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Public Health Service
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SOLID WASTE / DISEASE
RELATIONSHIPS
a literature survey
This report (SW-lc) was written for the Solid Wastes Program
by THRIFT G. HANKS, M.D.
Life Systems Division, Aerojet—General Corporation
under Contract No. Ph 86-66-151
U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Public Health Service
BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL
NATIONAL CENTER FOR URBAN AND INDUSTRIAL HEALTH
Solid Wastes Program
CINCINNATI
1967
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The ENVIRONMENTAL HEALTH SERIES reports the results of scientific and engi-
neering studies of man's environment. The reports provide information on research
activities conducted and supported by Centers in the Public Health Service's Bureau
of Disease Prevention and Environmental Control. The subject of each report is
indicated by these letters:
AP — Air Pollution
RH — Radiological Health
UIH — Urban and Industrial Health
Reports in the SERIES will be distributed as supplies permit. Requests should
be directed to the Center identified on the title page.
Public Health Service Publication No. 999-UIH-6
2d Printing
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foreword
THE SECRETARY OF HEALTH, EDUCATION, AND WELFARE, John W.
Gardner, has said that maintaining the quality of the human environ-
ment "is potentially the most important technological challenge of our
age." This challenge will go unmet as long as efforts to dispose of solid
wastes continue to cause extensive environmental pollution, place an in-
credible economic burden on the people of the United States, and con-
tribute to the spread of a host of human illnesses.
Any one of these reasons would be sufficient to dictate a concerted
national effort to improve solid waste disposal practices. But the fact that
the health of the American people is seriously and needlessly threatened
makes imperative the requirement that the solid waste problem be brought
under lasting control.
It is my hope that this report, which attempts to summarize the
current scientific knowledge of the health implications of solid waste dis-
posal, will prove to be a landmark on the road toward safe and sanitary
solid waste management. I hope that it will stimulate the additional re-
search needed to close the gaps in present knowledge of solid waste disease
relationships and that it will motivate scientists and others concerned with
protection of the public health to turn their attentions to this vitally im-
portant health problem.
—RICHARD A. PRINDLE
Assistant Surgeon General
Director, BUREAU OF DISEASE PREVENTION
AND ENVIRONMENTAL CONTROL
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preface
THIS is A REPORT of a comprehensive literature survey of the public health aspects
or disease relationships of solid wastes.
The study was conducted by the Life Systems Division of Aerojet-General Cor-
poration, Azusa, California, under a contract with the Solid Wastes Program, United
States Public Health Service. The study was directed by Thrift G. Hanks, M.D., who pre-
pared the body of the report. Although there is a paucity of past work on the etiologic
factors of solid waste, an attempt has been made to cover the field comprehensively enough
to meet the needs of public health practitioners.
No single treatise in the past has attempted to correlate the available information
as to various diseases directly or indirectly related to solid wastes. Such a work is obvi-
ously desirable because of the complexity of the solid waste/public health interface.
The facts brought together in this volume are widely scattered in literature and
many of them were difficult to obtain. Although a logical plan was followed in deciding
what to include in the report, many of its postulations and conclusions admittedly are
difficult to uphold by documentation. There is no guarantee that all pertinent literature
was retrieved, but there is a fair guarantee that documents representative of the total
pertinent data were reviewed so as to give a reasonably valid statement of known rela-
tionships and of suspected or possible relationships as well as of lack of relationships. As
a result, this document is an excellent and useful literature review.
The authors have not limited the text strictly to solid waste, but have drawn upon
data from other etiologic modes in order to arrive at possible connections of solid waste and
its by-products to disease transmission. Their inability to present a "proof positive"
solid waste/disease relationship stems from the fact that our present state of knowledge
is not sufficiently standardized to make possible the preparation of a concise account of
the subject. The problem of identifying direct health effects is not unique for solid wastes,
but occurs throughout the field of environmental health. However, the postulations made
and the evidence cited in support provide potential means for interpretation of waste/
disease relationships via different pathways and also enable the health worker to identify
areas where more extensive research in the disease aspects of solid wastes is needed, particu-
larly from the viewpoints of epidemiology, etiology, pathology, symptomatology, and pre-
vention.
Mr. Ralph J. Black, Assistant Chief of the Solid Wastes Program, served as the
project officer of this study.
— LEO WEAVER, Chief
Solid Wastes Program
NATIONAL CENTER FOR URBAN AND INDUSTRIAL HEALTH
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THIS REPORT has been submitted to the Solid Wastes Program of the United States
Public Health Service in partial fulfillment of CONTRACT NO. PH 86-66-151 which was per-
formed during the period 15 June to 15 December, 1966. The report proper is contained
in this volume, Volume I.
A list of references as prepared by the contractors follows immediately after the body
of the report. Volume I also contains three appendixes. Appendix A is entitled Research,
Appendix B is called Solid Wastes Sources and Constituents, and Appendix C is desig-
nated Descriptor Glossary. The annotated bibliography in the separate, unpublished vol-
umes (Volumes II through V) has been microfilmed by University Microfilm Company,
Ann Arbor, Michigan, who will be sole distributors.
VI
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contents
PAGE
INTRODUCTION 1
RATIONALE AND METHOD 3
SUMMARY AND CONCLUSIONS 5
GENERAL RECOMMENDATIONS 7
DEFINITIONS 9
SOLID WASTE/DISEASE RELATIONSHIPS 10
A. GENERAL DISCUSSION 10
B. PATHWAYS 11
Pathway 1: Biological Vectors 11
Pathway 2: Physical and Mechanical Hazards 13
Pathway 3: Airborne Solids 13
Pathway 4: Direct Contact 14
Pathway 5: Water Supply 14
Pathway 6: Food Supply 14
Pathway 7: Socioeconomic Factors 14
C. DISEASE ASSOCIATED WITH CHEMICAL WASTES 14
General 14
Postulation 15
Evidence 17
Discussion 23
Conclusions 25
Recommendations 26
D. COMMUNICABLE DISEASE 28
Fly-Borne Disease
GENERAL 28
POSTULATION 28
EVIDENCE 29
DISCUSSION 47
CONCLUSIONS 49
RECOMMENDATIONS 49
Disease Associated with Human Fecal Waste
GENERAL 50
POSTULATION 52
EVIDENCE (SPECIFIC DISEASES) 52
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(continued)
PAGE
Disease Associated with Human Fecal Waste (continued) 52
(1) Amebic Dysentery and Other Intestinal
Protozoal Infections, 52
(2) Cholera, 55
(3) Coxsackie Disease, 57
(4) Infectious Hepatitis, 58
(5) Poliomyelitis, 60
(6) Shigellosis, 63
(7) Typhoid and Paratyphoid Fevers, 67
(8) Tuberculosis, 70
(9) Worm (Helminth) Infestations, 70
DISCUSSION 73
CONCLUSIONS 75
RECOMMENDATIONS 75
Disease Associated with Animal Fecal Waste
GENERAL 77
EVIDENCE 78
DISCUSSION 85
CONCLUSIONS 85
RECOMMENDATIONS 86
Rodent-Borne Disease
GENERAL 86
POSTULATION 86
EVIDENCE 87
DISCUSSION 90
CONCLUSIONS AND RECOMMENDATIONS 91
SPECIFIC DISEASE 91
(1) Plague, 91
(2) Leptospirosis, 95
Mosquito-Borne Disease
GENERAL 97
POSTULATION 98
EVIDENCE 98
DISCUSSION AND CONCLUSIONS 104
RECOMMENDATIONS 105
SPECIFIC DISEASE 105
Miscellaneous Communicable Disease
FUNGUS DISEASE 106
ANTHRAX 113
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contents
(continued)
PAGE
TRICHINOSIS 116
TRYPANOSOMIASES 117
CROP DISEASES 118
E. INJURIES AND SAFETY CONSIDERATIONS 119
General 119
Postulation ... 119
Evidence 119
Safety Survey 120
Discussion 127
Conclusions and Recommendations 128
F. DISASTER 129
Discussion 131
Conclusions 131
Recommendations 132
REFERENCES 133
TABLES
1 Explanation of Terms Used in Table 2 122
2 Sanitation Workers' Injury—Frequency Data 123
3 Correlation Coefficients, Sanitation Workers' Injury Frequency 124
4 Personal Injury Data 126
5 Injury Analysis for 1964 127
FIGURES
1 Survey Plan 3
2 Solid Waste/Human Disease Pathways (Postulated) 11
3 Chemical Waste/Human Disease Pathways (Postulated) 16
4 Human Fecal Waste/Human Disease Pathways (Postulated) 52
5 Animal Fecal Waste I Disease Relationships (Postulated) 78
6 Solid WastelPlague Pathways (Postulated) 87
APPENDIX A: RESEARCH 148
TABLE A-l RESEARCH TOPICS (REPRESENTATIVE) 148
APPENDIX B: SOLID WASTE SOURCES AND CONSTITUENTS . . .160
APPENDIX C: DESCRIPTOR GLOSSARY 168
ix
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INTRODUCTION
IT is FORTUNATE that persons concerned with public health have acted to control
disease without waiting for the discovery of "ultimate scientific truth". Only now are
some of the ecologic and epidemiologic details being established to justify essential public
health measures instituted decades ago. Nevertheless "guilt by association" between solid
waste and disease does not provide the kind of foundation needed to provide scientific
data upon which public health directors, sanitary engineers, government officials, and the
voting and participating public may act with confidence and a minimum of dispute in
dealing with the enormity of the solid wastes problem in the United States.
The assigned purpose of this study, therefore, has been to review with reasonable
thoroughness the scientific literature reporting any relationships between disease and the
solid wastes generated by the activities of man. Thus the direction of this study has been
epidemiologic in nature, and its methods have been based on the requirements of epidem-
iologic validation.
Theoretically, if all etiologic factors are present in a requisite quantitative and
sequential manner, a necessary and sufficient climate for disease will exist, and the disease
process may result. Any chain or cycle of events between agent and host, and within the
pattern of the disease, must be unbroken. Each link must be firmly established by re-
producible observations. Proven demonstration of solid waste/disease relationships is
hampered by: the complexity of solid wastes components; the biologic and chemical
changes that occur in wastes under widely varying conditions of storage, handling, treat-
ment, and disposal; and the intricate pathways that may underline human exposure and
disease. There is also the frequent need to isolate one among other possible etiologic
modes, so that if there is a relationship the association may be hidden by more readily
demonstrable, plausible, and significant etiologic mechanisms.
Despite these difficulties, the literature contains a number of statements implying
or averring that significant connections between solid wastes and human disease exist.
But the dearth of explicit relationships found at the start of the study led to a need to
postulate the essential links, then to attempt to determine such connections as might
be indicated by isolated published observations, and finally to the attempt to establish or
exclude each linkage in an epidemiologically satisfactory manner. Some of the postula-
tions are diagrammed in the text of this report. Each postulated solid waste/disease rela-
tionship is presented as follows: First, a general statement on the disease under consid-
eration; second, a postulation on its association with wastes; third, the evidence found in
the literature supporting this postulation; fourth, discussion of the evidence; fifth, conclu-
sions relating to the disease/waste association and to possible projections of the observa-
tions; sixth, recommendations for research or other activities.
We do not apologize for some of the extensive explorations carried out in pursuit
of solid waste/disease relationships. Essentially, each search was based on a published
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SOLID WASTE/DISEASE
statement or opinion that a relationship could, or did, exist, and only by thorough exam-
ination could we test the validity of such a statement. At times the examination required
an investigation of evidence pertaining to factors seemingly unrelated to solid wastes in
order to infer chance or indirect contributions of solid wastes to the spectrum and inci-
dence of disease.
It should not be surprising that so much opinion and so little data were discovered
in this study. The complexity of the subject matter, the obscurity of disease pathways,
and the absence of reliable methods contributed to the paucity of scientific information in
this area. Tradition and teaching dating back half a century, however, have tended to fix
certain beliefs for which valid demonstration has only recently been established. Yet de-
spite any shaky foundations in older public health lore, we may well be grateful that our
pioneers in public health acted on limited data and much intuition. We are a healthier
nation for it. The lesson may help to support the initiation of action in our present prob-
lems concerned with the management of solid wastes before all demands for proof positive
are met.
Acknowledgements
Robert E. Mitchell abstracted and summarized the material on waste sources and
constituents, proposed and conducted the safety survey, and (with the assistance of Rex
Farquhar, statistician) analyzed the survey data. Robert Geckler, PH.D., prepared the
summary on research (Appendix A). Perry Ann Stith, M.S., researched a significant por-
tion of the chemical waste/disease citations.
Special recognition is given to Myra Grenier, Aerojet Corporation Librarian, and
her staff, particularly Shirley Stephenson, for their splendid support.
Among the library sources, particular thanks go to the Linda Hall Library, Kansas
City, Missouri. Local sources provided invaluable help. Elizabeth Acker, head of the refer-
ence department of the Los Angeles Medical Society Library, gave gracious support. The
libraries of the California Institute of Technology, Pasadena, University of California at
Los Angeles, University of Southern California, and the City of Hope Hospital, Duarte,
California, were used extensively.
— THRIFT G. HANKS
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RATIONALE AND METHOD
A LITERATURE SEARCH involving solid waste and disease relationships imposes a
choice of primary descriptors, in that the selection of the universe of published disease
processes would overwhelm the searchers. It was therefore decided that the term waste
and its synonyms and near-synonyms would be used as the primary search terms, while
postulated or cited disease and other descriptors would serve as secondary search terms.
A sampling of literature indexes was made. This involved use of the initial terms
arrived at by the description of the study, and the experience of the study personnel. An
expansion of the initial descriptor list was then prepared from the terms found under the
cross-indexing of the indexes. A cyclical search plan was set up and extended to include
activities leading to a final report. The resultant survey plan is shown in Figure 1.
FIGURE 1. Survey plan.
In support of the search, postulated waste/disease relationships were diagrammed.
A few of these diagrams are contained in the report (Figures 2 through 6).
It was evident that a statistically random sampling of the literature could not be
relied on to discover a sufficiently inclusive selection of existing references to satisfy the
intent of the search. Instead, a screening of titles was used for which the descriptors were
chosen to match each link of the postulated connections between waste and disease. Since
a priori construction of all links was not possible, some repetitive searching of indexes was
necessary. However, the method tended to limit the number of titles. On the other hand,
a sample title search, using a postulated disease alone as the descriptor, resulted in no
selections from approximately 11,000 titles.
More than 200,000 titles were screened before tabulations were discontinued. It is
estimated that approximately 350,000 titles in all were scanned for selection. When pos-
sible, initially selected titles were further screened by examination of the abstracts before
final selection was made. The indexes used were Index Medicus, Chemical Abstracts,
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SOLID WASTE/DISEASE
Biological Abstracts, Applied Science & Technology, Engineering Index, International
Abstracts of Biological Sciences, Industrial Arts Index, Psychological Abstracts, Annual
Review of Psychology, and Readers Guide to Periodical Literature.
