In speaking of the health of a given locality it has always been deemed necessary that the climatic and telluric conditions should be considered. For the purpose of a comparative study I requested Prof. Willis L. Moore and Prof. A. J. Henry, of the United States Weather Bureau, to furnish me with meteorological data covering a period of thirty years for the city of Washington and six other cities where the climatic conditions are quite similar to those which obtain in this city. A careful analysis of these data and a study of the comparative mortality statistics justify the conclusion that there is absolutely nothing inimical to health in the

climate of Washington. It was found, however, that although the city enjoys practically the same climate as Cincinnati, Indianapolis, Detroit, Philadelphia, Springfield and Kansas City, it has the highest death-rate* -22.8 per 1,000, Philadelphia coming next with a rate of 21.2 per mille, while Detroit, Kansas City, Indianapolis and Springfield have an average of 17.5 per 1,000.†

As a matter of record, Dr. Busey, in one of his addresses, quotes the "Washington Gazette" of 1797, that "during that year, in a population of two thousand, but seven deaths occurred in this city." If, then, during succeeding decades, "fatal epidemics of bilious fever, intermittent bilious fever and bilious dysentery" and typhoid fever occurred, and the reputation of the National Capital as regards health conditions has suffered, it cannot be the effect of climate, but of something added to the climate, and students of the subject have long since recognized that, apart from temperature, humidity, atmospheric pressure, winds, sunshine and other meterological conditions, there are many factors such as soil, water, impure air, the presence of insects, social and racial problems —which play an important role in the healthfulness of a given locality. It can be safely asserted that a number of causes have operated in the production of unsanitary factors in the National Capital.

The topography of the basin in which the city is located was undulating, interspersed with small valleys, ravines, morasses and lowlands subject to periodical overflows. The lowlands, according to Dr. Busey, "spread south of the F street ridge to the river shore, including a greater part of the White Lot and the Mall, and in the section known as 'the slashes,' lying along the northern boundary from the Tiber to Rock Creek, and dipping in many places far into the interior of the basin. When the city was first platted there were no Potomac and Anacostia river flats; the formation of the Potomac marshes is attributed to the construction of the Anacostia causeway in 1805 and the building of the Long bridge in 1808, and the Anacostia river flats to the construction of the Kentucky avenue bridge in 1795 and the Bennings bridge in 1797." Whatever their cause may have been, they increased from year to year by continuous depositions and soon became notorious breeding grounds for mosquitoes and the chief source for the propagation of malaria. The Potomac flats have been reclaimed since 1882, adding about 621 acres to

*Of these seven cities Washington had the highest death rates from malarial, diarrheal diseases, typhoid and consumption (Philadelphia exceeding in pneumonia).

+Considerably less than the general death-rate in the registration area in the United States, representing 10,000,000 inhabitants. For the census year 1900 this was 18.6 per 1,000.

our parking system, but the. Anacostia river flats, which cover an area of over 1,000 acres, the title to which is vested in the United States, still continue to be a menace to the health of our inhabitants. The reclamation of the Potomac flats has greatly reduced the prevalence of malaria, as shown by the statistics of the health department, and it is reasonably and scientifically correct to maintain that similar results would follow the reclamation of the Anacostia flats. Take away the mosquito breeding places of every description and there will be no extra-corporal habitat for the germs of malaria. It is a deplorable fact that, although this measure has been urged by the Commissioners since 1894, no legislative action has yet been taken.

RELATIONS OF WATER SUPPLY AND SEWERS TO HEALTH.

Prior to the introduction of Potomac water in 1859 the inhabitants had to depend upon springs, pumps, wells and cisterns subject to pollution. from the sewage of cesspools, vaults and box privies. It was the old story of wells and privies being dangerous neighbors and failure to recognize the necessity that a system of public sewerage must go hand in hand with the public water supply, the neglect of which compels recourse to various makeshifts and must inevitably lead to pollution of soi!, water and air. There can be no question that these factors have played an important role in the causation and spread of typhoid fever, dysentery, diarrhea and other intestinal infections and have served to swell the general mortality rates. Many of these conditions have been improved, a comprehensive system of sewerage disposal has been adopted within the city limits, and the number of public pumps has been reduced from 171 in 1895 to 42 in 1908. The number of private wells, however, is a matter of conjecture.

It may be urged that with the introduction of a purer water supply in 1859, health conditions, especially as regards the so-called water-borne diseases, should have improved, but it is a long and tedious matter to convince the average man that a clear, sparkling and very palatable pumpwater in cities may be, and very frequently is, liable to the grossest forms of pollution. He knows from observation that hydrant water is at times absolutely filthy from suspended matter, and that it reaches in summer a temperature which is far from palatable. But he does not know that the well water in its passage may have simply been deprived of the suspended matter, without losing some of the most dangerous forms of disease germs. It involves, therefore, many years of education to impress the public with the dangers of pumps, and, by the time this was fairly

well accomplished (although many even now are still in doubt) the Potomac river, by reason of an ever-increasing population in the towns, villages and settlements located along the banks and within its watershed, had become itself a dangerous source of infection.

My suspicions that typhoid fever germs might travel all the way from Cumberland, a distance of 134 miles, and infect the consumers of Potomac water in Washington, were confirmed as early as the winter of 18891890 by studying the effects of the typhoid fever epidemic at Cumberland upon the prevalence of the disease in Washington. The records of the health office show that during this epidemic, from December, 1889, to April, 1890, the deaths from typhoid fever amounted to 74, as compared with 42 for the corresponding months of the previous year. Indeed, we had almost double the number of typhoid deaths during these months than for any corresponding months either before or since this epidemic. Cumberland had about 45 deaths and 485 cases. Washington had 74 deaths and about 800 cases, and yet the starting point of all was the excreta of one patient washed into a little run which empties into the Potomac river 300 feet above the pumping station of the water supply for Cumberland. In the face of this fact and the almost constant presence of intestinal bacteria in Potomac water, the writer had no hesitation in declaring that the excessive typhoid fever rate of the National Capital was largely due to contaminated Potomac water, and urged, with other members of the profession, the speedy purification by means of sand filtration as well as the prevention of river pollution.

FILTRATION OF THE POTOMAC WATER.

In 1901 and subsequent thereto Congress appropriated sufficient money for a complete system of slow or natural sand filters. This filtration plant was completed under the supervision of United States engineer officers, with Allen Hazen as consulting engineer, in the fall of 1905. It covers twenty-nine acres and is the largest in America, and in many respects the most modern and scientific in the world. It handles about 75,000,000 gallons a day and eliminates ninety-eight to ninety-nine per cent of all the bacteria; and we have at least the comforting assurance that a corresponding percentage of disease-producing germs will also be removed. The effects of filtration upon the typhoid fever rates are shown by the fact that the rate reached as high as 104 in 1890, and was still 60.3 during the five-year period 1896-1900, but has fallen in 1907 to 34.6 per 100,000. As a result of the installation of filtration plants elsewhere, not only a reduction of eighty-one per cent in the deaths from