Note "A" cities that are using artesian water.

In comparing Table "A" with Table. "B," our typhoid mortality in Escanaba looms up in marked contrast with that of other cities of the United States, with a greater population and much less favorable environment. The intensity of our typhoid is still more forcibly expressed in the words of the Monthly Bulletin of Vital Statistics published in Lansing, which correctly states, "There were more deaths in Escanaba from typhoid in April, 1904, than in all cities of like class in the state taken together; just as many in March, and just as many in May. There were five deaths in February from typhoid, or as many as occurred in all other cities of the class with over thirty times the population, and in March there were four deaths from this cause, which actually exceeded the deaths from typhoid in all other cities of the class." In passing, I will state, and you will observe in Table "B," that artesian water does not establish immunity against typhoid infection.

The mortality of bowel trouble other than typhoid, however, as pictured to you in types 1, 2 and 3, has been the most serious and has demanded the most of our attention. The deaths recorded give one but little idea of the magnitude of these disturbances

1905 1906

1907

Up to and inclusive, May 11, 1907.

69

The mortuary tables as presented net the history of bowel disturbances a very interesting fact, in the exacerbation and decline of these troubles. An interdependence between typhoid and allied troubles is clearly suggested in Table "E." It will be noticed that typhoid in its ascendency, as far as its death rate is concerned, in every instance is characterized by a corresponding prevalence of diseases other than typhoid, and vice versa. In this definite relationship, so graphically shown, is strongly suggested a common cause in these outbreaks.

I have reason to believe that the importance of water in relation to a group of bowel disturbances as described to you, is well understood. I have also reason to believe that you are reconciled by the thought that the symptomatology of the diseases as given you, is not at variance with that of other similar epidemics, which in Escanaba and elsewhere stand forth as a blot on this glorious country of ours. At any rate, it is an axiomatic truth, in sanitary science,

strongly suggested water pollution, and epitomizes every phase of our situation. On the morning of March 1st, 1904, when the epidemic described was at its height, I was called to the home of Mr. P., who had arrived in the city February 27th., with a wife and a family of five beautiful children in full health. The family of children consisted of a daughter 8 years of age, and four boys at the ages of 10, 5, 3, and 1, respectively. Arriving in the city February 27th., on March 1st, 48 hours after their arrival, Tom, age 5, and Lizzie, age 8, took sick with a severe attack of vomiting and an intense diarrhea. The remaining three boys, 10, 3, and 1, respectively, were also indisposed at this time, but were acutely sick, as were the other two children. Calling at the home March 2d, I found the whole family sick with one form or another of bowel trouble. The parents and children, in the course of their sickness, developed a symptomatology common to types 1, 2, and 4, even to the characteristic vomitus and stools, the stools varying from feculent or seromucous, to a muco-purulent, mixed with clear blood or coagula of blood, as well as necrotic bits of mucous membrane. The boy of 10, following repeated attacks of the disease as described to you in type 1, three weeks following the initial illness, developed typhoid fever. Cultures made from the stools of these patients netted me nothing but the bacillus coli communis. When first called to this home, my attention was called to a crepe on the house next door. Typhoid there had claimed as a victim a child of 14. At the same time, another child was battling for supremacy in that same household, with a typhoid infection. Those two adjoining homes, drawing water from the same faucet, enacted the tragedy so often repeated in Escanaba.

Getting down to fact, as far back as 1899, Gardner S. Williams, formerly

hydraulic engineer in charge of the laboratory at Cornell, now affiliated with the University of Michigan, compiled a report on Michigan water supplies. In this report he cites Escanaba as one of the fifteen possibly contaminated great lakes supplies. Was this disposition of Escanaba a correct one? With the opinion of Gardner S. Williams, and with the brief history of the intestinal disturbances that I have given you, the question of water has a most interesting history in Escanaba.

Escanaba is situated on Little Bay de Noc, an inlet of Green Bay. Until the year 1887, Escanaba's only source of water for domestic purposes was that obtained through driven wells. In the year 1886 a franchise was granted to a corporate body of men for a supply of water, the natural source of which should be Little Bay de Noc. Map "A," if consulted, will more clearly bring to your minds the essential features of the bay, of the bay bed, of its currents and also winds, as these have a bearing on the subject we have before us for study this morning. I shall state that the flow of the main current of water is south, and the winds prevailing are southerly. On account of sand shoal formations which exist in the bay, the main current of water is confined by very sharp and definite channel banks. Escanaba, as Map "A" will show you, is built on a peninsula, commonly known as "Sand Point." From the point of the peninsula, and from off the shore, such a sand shoal extends for many miles southward, out into the bay, forming the bay. bed for a veritable distance of 1,500 to 3,000 feet. This exists as a plateau, until an abrupt dip occurs, where it serves the purpose of the deep channel bank.

Following the granting of the franchise in 1886, the water plant was immediately installed. When completed, the water was obtained through an in

take 1,500 feet in length, extending out into the bay on the shoal described. This intake was in 20 feet of water. In order to insure adequate fire protection at this time, it was deemed advisable to construct what was termed a "short in

service, consisted of the intakes described, a sand bottom settling tank, and the pumping mechanism.

With the introduction of faucet water and the increasing density of population, the rural methods in vogue for the dis