From an original list of 1,727 selected titles, 1,236 were received, read, and ab-
stracted. The remainder were either not available or were cancelled when circumstances
directed. (Translation of Slavic literature was not available, for example.) The physical
method used for abstracting was 'highlighting' by colored ink, with broad felt pens to
mark material for typing. Although this method did not always provide smooth sequenc-
ing of quotations, it did permit a time saving of at least twenty-fold over written abstrac-
ing, and five- to ten-fold over dictation.
From the perused 1,236 articles, books, reports, proceedings, and other sources, 754
abstracts were chosen for reference and inclusion in the annotated bibliography. We be-
lieve that the pertinent literature retrievable by feasible search methods and descriptor
usage has been identified, either in the referenced material or through its citations insofar
as the basic purpose of the study is concerned. No pretense is made that all, however, or
even the key, literature relating to important or perhaps crucial aspects of the ecology
and epidemiology of the disease, vectors, or hosts in question has been identified.
As a check against the manual methods used in this study, the National Library
of Medicine was asked to use its MEDLARS system to retrieve solid waste/disease informa-
tion. It should be noted that through this source there was access to data indexed only
after 1963. With the use of descriptors supplied from this study, a computer run was made
on all available literature (477,000 titles). From this run, 195 references were recovered.
Unfortunately, these references were not available in time to obtain and study the articles
not duplicated in the manual study. Since only 27 references were duplicated, however,
the relevancy of the remaining 168 is unknown and should be determined. Correlation
of the references obtained by the two methods would appear of fundamental importance
to any retrieval system to be proposed for solid waste information.
A third requirement dealing with hazards of sanitation workers is discussed in the
section on safety in this report.
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SUMMARY AND CONCLUSIONS
THE LITERATURE FAILS to supply data which would permit a quantitative estimate
of any solid waste/disease relationship. The circumstantial and epidemiologic informa-
tion presented does support a conclusion that, to some diseases, solid wastes bear a
definite, if not well denned, etiologic relationship. The diseases so implicated are infec-
tious in nature; no relationship can be substantiated for noncommunicable disease agents
associated with solid wastes, not because of negating data, but because of lack of data.
(An exception to this statement may exist in the instance of methemoglobinemia of
infants in which nitrates of excretory origin may play a part.)
The communicable diseases most incriminated are those whose agents are found
in fecal wastes — particularly human fecal wastes. Where these wastes are not disposed
of in a sanitary manner, the morbidity and mortality rates from fecal-borne diseases in
the population are high. Despite the fact that other factors are known to contribute to
some reduction of these rates, the inescapable conclusion is that the continued presence
in the environment of the wastes themselves is the basic causative factor. Therefore
transmission — whether by direct contact, vector transfer, or indirect contact — is due
to environmental contamination by these wastes.
Flies are carriers of many disease agents, however, and fly-control experiments in-
dicate that they are significant transmitters of shigellosis (bacillary dysentery). The
known ability of fly vectors to proliferate enormously in organic wastes, to contaminate
themselves in fecal wastes, and then to contaminate man or his environment, incriminate
the fly as a secondary hazard. The wastes from which the fly arises, or by which it is
contaminated, thus constitute the primary hazard. In other words, any solid waste which
promotes fly propagation will contribute to the incidence of a disease when the agent
of that disease is available to the fly, and when other conditions of transmission (for
example, the ability of the fly to transmit the agent, proximity of flies to hosts, dosage
factors) are satisfied. Since these contributory conditions may vary significantly from
place to place and from human population to human population, the definitive factor must
be the domestic fly population, which in turn is largely regulated by the breeding oppor-
tunities afforded by numerous solid wastes.
The importance of solid wastes to mosquito-borne disease is far less clear. The
relative contribution of solid waste-bred as opposed to that of other media-bred mosquitos
has not been studied. The inference to be drawn from available information is that, under
certain circumstances (see section on mosquito-borne disease), the presence of breeding
places provided by solid wastes could contribute to dissemination of a disease agent in a
human population, although to an unknown degree.
At this time, few human cases of rodent-borne zoonoses are being reported in the
United States. No recent data were found bearing on the relative importance between
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SOLID WASTE/DISEASE
solid wastes and other media in contributing to domestic rat populations, thus incidence
of the reported zoonoses cannot be estimated in relation to solid wastes. Human plague
experienced in recent years in this country seems to be totally of direct sylvatic origin.
The importance of the domestic rat in the few reported cases of leptospirosis cannot be
judged because of insufficient epidemiologic data. The direct origin of the leptospirae
responsible for human infection were largely of bovine or other domestic animal origin.
The further tracing of the organisms to rats was not accomplished (see rodent-borne dis-
ease section). Other solid waste/disease relationships must remain speculative pending
far more definitive studies. Because of the low level of incidence of a number of diseases
for which a relationship could be postulated, it would appear that there is little hope of
obtaining data sufficient for analysis in this country, and that applicable studies would
have to be made on foreign populations if a more valid comprehension of an association
is to be made.
The fact, however, that much basic and many 'tag ends' of research attesting to
specific relationships or their degree have not been carried out should not serve as an
excuse for failure to act. It is known that insanitary disposal of fecal and food wastes
is a cause of disease in this country. It may or may not be economically sound practice
to investigate disease transmission under various waste and water treatment methods
before undertaking large treatment projects. But in any case it does not appear to be
sound practice to delay the installation of sanitary toilets and water supplies pending the
outcome of such research.
So little is known about the kinds and degrees of contamination of the human
environment by industrial and other chemical wastes, and the impact of trace amounts
of such materials on human health, that their relationships to health remains essentially
unexplored. This entire field is open to investigation; the implications for the research
effort, of course, are as broad as the gap in knowledge.
One rather puzzling finding is the high accident frequency rates among sanitation
workers (see section on safety). This warrants study of this population to explore
reasons for these rates and to estimate the public health risk of solid wastes factors
encountered in the study of this group, who have a more intimate exposure than the
general public to disease agents contained in wastes.
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GENERAL RECOMMENDATIONS
SOLID WASTES have been demonstrated conclusively to be associated with some
diseases in the United States. Although the incidence of disease due to wastes is low in
this country as a whole, it is demonstrably higher in certain groups — particularly those
without general sanitation, including proper waste disposal means. In the chain leading
disease from waste to human host, the major point of attack must be upon those wastes
which contain disease agents or serve as sources of propagation for carriers of disease.
Wastes must be so handled or treated that the pathogens they contain are destroyed —
not merely reduced in numbers — and carriers of pathogens denied access to the wastes
for breeding or sustenance. To the extent that known effective measures are not feasible
at this time, research should be directed at the development of effective, yet practical,
methods.
Since lack of data is extensive in regard to chemical wastes, two major paths of
investigation are advised: first, delineation of the type and degree of contamination of
the environment due to chemical wastes; and second, accelerated and long-range toxi-
cologic studies on effects of chemical waste materials common to the environment in the
concentrations found there. The knowledge needed is that of the effect of decades of
exposure to trace amounts of the waste substances.
In addition, exposure and disease spectra of sanitation workers should be de-
termined to provide comparative data, as well as to permit better protection of this group.
It appears that we need more information on the techniques and the organiza-
tional and administrative means for sanitary disposal of solid wastes in times of crisis
or disaster. As a preliminary step, the available information should be assembled as a
basis for determining what additional knowledge is required. Correction measures against
disease cannot deal exclusively with a relatively limited aspect of an etiologic situation
as broad as that associated with solid wastes. Educational and legal weapons are re-
quired. Considering the deficiencies of health education as a whole in America's school
systems, it is not entirely appropriate to select the public and personal health aspects of
solid wastes as the focus of expanded instruction on health. Yet from a system of educa-
tion developed on this aspect of health, an inclusive health education program of value
might arise. Certainly, some means developed for use in the schools is needed for break-
ing some children from the cultural morass of insanitary practices to which their birth
and environment condemn them.
Education of industrial personnel, the general public, the medical profession, and
government officials is an added requirement. Educational and motivational materials
and techniques need to be developed for the accomplishment of these goals. Strict legal
controls and their enforcement are mandatory. However, regulations must be based on
reasonable standards. At the present level of knowledge, it is not possible to adopt
standards directed at all aspects of environmental contamination, including sources of
291-982 O - 68 - 2
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SOLID WASTE/DISEASE
solid wastes. For example, research is needed to permit the development of standards on
chemical, viral, and (to a lesser extent) other biotic contamination arising from solid
wastes. In the interim, considering the tendency of contaminants to ignore present juris-
dictional boundaries, the legal and governmental means necessary for the effective appli-
cation of regulatory standards need to be developed.
Additional studies on environmental contamination by chemical wastes have already
been suggested. Such studies probably could benefit from, or require, automated mon-
itoring systems. Such systems could then be adapted to environmental control for the
protection of health. Their development therefore deserves consideration for at least two
basic reasons (economic, regulatory, and legal reasons also suggest themselves).
In this report, occasional reference is made to the hazard arising from compart-
mentalized approaches to the control of environmental pollution. In almost every action
to be recommended for the prevention of solid waste-related disease, there is a parallel
requirement apart, but not detachable, from the solid waste phase which relates to all
environmental contamination. The same considerations apply in reverse to water- and
air-pollution control measures. That is, corrective measures (or research directed at their
development) cannot be considered separately from overall waste management problems.
The obvious conclusion is that environmental health is not a subject for dissection. Spe-
cialists may be required for diagnosis, but the therapy must be integrated. The basic
recommendation, therefore, is that of an integrated program of study, analysis, and action
directed at applying the best talents of our society as a whole to the control of environ-
mental pollution.
More detailed recommendations are contained in this report under the section on
research and at the end of each section on disease.
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DEFINITIONS
IT is PERHAPS APPROPRIATE to explain the definition of solid waste given below.
First, there is no consistent definition to be found in the literature or among workers in
the field of waste studies. Second, a waste may undergo as many as three or four phases
of solid/nonsolid existence from the time it is evolved until its 'final' disposal. For ex-
ample, wastes that go into suspension or solution cannot be abruptly dismissed. Through
evaporation, precipitation, adsorption, and other phenomena, such waste often reappears
in solid form.
Today's so-called liquid wastes may become tomorrow's solid wastes if public
health or other considerations dictate that liquid transportation of solids be discontinued.
A similar future problem may apply to solid wastes, or the combustion products of wastes
now discharged into the air.
To classify such wastes on an arbitrary or jurisdictional basis would at this time
almost certainly result in the lack of timely consideration of research for handling them,
should their present modes of disposal be prohibited. This in turn would result in delays
and elevated costs.
The following definition is given with the above considerations in mind:
Solid Waste: Solid waste is that normally solid material arising from animal or human
life and activities and discarded as waste, regardless of its mode of transportation, sus-
pension, or modification. It therefore includes waste particulates suspended in air or
water, and soluble waste solids contaminating water or soil.
The following definitions are similarly arbitrary:
Descriptors: Those terms which define, for purposes of information retrieval, the subject
matter encompassed by this study.
Descriptor Glossary: The table of search terms found to be most helpful for information
retrieval. It contains major descriptors, synonyms, or near-synonyms of these descriptors,
and modifying terms which more specifically define the subject matter sought.
Disease Agent: Any organism or material capable of causing disease.
Waste Disposal: The final deposition of waste by man. This does not include its ulti-
mate dissemination by forces other than man.
Waste Handling: The physical manipulation of waste involving human exposure to the
waste's components.
Waste Sources: Those activities — domestic, municipal, industrial, or commercial —
which generate waste.
Waste Treatment: The intentional processing of waste with the goal of changing its
content as to quality or quantity, or both.
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SOLID WASTE / DISEASE RELATIONSHIPS
A. general discussion
HYPOTHETICAL!/?, solid wastes can produce undesirable effects by biological, chem-
ical, physical, mechanical, or psychological means. For example, human pathogens in
human feces provide a biological threat, industrial wastes create chemical hazards, flam-
mable materials involve a physical danger through fires or explosion, and broken glass
and other sharp-edged wastes create mechanical hazards. These hazards, plus unsight-
liness, costs of waste disposal, special interest and jurisdictional disputes, threats to
property, and other factors, provide a basis for possible psychological and behavioral
disturbances.
To relate human disease, disability, annoyance, or other undesirable effects un-
equivocally to the production, disposal, or accumulation of solid wastes is not a simple
procedure. It requires, in fact, that all of the steps in the pathway from solid waste to
human affliction be validated by unequivocal measures. This validation depends on the
1) Discovery of harmful or potentially harmful agents in the waste, or,
2) Demonstration that such agents develop within, or in association with, the
wastes.
3) Discovery of disease or other effects among the population which may reason-
ably be associated with these agents;
4) Demonstration of the pathways by which the effects are accomplished;
5) Demonstration of the absence of effects following interruption of these path-
ways by one means or another, or their absence in populations not similarly
exposed.
Among the human population, conditions exist which satisfy requirement three
above (that is, there are numerous cases of disease, injury, or behavior which reasonably
could be suspected of arising from the kinds of hazards postulated). Perhaps the easiest
to associate would be arguments arising out of jurisdictional or economic aspects of solid
waste management.
The most difficult requirement to fulfill is the fourth. It will be helpful to consider
the possible pathways.
Disease agents must find access to the body if they are to have an opportunity
to cause an effect. The agent and the victim must have environmental association, there-
fore, either directly or indirectly. Direct contact could occur, for example, in the handling
of a waste by the potential victim. Indirect contact could occur through transportation
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11
of the agent to the victim as, for example, through the means of a biological vector such
as a fly, mosquito, or flea, by way of water supply contaminated by waste, or by airborne
solid waste particles.
In detail, the pathways by which agents of disease could result in human exposure
and possible disability can be highly complex, but a simplified diagram of the general
modes of transmission can be presented (Figure 2). Except for their brief mention, the
possible psychological effects of solid waste will not be discussed in this report.
PHYSICAL
AND
MECHANICA
HAZARDS
SOCIO-
ECONOMIC
FACTORS
HUMAN DISEASE
DISABILITY
MALNUTRITION
FIGURE 2. Solid waste/human disease pathways (postulated).
B. pathways
THE GENERAL CASES of the first six of the several pathways diagrammed above will
be presented first. However, in treating individual diseases, overlapping of pathways
permits no such separate categorizations.
Pathway 1: Biological Vectors
The term vector, as used here, refers to any living agent which transports, directly
or indirectly, a disease agent. Later in this report it will have its more technical mean-
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12 SOLID WASTE /DISEASE
ing — that is, an arthropod transmitter of disease. Vectors become important to the solid
waste/disease relationship insofar as the waste is a cause of their multiplication and their
proximity to man, or a source of their contamination by pathogens.
