Waterborne disease

“ Another cause of such outbreaks is a polluted water-supply, as in some epidemics of diarrhoeal disease or of typhoid fever. If the outbreaks of these diseases are pretty sharply localized, and depend upon the fouling of a well or wells, it will usually not be very difficult to trace this cause. If, however, the town has water-supply by means of pipes from a single source, while the outbreak of disease is limited to a part of the town or to a single large building, it will probably be almost impossible to establish any connection between the disease and the drinking water. ”

“ The physical conditions favoring the presence and multiplication of bacteria in water under natural conditions are a low altitude, warmth, abundance of organic matter and a sluggish or stagnant condition of the water. As regards water-borne infectious diseases, such as typhoid or cholera, their transmission to man by water may be excluded by simple boiling or by an adequate nitration. The freezing of water, whilst stopping the further multiplication of organisms, may conserve the life of disease germs by eliminating the destructive action of commoner competitive forms. ”

“ If the water is defiled or contaminated by germs of typhoid fever, diphtheria, or other diseases, whose bacteria may be carried by water, the disease may be spread wherever the water is used.
No earth closets or human or animal waste should be in the neighborhood of the well. Water should come from high ground and clean places with no possibility of gathering infection on the way to the house. ”

“ The blood drawn before death appears good in every respect. The hydrophobia seems to be a symptom peculiar to the human race; for the mad animals which communicate the infection do not seem to have any dread of water. If the disease once exhibits its symptoms in a human patient, the chances for recovery are small indeed; there having never been one well authenticated case of the recovery of a really hydrophobous person. Prevention is the only chance, and removal of the contagious matter the only fair hope of preserving life. ”

“ Water does not get disease germs from the ground, but from man. Almost every town has a sewer system that empties into some stream. This practice was started a long time ago when men thought that running water would purify itself in the course of a few miles. We have learned, however, that this is not true. Germs will continue to live in running water just as they do in any other water, and disease germs will live in a stream from twenty-five to thirty-five days. Estimate how far a stream will flow in that length of time, and you will know how far disease germs will travel in that way. ”

“ Water and milk and raw shellfish are the three foods which in the highest degree fulfill all the requirements of a dangerous disease medium. If water is taken from streams or ponds or wells into which sewage enters, and is used for drinking without adequate storage or purification, the best possible opportunity is offered for a transfer of infection on a gigantic scale. The great epidemics of typhoid fever and cholera which used to sweep through European cities and more recently have continued to ravage American communities, bear eloquent testimony to this fact. ”

“ Unless an excessive amount of organic matter is so transmitted, no evidence will be found that such pollution has existed through any outbreak of disease. But if once the discharges become affected through a person having typhoid fever, then the result of the infection is apparent immediately. If, therefore, an inspection of the stream above the point where it is proposed to take the water-supply shows the existence of privies, as shown by Fig. 36, the water should not be used for domestic supply, although a number of individuals may have been using the water for years without bad effects. ”

“ In the cases in which the cholera poison gains access to a limited supply of drinking water, such as a tank or pumpwell, the outbreak it occasions is always sudden, violent, and limited; but when a river is the medium of the propagation of the disease, its progress is more gradual and extended, being diffused amongst the whole population using the water. ”

“ The difficulty of obtaining good food, and the absence of sanitation which is the main cause of the impurity of the water, are the obstacles which must speedily be overcome in order to make the second feature assume its proper value in the treatment of disease. The rainfall is everywhere adequate for the supply of pure water, but this must be properly stored and kept from contagia. ”

“ Their condition of life in sewage is not normal and in general their existence therein is of short duration. It may be of sufficient length, however, to permit the transmission of disease. The diseases which can be transmitted by sewage are only those that are contracted through the alimentary canal, such as typhoid fever, dysentery, cholera, etc. ”

“ There cannot be any longer a doubt as to the value of sand-filtration as a means of water-purification, but the responsibility which we have seen attaches to this treatment of water cannot be exaggerated, for whilst when efficiently pursued it forms a most important barrier to the dissemination of disease germs, the slightest imperfection in its manipulation is a constant menace during any epidemic. ”

“ Quite recently the discovery has been perfectly and successfully tried with water impregnated with the germs of every known disease. So long as so many great towns draw their water supply from open streams liable to all kinds of contamination, Dr. Darbyshire felt sure there would be no public safety till the remedy was found.
"The remedy had been found and would have been made public directly, when there came the now historic case of the Santa Anna and the alarming outbreak of bubonic fever at Ashchurch. ”

“ It seems probable that towards the end of a drought the very air, uncleansed by shower and storm, becomes charged with disease germs. As to water pollutions, sometimes the disease is at its fiercest before a heavy fall of rain, to disappear almost magically afterwards. At other times the rain seems to intensify the epidemic. The dry air of the interior, however hot, has always been thought to be antagonistic to the disease. It has not proved so of late years. Occasionally there is an outbreak of exceptional virulence in some particular locality ”

“ Emmerich has shown that the purest water after being used to clean the floor of a room contains in a very short space of time abundant germs of disease, so much so that a drop of it injected under the skin of a rabbit or Guinea-pig is followed by a fatal result. With this dangerous slop-water it is the custom to charge the earth in and about our dwellings. Since man began to live in towns where drainage was in vogue, diseases dependent on conditions of soil (cholera and typhoid fever) have undergone a striking decrease. ”

