supply from the limestone rocks suffered from a more or
less severe form of the disease. Dr. Wilson, on the other
hand, found that at Bhagsoo goitre was very prevalent, yet
the waters here are very soft, and almost free from lime and
magnesia compounds. Other constituents, such as sulphide
of iron, copper, etc., have been suspected to be the cause of
goitre, because in certain districts where the disease prevailed
such impurities were present ; but observers have not been
slow to point out that such explanations are not generally
applicable. That the disease is really attributable to the
water and not merely to the influence of soil, site, etc.,
appears to be fully established. A French Commission
sitting in 1873 reported that at Bozel in 1848 there was a
population of 1472, of whom 900 were goitrous, whilst at
St. Bon, a village some 2600 feet higher, there was not a
single case. When the water supply of St. Bon was laid on
to Bozel, the disease decreased so rapidly that in 1864 there
were only 39 people in the latter village found to be suffering
therefrom. In the French military journals there are many
cases quoted, proving that certain waters will produce goitre
in a few days, and that persons were in the habit of resorting
to the use of these waters to escape conscription. On the
other hand it has been pointed out that in certain villages
supplied with water from the same source, some were afflicted
with goitre, whilst others were not. Hirsch, in summing up
all the evidence as to the cause and distribution of the
disease, says : " As to the nature of this goitrous virus and its
means of conveyance, it is impossible to form a well-grounded
opinion. Its existence and development would appear to
depend upon certain definite kinds of soil, such as a soil con-
taining dolomitic rock, and it would appear to occur princi-
pally in water. Whether its nature is organic or inorganic
is a question that evades our answering."
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128 WATER SUPPLIES
Plumbism. — Natural waters rarely contain lead, and prob-
ably never in sufficient quantity to produce any evil effects ;
but certain waters, both hard and soft, containing very little
or no alkaline carbonates, dissolve traces of the metal if con-
veyed through leaden service pipes. The amount of lead
dissolved depends upon the character of the water, the length
of time which it is in contact with the pipe, the temperature,
pressure, and possibly upon other factors of which we as yet
know but little. The effects produced by the small amount
of lead dissolved are rarely so serious as to cause death, or
even the severe colic or paralysis characteristic of lead
poisoning, and for this reason the injurious results of the
long-continued use of waters so polluted are only gradually
receiving recognition. Amongst the effects produced are a
state of listlessness, leading to melancholia, depression, and
actual insanity, pallor and debility, constipation and in-
digestion, paralysis, colic, gout, kidney disease, blindness,
etc. Still-births increase, and the children of lead -poisoned
parents are rickety and ill-developed. That the effects are
much more serious and widespread than is generally sup-
posed, is being rendered evident by the reports of the medical
officers of districts in which such waters are used. Thus
Dr. Hunter, the Medical Officer of Health for Pudsey (York-
shire) says in his report for 1891 : "Lead poisoning has been
common in the town during the year. This is a matter
that, from its importance, claims your serious attention. As
lead poisoning is not often registered as a primary cause of
death, it does not make a show in the death-list, but there
is no doubt that the death-rate is greatly increased by its
prevalence in the town, the deaths being registered as
caused by diseases of the various organs of the body that
have been affected by the lead. But if even no death could
be put down to lead poisoning, the amount of pain, suffering,
and misery caused is widespread, and can only be appreci-
ated by the sufferers. There is a mistaken feeling amongst
those who are lucky enough to escape, that the risks of this
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IMPURE WATER, ITS EFFECT UPON HEALTH 129
kind of poisoning are exaggerated." Dr. Hunter found in
the water first drawn from the taps in the morning from
•2 to T3 grains of lead per gallon. Dr. Barry, of the Local
. Government Board, estimates that in the West Riding of
Yorkshire alone 600,000 persons are liable to lead poisoning
by the drinking waters with which they are supplied. 1
Water which has stood in the pipes all night naturally
becomes most seriously contaminated, and probably, were the
users careful to allow this to run to waste before drawing
any for drinking purposes, cases of lead poisoning would be
less common. The water which afterwards passes through
the pipes will contain an exceedingly slight trace, unless a
great length has to be traversed. Such waters will of course
take up the metal if stored in lead cisterns, or if drawn from
a well through a leaden pipe. The quantity of lead necessary
to produce any ill effect varies in different individuals. The
great majority appear to be able to eliminate the poison as
fast as it is introduced, but in others it tends to accumulate
until the amount stored in the system is sufficient to affect
the function of some organ or even to induce a diseased
condition. The actual amount of lead consumed by any
individual in the districts above referred to cannot be esti-
mated, since the quantity present in the water may have
varied almost with every time of using. It is possible that
there are individuals so susceptible that the most minute
quantities will in time produce an appreciable effect. The
only safe course is to prevent waters with a plumbo-solvent
action coming in contact with the metal, by the use of tin,
iron, or copper for the pipes and of slate for the cisterns.
