sterilized. It seems hardly possible that bacteria of pathegenic type could exist under these conditions. .

I conferred with Dr. Hanson, the local health officer, and he informed me that he could recall only two cases of typhoid fever in the town since the water supply was introduced, and that these cases were imported, occurring at the time of the coal strikes three years before. He also stated that the general health tone was excellent. From this it appears that despite the fact that the baceriological analyses of the water showed it to be seriously contaminated, this water has not been the cause of any outbreaks of typhoid. Recommendations.

I would recommend a thorough cleaning

of

the reservoir and flushing out of the pipe lines at the ends of all branches, after having dosed the water in the tank rather heavily with hypochlorite of lime. I would further suggest that if possible pumping in the future be done at a lower rate in order that there may be less danger of overworking the filter. If these two steps do not cause the water to show a less bacteriological content, it would be wise to install a small emergency chlorinating plant.

Chlorinating Plant.

It should be noted that a liquid chlorinating plant of the Wallace & Tiernan make has since been installed as the result of the above recommendation. The plant was erected by the Division of Sanitary Engineering.

RONDA-KANAWHA COUNTY.

Typhoid Fever.

On October 25, 1915, Dr. Hodges called this office over the telephone and stated that there were fourteen cases of typhoid fever in the town of Ronda, Kanawha County, that had developed since the first of September, and that he would be glad if we would make an investigation to determine the cause of the outbreak. On Tuesday, October 26, I visited Ronda, and in company with Dr. Hodges, investigated the outbreak.

General. Bonda is a small town located on Cabin Creek, approximately four miles from its mouth. The population, according to the United States Census of 1910, was 112; I am told, however, that the present population amounts to about 230. The interests of the town center around a large coal mine located at this point, and its population is composed almost entirely of miners and their families. There are coal operations over the entire length of Cabin Creek, a distance of some twenty-three miles, exclusive of the many streams that enter from both the east and west. The fall of the creek is rapid, averaging about fortythree feet per mile over its entire distance, while for some stretches the fall is as high as 140 feet to the mile. The creek is throughout its length thickly built up with mining settlements, many of which have not been without typhoid for a number of years. This last fact, combined wth the rapid fall of the stream, and the character of the population, makes

it not at all surprising that outbreaks of typhoid should occur nearly every year at various points.

History of Outbreak. A house to house study of the fourteen cases was made. While making this study a case which had been slow to develop was found, making a total of fifteen. The history of the majority of the cases showed that no ice cream or ice had been used, and in a number of cases only condensed milk had been used; in others, they had their own cow or sometimes bought milk from the store which receives it

from a variety of sources. Vegetables were practically all home grown. Eleven of the persons having typhoid fever had used the same well and lived in its immediate vicinity. Sketch No. 1 accompanying this report shows the general location of this well, which is marked A, and the houses in its vicinity in which typhoid occurred. Some of the other cases had been observed to drink from the well in question.

Turning again to sketch No. 1, it will be noticed that every house within its immediate vicinity has had typhoid fever, with the exception of two, namely, houses Nos. 2 and 7. Of these, house No. 2 obtained its entire supply of drinking water from the small spring located in the back yard, and house No. 7, while occupied at the time of my visit, had been vacant since early summer until about October 22, 1915, or three days previous to my investigation. While I was examining the surroundings of the spring back of house No. 2, Dr. Hodges discovered a new case of typhoid fever in house No. 1 The patient admits having used the water from the well in question frequently. Three cases of typhoid fever occurred in house No. 3 Houses 4, 5, 6 and 8 each had a case of typhoid fever. The cccupants of houses Nos. 9 and 10 obtained their drinking water from well "B" in the rear of house No. 14, while those living in house No. 11 obtained their drinking water from well "C" in the yard of house No. 15. House No. 12 drew its water from well "D" at house No. 13. I could obtain no record of any of the occupants of these houses having used the well in question (well lettered A on sketch 1) at any time. A case of typhoid fever occurred in house No 15, but the patient stated that at no time did she ever use the water from well "A" in the yard of house No. 4; that the only drinking water which she could recall having used was at her own well and the one near the store in town. There is a possibility that flies may have caused her case of fever, or that she may have used the well, as it was on her path to and from the postoffice and not recalled it. Two of the persons who had typhoid fever moved from the houses in which they were living about two weeks previous to the date of onset. These were the cases in houses Nos. 6 and 8. They moved to houses located near the company store, which is across the creek. Approximately three weeks after the illness of the first of these two patients, three other cases of typhoid broke out among people who used the well in the corner of the yard of the house to which one of the patients moved. There is a possibility that this well could have become polluted by the excrement from the patients. The well is approximately 16 feet deep, and the water surface about 11 feet from the top of the ground. As the flow of ground water during the dry season is probably from Cabin Creek to the well. and consequently under the privies of the houses in which the patients lived, it is possible that pollution could have penetrated to this well and infected the water. All three of the patients used this water at frequent intervals. This well is separated from a second well, only about 60 feet away, by the railroad embankment. The difference in level of the water in the two wells, if any, is too small to be noticed, and apparently they are both drawing from the same underground stream. There is a possibility that this well also has been infected, and I directed Dr. Hodges to take bacteriological samples of both, that their character might be