Biological disease agents affecting man have evolved and are still evolving. Some
disease agents are adapted to lower animals and infect man only incidentally; that is,
man is not a natural reservoir. In case of human disease from such sources, man can
serve as a 'dead-end' for the agent, or he can transmit the agent among his own species
or to other species. Other agents are totally or partially restricted to man. Lower animals,
however, may form part of the pathway by which human infection takes place in such
disease.
The biological vectors of disease agents that can attack man comprise members
of essentially every family and genus of higher forms. The carrier (vector) status may
be either mechanical or biological; that is, the agent may be transported on or in the
vector without multiplication or change in phase (mechanical carrier state), or the agent
may require passage in the carrier for multiplication or to undergo a necessary cyclical
change there (biological carrier state). The carrier may therefore be either a true 'host'
of the disease or serve only as an agent of transportation.
The pathway involving biological vectors is concerned with disease-carrier or host
states among animals (that is, with domestic, commensal, or wild animal life which pro-
duce infective solid wastes or serve as links in a chain of infection ending in man).
Fecal Wastes. Many of the most devastating infectious ailments are the enteric
diseases of man and animals. Their agents are commonly excreted, often in enormous
numbers, in the feces of infected individuals, and comprise all major categories of path-
ogens: bacteria, viruses, protozoa, and helminths. The highly dangerous human bacterial
agents of typhoid fever and cholera have been responsible for many millions of deaths.
They are prevalent in all countries and continue to cause much disease and death in areas
existing in both 'developed' and developing countries in which sanitary disposal of human
feces has not been achieved. The same problem exists with regard to other disease forms
found in feces, especially as a cause of death among infants and children.
Enteric diseases for which domestic animals are the natural reservoir may cause
human disease through direct infection. By causing disease or death of the animals,
these diseases can contribute to malnutrition and death in man. It is possible that there
are hundreds of kinds of enteric animal disease agents. An unknown number are, or
may become, transmissible to man either at present or, by evolution, in the future.
Among these kinds are hundreds more of serological variants — infection with one of
which may not provide immunization against other variants of the same species. For
example, more than 1,000 serologically different salmonellae are recognized.324- P-266 As
world-wide trade and spread of transportation increases, the spread of species, subspecies,
and strains of such organisms, at least among animals, will continue to mount. 324> P m
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literature survey 13
The discussion of specific diseases related to fecal wastes is presented elsewhere in
this report.
Solid Wastes as Sources of Food and Harborage to Potential Carriers of Disease.
The commensal rat and mouse are examples of evolutionary adaptations of a wild form
to man's habitat. Their association, particularly that of the rat, with human refuse has
been commented on throughout much of written history, as has their suspected role in
human disease (see section on rodent-borne disease).
In addition, certain insects such as cockroaches, domestic flies, and domestic
mosquitoes have been noted to share this relationship with human refuse and are sus-
pected of spreading disease to man (see sections on fly-borne and mosquito-borne disease).
Pathway 2: Physical and Mechanical Hazards
Solid wastes often contain flammables and, in the course of biological or chemical
decomposition, evolve explosive, poisonous, or asphyxiative gases. These gases traverse soil
and can presumably create hazards to humans and their dwellings if these are proximal to
the disposal, treatment, or other sites of processing of solid wastes. Solid wastes can also
cause injury by mechanical means (see section on safety).
Pathway 3: Airborne Solids
Solid wastes are evolved in many combustion processes. A particularly heavy
source of particulates is the burning of coal. Incineration of solid wastes creates solid mat-
ter which enters the air. It is also conceivable that pathogenic soil fungi, multiplying
through the nutritive effect on soil of some solid waste constituents, can release spores
to the air (see section on fungi).
Pathway 4: Direct Contact
It must suffice to surmise in the general case that many possibilities for direct
contact of humans with biological or toxic agents in solid wastes must exist. In this
regard, solid waste must be considered in two rather distinct contexts: first, as a collec-
tion and disposal problem involving sanitation workers, and second, as a problem of per-
sonal and household hygiene (at least insofar as an analysis of cause and effect relation-
ships in disease is concerned). It will thus be necessary to consider both household and
municipal pathways.
Possibilities for kinds of exposure are to be inferred from the sources and con-
stituents of solid wastes. Exposure itself depends on proximity; hence occupations
causing the worker to be directly exposed would be presumably of greatest concern, par-
ticularly since the factors of dosage and length of exposure are paramount in human
disease factors. Thus, farm workers would appear to have major exposure to animal
wastes, hospital staffs and attendants to infective human wastes, sanitation workers
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14 SOLID WASTE/DISEASE
handling solid wastes in or outside industry to toxic wastes, and so on. Similarly, family
members — especially children — may be intimately exposed to accumulations of solid
wastes in and about the home, the risk being proportionate to the hazard in the waste
(see sections on safety, human fecal wastes, and animal fecal wastes).
Pathway 5: Water Supply
Solid waste materials which are soluble or suspendible in water may create a poten-
tial source of hazard by runoff into surface waters, or by leaching and percolation into
ground water or aquifers used for potable water. In addition, the possible change from
solid to liquid or suspended, and again to solid state, could presumably cause special con-
cern with evaporation of the solvent and concentration and accumulation of the solid
phase (see section on chemical wastes).
Pathway 6: Food Supply
The possibilities for introducing toxic agents or biological pathogens to the human
organism through the food-waste cycle are many and complex. Presumably, exposure
could result from direct contact, as in the use of containers containing remnants of waste
for food transport, from contamination through the agency of biologic vectors such as flies
and rodents, and from contamination by waste residues during food processing. Ex-
posure also could come about through contamination of food crops by fertilizers prepared
from wastes or prepared foods in markets merchandizing such fertilizers, through contam-
ination of edible fish by discharge of wastes into bodies of water, or by infection of animals
used as a source of food.
Pathway 7: Socioeconomic Factors
These will not be analyzed because no definitive studies have been addressed to
any aspect of this pathway. Common observation, nevertheless, leads to the conclusion
that special interest conflicts, educational and cultural deficits, jurisdictional disputes, and
similar factors have caused and will continue to cause delays in correcting deficiencies in
solid waste management and, by so doing, create a pathway potentially leading to human
disease and degradation of the environment to the lessening of human well-being in general.
C. disease associated with chemical wastes
General
Man uses hundreds of thousands of chemical materials or creates them incidentally
in industrial and other activities. Each of these materials, either in its original form or as
a breakdown or by-product, will probably appear at some time as a waste. To demon-
strate the possible harmful effects on man would require first, that the products be fol-
lowed, in most cases, through an extremely complex pathway in which numerous changes
in chemical nature and concentration may occur; second, that they remain identified in
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literature survey 15
this journey and not confused with materials of the same nature from other sources;
third, that they be traced onto or into the human body in a form and concentration that
can produce disease; and fourth, that the host be adversely affected thereby.
Barring this, epidemiologic methods are needed to demonstrate convincingly that
a disease in a population is of a type to be expected from a specific waste chemical, that
this chemical be demonstrated as having access to the population, and that no other
source can be similarly implicated.
Attempts at categorization of chemicals for toxicologic purposes have been shown
to serve little purpose. Minor changes in structure of a compound can bring about
major changes in its biological effects. In addition, the task of itemizing the enormous
number of wastes as to their toxicologic potentialities is beyond the scope of this study.
Consequently, a postulation of possible pathways for chemical wastes to reach a human
body will be described, and attempts will be made to validate parts or all of these routes from
the literature. Complete itemization of chemical wastes of toxic or carcinogenic potential
will not be attempted. Only those wastes will be discussed that can serve to illustrate
points in the postulation, or, if possible, that are known to cause human disease.
The wastes to be considered are those that are normally solids when in a dry state,
or liquids of a sufficiently hazardous nature to require special handling.
It is entirely possible that present practices in which toxic chemicals are discharged
into water will be proscribed in the future. 267>272 It will then be necessary to apply
special handling procedures to protect the public against new avenues of exposure. In
addition, waste chemicals discharged into liquid media may be precipitated by waste
treatment processes and become concentrated in the resulting sludge solids, creating
other potential risks to public health by pathways to be discussed.
Postulation
Hazardous wastes chemicals can adversely affect the public health via a number
of pathways, depending on the method of disposal and the nature of the end product, its
concentration, and the effective dose in the population. These pathways are illustrated
in Figure 3.
Chemical waste can be disposed of by the following methods: (a) landfill, dump-
ing, surface and subsurface disposition; (b) streams, lakes, etc.; sewage treatment ponds;
(c) (as a component of treated waste) fertilizer, soil conditioner; (d) (as a component
of treated waste) animal feed; (e) incineration.
Chemical wastes or wastes which contain chemical products may, through handling,
produce dust, while their presence in waste undergoing treatment involving aeration may
result in their being air-borne through the bubbling action of the treatment process.
As a result of the leaching action of rain, it is possible for chemicals on soil or in
dumps, landfills, or wells, to enter ground-water reservoirs and thence human water sup-
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16
SOLID WASTE/DISEASE
plies. When disposed of on land, they can be leached into surface streams or ground
water. They can also contaminate water into which they are directly discharged. In this
way they can create a risk to humans if the contaminated water supply is used as drink-
ing water, or cause toxic compounds to appear in aquatic life which could then become
part of the human food chain.
DUMPING
LANDFILL
SURFACE
SUBSURFACE
iDEEPWELL INJECTION
STREAMS, LAKES ETC;
SEWERS; WASTE-
TREATMENT PONDS
FIGURE 3. Chemical waste/human disease pathways (postulated).
If chemicals are contained in wastes converted into fertilizers, soil conditioners,
or animal feed, they could presumably enter edible plants, meat, or milk and thus con-
stitute a hazard in human food supplies.
Through incineration, they or their by-products can contaminate the skin or the
lungs of individuals. In addition, by the handling of wastes, human beings can subject
themselves to the toxic action of chemicals through direct contact or inhalation of dust.
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literature survey 17
Evidence
DISPOSAL METHODS
Land Disposal. The literature deals essentially with five land disposal methods:
(a) dumping2- 70> 136- 214- 216> 217> 231- 24°- 243- 29°- 291' 636- 640> 714- (b) landfill200' 232- 202> 216> 215-
268, 493. (c) surface deposition387' 234' 79> 217- 215- 27°. 284- 316- 627- 64°; (d) superficial subsurface
deposition 20°- 70' 202- 255' 27°; and (e) deep well injection. 209> 217> 22°. 2U- 224' 27°- 283- 633' 64°
Water Disposal. The literature is replete with references to discharge of wastes
containing chemicals into various bodies of water and flowing streams. 232' n- 234- 59> 61- 67>
79, 202, 209, 214, 216, 217, 220, 215, 231, 241, 242, 243, 245, 246, 255, 256, 267, 268, 272, 277, 284, 416, 480, 495, 617,
644, 646, 745 The bodies of water include lakes, ponds, oceans, and various lagoons or ponds
used for holding or treatment of wastes.
Air Disposal. Wastes are frequently burned. 20°- 232> 387' 234' 220' 215' 227' 230' 231- 253'
255, 268, 293, 295, 402, 403, 404, 412, 440, 644 These wastes include all types of municipal wastes,
crop residues, and dried sludge from waste treatment processes. Solid wastes also result
from burning of primary fuels such as coal, heating oils, gas, and various locomotive fuels
such as diesel oils and gasoline.
All of these methods of combustion usually produce particulate matter. The
particulates are either discharged into the atmosphere or collected by various means.
23, 34, 240, 293, 294, 296, 298, 297, 299, 411, 426
PATHWAYS
1) Soil Contamination. Some nonbiological wastes are often mixed with other
forms of waste for purposes of treatment and become precipitated in the sludge. 63- 136'
138, 202, 207, 209, 215, 224, 227, 236, 241, 243, 244, 245, 254. 268. 284, 402, 495. 710
One method of disposal of sludge is to use it as a 'fertilizer' or soil conditioner. 202'
214, 2i5, 2i6, 254, 268, 280 Thompson et ol. 268 found 26 metallic components of air-dried sludges
in which concentrations ranged from 0.001 to 30 percent.
At this point, the literature becomes highly speculative in regard to disease caused
by chemical wastes. Hueper387 has been perhaps the most outspoken critic of industry in
its practices of polluting the soil, water, and air, and has repeatedly warned that these
routes of transmission could add to the total carcinogenic load in the population. He
states that industrial carcinogenic pollutants may be absorbed by and accumulated "in
fruits, vegetables, and food animals using water contaminated with such materials." Rain
water could cause soluble chemicals in wastes used as fertilizers or soil conditioners to be
made available to plants. Presumably, these could then be taken into the fruits and
vegetables or into food animals feeding on forage containing the pollutants.79 Other
evidence is highly circumstantial. 63
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18 SOLID WASTE/DISEASE
Concern over the possible intoxication of humans by pesticides has led to the find-
ing that some of these agents are accumulated in crops. 646 It is known that pesticide
chemicals are absorbed by plant roots and distributed into various tissues of plants. 316
However, similar investigations relating to chemical components of waste per se were not
discovered. There is evidence, obtained in work on pesticides, that at least some pesticide
chemicals are ingested with contaminated food in the human food cycle. 386
2) Water Contamination. Surface Waters. Gurnham20() states that contamination
of streams by toxic wastes creates a hazard to public health: "Injuries to people by
such discharges have fortunately been rare, but the killing of farm animals is frequent
enough to indicate the danger." This author also states that similar danger exists from
food fish which may have absorbed toxic materials from water. However, it has also been
stated that there have been no known adverse effects on human health which can be
traced to the presence of refractory contaminants in the tap waters of this country. 82
The literature concerning methemoglobinemia due to nitrates was reviewed to the
extent that no case could be traced to pollution due to chemical wastes. However, there
is epidemiologic and chemical evidence that this affliction is associated with nitrates
and nitrites from water pollution due to biological wastes. 277> 353' 709
Woodward14 stated that the presence of goitrogenic materials in some drinking
waters "seems beyond question". He speculates that these could be due to the presence
of wastes or their degradation products.
There has been some debate on whether certain materials, either by their presence
or absence in drinking water, may be associated with certain kinds of cardiovascular dis-
ease. 129' 374' 578' 67° However, a panel convened to investigate this possible phenomenon
reported that "no causal relationship has been established between the total dissolved
inorganic constituents of drinking water and cardiovascular disease." 577
The possibility that toxic chemicals could enter the human food cycle through their
accumulation in aquatic life was investigated. Fish are known to be killed by water pollu-
tion, but the mechanisms are poorly understood. In evidence of this is the continued
controversy over fish kills allegedly due to pesticides. However, the crucial question for
this investigation is whether or not waste toxins enter edible aquatic life through whose
consumption humans are affected adversely by these same toxins. There is some indica-
tion that oysters can take up carcinogenic agents. 67 Further information concerning the
presence or biological amplification of nonradioactive wastes in aquatic life was not
discovered.