The so-called tin-lined lead pipe is not to be commended,
since, during the process of lining, the tin dissolves a small
amount of lead, forming an alloy which appears to be almost
as easily acted upon by water as lead itself. Some time ago
I found a large trace of lead in a water which was supposed
never to have been in contact with that metal. It was stored
1 Vide Appendix.
K
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130 WATER SUPPLIES
in tinned copper and passed through block tin pipes. The
lead was traced to the tin lining of the copper vessel, and the
makers denied the possibility of there being any lead therein,
and asked me to visit their works and see the process of
" tinning." I availed myself of the opportunity, and found
the tin melted ready for the work to be commenced. I was
informed that this was "pure" tin, but upon further in-
terrogating the workmen I ascertained that it was technically
called " pure " tin for tinning purposes, and contained, if I
remember aright, about 15 per cent of lead, the latter being
added to cause the tin to adhere to the copper. My corre-
spondent, one of the partners in the firm, was himself ignorant
of this fact. Tin-lined iron pipe, known in commerce as the
"Health" pipe, is absolutely safe, and the best form of
service pipe for all drinking waters. An interesting sample
of water was recently submitted to me for examination. It
was found that the leaden pipes from the hot -water cistern
regularly split at the bends after being in use for about a
couple of years. The pipes from the cold-water cistern were
unaffected. The water proved to contain only about 1
grain of carbonate of lime per gallon, though it had several
degrees of hardness. When cold it had not the slightest
action upon lead, but after being boiled it attacked the
metal so energetically that I have no doubt of its being able
to erode the pipes in the manner described. Doubtless, at
the angles slight fissures would be found in the lead, and by
the prolonged action of the water these would ultimately
extend right through the thickness of the pipe.
The various ways in which lead can be removed from
water, and by which an " active " water can be rendered "in-
active " will be described in a later chapter.
Diseases due to Specific Organisms,
Whilst waters containing impurities both of vegetable and
animal origin are constantly being drunk with apparent im-
punity, yet in almost all cases it is found that sooner or later
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IMPURE WATER, ITS EFFECT UPON HEALTH 131
outbreaks of disease occur pointing to some specific polluting
material having gained access to them. The danger naturally
is greatest where the filth which contaminates the water is
derived from human excrement, whether it be discharged from
sewers into our rivers, or oozes through a defective cesspit,
cesspool, or drain into wells or tanks, or whether it percolates
through the sewage-sodden ground around our habitations, and
in an imperfectly filtered and purified condition reaches the
subsoil water from which our supplies are derived. In such
cases our observations only require to be continued sufficiently
long to ensure an outbreak of some specific disease being
recorded. Of this many illustrations will be given when
typhoid fever and cholera are being considered. There are
other diseases, however, which are due to specific organisms
which apparently may occur in water free from pollution by
sewage. Of these the most important is malaria, or malarial
fever, a disease which in many countries is far more pre-
valent than any other.
Malaria. — Malarial disease is at the present time almost
unknown in England. Even in the districts in which ague
was most prevalent, as in the fens of Lincolnshire and marshes
of Essex, it is now but rarely met with. Whether this be
due to better drainage or purer water supplies it is impossible
to^decide, probably both are important factors. The organ-
isms which gain admittance into the blood of the infected
person have only recently been discovered, and their life
history has not been so completely studied as to throw much
light upon the way in which they enter the system. Swampy
districts are most frequently malarious, but they are not
necessarily so, and swamp water which is usually loaded with
vegetable matter is frequently drunk without causing malaria.
