MORTUARY TABLE No. 3.

Typhoid Mortality of 1876 compared with that of 1875, and Typhoid Death-rate of 1876 compared with the average Typhoid Death-rate for ten years.

It will be seen by reference to our tables, that our own outbreak began a little earlier and continued a little longer before the intermission, just as our heated term did; but that the same abatement in the autumn and the same exacerbation in the early winter were observable here as there. Berlin at the same time suffered from a very serious outbreak of the same disease. Other American cities found the purity of their water supply seriously impaired by the heat and drought.

A writer in the Sanitarian of February, 1877, says of the Croton water in New York: "So impure was it after a severe rainfall in July and August of the present (past) season that the press of the city devoted entire pages to complaints and to discussions of the subject. One of the most remarkable facts noted was, that while the rainfall was greater in the former month than in any other July since 1873,

the Croton supply was impure, and had a foul odor, not only through the entire month, but through the preceding one."

And yet, such is the force of local prejudice, that men could actually be found fatuous enough to bottle up this reeking fluid and bring it on to Philadelphia in order that they might not be compelled to drink the Schuylkill water.

The report of the Maryland State Board of Health, by Dr. E. Lloyd Howard, mentions the occurrence in Baltimore last summer of an explosion of typho-malarial fever which cost the city fifty-nine lives, a large amount of suffering, and over eight thousand dollars.

It was to be expected, then, that Philadelphia, having a water supply, it must be admitted, not above suspicion-to the impurities of which, indeed, these reports have not failed to allude in terms of strong reprobation and urgent warning for the past six years-and having already a fixed typhoid death-rate of somewhat more than one per diem, should, under the combined aggravation of drought and excessive heat, have this death-rate greatly increased. That of Paris was trebled by these causes, as has been shown. That of Philadelphia was not doubled. We escaped, therefore, quite as well as we had any right to expect, and do not need to look further for an explanation of this augmented mortality. But in order to determine to what extent impurities in the Schuylkill may perhaps have been responsible, it will be of considerable importance to observe the localities in which the greatest increase occurred.

Your committee last year determined with approximate accuracy the fever haunts of the city as indicated by the record of ten years. If the returns for the year under discussion correspond closely with the distribution thus determined, we may conclude that conditions already existing were simply intensified by the heat and drought. But if there are marked discrepancies, it becomes a matter of consequence to inquire into the meaning of these discrepancies. The first point which impresses us in glancing over our table of ward returns is the much more uniform dissemination of the disease throughout the entire city. Instead of confining itself to the Delaware front and certain densely crowded and notoriously insanitary sections, as heretofore, it has existed to an alarming extent in every quarter, and in some of the healthiest districts. The second is, that its increase in specified sections bears no relation to the general increase of mortality. The third-that while in the regions recognized as its favorite abodes, it manifests about such a rate of increase as the growth of population, and the unfavorable atmospheric conditions of the year would warrant us in anticipating, in portions of the city which have usually been comparatively free

from its ravages, it has far exceeded this rate. The first of these propositions is too much a matter of personal experience with every one present to need detailed proof. Of the second, the following. are instances: The deaths from all causes in the Second Ward fell off from 729 in 1875 to 640 in 1876, while the deaths from typhoid increased from 15 to 21; the deaths from all causes in the Fifth Ward were slightly reduced, those from typhoid were more than doubled; a decided reduction of general mortality in the Ninth and Tenth Wards accompanied a nearly fourfold increase of typhoid, and in the Eleventh Ward a more than threefold. On the other hand, in the Twenty-eighth Ward the death-rate increased from 392 to 473, and the typhoid deaths fell from 13 to 8. The only other ward in which there were fewer deaths from typhoid than in 1875 was the Twenty-third, where they were reduced from 23 to 18, while at the same time the general mortality diminished in nearly the same ratio. An addition of 338 to the whole number of deaths in the Twentieth (including the Twenty-ninth) Ward, comprised only one additional typhoid death. We may note in passing, however, singular coincidences of stationary death-rates in respect to both general and specific causes. In the Third Ward the mortality was practically identical in the two years, 463 and 462, and the typhoid mortality was also identical, 11 in both years. The same was true of the Thirteenth, in which the figures were 353 and 354 for the former, and 10 in both for the latter; and approximately of the Nineteenth (including the Thirty-first), when the mortality was 1713 in both years, and the typhoid mortality only increased from 74 to 81. The examples which illustrate the second are equally pertinent to the third proposition.

The increase from 15 to 44 deaths from this affection in the Twenty-fourth Ward, in which the Centennial Buildings were situated, does not surprise us. Its suddenly doubled population, its hastily erected dwellings, with their imperfect and often deficient sewerage, its immense areas of undrained land, often lying under stagnant water, and of newly upturned soil, all would lead to the anticipation of such an outbreak.