In the related field of poisoning by pesticides, it was stated265 that "wide spread
use of chlorinated pesticides on the West Coast has not resulted, contrary to often ex-
pressed fears, in gross contamination of West Coast fish life . . . ". There was no evidence
of biological amplification of these chemicals in this aquatic life.
In spite of the paucity of information concerning this possible pathway, or very
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literature survey 19
probably because of it, concern is expressed: "Surface waters at present serving millions
of people are continuously dosed with industrial wastes containing undetermined amounts
of unknown chemicals of undetermined toxicity."267 From their investigations, Borneff
and Fischer46 concluded: "The dosage of cancerogenic substances taken up per person
per year is estimated to be of the order of milligrams when surface water is used for
human consumption without preliminary carbon nitration."
Hueper and Payne79 found that extracts of raw and finished water of a river
"heavily polluted with industrial chemical pollutants, when subcutaneously injected
into mice, elicited the development of ... sarcomas at the site of injection." These au-
thors also implicate such pollutants as the cause of leukemic reactions and a bladder
papilloma in mice.
It is stated that "trace quantities of many chemical, biological, and radiological
pollutants are being detected in [the nation's tap] waters in many areas. Although it is
not known that their presence is harmful, it is also not known that their presence is safe." 82
Ground Water. In the proceedings of the 1961 symposium on ground water con-
tamination 745 there is the following comment: "... Waste disposal wells and lagoons,
leaking chemical storage tanks, and cesspools [were listed] as the most important
reported sources of contamination [of ground water]. The most commonly reported in-
organic contaminants were salt water, oil-field brines, and sodium chloride, with an
occasional report of specific toxic agents such as fluoride, chromium, and nitrate. In
most instances, little difficulty was encountered in establishing the particular origin of
the more toxic contaminants."46 The author, W. J. Kaufman, states further: "The
inorganic chemical contaminants of ground water differ from organic and biological con-
taminants in many ways, the most important differences being their indestructibility,
the persistence of pollution resulting from their presence, and the great difficulty and
cost of their abatement. It is possible to cite numerous instances of small concentrations
of toxic inorganics that appeared in ground water and impaired its acceptability for
domestic use. It is probable that the major impact of inorganic contamination is not on
man's health but rather on his agricultural and industrial enterprises ..." (p. 43).
Middleton and Walton, writing in this same reference, state: "A wide variety of
organic contaminants are reaching ground waters from leaky tanks, lagoons, and septic
tanks, or by accidental means. The problem is nationwide, and the reported incidents
probably represent a small fraction of actual occurrences. The presence of contaminants
has been evidenced by taste and odor, foaming and crop damage. Once the contaminants
have entered the ground water, they may travel for long distances and persist for many
years." (p. 55).
Also, in these proceedings, Flynn (pp. 71-82) refers to an industrial contamina-
tion of domestic water wells by industrial wastes; Deutsch (pp. 98-104) reports on ground
water contamination of a domestic well by electroplating wastes, including cyanide,
chromium, nickel and copper; Weaver (pp. 104-110) refers to the pollution of ground
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20 SOLID WASTE/DISEASE
water by chemicals due to leaching of sanitary landfills. Burttschell et al. (pp. 115-117)
report ground water pollution by organic industrial wastes; Walter (pp. 121-125) reports
on extensive (5 square miles) contamination of ground water by industrial chemicals.
A World Health Organization bulletin 714 states (p. 951) that, in Europe, the chief
sources of ground water contamination are domestic sewage and soluble refuse, industrial
effluents and soluble wastes, accidentally spilled liquids, saline waters of geographic
origin, and sea water. The contamination from domestic or industrial sources is due to
pollution of the soil or water courses by wastes without prior adequate treatment. In
addition, poor selection of disposal sites has led to pollution of aquifers. Poor construc-
tion of wells and poor pumping practices were noted as positive factors in this regard
(p. 951). The authors, Buchan and Key, note a number of instances of ground water
pollution by industrial wastes.
Scottu reported contamination of ground and surface waters by industrial wastes:
"Ground water . . . from the test wells . . . was contaminated. . . . Well waters which
formerly showed less than 0.1 mg/1 iron and manganese now contained 40 to 20 mg/1
of these elements. Use of such ground water facilities has necessarily been discon-
tinued. . . ." This author notes the unpredictable nature of flow of the waste from a
treatment pond.
Borneff and Knerr44 reported experiments in which "Particles containing car-
cinogenic compounds (asphalt, tar, soot, etc.) of the size downward to about 10 milli-
microns . . . may reach subsoil water .... The behaviour of carcinogenic compounds in
soil under the influence of solvents, for example, . . . detergents, cannot be judged defi-
nitely until further experiments have been performed." Borneff45 reported on the de-
velopment of carcinoma in the mouse only when the carcinogen had been dissolved by
surface-acting compounds in the drinking water. However, he states that the solubilization
of carcinogenic compounds by detergents contained in waste water, or in surface waters
contaminated by waste water, lacked experimental proof. As has already been re-
ported, 257 there is contradictory evidence on the action of detergents in promoting the
passage of contaminants through soil.
Potential risk to humans through contamination of underground sources of water
supply by cyanides is mentioned.243 Cyanide wastes are said to have caused fatalities
when disposed of in sewer systems.254
The potential contamination of ground waters by chlorinated and fluorinated hy-
drocarbons is discussed.255 No evidence of actual ingestion of these chemicals by this
means was mentioned.
Hettig260 states that there is potential danger "if subsurface faults allow large
amounts of unconverted wastes to contaminate the ground water".
Well water pollution by laundry waste has been reported.266
Gross contamination of well waters by oil well wastes and by refinery wastes was
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literature survey 21
reported by Maehler and Greenberg.27() Morris and Weber272 also report on ground
water contamination by industrial pollutants.
Experimental leaching of ash dumps was carried out by the University of Cali-
fornia. 29° This experiment was carried out in an area of very low annual rainfall. A
further report473 states that a sanitary landfill in intermittent or continuous contact with
ground water will cause the ground water in the immediate vicinity to become grossly
polluted. A report of interest in ground water contamination in relation to refuse is
contained in reference 636.
Another study 478 found that, although the practice of dumping acidic wastes has
not been permitted in the Baltimore area for 20 or 30 years, ground water in the Patuxent
formation in the contaminated area has been rendered practically useless for most pur-
poses. Traces of toxic materials (cadmium and hexavalent chromium) were found.
Miller and others 627 state, "Ponding and ground surface waste disposal continued
to be the practices most hazardous to potable ground water supplies and should receive
continued scrutiny."
"Wastes too difficult or troublesome for surface disposal are dumped into a deep
well where they sometimes pollute useful aquifers pierced by the well." 64°
McKee644 reports pollution of ground waters by sanitary landfill. Further quota-
tion of similar statements does not appear necessary to establish the fact of ground water
contamination by chemical wastes.
3) Air Contamination. Hueper387 speculates on the contamination of air by in-
dustrial wastes. He is concerned particularly with the additive or synergistic actions of
such wastes in regard to the total possible carcinogenic load on the population.
One report231 stated that air pollution through the burning of wastes creates
hazards. Of interest to possible pulmonary disease is the statement that, in one study
on a large incineration project, 12 percent by weight of the evolved ash consisted of par-
ticles measuring less than 5 microns. Lenehan 23° states that a 500 ton per day municipal
incinerator will produce 10,000 pounds of fly ash per day unless air pollution control
equipment is used. And, while he notes that electrostatic precipitators can remove fine
particles with almost 100 percent efficiency, he finds that such equipment is not used
because of the cost involved.
Greeley253 discusses the evolution of gaseous products in incineration of munic-
ipal solid wastes. He also notes the potential for air pollution by particulate matter from
such sources and states that, insofar as he knew, no electrostatic precipitators had been
installed in refuse incinerators in the year reported (1956).
Incineration of waste sludges is noted by Thompson. 268 Although he reports on
the finding of some 26 metallic components of these sludges, he gives no data on their
presence in airborne combustion residues.
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22 SOLID WASTE/DISEASE
Chambers293 discusses air pollution by primary solid wastes of industrial source.
He lists metallic fumes, and dust containing lead, vanadium, arsenic, beryllium, and
nonmetallic elements (fluorine and phosphorus) as being constituents of such wastes. He
states that 25 pounds of solid, such as dust, smoke and condensed fumes, result from each
ton of waste burned. He also lists the waste solids evolved from combustion of various
fuels.
Eliassen 295 states: "The major contributions to air pollution from domestic sources
are the products of combustion from space heating and refuse incineration. . . . Refuse
disposal is the major source of air pollution from municipal activities. ... [It] increases
with the use of ... open burning or refuse . . . . " He gives the various amounts of air-
borne solids produced from different types of waste incineration.
Howe402 refers to the finding of toxic chemicals in sludge and to incineration of
such sludge. No mention is made of any analysis of airborne residues of such incineration.
Rogus 404 states that the burning of refuse accounts for up to 10 percent of total
air pollution in urban areas. The contaminants include inorganic gases, organic sub-
stances, and particulate matter.
Ashe408 reports excessive deaths associated with very heavy air pollution among
persons recorded as having chronic bronchitis, bronchopneumonia, and other lung or heart
disease. The air pollution included "vast quantities of particulate matter and gases of
various kinds."
Breslow409 discusses pulmonary disease, including asthma and emphysema, as
possibly associated with air pollution. In regard to emphysema, he states: "We are by
no means in a position to draw any sound conclusions about this matter." He also im-
plicates lung cancer as a possible consequence of air pollution.
Nelson 41° discusses "The possibility that the presence of particulates might syner-
gistically potentiate the irritant action of gases on the respiratory system" and states
that there appears to be experimental verification of this in animal studies.
Kotin411 discusses pollution of urban atmosphere by carcinogenic agents. He
states: "Carcinogenic materials have been identified in the air in a particulate state that
permits their being breathed and deposited on the lining of the lung."
Stenburg412 states that "excessive discharges of smoke and fly ash to the atmos-
phere are the recognized by-products of the poor combustion at one time or another
identified with practically all types and sizes of [waste] incinerators". He says that
customary methods of incineration of wastes remove larger particulates but are not
effective in removing particles in the lower micron ranges.
Bush415 stated: "Particulate material from municipal incinerators amounts to
about 4 to 5 Ib. per ton of refuse burned. On the basis of particle count, using the
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literature survey 23
electron microscope, this corresponds to 1X1015 to 20X1015 particles per ton of refuse
burned, with more than one half the particles being less than 0.1 micron in size. ..."
Feldstein 438 states: "The kinds of air polluting products formed during open dump
burning, burning of land-clearing debris, burning in single-chamber incinerators and com-
bustion in the automobile engine are quite similar, differing generally in the quantities
of each component produced .... Greater relative quantities of organic gases, ethylene,
particulates, olefins and oxygenates, are produced by poor combustion in single-chamber
incinerators than are produced during the operation of gasoline engines." This author
also says that "Twenty-four tons of particulate matter are produced during the burning
of 2,000 tons of land-clearing debris. Because of the generally poor combustion which
occurs in such fires, it is estimated that about 50 percent of the particulate matter is
in the size range greater than 50 microns."
Ellsworth and Ballinger440 state that the burning of automobile bodies has "cre-
ated such air pollution problems that public opinion has caused the practice to be out-
lawed in many cities and residential areas."
4) Direct Contact. Material under this heading that is related to sanitation
workers will be discussed under Safety in a separate section.
The rare reporting of accidental ingestion or inhalation of solid waste materials
among the general population does not necessarily mean that occurrences themselves are
rare. Any ensuing symptoms could very well be ascribed by the public to other causes.
The literature does not provide data on either the frequency or severity of such exposure.
5) Miscellaneous. Although it is known that animal feed is sometimes prepared
from waste materials and that the finding of cancer in some animal species has led to
the suspicion that such feeds may contain carcinogenic contaminants, there is nothing
in the literature relating waste in contaminants to cancer in animals, or to a risk to
humans, except in a hypothetical way.
There little in the literature that comments on pesticides and their effects as
wastes on man. Such information as exists deals with accidental poisoning of children
playing with discarded pesticide containers at home or a rare contamination of food by
containers previously used for carrying pesticides.
Discussion
Although there has been considerable speculation in the literature as to potential
risk to human health from the various disposal methods used for chemical wastes, the
investigator in this study was unable to discover in the literature any reliable evidence
supporting a relationship.
There are major barriers to such an attempt. Reference to lack of data is frequent
in the literature.
291-982 O - 68 - 3
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24 SOLID WASTE/DISEASE
In 1959, Nelson410 stated: "We have no evidence at this time that systemic dis-
eases from trace quantities of toxins are of significant health concern. It may be that
obscure relationships exist of which we know nothing at the present time."
Ettinger628 says: "There is a vast area of ignorance concerning the toxicology
and pharmacology of both synthetic and naturally occurring organic materials, and new
materials are being made much faster than the toxicology of known materials is being
studied."
Gurnham 20° states that "little is known of the possible cumulative action of
metal salts and similar poisons that may lead to general ill health and debility . . . ".
Hueper387 makes the following statement: "Only very fragmentary information is
available as to the potential carcinogenic properties of a considerable number of these
agents (carcinogens found in the air, soil, or drinking water)."
Woodward14 states: "Knowledge of the nature of organic chemical pollutants in
water is very sketchy and knowledge of their physiologic significance is even more so."
In regard to tap water contaminants, it is said: "Although it is not known that their
presence is harmful, it is also not known that their presence is safe." 82 The unknowns
of surface water contamination were referred to previously in reference 267.
Thompson and others268 make reference to the lack of data on the metallic content
of sludges.
The need for research on ground water contamination is summarized in reference
745 (pp. 165-215). This need covers many fields, including geology, hydrology, and
chemistry, although substantial preliminary studies are available. 745> pp-7-si; 473, 636, 743 The
scope of the ground water research requirement is also evident from a report by Lit-
vinhov748 on water pollution in eastern European countries (pp. 447-448, 452, 459).
It is stated 714< P- 100° that "there have been very few attempts to carry out strictly
controlled experiments on the purification of polluting matter as it travels through the
ground. This is doubtless because of the extreme difficulty — almost impossibility —
of accurately simulating natural conditions while retaining the necessary control." Mis-
takes already made, with resultant long-range pollution of ground water, and their as-
sociation with ignorance of geologic and hydrologic factors, have been noted in ref-
erence 11.