determined. The well on the railroad embankment. is frequently used by railroad men. There was a recent wreck on the Chesapeake & Ohio Railroad, which partially demolished the house in which one of the cases of typhoid lived and the occupants were obliged to remove to the other side of the river to a house located near the mouth of Gatewood Brook. Two cases of typhoid fever occurred in another house in this district. Both of these cases, as well as case mentioned above, used the water from a bored well at the intersection of the roads. It seems extremely unlikely, however, that they could have taken fever from this water, for if it were seriously polluted, there would be many other cases occurring in this district, as the well is used by thirty-five families, and also is used at the school located across the river. I could not ascertain positively the depth of this well, but I am told that it is thirty feet with a six-inch casing. Not one of the above three cases could recall having used the water from well "A" on the other side of town where so many cases occurred.

Description of Well "A." Well A, sketch 1, is located at the mouth of a narrow gully, extending up into the hillside, and is practically in the focus of its drainage. As will be seen by the sketch, there are a large number of privies which contribute their filth to its pollution. Dish water and bedroom slops are thrown directly on, the ground from the houses in this vicinity, and the well is in line to receive any pollution of this character from the two houses above it, numbers 4 and 5. It is 34 feet to the bottom, while the depth of the water was sixteen feet. As nearly as I could judge, the water in the well stood somewhat higher than that in Cabin Creek. Dr. Hodges had already directed that the well be cleaned, and this work was done the day before my visit. However, I was able to see the man who had charge of the cleaning, and he informed me that he found a couple of skeletons, apparently of rats, several tomato. cans, some bits of cloth and a powder keg which apparently had contained human excrement. Evidently this keg had been used under some privy and later thrown down the well as the easiest way to get rid of it. About three weeks previous to the outbreak, all the privies in town were cleaned by a negro who was supposed to thoroughly lime and bury the contents. It may be that some of this filth could have been washed into the well by the heavy rains of late July.

Conclusions. It seems as though there could be no doubt that at least eleven of the cases of typhoid were caused by drinking water from well "A," and it may be possible that the other three cases were caused by using the water from either of the wells near the railroad tracks, these wells receiving their contamination from persons taken ill from drinking water from well "A."

Recommendations. I ordered that well "A" be closed against all further use and abandoned for all time. Its location is such that it can never be anything but seriously polluted, and no amount of precaution would improve its character. A tight cover has been nailed on the well, 'which should prevent any one from getting water from it. I requested Dr. Hodges to take bacteriological samples from the spring in the yard of house No. 2, shown on sketch No. 1, from wells near the railroad and the drilled well at the junction of the roads. Both railroad wells

are being used by a large number of railroad men who are back and forth over the entire length of the creek, and consequently, if seriously polluted, the lives of a great many people would be endangered.

Like most mining settlements, the sanitary conditions at Ronda are not all that they should be, and there is grave danger that any dug well in the thickly built-up operations must be seriously polluted, or at least liable to contamination at any time.

It would be advisable to open a well on the hillside back of the town and pipe water to three or four hydrants, from which it could be carried in buckets to the various houses, and abandon all the dug wells that are now in existence. It may be that water could not be obtained on the hillside without going so deep that it would tap the same stream of water that is now being used at a point so low down that it would still be liable to contamination. I do not know the slope of the ground water level in that region, nor do I know whether it is possible to strike an artisian well of good quality by drilling. However, Ronda is in urgent need of a different water supply from that which she is now using. It would, I feel, be a wise investment for the company carrying on the mining operations at this point to install a safe water supply.

TABLE IV.

RESULTS OF ANALYSIS OF WELLS AT RONDA.

No. 11898 Spring in yard of House No. 2, Sketch No. 1, Cabin Creek District, Kanawha County.

650 bacteria per c. c.

66 acid colonies per c. c.

B. coli in 1 c. c. present.

B. coli in 10 c. c. present.

Report unsafe.

No. 11897 Dug well on railroad embankment, Coalburg Colliery Com

Depth of well 25 feet, water 8 feet.

Dept of well 25 feet, water 8 feet.

1050 bacteria per c.c.

3 acid colonies per c.c.

B. coli in 10 c. c. present.

Report unsafe.

No. 11900 Drilled well at junction of roads, Cabin Creek District,

No. 11899

Kanawha County.

Bacteria per c. c. 95.

No acid colonies per 1 c. c.

B. coli in 1 c. c. none.

B. coli in 10 c. c. none.

Report safe.

Dug well near railroad and company store, Coalburg Colliery

Company, Cabin Creek District, Kanawha County.

Depth of well 40 feet, water 10 feet.

500 bacteria per c. c.

160 acid colonies per c. c.

B. coli in 1 c. c. present.

B. coli in 10 c. c. present.

Report unsafe.