This is doubtless due to the fact that whilst the natural habitat
of the malarial parasite discovered by Laveran is in tropical
water-logged districts, yet it is not of universal occurrence
in such districts, and may, under certain conditions, of which
we are yet ignorant, thrive elsewhere. The disease, however,
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132 WATER SUPPLIES
is only of interest here, inasmuch as there is evidence sufficient
to warrant us in believing that one of the modes in which the
malarial organism enters the system is with the drinking
water. Thus Dr. Parkes, during the Crimean War, questioned
the inhabitants of the highly-malarious plains of Troy, and
found that it was universally believed " that those who drank
marsh water had fever at all times of the year, while those
who drank pure water only got ague during the late summer
and autumnal months." Mr. Bettington, of the Madras Civil
Service, who carefully investigated this subject, obtained very
strong evidence of the production of malaria by drinking
water. In one village he found that fever was prevalent
amongst those who drank water from one source — a tank fed
partly by marsh water — but absent amongst those who obtained
water from other sources. In another village in which fever
was endemic, it entirely disappeared when a better water supply
was obtained. In the Wynaad district, where malaria is very
fatal, he says that it " is notorious that the water produces fever
and affections of the spleen." Boudin relates that " on board
a French ship-of-war bound from Bona to Marseilles, a malig-
nant epidemic of malarial fever broke out at sea, 13 men
dying out of a crew of 229, whilst 98 were more or less seriously
ill, and had to be sent into hospital at Marseilles ; it came
out, on inquiry, that the vessel had shipped at Bona several
casks of marshy water, which had given rise to lively dissatis-
faction among the crew on account of its disagreeable smell
and taste, and that not a single case of sickness had occurred
among those of the crew who had drunk pure water." Not-
withstanding such apparently conclusive evidence, many
observers doubt the production of malaria by drinking water.
Amongst the more recent ones may be cited Mr. North, who
spent much time in investigating the cause of this disease in
and around Rome. He observes that the healthiest parts of the
city of Rome are supplied with water from springs which
arise in a locality so unhealthy that there is great risk to
health, and even to life, in passing the nights there during
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IMPURE WATER, ITS EFFECT UPOM HEALTH 133
certain seasons of the year. He concludes that there is not
sufficient proof of the disease being conveyed by water, not-
withstanding that such a belief is universal in all districts in
which the disease prevails.
Enteric or Typhoid Fever, — The production of typhoid
fever by the use of polluted drinking water is an indisputable
fact, and the instances which can be adduced in proof of this
statement are so numerous that it is difficult to make a
selection. The following examples are given not only as
illustrating such proof, but also on account of their being
typical of outbreaks produced by the pollution of the water
in most diverse manners. In some the source of the infected
material was almost self-evident, in others the discovery of the
mode by which the water became contaminated taxed the
ingenuity and patience of the investigator to the utmost,
whilst in others specific pollution could only be inferred.
At Lausen in Switzerland an outbreak of typhoid fever
occurred 1 amongst that portion of the population which derived
its drinking water from a certain spring. On the other side
of the hill was a brook which passed underground, and it was
suspected that this stream really fed the spring in question.
When flour was added to the brook water, however, none of it
made its appearance in the spring, but when salt was dissolved
in the stream, its presence was soon after discovered at Lausen.
Obviously the water in traversing the hill became filtered so
completely as to remove all the particles of the flour, yet such
filtration had failed to remove the typhoid poison, which it was
proved had been introduced into the brook by the stools of a
patient suffering from that disease. Shortly after the fouling
of the stream typhoid fever broke out amongst those who used
the spring water, 67 persons being attacked within 10 days.