McKee352 discusses ground water pollution and states that "little quantitative
information is available on the actual occurrence and movement of gases through soil
and their relation to the quality of water in the upper fringe of the groundwater table."
The uncertainty with regard to drinking water constituents and cardiovascular
disease has already been referred to previously.
The following statement appears in reference 640: "Knowledge is scant on many
aspects of groundwater contamination."
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literature survey 25
Weaver745> p 109 states: "One cannot help wondering . . . about the unfortunately
large number of communities that still resort to uncontrolled dumping. The impact of
these practices on ground water and other public health implications involved are cause
for concern. We need to know much more about both the geological and climatic charac-
teristics that, along with operational techniques, are so important to short- and long-term
effects of degradation and possible leaching of refuse disposed of on land. We also need
to have a much clearer picture of conditions as they now eixst in areas where refuse pres-
ently is being disposed of by landfilling."
The state of knowledge with regard to air pollution by solid wastes or its incin-
eration is typified by the statement by Dixon294 to the effect that certain types of air
pollutants can cause chronic bronchitis. The exact mechanisms of causation, however,
are not clearly understood.
One of the problems in this study was the question of classification of pesticide
residues and their relation to crop wastes. A parallel question (that is, when is a waste
not a waste) occurs in connection with other wastes which from time to time have been
found to have utilitarian value. Another question which is largely unresolved is this:
When does the farmer stop being a farmer and become a waste handler? And, in this
regard, how does one separate his degree of exposure to pesticides while he is spraying,
harvesting, or pruning, from his exposure in the act of hauling away crop waste? This
issue is raised, if only to point to the danger of attempts at compartmentalization of
environmental health studies.
The quotations given are typical of those relating to the unknowns of waste path-
ways and quantitative data. However, there exists an equally important hiatus in the
knowledge of the disease postulated to be associated with these wastes. One entire seg-
ment of medical knowledge that is missing is that involving the effects of small amounts
of chemicals of many types ingested or inhaled over a period of many years.
If comprehensive information were available on waste materials and it could be
demonstrated that such wastes were entering the population, it would still be extremely
difficult to say what relationship they bore to the presence of any disease discovered in
this population. Investigators at this time are able only to hint at possible association
between contaminants of soil, water, and air, or of materials naturally present in the soil
and morbidity. 683- 746' 41°- 737' 738' 712 Armstrong 85 summarizes some of the problems to be
met in any attempt to trace relationships between soil elements and disease.
Conclusions
The literature makes it clear that there is contamination of soil, water, and air by
chemical wastes. Beyond this, there is no factual evidence which permits a conclusion
that any human disease is positively related to such wastes. Such information as is con-
tained in the literature on this subject is speculative.
However, certain bits of knowledge have been proffered which compel attention to
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26 SOLID WASTE/DISEASE
a possible relationship. For example, the production of large quantities of submicronic
particles in the incineration of wastes make it certain that these particles will have direct
access to the deep lung structures if they are inhaled. It is known that perhaps 90 per-
cent of inhaled particles of this size are retained in the deep lung tissues. Should such
particles contain toxic materials or carcinogenic agents, damage to the lung could occur.
In addition, fly ash from incinerated waste contains materials that are known to cause
disease in occupational exposures, although there is no evidence that these substances
cause pulmonary disease in the general population.
One conclusion reached is that a great deal of contamination is instituted without
any knowledge or apparent concern for the possible consequences. This statement ap-
plies to all forms of waste disposal.
Recommendations
To establish or negate a relationship between chemical wastes and human dis-
ease, an integrated, systematized program of investigation is mandatory — it is manda-
tory, that is, if a timely result considerate of costs is sought.
This program would be concerned with environments, populations, and their rela-
tionships. Under environments it is necessary to determine qualitatively and quantita-
tively the waste chemical contaminant spectrum. Under populations, it is necessary to
define the disease spectrum. (The disease spectrum is not further subclassified at this
point because we possess relatively little information on the contribution of environ-
mental contaminants to any disease.) Under interrelationships, it is necessary to relate
contaminants and disease in a manner leaving little reasonable doubt as to the relation-
shyj. It is convenient to distinguish between studies directed at environments and those
at populations. The former are easily separated from medical and toxicologic studies in
their execution, if not in other respects.
Since the number of environments is large, preliminary studies are required to
determine if there are representative environments permitting a limitation of the total
number to be studied, and also to identify those that can serve as controls.
The basic environmental studies finally chosen should develop a useful body of
knowledge on the contribution of wastes to environmental contamination.
It should be noted that the 'body of knowledge' thus derived will have little ap-
plication to the question of disease relationships if there is not parallel study directed
at discovery of the effects of waste contaminants on man. Here the field is essentially
unexplored. A much greater effort is needed to determine what waste chemicals, in what
amounts, over what periods, adversely affect man.
An applicable environmental study — that is, a study applicable to the solution
of disease and pollution questions within some reasonable expectant period — must be
accompanied by medical, toxicologic, and epidemiologic studies. Expanded animal
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literature survey
27
research is needed in addition to the efforts presently sponsored by the Armed Services,
NASA and the AEC, relating to environments of special concern. The pioneering work
of Tipton, Schroeder, and others on trace elements and disease requires extension by
diagnostic, toxicologic, and epidemiologic investigations of trace elements in selected
populations so that some possibility exists for comparing the disease spectrum of these
populations with that of waste chemicals in the environment. It remains to be discovered
if accelerated exposure and extrapolation techniques can be adapted to estimating the
effect of very long exposures to small amounts of contaminants from short-range experi-
ments. Epidemiologic studies of exposed and control populations should be expanded
to provide both basic data and the means for estimating the validity of accelerated animal
exposure experiments.
Studies conducted piecemeal, or compartmentalized according to some preconceived
jurisdictional division, cannot hope to provide the information necessary to timely planning
for economic, well-founded pollution control activities. They would also be far more
costly and time-consuming in themselves than if an integrated approach were used.
For these reasons, the following program is recommended:
/. Environmental Contamination Studies
Phase 1. Summarization of existing knowledge on
waste chemical contamination of the
environment and of current and projected
research in this field
Phase 2. Requirements analysis
Types of data
Types and numbers of environments to be studied
Personnel
Methodology and instrumentation
Jurisdictional responsibility assignments
Priority assignments
Phase 3. Selection of study plan
Phase 4. Surveys of selected environments
Phase 5. Study analysis and interpretation
Identification of chemical waste contaminants, sources,
and concentrations
Identification of exposed populations
Phase 6. Report
At any time useful data are obtained, they would be made available to the popu-
lation study.
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28
SOLID WASTE/DISEASE
II. Studies on the Population
Phase 1. Assembly of existing data on trace elements and disease
relationships
Phase 2. Requirements analysis
Toxicologic data
Epidemiologic data
Medical data
Methodology and instrumentation
Personnel
Priority assignments
Jurisdictional responsibility assignments
Phase 3. Selection of study plan based on existing and postulated
environmental contamination data
Phase 4. Conduct of studies
Phase 5. Analysis and interpretation of studies
Phase 6. Recommendations
662
D. communicable disease
Fly-Borne Disease
GENERAL
THE FOLLOWING LIST of human diseases are said to be transmitted by flies 517> pp- 658~
enteric diseases (typhoid, bacillary and amebic dysentery, diarrheas, Asiatic cholera,
helminth infections); myiasis, loiasis; onchocerciasis; Ozzard's filariasis; leishmaniasis;
African sleeping sickness (trypanosomiasis); yaws; tularemia; bartonellosis; catarrhal
conjunctivitis; sandfly fever.
To this may be added as possible fly-borne diseases (see section on evidence
for references): anthrax; salmonellosis; protozoal infestations; trachoma; poliomyelitis;
tuberculosis; hepatitis.
POSTULATION
Flies, according to ecologic factors and species characteristics, are able to carry
parasites pathogenic for humans and to transmit them to humans and so cause human
infection. Flies are aided or hindered in this by certain characteristics and factors of
human origin, among which are socioeconomic and technical levels, cultural mores, and
household and personal hygienic practices. When community or personal practices permit
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literature survey 29
accumulations of fly-breeding media, the potential for human infection via fly-borne
pathogens is increased. Such media are found in solid wastes of human and animal
origin. To support this postulation, it will be necessary first, to associate flies with solid
wastes; second, to ascertain that flies are carriers of human pathogens; and third, to
demonstrate that flies transmit these pathogens to humans so as to cause infection and
disease.
EVIDENCE
Flies breed in large numbers in human and animal excreta355' 68°- 354> 9> 356- 544>
121, 336, 194, 391, 152, 153, 193, 314, 301, 170, 77 ag wg]| &s Jn food Wastes 194' 680' 91> 391' 622> 187' 152' 153'
193, 442, 314, 171, 443, 444, 181, 544, 11. 49, 150, 77, 84 They are ^ foun(j bree(Jing in large num-
bers in sewage sludge. 688- 544 Species preferences, type of breeding medium, and climatic
and micrometeorologic factors have distinct effects on breeding habits, but a number of
species are highly adaptable and breed in whatever medium is available. 193' 152> M4
Nash 68° reported that, as early as 1902, he was certain that "flies bred in deposits
of house refuse and manure" and referred to similar conclusions reached by others in
1907 and 1908 (p. 142 and p. 149). Magy84 lists the fly breeding media among wastes
found in Orange County, California, and 13 species of flies associated with them. The
media include crop wastes, livestock wastes, community organic wastes (industrial, food
processing, and fertilizer plants), residential refuse, commercial food handling wastes, leaf
and litter debris, dead animals, solid wastes (sludge) recovered from sewage treatment
plants, domestic animal manures, and miscellaneous wastes (dog and cat droppings,
backyard compost piles, spilled garbage, etc.). Hart475 states that manure management
on concentrated livestock farms is a serious problem, principally because of the fly-breed-
ing potential of fresh manure. Taiganides and others490 state that manure is a health
hazard and fly-breeding ground, and must be treated. Garbage discarded by rural in-
habitants produced flies (Garrison et al). 15° Dorris422 found that aquatic fly larvae are
produced in large numbers in the sludge of waste stabilization ponds. Wiley49 stated
that a major problem of solid waste storage is fly production.
Hartman 17° referred to the enormous fly production potential of chicken manure:
"There was a time when [flies] were so thick that workers . . . had to cover their mouths
with rags or handkerchiefs . . . . " In discussing whey solids disposal, Scott395 said: "Fly
breeding nuisances can result from land disposal methods . . . . "
Miles444 discussed the need to control waste collection and disposal methods to
avoid fly breeding; fly production occurs at any point at which flies have access to waste,
even in waste incineration plants. An unexpected result of attempts at fly-production
control through use of insecticides in privies was discussed by Kilpatrick and Schoof. 301
In untreated privies, few Musca domestica were produced; the major species bred was
the soldier fly, Hermetia illucens. Treated privies showed the reverse: few soldier flies,
but large numbers of domestic flies. The former, highly sensitive to the pesticides, were
eliminated and the customary consistency of the medium, brought about by their pres-
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30 SOLID WASTE/DISEASE
ence, was changed so that the domestic fly, resistant to pesticides, found the medium to
its liking.
La Brecque 443 referred to dumps as sources of insects and to half-burned garbage
as a source of prolific breeding of flies. Flies will emerge from as much as five feet of un-
compacted cover in refuse; their eggs are deposited in the organic matter of the waste
prior to collection or at the disposal site if it is not covered rapidly (Black and Barnes). m
Gotaas314 said that good fly control is "difficult, if not impossible, when food attractive
to flies is composted anaerobically in stacks in warm weather". He stated further that
"garbage, faeces, animal manure, abattoir wastes, and tomato and several other food proc-
essing wastes, are excellent media for the breeding and development of a large fly popu-
lation. If adequate control measures are not practiced, particularly when composting
manure and faeces, the compost depot will be infested with extremely large numbers of
flies and a health hazard almost as serious as that caused by open, uncontrolled garbage
dumps will be created."
Black and Barnes442 stated: "It is generally conceded that one of the most im-
portant reasons for burying garbage or mixed refuse is to control flies." However,
McGauhey145 said that burying wastes in the soil may increase crop diseases and in-
sects. Wolf 677 noted the fly-production potential of sludge drying beds and reported the
experimental breeding of Musca domestica in digested sewage sludge of different ages,
pH, total solids, etc.
Webb and Graham193 referred to enormous numbers of flies, including Musca
domestica, found in association with a military post garbage dump in Canada. Experi-
mentally they found that "human feces attracted practically all species of flies attracted
to the other baits (cooked meat, milk-sugar mixture and chopped fruits) and usually
in much larger numbers."
Siverly and Schoof152 surveyed fly production in Arizona. They recovered M.
domestica from more than 50 percent of the samples and from 19 of the 21 different
classifications of media. "Muscina spp., in common with M. domestica, were able to
utilize all general categories of production media — excrement, garbage, and miscel-
laneous types . . . . " The preferences of other species are discussed. In addition, sea-
sonal occurrence as related to species is mentioned as is the year-round adaptability of
M. domestica. These authors also developed a "production index" by assigning values
of 1, 3, and 9 to light, moderate, and heavy infestations of media "whereby the degrees
of fly infestation can be quantitatively compared during the four seasons". They stated
that "... chicken and pig excrement, garbage, melons, and stock feed displayed the
highest fly production potential."153
Quarterman and others187 mention dairies, an abattoir, and a city garbage dump
as heavy fly-producing sources in a Georgia study. Golueke and Gottas 622 say, "Espe-
cially serious are open dumps where flies — flourishing on exposed garbage and breeding
countless new generations are paralleled in numbers only by a well-fed rodent population."
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literature survey 31
Schoof and others 391, reporting on surveys in three U. S. cities and suburbs, make
the following statements: "Although numerous media such as fowl excrement, dog stools,
sea food wastes, and dead animals yielded a higher percentage of positive samples in re-
lation to the total number of the particular substrate located, the ubiquitous occurrence
of garbage in the city overshadowed these as to overall significance in fly production.
Dog stools and fowl droppings composed over two-thirds of the total positive excrement
samples detected. Because of zoning restrictions, feces of the larger domestic animals
were almost totally absent. In the miscellaneous categories, meat, dead animals, and
coffee-grounds predominated." "Household garbage (in containers and scattered) was
the most frequent producer of positive substrates . . . . " This article is of significant
interest in regard to fly production.
McGauhey 91 speaks of the sanitary landfill as "at worst ... a dismal undertaking
conducive to the breeding of rodents, flies, and other vectors of disease . . . . " Coffey
and Dunn 465 list food wastes as food for flies. Maier and Baker17S state that proper dis-
posal of food wastes essentially eliminated all foci of intense fly breeding in a Texas
county.
