhoid fever.

To prove the possibility of fecal matter being carried out from the end of the sewer to the mouth of the water-supply pipe is not merely theoretical, it is only necessary to examine some of the extensive coal works located along the Monongahela River.

At these the slack is screened on the edge of the river, and the fine dust collected and thrown into the stream through a box or trough, set at a suflicient angle to give it considerable velocity; when the dust strikes the water it appears to float on the surface and flow away with the current-in low water, however, there will be found a deposit of this black material extending in a narrow line, almost in a straight direction, probably two or three hundred feet into the river.

As already stated, the time being remote from the outbreak of the endemic, it is scarcely possible to demonstrate beyond doubt any theory that may be offered-but, the hypothesis that the disease originated from pollution of the water taken from the river, seems to be, considering all the circumstances, most worthy of consideration. However, be the origin what it may, we have no doubt that

the insalutary condition of the buildings and their surroundings is eminently calculated to intensify and continue such a disease.

This opinion will hardly be controverted when it is understood that each of the cells contains only 384 cubic feet of air space, while Mr. J. R. Martin (Holmes' Surgery, vol. v. p. 1014) says each bed in a hospital ward should have from 1500 to 2000; also, the cells, corridors, and hall give for each inmate, when all the cells are occupied, 923 cubic feet of air, and no means for renewing the air when vitiated-a defective heating apparatus, conjoined with the severity of the winter, rendering it necessary for the inmates to economize the heat as much as possible by closing the apertures intended to admit fresh air; openings without traps into the main sewer in the court yard; water closets in the infirmaries without flushing; thick coating of mouldy paper on damp and boggy walls, and general want of cleanliness.

If the origin of the endemic of 1874 and 1875 has not been positively determined, we believe it will be conceded that sufficient defects have been discovered in the construction, arrangement, and management of the House of Refuge, or Western Pennsylvania Reform School, in a sanitary point of view, to condemn its further use for any such purpose.

We are indebted to the Board of Health and Dr. W. Snively, Registrar, for the following report on vital statistics for the city of Pittsburg

4 weeks and 2 days, ending Jan. 30.

4 weeks, ending Feb. 27 5 weeks, ending April 3...

35.5 32.5 2.0 2.8 15.0 12.7 14.7 12.5 4.35.5 4.9 5.8 1.7 2.3 2.1 3.5 4.5 3.5 5.0 3.5 5.1 1.7 4.3 2.1 3.3 2.0 1.6 3.8 .7.1.2.3.1 52 4 47.6 100.90
556

each period of life on total