But what shall we say of the Eighth, Ninth, Tenth, and Fifteenth, contiguous wards, lying along the Schuylkill, possessing every vantage in point of location, drainage, architecture, and population, comprehending within their limits the residences of our wealthiest citizens, and heretofore exhibiting the lowest death-rate from typhoid of any of the built-up parts of the city? Why does the Tenth suddenly advance from its average typhoid death-rate of 3.75 to 10,000 persons living to one of 11.89 higher than that of the

Nineteenth, which is 11.65? We fear there can be but one answer to this question. The only factor in the production of this affection, so far as we know with positive assurance, which could have been materially increased either in quantity or efficiency, was infectious material in the drinking water, and the drinking water of all this section comes from Fairmount dam.

The fact is a significant one that the increase was most marked in the Fifteenth Ward, jumping from eight up to forty-five, when we remember that this ward is principally supplied by the Spring Garden Water Works, which draw their supply from a point in the river acknowledged to be seriously contaminated by sewage. The drainage of a number of breweries into the river at a point above the dam is instanced. All the other conditions of this sectiondrainage, sewerage, cleanliness, food supply, etc., were as usual, and we cannot, therefore, look to them for an explanation. The intense heat, the long drought, the increasing population along the river banks, and especially the disturbance of the bottom of the stream by the immensely increased steam navigation during the summer, are sufficient to account for a decided increase in the morbific material held in suspension in the water, without the supposition that the excrementitious sewage of the Exhibition grounds reached it in any appreciable quantity.

But our report would, notwithstanding, not be complete without a reference to the so-called "Centennial Sickness," the fame of which certain sensational sheets, never friendly to the great enterprise, took care to spread far and wide throughout the country.

As seen in Philadelphians, independently of typhoid fever, it almost invariably assumed the diarrheal type, and was very amenable to treatment. In many instances each visit to the Exhibition was followed by an attack of looseness of the bowels, accompanied or not by nausea, which usually passed off in a day without further care than attention to the diet.

After reading carefully all the authentic reports from medical observers which have appeared upon this subject, however, your committee are of the opinion that this affection was not one but many diseases-in one case simple diarrhoea, in another pure debility, in a third true typhoid, in a fourth typho-malarial fever, and so on—and that in a large proportion the visit to the Exhibition was but the spark which kindled morbific fuel already piled up in the system.

They attribute their existence, beyond the obvious and sufficient causes of fatigue, exposure, excitement, and improper diet, to a poisonous condition of the atmosphere, in the buildings and about

the grounds of the Exhibition, owing, in the first place, to crowdpoisoning, the emanations from such immense congregations of human beings, so closely packed together, vitiating the air beyond the power of any system of ventilation to purify it, especially when intense heat is stimulating the sudoriparous glands to the last degree of activity—even the open air becoming on some occasions noticeably impure from this cause; and, in the second, to imperfect drainage and the want of proper sanitary precautions during the years of preparation. The chairman of this committee took occasion at three different times to call the attention of the Medical Director to evils of this nature, and has reason to believe that they were rectified in those particular instances. But the committee cannot but feel that the mistake of the Commission was, that it inaugurated and carried out this great undertaking, involving the lives and health of millions of their fellows, without appointing a single officer whose duty it was to superintend its engineering operations in the interests of public health—a sanitarian as such. It was not until the end of November, 1875, that the accomplished Medical Director received his appointment, when too late to make any alteration in architectural or engineering sanitary arrangements; nor did his authority extend beyond the organization and control of a bureau of medical relief. The admirable efficiency of this service, and the dignified and unobtrusive manner in which its delicate duties were performed, must not be passed by in silence, but cannot atone for the previous culpable neglect of the Commission in this regard. It is not probable that any very large amount of fecal pollution reached the Schuylkill from the Exhibition grounds, but the impure condition of the atmosphere at many points, and especially in Lansdowne ravine where so many resorted to listen to the music of the bands, to rest and to lunch, was but too palpable to the sense of smell.

While fully recognizing then the glaring defects in the sanitary provisions of the Exhibition, your committee felt that it was due both to Philadelphia and to the Commission, to point out the fact that, on the other hand, a certain amount of mortality was inevitable among the large numbers who thronged the city and the industrial palaces, and that the fact of a death occurring after a visit to the "Centennial," was by no means a proof that the visit was the cause of the death. A careful estimate was, therefore, made of this inevitable mortality and published in one of the daily papers the early part of the present year, "in order to remove as far as possible any uncomfortable impression which might still