1) Flies and Their Proximity to Humans. If flies are to function as vectors of
human disease, it must be demonstrated that they are able to travel to human domiciles
from breeding areas and that they have direct contact with man, his food or other articles
or substances which can serve as intermediate means of transfer in the passage of disease
agents.
As to direct association, certain flies are so well adapted to man and his surround-
ings that they have become known as 'domestic' species. Others are adapted to man's
domestic animals. Other species are occasional visitors of human habitats.
It has been shown that flies travel long distances from breeding areas to human
dwellings. 187> 188' 193> 186> 78> 84 Magy84 noted fly dispersion of up to 20 miles from the
source. Under "population pressure" and the odor of attractants, flies migrate readily
from breeding site to sources of food and between sources of food. 1S1- 186' 38' 540- 121- 336-
194, 395, ITS, 187, 188, 78 There is also evidence that M. domestica is an instinctive wanderer.188
Since there is some question that adult flies are contaminated with human
pathogens by their breeding medium, 30° contamination by organisms pathogenic to
humans must be observed to take place by other means. The wandering characteristic
of many flies has been noted above. Specifically, their attraction to both excrement and
human foods must have been observed and their contact with other sources of pathogens,
and thence with humans, must have been demonstrated if the chain of events from waste
to human is to be established.
Some of the earliest observations refer to the visible tracking of lime used to treat
human feces in latrines to food served soldiers in mess tents. Other observations attest
to this potential or actual mode of transfer of pathogens. 542> 193> 78> 361'179> 321'319> 185 Much
circumstantial evidence of such transfer is contained in the references given previously.
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32 SOLID WASTE/DISEASE
Direct contact of both bloodsucking and nonbloodsucking flies with humans is common
knowledge. Occupational and recreational activities offer many opportunities of contact
in areas where flies prevail. 86-170' 39S> 475
2) Flies as Carriers of Human Pathogens. Recent writers38- 75 dismiss older
studies of the passage of organisms through flies as not being sufficiently controlled, but
accept older studies attesting to the ability of flies mechanically to carry pathogens.
The evidence for both methods of potential transmission is contained in the material on
individual disease agents presented in the next section. In summary, however, flies are
shown to be capable of both means of carriage, depending on the organism involved. For
example, Hawley and others 13S found that bacteria, when fed in sufficient numbers to
flies, underwent multiplication and were excreted by them. Knuckles 679 found Salmonella
schottmuelleri and S. typhimurium to multiply indefinitely and throughout the life of
the blowfly [Phormia regina (Meigen) ]. A large literature attests to the external car-
riage of pathogenic organisms.
3) Flies and the Transmission of Human Pathogens. Although earlier observa-
tions of the possible association of flies with disease had been made, the Spanish-Ameri-
can war gave impetus to that impression in this country, and led to great concern among
public health officers about sanitary disposal of human excreta. Sternberg in 1899, in
reporting "Sanitary Lessons of the [Spanish-American] War," said, "I find that the
disease [typhoid fever] was imported by this regiment into its Cuban Camp . . . . ;
that it was clearly not due to water-infection, but was transferred from the infected
stools of patients to the food by means of flies, the conditions being especially favorable
for this manner of dissemination by reason of the close proximity of the picket lines to
mess-tents and latrines." 388 In 1901, reporting on the Boer War hospital, Bowlby and
others548 noted that flies seemed to be especially attracted to enteric [typhoid] fever
cases. This account reads as follows: "At Bloemfontein the flies were a perfect pest;
they were everywhere, and in and on every article of food. It is impossible not to regard
them as most important factors in the dissemination of enteric fever. Our opinion is
further strengthened by the fact that enteric fever in South Africa practically ceases
every year with the cold weather .... With the cold nights, the flies disappeared. It
seemed to us that the cold weather reduced the number of enteric cases by killing these
pests."
Similarly, in 1902, Dunne and Cantab302 wrote: "The plague of flies which was
present during the epidemic of enteric typhoid at Bloemfontein in 1900 left a deep im-
pression on my mind, and, as far as I can ascertain from published reports, on the minds
of all who had experience on that occasion. Nothing was more evident than the fall in the
admissions from enteric fever coincident with the killing off of the flies on the advent of
the cold nights in May and June."
In 1903, Nash540 wrote: "I feel justified in ascribing the principal role in the
causation of epidemic or summer diarrhoea to flies, more particularly the common house-
fly and the blue-bottle fly. I maintain that flies are the chief agents concerned in carrying
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literature survey 33
faecal pollution to milk and other foods during the summer months." He noted the co-
incidence of the appearance of flies (Musca domestica) and epidemic diarrhea and the
death of 13 infants from the latter within three weeks of its onset in the community, and
the converse (the rapid abatement of the disease with the disappearance of flies). He
was especially concerned with the availability to flies of midden and refuse heaps in the
vicinity of cowsheds and dairies, and the contamination of milk which could follow.
Aldridge 35S further indicted flies as transmitters of enteric fever, although he recog-
nized that "we are still without experimental proof." He stated: "It is a well ascertained
fact that enteric fever is particularly prevalent where dry methods of removal of excreta,
such as pail and earth closets and trench latrines are in use; that is, where flies have
ample opportunity of crawling over the excreta, which they do not have in water-closets.
There seems to be no doubt that in India, speaking generally, the seasons of greatest
prevalence of enteric fever correspond pretty closely with the seasons of greatest preva-
lence of flies."
Aldridge describes the spread of the disease and the circumstantial evidence match-
ing it with proximity of flies and their access to latrines and messes. He states: "A
study of the incidence of enteric fever shows that the stations where there are no filth
trenches, or where they are a considerable distance from the barracks, all have an admis-
sion-rate below the average, and all but one less than half the average." He also notes
the ability of flies to contaminate culture media with bacilli from excreta.
Also, in 1907, Buchanan 36° conducted experiments in which the agents of typhoid
fever, swine fever, staphylococcal abscess, pulmonary tuberculosis, and anthrax were suc-
cessfully transmitted to culture media by flies, and noted the death of a guinea pig
inoculated with the culture of the tubercle bacilli thus obtained. He made the following
summation: "The experiments conclusively show that flies alighting on any substance
containing pathogenic organisms are capable of carrying away these organisms in large
numbers on their feet and of depositing them in gradually diminishing numbers on
surface after surface with which they come in contact. They further serve to demonstrate
the necessity for the exercise of stringent measures to prevent the access of flies to all
sources of infection and to protect food of all kinds against flies alighting on it."
In 1908, Klein 303 reported that, in addition to a great number of B. coli communis,
"limited numbers [of] a species of microbe which is not distinguishable from B. typhosus"
were found in cultures grown from minced flies. The flies had been obtained by Dr.
Hey wood Wilshaw from a locality in which enteric (tjphoid) fever had occurred.
Nash 68° in 1909 referred to Nuttall's 1899 summary of the literature to that date
dealing with flies in relation to disease and covering 350 references dating to the 18th
century (p. 160). Flies were incriminated as carriers or transmitters of anthrax, plague
("carrier state conclusively proved"), typhoid, tuberculosis, leprosy, cholera, and diarrhea
(pp. 160-161). Nash blames the fly and calls attention to the rapid decrease in incidence
of disease when frost kills off the flies so that "no 'carriers' are available" (p. 162). He
points to the danger to infants from fly-borne disease (p. 164).
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34 SOLID WASTE/DISEASE
Major Faichnie, writing in 1909 in the Journal of the Royal Army Medical Corps,
reported this incriminating data on flies: "Caton Jones pointed out that since a raid
on flies had been commenced in Nasiribad, in 1904, the enteric fever rate there had very
much diminished, and that the results obtained were partly due to a better system of
trenching the night soil, by which the breeding of flies was prevented." He wrote that
"In Mhow, there was also a sudden diminution in enteric fever in 1907, which has been
maintained ever since. This diminution coincides with the inspection of the station by
Surgeon-General Trevor, who found the trenching grounds swarming with flies. Since
then ... for eighteen months scarcely a fly has been bred there." He felt that typhoid
inoculations, which did not include all personnel, could not account for all of the reduc-
tion in cases and noted that the water supply was pure. Further, "One station may
swarm with flies, bred only from the excreta of cows and horses, and yet have not en-
teric; while another place, where there are very few flies, but where these are bred from
human excreta may have an epidemic. . . .It is the breeding ground that constitutes the
danger . . . . "354
Ainsworth, 199 in the same journal in the same year, had this to say: "I readily
admit that the operations recorded and the arguments advanced in this paper are open
to the objection that they afforded by scanty data upon which to base so important a
conclusion that the house-fly is frequently the intermediary and probably by far the
most common intermediary, in the propagation of ... enteric fever. Nevertheless, . . .
there is an isochronism . . . between the advent of the house-fly in Poona and the sea-
sonal prevalence of enteric fever, which is highly significant and at least suggests that a
prima facie case has been established for further investigation." He demonstrated that
seasonal heat and moisture "combined with suitable breeding media, will of a certainty
produce flies." He concluded that his charts on fly/enteric coincidence are sufficient
proof of the fly's role as intermediary and the acceptance of the disease as "probably"
fly-borne.
Dr. James Niven,9 in 1910, noted that the "social condition" related to the health
of infants had much to do with their death from summer diarrhea. He made the follow-
ing observation: "The summer wave is not due to dust . . . There is nothing to support
the view that the infective organisms are of animal origin, and the connexion between
privy-middens and diarrhoea goes far to prove the contrary. The disease becomes more
fatal only after house flies have become more prevalent for some time, and its fatality
rises as their numbers increase and falls as they fall. The correspondence of diarrhoeal
fatality is closer with the number of flies in circulation than with any other fact." He
stated also that "... no other explanation even approximately fits the case." In asso-
ciation with fly prevalence and numbers during summer diarrhea epidemics and the
ability of flies to carry bacteria, Dr. Niven felt that it was "unnecessary ... to multiply
references".
In this country, Ridlon356 in 1911 reported on typhoid fever in Charlestown,
West Virginia, and felt that "the most probable source in 5 cases was from flies. These
cases were located within 200 feet or less of other cases where the disinfection of stools
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literature survey 35
was inefficient, where there were no screens, and where the abundant flies had free access
to both dejecta of patients and the food." He notes that fly prevalence can be "greatly
limited by proper care of their breeding places, including stable manure, household refuse
and garbage." He did note the possibility of numerous other sources of infection, includ-
ing public water supply (highly contaminated), food, ice, and personal contact, but dis-
counts water supply in the cases at hand. He ascribed ten cases to personal contact.
In 1912, Cox and others678 reviewed the literature dealing with bacteria carried
by the housefly and reported their own investigations on this subject. They found that
flies coming from "insanitary or congested areas of the city" (Liverpool) carried from
800,000 to 5,000,000 "aerobic bacteria" per fly, while flies from the "more sanitary, less
congested or suburban areas" carried 21,000 to 100,000 per fly. Similarly, the number
of "intestinal bacteria" carried were greater in the former (from 10,000 to 330,000,000)
as compared to 100 to 10,000 in the latter.
It was found 678 that "Pathogenic bacteria and those allied to the food poisoning
group were only obtained from the congested and moderately congested areas and never
from the suburban areas." The authors identified 126 strains of bacteria, among which
were streptococci, staphylococci, sarcinae, B. pyocyaneus, several of the colon groups,
including B. coli commums, salmonellae, "Morgan's infantile diarrhoea group", and mis-
cellaneous groups.
Flies were soon incriminated in other diseases. Le Boeuf358 in 1912 found flies
(Musca domestica) heavily contaminated with Hansen's bacillus after their feeding on
leprous ulcers. He thought that this fly was possibly an important factor in the spread
of leprosy through deposition of bacilli in wounds of healthy individuals.
In 1912, Rosenau369- P 15M announced the "apparent" experimental transmission
of poliomyelitis from sick to well monkeys by the bite of the common biting fly, Stomoxys
calcitrans.
Also in 1912, Anderson and Frost 368- PP 173:i-5 stated that their experiments showed
conclusively that "in confirmation of (results) announced by Dr. Rosenau," poliomyelitis
was transmitted to monkeys through the agency of the stable fly (Stomoxys calcitrans).
Brues and Sheppard in the same year felt that this fly (S. calcitrans) was impli-
cated epidemiologically in the transmission of poliomyelitis (pp. 305-324). 37°
In a recognized classic, Flies in Relation to Disease: Non-Blood Sucking Flies,
Graham-Smith summarized the evidence at that time (1913) in the following way
(p.viii): "Far reaching conclusions founded on insufficient data at present available can
fulfill no useful purpose .... It may be claimed, however, that a very strong case has been
made out for the thorough investigation of the relation of non-biting flies to disease." 121
He stated also, "In order to determine with any degree of certainty the part really
played by flies, we need more particularly a large amount of epidemic evidence such as
would be afforded by changes in disease incidence following the control of the fly nuis-
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36 SOLID WASTE/DISEASE
ance. At present there is very little such evidence and until recently there was none.
Vague surmises have been plentiful, but trustworthy observations few" (p. ix). He then
proceeds to document existing information, pointing out the difference between fly con-
tamination with laboratory cultures of organisms and natural contamination, criticizing
earlier bacteriologic methods in the identification of bacterial species, and, especially,
epidemiological methods (p. 125). However, on page 126, he states that "... in a few
instances the evidence appears to be conclusive." He notes the problem of identification
of the agent of typhoid fever (p. 129). He states, nevertheless (p. 146), that "The re-
ports relating to military camps in war time show very conclusively that flies are under
those conditions the principal agents in spreading the disease [typhoid fever]."121
Graham-Smith is of the opinion that, as to dysentery, paratyphoid, and food poi-
soning "... no instances of infection by flies have yet been recorded" (p. 148). Of sum-
mer diarrhea, he says (p. 172) that "The epidemic and bacteriological evidence is so
suggestive . . . that an attempt to definitely settle the connection between flies and
summer diarrhea by preventive measures against flies in a selected area seems now justi-
fiable." He feels further evidence for the fly-disease association is needed for cholera
(p. 175), that the relation to tuberculosis is uncertain (p. 179) as it is in regard to an-
thrax (p. 186). He apparently accepts the evidence (Howe, 1888; Nuttall and Jepson,
1909) for the spread of polio, but says, "... up to the present, we have little knowledge
of what part [flies] play in the dissemination of disease" (p. 190), and extends this con-
clusion to include smallpox, tropical sore, trypanosomiasis, and yaws (pp. 190-194).121
In 1913, Brues repeated his claim that epidemiologic and experimental evidence
strongly implicated flies in polio transmission. 189> PP 101-110 Terry, in 1913, in a study of
typhoid fever in Jacksonville, Florida, stated: "I am fully aware that the facts above
stated do not furnish all the requirements of strictly scientific proof that our typhoid
fever was for the most part fly-borne, but it would appear that this was the case, as the
only measures we have made use of to reduce our typhoid rate have been directed against
this insect and the only change in sanitary conditions throughout the city has been
the fly-proofing of the privies. I feel that we are justified in attributing the major portion
of our cases, prior to the enforcement of privy law, to the house fly." 336
In 1914, Mitzmain 359- pp 75-77 reported the successful transmission of anthrax from
animals just dead from the disease to guinea pigs through the bites of stable flies
(Stomoxys calcitrans) and horseflies (Tabanus striatus). The organisms were recovered
from the vectors.