In 1872 an epidemic occurred at Nunney (Somersetshire)
which Dr. Ballard investigated on behalf of the Local Govern-
ment Board. He found that the brook supplying the village
with water had been specifically polluted by the drainage of
1 In August 1872. Deutsch. Arch./, klin. Med. Bd. xi., 1873, S. 237.
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134 WATER SUPPLIES
a house into which typhoid fever had been introduced from
without. 76 cases occurred amongst a population of 832.
In 1874 a serious outbreak at Over Darwen (Lancashire),
was investigated for the Local Government Board by Dr.
Stevens. It was proved that a patient who had contracted
the disease elsewhere resided in a house the drain from which
was blocked and defective at a point where it crossed a leaking
water main. Dr. Stevens succeeded in demonstrating that
the sewage was sucked into the water main freely and regu-
larly. The disease spread rapidly, and no less than 2035
persons, or nearly one -tenth of the whole population, were
attacked within a very short period.
In 1882 a serious outbreak occurred at Bangor (N. Wales),
which ultimately affected 540 persons out of a population of
about 10,000. In May a case of enteric fever had occurred
in an isolated house which discharged its sewage into a small
stream which at a point lower down joined a larger stream,
the Afon Gaseg, from which Bangor derived its water supply.
During June two other cases occurred in the above house,
and specifically polluted sewage continued to find its way
into the Afon. The filter beds were said to be very imperfect,
and these were disturbed on 30th June by the bursting of a
water main. Within a fortnight of this accident the outbreak
commenced, attacking simultaneously various localities in the
town.
In 1879 an epidemic occurred at Caterham and Kedhill
in Surrey. Within a fortnight 179 persons were attacked.
Of the 143 houses first infected, 136 had their water supply
exclusively from the public mains, and in the other 7 houses
this water was occasionally used. Of the 2258 houses in
the two parishes, 1343 derived water from the mains; the
remainder were chiefly supplied from wells. Dr. Thorne,
who investigated the outbreak, found that just prior to the
outbreak, the Water Company had been enlarging their re-
servoirs and had sunk a shaft down to the conduit. One
of the labourers employed in this conduit had contracted
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IMPURE WATER, ITS EFFECT UPON HEALTH 135
typhoid fever at Croydon, but was able to continue his work.
Diarrhoea was profuse, and as he could not conveniently leave
the shaft his motions were passed at the bottom and were
afterwards washed into the conduit. "The outbreak took
place simultaneously in Caterham and Redhill exactly fourteen
days after the water supply had been befouled in this manner."
In 1880 a case of typhoid fever was introduced into the
town of Nabburg (pop. 1900) and spread among the inmates of
the infected house ; about a fortnight later other cases occurred
amongst the inhabitants of the row in which this house was
situated, and within the next fortnight about half (35 out
of 77) the inhabitants were suffering from typhoid fever.
Three out of the row of 17 houses and the poor's -house
remained free from the disease, and it was found that these
were supplied with water from a well, whilst all the others
derived their water supply from a tank fed by a pipe which
ran through a slop puddle. This slop puddle received the
drainage from a dung-heap upon which typhoid excreta had
been thrown, and the water pipe was perforated at the part
where it was covered by the filth. As soon as these pipes
were repaired the epidemic ceased.
The danger which may arise from the proximity of a sewage
farm to a water supply is well exemplified by the Report of
Dr. Page to the Local Government Board on an outbreak of
typhoid fever at Beverley (Yorkshire) in 1884. The sewage
of the East Riding County Lunatic Asylum was disposed of
upon a field next the Water Company's well and works, and
the effluent water " following in the direction of the natural
line of drainage " percolated towards the Company's premises.
Certain defects were found in the well, and prior to the out-
break cases of typhoid fever had occurred in the Asylum.
The total number of households invaded was 125, and there
were 231 cases, 12 of which proved fatal.
In all the above instances the source of the specific pol-
lution was discovered. In the following there was proof
only of the contamination of the water by sewage. This
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136 WATER SUPPLIES
must have contained the specific organism of typhoid fever,
but the cases which introduced these into the sewage remain
undiscovered, though in some instances the possibility of such
specific contamination was proved.