“ But in large numbers, and in company with the other named species, it is almost certain evidence of sewage-polluted water.
It may occur to the general reader that, as the typhoid bacillus is not extremely rare, drinking water may frequently act as a vehicle to carry the disease to man. But, to appreciate the position, it is desirable to bear in mind the following facts: the typhoid bacillus is only found in the human excrement of patients suffering from the disease; it is short-lived; in ordinary waters there exist organisms which can exert an influence in diminishing its vitality ”

“ Even a small puddle can breed millions of mosquitoes. No empty tin cans should be allowed to collect about the kitchen door; they gather rain-water and soon breed mosquitoes.
Typhoid-free Water
We take in many disease germs through food or drink. Every year 300,000 people in the United States enlist under the typhoid banner. To elude the typhoid-germ we need first of all pure water. But when one is in doubt as to the purity of water, it is advisable to boil water in order to destroy possible typhoid germs and other dangerous germs and impurities. ”

“ But before anyone can confidently say how dangerous it is to swimmers and others who make intimate use of rivers and creeks, water scientists are going to have to learn more about its measurement and classification than they presently know.
No easily applied method of testing can effectively establish the guaranteed absence of human disease germs. ”

“ In this way an epidemic may be carried to an entire town, and to persons who themselves have taken every precaution against the disease. [Pg 287]
Drinking water should be boiled unless one is sure of the water-supply, and surface wells are never safe unless we know that they drain only from clean sources, and then the water should be analyzed frequently. Boiling absolutely destroys typhoid and other germs, and well repays the extra work it makes. One case of typhoid fever causes more work than boiling the water for years, if we consider the work only. ”

“ Beside typhoid-fever bacteria, those organisms which cause digestive disturbances, and severer troubles, such as diarrhea, dysentery, and possibly other unknown diseases, may be carried into well water. During cholera epidemics, polluted wells might form centers of infection. Eggs of animal parasites may be washed in from the surface. Again, the barnyard manure, representing the mixed excrement of various animals, may under certain conditions be bearers of disease « 18 » germs, and such excrement should, under no conditions, be looked upon as entirely harmless to human beings. ”

“ In the words of one of the State reports, "The death-rate from typhoid fever has generally fallen as the per cent. of the population supplied with public water has risen, for the reason that the majority of the deaths from this disease have occurred among communities and portions of communities not supplied with public water." ”

“ If a hundred typhoid germs are discharged into a lake their fate is much the same as that of a hundred men under the same conditions. A few of the men may be good swimmers and a few may be lucky enough to cling to floating planks. Most die very quickly, however, and in the course of time all will surely perish. So with most disease germs in water or soil or anywhere outside the body. Certain pathogenic microbes may actually multiply in suitable media, in milk for example. ”

“ Danger of direct infection from the patient is slight, but the poison remains in the evacuations from the bowels and is propagated by them. By this means a reservoir or river has been known to infect a whole town. Broken or defective drains, the entrance of sewer gas into houses, wells polluted by cesspool drainage, and milk diluted with infected water, are among the principal means of spreading the disease. It is an absolute rule that all bedding which becomes soiled should be destroyed, and the refuse of the sick room should be instantly disinfected and removed from the dwelling. ”

“ Where a sewerage system exists there is very little danger of the spread of hookworm disease and the same is true where there is proper disposal of the faeces by burning, boiling or treatment in a septic tank. In rural districts, however, where the stool is often deposited in the shade and retirement of a clump of trees, the soil becomes infested with myriads of larvae, so that one standing with bare feet on such a spot easily becomes infected. ”

“ Of late years disease has played terrible havoc in some of the best rivers in the country. In one of these, known to the writer, scarcely a fish is caught which does not show scars left by the disease—want of tail, partial loss of fins, and white patches where the fungus has previously grown. That numbers of the fish attacked do survive there can be no question; and that the disease may be prevented at the cost of a few fish we have but little doubt. ”

“ The statistically ascertained improvement in the public health in respect of dysentery in such large towns as Calcutta and Madras, following so closely on the introduction of improved water supplies, and the improvement in the health of the British Navy following the introduction of regulations requiring that in all places in which the water supply is not above suspicion the drinking-water served out to the men shall be distilled, constitute powerful testimony in favour of regarding dysentery as a water-borne disease. ”

“ The advocates of the contagion theory have no weakness for sewage, especially in an olfactory point of view. They say, also, that it places disease under the most favorable conditions for the consummation of its evil mission. But they assert, in opposition to former theories of the Board of Health—that has an unlimited command of print and pay—that sewage, in itself, does not breed fever and infection, unless it is charged with specific ingredients of contamination. Infectious diseases are only communicated by the virus of specific poison. ”

“ It prevails as an endemic disease in all the inhabited parts of Europe, Asia, and America, and the occurrence of epidemic outbreaks depends largely upon an unusual degree of contamination of the water supply of a community by the discharges of those sick with the disease. ”

“ Inorganic impurities are of much smaller consequence as regards health than organic; hence the great advantage of deep well-water over river water. It has been suggested, however, that when deep well-water becomes polluted, it is more dangerous than equally polluted river-water, because in the latter the normal bacteria of water are more abundant, and possibly interfere with the continued life in water of disease-producing bacteria. ”

“ While we are protecting our water-supplies against sewage, we can, in the meantime, render that sewage comparatively harmless by thoroughly disinfecting and sterilizing all discharges from every known case of the disease. ”