In another classic, The Housefly, C. Gordon Hewitt194 discusses the habits of
flies in relation to their possible association with human disease (pp. 89-96), the house-
fly in regard to breeding media, and other fly species in relation to human domiciles
(p. 201). He assembles evidence on flies as carriers of pathogens (swine fever, p. 204;
intestinal infection, p. 200; eye diseases, p. 213; anthrax, p. 201; and fly contamination by
microorganisms (pp. 218-219).
In 1921, Root304 reviewed experiments dating back to 1913 on the carriage by
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literature survey 37
houseflies of intestinal protozoa. In his own experiments, he found that cysts of Giardia
remained viable in the fly for 16 hours, that cysts of amoebae remained alive for 48 to
50 hours in the fly and that cysts of Chilomastix were viable up to 80 hours. He further
commented that "If a fly containing a cyst is drowned in water, milk, soup, or other
liquid food, the cyst will live still longer, about a week, and there seems to be a possi-
bility that human beings might be infected by swallowing such drowned flies (pp. 131-132,
139, 150-153).304
Hall, in 1929, implicated flies and other arthropoda in the transmission of helminths
(pp.1, 2, 64, 69-72). 305
Gill and Lai established in 1931 that cholera vibrios were capable of surviving in
the fly for a period of at least five days. Furthermore, the fly was shown to be capable
of infecting food by its feces. They felt that, in hot countries, insect transmission was
of predominant importance and that "One of the most important, if not the most im-
portant, method of controlling cholera is the provision of an efficient system of sanitary
control, more especially in the collection, removal, and disposal of night soil and
refuse." 361
In 1935, Craig318 by various epidemiologic arguments supported the transmission
of amebiasis by flies. He discussed this in connection with the use of night soil on gar-
dens (pp. 46-47), and discussed further an epidemic of the disease observed and believed
by him to be vectored by flies (pp. 56-58).
In 1938, Pokrovsky and Zima179 stated that "there is not the least doubt that flies
are carriers of helminth eggs, chiefly on the feet." Their experiments showed that flies
could carry the eggs of Enterobius vermicularis, of Diphyllobothrium, of Ascaris, of Hy-
menolepis and cysts of protozoa. They found 47 percent of flies captured in food shops
to be infected by such eggs. They emphasized the need for health education to correct
this situation.
In 1939, Manson-Bahr stated that "The evidence against the house fly is fairly
complete" in association with transmission of dysentery bacilli. He noted the coinci-
dence of epidemics of house flies with epidemics of bacillary dysentery and the decline
of the disease incidence during periods when flies were rare. His conclusion from the
works of others was that, to a limited extent, amebiasis could also be transmitted by flies.
He also noted the possibility that human feces could serve to spread the disease through
contamination of vegetables and fruit in those areas where night soil was used for agri-
cultural purposes. He felt, however, that cholera was mainly a water-borne disease. 321
Claphan, in 1939, showed that flies could serve as intermediate hosts of the nema-
tode Syngamus trachea, a cause of "gapes" in chickens. 192 While this nematode is ap-
parently not a human pathogen, the work implicates flies as carriers of disease agents
in general.
In 1940, Craig and Faust319 stated that "the contamination of food and drink
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38 SOLID WASTE/DISEASE
by droppings of flies that have fed on material containing the cysts of Entamoeba his-
tolytica is an important method of transmission where flies are numerous and foodstuffs
are unprotected from these insects. This method is most important in military camps,
work, or recreation camps, and wherever large numbers of individuals are gathered to-
gether and flies are prevalent." In regard to leishmaniasis, they stated "Today the only
insects considered to be transmitting agents are flies of the genus Phlebotomus." How-
ever, they noted the small number of successful attempts in the experimental trans-
mission of the disease by this route. They commented that all attempts to that date
to produce infection in man by bites of the sand fly, Phlebotomus papatasii, have been
negative, although it was felt that oriental sore, a form of leishmaniasis, was believed to
be most commonly transmitted in nature through the bites of this fly. The fly was
proven experimentally to be contaminated by the organism responsible for this disease.
It had been found possible to produce the sores in man by inoculating material contain-
ing these agents which had developed within the fly, although "the crucial experiment
of transmitting infection by the bite of the fly has not been successful." Craig and Faust
also noted the transmission of Trypanosoma gambiense by the bites of flies of the genus
Glossina (tsetse flies). However, flies were not implicated in the transmission of Trypa-
nosoma cruzi. The authors did not implicate flies in the transmission of Balantidium coli
or Ascaris lumbricoides. Similarly, flies were not indicated as carriers of the eggs of trem-
atodes pathogenic for man.
Craig and Faust discussed the flies which are considered capable of transmitting
pathogens to man and implicated the common housefly, Musca domestica, in the enteric
infections — typhoid fever, salmonellosis, bacillary dysentery, cholera and amebic dysen-
tery. They stated that the control of houseflies was responsible for the decline in typhoid
epidemics. They equated the domestic flies with the spread of the pathogens of tubercu-
losis, plague, tularemia, anthrax, brucellosis, typanosomiasis, leishmaniasis, acute catarrhal
conjuntivitis (pinkeye), yaws, and trachoma.319
Sabin and Ward366 demonstrated in 1942 the presence of poliomyelitis virus in
batches of flies taken during epidemics of this disease in two major cities in the United
States. They concluded that there was no doubt that flies were carriers of the agent,
but, in these experiments, were unable to determine where the flies obtained the virus.
They felt that the chief reservoir of infection lay in human excreta and that spread of
the disease by insects was possible.
Ostrolenk and Welch357 demonstrated in 1942 that a potent strain of Salmonella
enteritidis could survive the duration of the life of experimental flies. They stated: "In
our preliminary studies of this problem we were able to demonstrate that flies are an
extremely potent source of pollution organisms, particularly in those food plants where
little attention is paid to sanitation and where the food is prepared for the consumer
without a final treatment to destroy these organisms." They found that the organism was
transmitted easily and rapidly through several populations of flies and that these flies
contaminated all surfaces with which they came in contact. They found that the fly
carried the organism both externally and internally. They were able to demonstrate
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literature survey 39
transmission of food poisoning bacteria from flies to mice, and a retransfer from infected
mice to flies.
In 1943, Bang and Glaser183 demonstrated the recovery of mouse-adapted human
poliomyelitis virus from adult biting flies infected by feeding on mice.
In 1943, Trask and others159 recovered poliomyelitis virus from samples of flies
collected within areas of epidemic poliomyelitis. The method of demonstration was the
infection of Java monkeys by the intranasal and intra-abdominal inoculation of material
obtained from the flies.
In 1947, Roberts185 concluded that while flies were proven carriers of the cysts of
Entamoeba histolytica, flies in the urban United States were of little significance in the
transmission amebic dysentery. They stated, however, that "in rural areas . . . particu-
larly in the tropics, flies may prove of greater importance, for, under such conditions,
not only do they tend to occur in greater numbers, but, owing to lack of sanitation, they
have readier access to infected excreta and to human-food supplies."
In 1947, Melnick and others176 carried out a fly-control program in association
with investigations on fly-borne poliomyelitis. They stated: "A temporary reduction in
flies was achieved . . . Under the circumstances, which were not ideal, there was no effect
on the poliomyelitis control." They pointed out why the results could not be considered
conclusive. The experiment, however, was important in that it represented one of the
first efforts which used modern insect control methods in the study of the epidemiology
of suspected fly-borne disease.
In 1947, James reported on the fly species that cause myiasis in man. He con-
cluded that such species were "almost exclusively nonbloodsuckers in the adult
stages . . . ". 8
In 1948, Philip378 was able to recover the agent of Q fever from houseflies (Musca
domestica) caught at large in an animal room in which Q-fever-infected animals were
kept. He was unable to transfer the infection between infected and noninfected guinea
pigs to which houseflies had free access. However, the test organism was recovered from
houseflies allowed to feed on infected material and shown to cause Q fever in injected
test animals.
In 1948, a second highly important experiment was conducted by Watt and
Lindsay, 38 using modern insecticides as agents of fly control. These authors were critical
of past observations on the fly as a vector of disease and stated: "Common assent has
for years ascribed to the fly a major role in the spread of enteric infections. Evidence
for this belief was incomplete and did not permit an evaluation of these insects as dis-
seminators of disease." They used treated and untreated towns, and studied the dissem-
ination of Shigella and Salmonella as dependent variables. They then reversed the treat-
ment and control role of the towns. They concluded with the following observation: "In
the area of high morbidity studied, a significant reduction in the amount of infection,
291-982 O - I
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40 SOLID WASTE/DISEASE
disease, and death resulted from the degree of control established. The effect on Shigella
infections was greater than on infections with the Salmonella group of organisms."
In 1949, Pipkin27 stated: "Although the experiments of earlier workers are not
to be discounted, it is thought that modern cultivation and techniques offer more
critical and exact methods of evaluating viability [of cysts of Endamoeba histolytica]."
His own experiments led him to conclude: "The passage of viable cysts of E. histolytica
in the fly vomitus 64 minutes after initial ingestion and in feces four hours and 20 min-
utes after ingestion offers a potential natural method of transmission under conditions
commonly occurring in backward and rural sections which might possibly explain com-
munity amebic infections."
In 1949, Melnick3es was successful in recovering poliomyelitis virus from flies col-
lected during an urban epidemic and transmitting the disease to monkeys inoculated
with the virus from these flies.
In 1951, Hawley and others135 conducted experiments which consisted of feeding
Musca domestica, the common housefly, with known numbers of Escherichia coli,
Salmonella schottmuelleri, and Shigella, dysenteriae. They found that flies that were
fed fewer than 1,000 of the various species of organisms in a single feeding apparently
did not pass the bacteria in their stools, but with increasing numbers of the bacteria
fed, definite multiplication did take place within the flies as indicated by their recovery
in the stools in greater numbers than were fed. These investigators found that the ex-
cretion of the organisms remained at a high level for at least six days.
In 1951, West in his book The Housefly 90 stated (page 266): "There is at the
present time acceptable laboratory proof of the transmission of approximately 30 diseases
(or parasitic organisms) by M. domestica and related forms." The author implied that
typhoid fever, paratyphoid fever, cholera, bacillary dysentery, infantile diarrhea, anthrax,
conjunctivitis, tuberculosis, and leprosy are transmitted to human beings by flies, although
no factual data of an epidemiologic nature are presented. Similarly, he implicated
viral disease, trachoma, polio, spirachetal disease, yaws, protozoan disease, amebic dysen-
tery, and giardiasis. However, he stated: "Flies are rarely the sole transmitting agency
. . . and in most cases, their role, however, important, must logically be considered sub-
ordinate" (p.272). Most of his discussion is with regard to the ability of flies to transmit
disease organisms, and there is essentially no epidemiologic evidence presented or re-
ferred to.
Gerberich184 reported in 1952, that chickens fed on infected flies were experi-
mentally infected by Salmonella pullorum. He concluded that his data established the
housefly as a vector of S. pullorum, and thus increased the potential area of bacterial
dissemination to that of the range of the flight of the housefly.
In 1953, Melnick and Dow363 reported further on flies and poliomyelitis, and on
Coxsackie virus and flies. They found that poliomyelitis virus was present in flies in
the absence of clinical cases in the town investigated, and concluded that poliomyelitis
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literature survey 41
infections were common in spite of the absence of paralyzed cases. They state: "Intimate
contact between persons is of unquestionable importance in the transmission of polio-
myelitis. A problem which still remains unsettled is to what extent this added dissemi-
nation of virus by flies contributes to the marked seasonal pattern of the usual polio-
myelitis outbreak." They remarked that there was no apparent true host-parasite re-
lationship between polio and Coxsackie viruses and flies. They found that there was an
apparent correlation between poliomyelitis virus recovered from flies and in privy speci-
mens collected in the same area. Furthermore, they were able to transmit poliomyelitis
from virus found in flies to monkeys. They concluded that other studies are needed to
evaluate the importance of flies in the transmission of poliomyelitis during epidemics.
In 1953, Francis and others, 364 reporting on the same 1948 epidemic of polio-
myelitis referred to in the previous reference, stated that there was a marked correlation
between the presence or absence of poliomyelitis virus isolations from privy specimens and
from the flies tested as reported by Melnick (above).
In 1953, Morellini and Sacca 329 refuted a number of previous claims or observa-
tions associating flies with the dissemination of tuberculosis. Also in 1953, Corbo92
reported a seven-year study on the trend of infant mortality due to gastrointestinal
diseases in an Italian province. He observed that the mortality curve dropped consid-
erably when houseflies were eliminated by the use of insecticides. He found also that
where resistance of the insects to insecticides was present, infantile mortality due to these
diseases was not reduced.
In 1953, Lindsay and others76 concluded from a study that "During effective fly
control in an area of moderate diarrheal disease morbidity, the prevalence rate of Shigella
infections and the morbidity rate from diarrheal disease were significantly lowered."
In 1954, in a continuing study of pathogenic human viruses and flies, Melnick and
others reported on a seasonal variation in which Coxsackie viruses appeared in some
specimens obtained in the summer and fall, but disappeared in the winter and spring.
Melnick found that Coxsackie viruses were recovered more regularly from sewage than from
flies. The virus was obtained from flies in residential areas not otherwise revealing any
source of contamination.
In some instances, the virus was present in residential areas but not at the sewage
disposal plant, the virus apparently having failed to survive the period of transportation
in the sewerage.
In 1956, Lindsay and Scudder75 stated: "The nonbiting flies are probably more
responsible for the transmission of the causative agents of enteric bacterial infections of
all types than are biting flies, including mosquitoes." These authors also said: ". . . In
many tropical and subtropical areas devoid of modern sanitation, the principal factor
influencing the spread of disease agents by flies and other means is the degree to which the
etiologic agents themselves are present. This is also true in many marginal areas with
inadequate sanitation and may likewise occur in areas of normal high standards during
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42 SOLID WASTE/DISEASE
temporary disruptions of sanitation facilities following disaster." Because of the poorly
developed status of bacteriological techniques and taxonomy in the years before World
War II during which most of the studies on passage of organisms through flies was per-
formed, Lindsay and Scudder felt that controls on those experiments were inadequate
and that the organisms involved are now impossible to identify in modern terms. They
state, however, "By way of comparison, the earliest work on the ability of flies to serve
as mechanical vectors is probably as significant today as when it was done." These authors
refer to important studies on shigellosis carried out by the United States Navy in Cairo,
Egypt. In these studies, infant mortality declined and recurred impressively in connection
with a decrease and increase in fly population associated with insecticide control efforts.