In 1867 an outbreak of typhoid fever occurred at Sher-
borne in Dorset. Dr. Blaxall, who was instructed by the
Local Government Board to investigate it, attributed it to
the direct connection of the water supply pipes with the closet
pans. Some of the taps to these pipes were broken. When
the water was turned off at the mains, the foul air from the
closet pans, or if the pan happened to be full of excrement,
actual faecal matter could be drawn into the water pipes.
In 1873 Dr. Buchanan contributed a most important
report to the Local Government Board on an outbreak of
typhoid fever at Caius College, Cambridge. Twelve of the
fifteen cases which occurred were in Tree Court, and Dr.
Buchanan could find no condition capable of explaining the
outbreak but the pollution of the water in the branch main
which supplied this court alone. He found that the closets
in this court were the only ones in the College flushed directly
from the main, and that on account of defects in the valve
taps, when there was an intermission in the water supply a
reflux of air and water took place into the main. There had
been two intermissions during the term, one a fortnight before
the first case, and the other a fortnight before a more general
outbreak. Inside the pipes a dirty-looking layer was found,
which upon analysis proved to be derived from sewage ; hence
doubtless not only sewer gas but also actual liquid filth had
been sucked from the closet pans into the pipes.
In 1887 an interesting outbreak occurred in the Mountain
Ash, Urban Sanitary District (Glamorganshire), which com-
prises several mining villages. The cases ultimately numbered
over 500, and the localisation was such as to throw suspicion
upon one particular branch of the public water mains. The
only possible explanation appeared to be the fouling of the
water in this branch at a particular point The ground was
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IMPURE WATER, ITS EFFECT UPON HEALTH 137
•accordingly opened there, and it was found that the water
main passed through some drains which had been " wantonly
smashed " for this purpose, and the main itself was defective
and leaking. Prior to the outbreak there had been inter-
missions in the supply, allowing the fluid filth by which the
pipe was surrounded to be sucked into it, and so contaminate
the water passing through that particular branch.
The following outbreak, due to polluted ground water, is
typical of a large number which have been reported from
time to time in districts deriving their water supplies from
wells sunk in a polluted subsoil. At Terling, in Essex, an
alarming epidemic of typhoid occurred in 1867. Out of a
population of about 900, no less than 260 were attacked
within two months. The wells supplying the cottages were in
close proximity to the privies, cesspits, bumbies, and manure
heaps. Towards the end of a period of drought a case of
typhoid fever occurred which probably was imported. Three
weeks later, and after a heavy rainfall, the disease broke out
with alarming violence. The well waters were proved at all
times to be seriously contaminated, but until the introduction
of the specific pollution the village had been free from the
disease. In the filth -sodden soil the typhoid bacillus had
probably found a suitable nidus for its rapid multiplication ;
thus the heavy rainfall would not only wash impurities into
the wells from the surface, but wash the organisms out of
the soil into the rising ground water which supplied the wells.
In 1889 an outbreak occurred at New Herrington, Durham,
278 cases being reported between the 1st April and 7th June
out of a population of 3600. Dr. Page discovered that a
deep well supplying the village was being contaminated by
the sewage of a farm three-quarters of a mile away. This
sewage discharged into a tank, and the overflow disappeared
down a fissure in the ground and ultimately found its way
into the well at a point 45 feet below the surface. Two tons
of salt were put down this fissure and soon after the amount
of chlorine in the well water began to rise, increasing ulti-
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138 WATER SUPPLIES
mately from 4 grains to 24 grains per gallon. Specific pol-
lution, however, was not demonstrated, as no case of typhoid
fever was known to have occurred at the farm for years.
Dr. Maclean Wilson last year investigated for the Local
Government Board an outbreak of enteric fever at Chester-le-
Street, between Durham and Newcastle. Of the 1100 houses
in the village some 40 per cent were supplied by the Consett
Water Company, and some 60 per cent by the Chester-le-Street
Company. Of the 41 infected households, all but 2 derived
water from the latter source, and these 2 were amongst the
initial cases, " possibly not due to the cause producing the
general outbreak." The Chester-le-Street Company draws its
supply from the Stanley Burn, about two miles above the village.
Above the intake quite a large population drains directly or in-