They also refer to an unpublished demonstration by Dow of the feasibility of transmis-
sion of the organism responsible for pinkeye by the gnat Hippelates, and to a relationship
between school absenteeism, "sore eyes", and numbers of this gnat. Murihead-Thomson
was quoted as reporting in 1954 on an association between a fly species and epidemic con-
junctivitis in India. Also cited were studies by Satchell and Harrison which "pointed
most convincingly to the transmission of (yaws) in part by wound-feeding flies." Lindsay
and Scudder state further that "The causative agents of some 30 diseases in all have been
associated with, or demonstrated by, laboratory techniques to be capable of transmission
by nonbiting flies. Without indicating the degree of importance, it may be said that flies
constitute one mode of transmission for the agents of such diseases as cholera, and various
protozoan and helminth infections." They said also that "The diverse findings shown indi-
cate the need for systematic studies of the conditions that promote or inhibit the survival,
multiplication, and passage of various microorganisms."75 Smith,332 in 1957 stated that
while claims (Rosenau, 1912; Anderson and Frost, 1912) had been made that biting flies
could transmit poliomyelitis virus, others (McFarlan et al., in 1946) in fairly recent years
were unable to confirm this either experimentally or on epidemiologic grounds. The
possibility of a mechanical transmission to man by infection of flies feeding on feces had
attracted more interest. However Smith said: "There is no evidence that it is of any
epidemiological importance."
In the book Bacterial and Mycotic Infections of Man,682 published in 1958, flies
are not mentioned in relation to the epidemiology of anthrax (pp. 339-340), but are impli-
cated as possible transmitters of salmonellosis and typhoid (p. 387) and bacillary dysen-
tery (p. 397) through food contamination. In the same text, deer flies are reported as
transmitters of tularemia (p. 432). No mention is made, however, of any association with
domestic fly species. No association of flies is made with swine erysipelas and erysipeloid
in man (p.461) in this book. Spread of cholera is attributed to flies (p.468).682
In 1958, Schliessmann and others 545 reported on a three-year study, completed in
1957, on the relation of environmental factors to the occurrence of enteric diseases in
mining camps in Kentucky. These authors found in their investigation that housefly
abundance was not significantly correlated with morbidity or Shigella prevalence. They
stated: "Lowest rates of reported diarrheal disease, Shigella-positive cultures and As-
caris-positive stools were recorded among study families served by complete community
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literature survey 43
sanitary facilities . . . The highest levels of the three indexes were reported from popula-
tions living where community sanitation facilities were entirely lacking. Individuals living
in homes provided with inside piped water and privy excreta disposal reported approxi-
mately twice the diarrhea and twice the Shigella prevalence and over three times the Ascaris
infection rate experienced by individuals using piped water and flush toilets."
Of interest was a further factor — namely, that the population groups using privies
showed lower infection rates of Ascaris and Shigella when water sources were inside the
house than did those groups whose water source was outside. Lower rates also seemed to
accompany the availability of installed bathing fixtures. Schliessmann and others felt that
their results strongly supported "the premise that incidence of acute infectious diarrheal
disease may be reduced significantly through selective modification of specific environ-
mental factors within communities without regard to etiologic or sociologic differences."
It is concluded that "specific environmental improvements, based on a knowledge of local
deficiencies, will invariably effect significant reduction in enteric disease."
In a World Health Organization report in 1958331 it is stated that the "inadequate
and insanitary disposal of infected human faeces leads to the contamination of the ground
and sources of water supplies. It often affords an opportunity for certain species of flies to
lay their eggs, to breed, to feed on the exposed material, and to carry infection." The
report also states: "In different parts of the world, different modes of transmission may
assume various degrees of importance: In some areas, water, food, and milk may be most
important; in others, flies and other insects; and, in still others, direct contact may assume
a major role. What is most probable is a combination of all ... The technical objective of
sanitary excreta disposal is therefore to isolate faeces so that the infectious agents in them
cannot possibly get to a new host." The report states also that "In temperate climates,
excreta-borne diseases are usually more prevalent during warmer months when flies are
more numerous and most active". 331
In 1959, Greenberg,182 presented arguments as to why early investigations dealing
with the transmission by flies of pathogenic organisms were unreliable. He reports on the
variable success in the recovery of different species of Salmonella and of Shigella flexneri
from fly larvae, pupae, and adult houseflies. When organisms were recovered, he noticed
a decrease between those found in maggots and those in the pupae stage. He found that
a small number of the pupae were sterile or retained only a few bacteria. In a second paper,
Greenberg noted 30° that both the transmission of Salmonella typhi or Shigella flexneri from
the larva to the adult housefly is consistently unsuccessful if the pathogen is introduced
into a contaminated larval medium. Under the same conditions, limited transmissions
occur with an organism such as Salmonella enteritidis. He experimented with laboratory
Chemical Specialties Manufacturers Association (CSMA) broth, human feces, garbage,
and horse manure as fly-breeding media. Greenberg stated: "Some flies retained only a
single species of bacteria whereas the majority of flies harbored an assortment of species.
These species are widely distributed saprophytes present in the feed, and feces of horses
and other animals. . . . The inability or limited ability of the pathogens to propagate
under competitie conditions in the various larval media likewise prevents or limits their
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44 SOLID WASTE/DISEASE
retention by the host. The author states "It appears that enteric pathogens are destroyed
in the very environment required by maggots for their development." In considering the
infectivity of the newly emerged adult fly, he continues as follows: "Typical associates of
newly-emerged houseflies are Proteus, Pseudomonas, and various Coliforms. Justification
for categorizing them as potential human pathogens lies in their increasing implication in
diarrheal diseases, especially of infants. Certain of the true pathogens, for example, S. en-
teritidis and S. paratyphi B.,may also be present in the adult fly, but their numbers would
probably be quite low considering the relatively low counts of most newly-emerged flies."
He stated also: "On the basis of dosage delivery, the risk of human infection from such a
fly is probably slight." He further states that "It should be emphasized that the successful
transmission of pathogens is more often the exception than the rule when normal contam-
ination of the larval medium is permitted. This has been shown for polio and other viruses;
for Salmonella pullorum; for S. typhi; and Shigella flexneri; for several species of Lepto-
spira; and for Toxoplasma." For this last quotation, he refers to the works of other authors.
Medical Entomology195 contains very little information concerning the fly-human
disease relationship not already referred to above. The author does comment on the nui-
sance value of flies as pests which interfere with man's activities.
Chandler and Read in 1961 reported a case of myiasis due to the fly, Psychoda.
689, P 786 This fly has been found breeding in sewage sludge 688' PP- 544-555. The authors asso-
ciate the sandfly (Phlebotomus) with sandflyfever and leishmaniasis (pp. 672-673),midges
(Heleidae) with filarial worms of man (p. 678), and hornflies (Siphona irritans) with seri-
ous losses in domestic animals (p. 693). They associate stable flies (Stomoxys) with sim-
ilar effects on man's meat and dairy animals, as well as with trypanosomiasis, anthrax,
conjunctivitis in children, and the transmission of domestic animal parasites (pp. 694-
695). They ascribe to the housefly the ability to transmit "filth germs, especially those
affecting the eyes and the alimentary canal," gonorrheal ophthalmitis, bacillary dysen-
tery, and other enteritides (p. 696). These authors also relate the eye flies (Chloropidae)
to human eye infections and yaws (pp. 708-709). Some flies which breed in human and
animal wastes are said to be the cause of some forms of myiasis (pp. 767-794). Other
flies, while related to disease, cannot be related to waste because their breeding or feeding
habits do not require waste. 688
In 1962, Scott and Littig395 discussed flies as nuisances. They stated: "Domestic
flies can be a serious threat to individual efficiency. In a fly-infested office the senior author
has observed employees spending over fifty percent of their time swatting and driving away
flies. Biting flies disrupt picnics and other recreational activities as well as the pioneering
efforts of mankind." The authors state that deer flies, horseflies, sand flies, punkies, and
other biting flies attack man and cause him great discomfort. They state also that the
stable fly can bite severely and the black fly can attack in such numbers that they kill
the victim (whether the victims are small or large numbers is not stated). The invasion of
tissue fly larvae (myiasis) is noted. These authors also state that domestic flies can
mechanically transmit typhoid, paratyphoid, cholera, bacillary dysentery, infantile diar-
rhea, amebic dysentery, giardiasis, pinworm, roundworm, hookworm, and tapeworm.
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literature survey 45
They ascribe the transmission of trachoma, conjunctivitis, and yaws to rasping flies. Biting
flies are said to transmit anthrax and tularemia. Other fly-transmitted diseases named are
African sleeping sickness, leishmaniasis, onchocerciasis, loaiasis, bartonellosis, and sand-fly
fever.
Horsfall in 1962 says in regard to the common housefly, Musca domestica, "Its
exact role in the etiology of human diseases may never be fully known and undoubtedly
varies according to the relative incidence of the flies. Situations where enteric diseases are
endemic usually have sanitary conditions which also permit extensive development. Once
the sanitation is good, incidence of both disease and flies declines."120- P• 15°
Metcalf and Flint86 in 1962 discuss (among other destructive insects) fruit flies as
a source of damage or destruction of fruit (p.814). They refer to horseflies as the known
carriers of loa loa, tularemia, and anthrax (p. 1008). They refer further to losses of human
and supplies through the attack of these flies on meat and milk animals, whereby the
animals lose weight and the yield of milk is decreased or the animals may be killed —
either as a result of overwhelming attack or as a result of introduction of disease organism.
A nice distinction between the problems presented by solid wastes in the bulk and
in small, isolated quantities is made evident by the horn fly. This fly feeds on cattle, but
deposits its eggs only in fresh cattle droppings. 86>p-954 ff It does not breed in accumulated
fecal wastes. Due to the damage it inflicts on major sources of human protein, its depre-
dations can lead to human malnutrition (see also reference 37). Yet, unless attendants go
about collecting freshly dropped dung, control of this fly through solid waste management
has no meaning for the prevention of disease — either animal or human. Nevertheless,
fresh animal droppings are solid wastes and must be classified as such; at least some atten-
tion to any health problems they might present is more likely to result from such an
approach.
Of the housefly, Metcalf and Flint (p. 1031 ff) say: "This fly is naturally infected
with the pathogens of more than twenty human diseases and many authorities believe
that the fly is an important vector of typhoid fever, epidemic or summer diarrhea, amebic
and bacillary dysentery, cholera, poliomyelitis, and various parasitic worms. However,
adequate epidemiological evidence is available only for bicillary dysentery." They state
that houseflies also serve as intermediate hosts of round worms of horses and tapeworms
of chickens.
Tarshis (1962), in discussing infectious hepatitis,530 quotes other authors on the
transmission of this disease by flies.
In 1961, Bruch and others551 had this to say about flies and diarrheal disease in
Central America: "In Guatemala, the diarrheas and the dysenteries occur so frequently
among children in the first few years of life that they are the leading cause of death for
the population as a whole. . . . Environmental conditions clearly are responsible for many
secondary sources of infection and for indirect transmission by vehicles and vectors. Pol-
lution of water by human wastes occurs readily. Fruit is susceptible to contamination in
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46 SOLID WASTE/DISEASE
its preparation and preservation. Flies are a hazard. On the other hand, living conditions
are such as to favor direct contact spread. . . . Flies are especially frequent in September
just as the rains end. The rather common increase in diarrhea in that month or in October
may well be associated with flies."
In 1963, Greenberg and others544 reported the results of a survey of a distribution
of salmonellae in the fly population of a slaughterhouse in a central Mexican city. "Flies
captured on offal had somewhat higher infection rates than those taken on manure: Ten
types of salmonellae were recovered from the former and five from the latter [media]. In
all, a total of twelve types was recovered from flies . . . Salmonella derbi was most preva-
lent, followed by S. anatum and S. new brunswick." The authors noted that the "slaugh-
terhouse may serve as a meeting ground for the indigenous fly . . . and enteropathogenic
bacteria from diverse geographic regions." They further stated: "This study has shown
that flies can be superior indicators of the presence of salmonellae in such an environment.
Fly pools have many more Salmonella types and higher percentages of positives than
either rats or livestock. . . . Flies were infrequently found in the slaughtering rooms and
were probably of little significance here as compared with [other] factors. The most obvi-
ous source of salmonellae for flies was carrion derived from the livestock. The higher
recovery rates of salmonellae from flies captured over carrion compared with their coun-
terparts from manure suggest that carrion is a better source of salmonella than manure
is." 544
The predominate type of salmonellae found in rats (namely, S. typhimurium),wa$,
not found in any of the positive fly pools. Greenberg, et al. stated: "Flies were not at-
tracted to rat feces because of the superior attractivity and quantity of offal manure." The
authors noted that the food preferences and dispersal patterns of the various flies helped to
determine their vector potential. Certain fly species were noted to have little contact with
man, whereas others, such as Musca domestica, were implicated in the fly-food-human
cycle. Comment in regard to flies in relation to disease is of interest: ". . . in the abba-
toir we studied, there is continuous year-round fly breeding, a fairly consistent feature of
regions with high enteric disease rates, serving to maintain a constant vector pressure
from flies. The public health danger from such mass-breeding, contamination, and disper-
sion of flies is clear. In the light of our findings, any program aimed at reducing diarrhea
and enteric diseases, in general, must include measures to eliminate fly and rat popula-
tions from the slaughterhouse area."544
Gupta and Preobragenski in 1964, reporting on the epidemiology of trachoma in
India, say this about flies: "It has been established that an important role is played by
the common house fly. ... the fly index rises before the onset of the two peaks of sea-
sonal epidemic conjunctivitis. It has also been noted that the age-groups of children
2-4 years — which is most exposed to flies — [having] not sufficient sense and capability
to keep the fues off their faces — gets the maximum [trachoma] infection" (p.47).681
In 1964, Greenberg543 made an interesting historical comment: "According to Al-
dronvandi writing in 1602, the Greeks and Romans were well aware of the possible spread
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literature survey 47
of dysentery by the ingestion of flies accidentally falling into food." With regard to his
own experiments, the author attempted to infect humans, without causing manifest disease,
by using very small doses of Salmonella typhimurium. He states that the absence of re-
sponse was probably due to the subthreshold dose of 10 3 and 10 5 organisms, at least 100
times lower than the number needed to produce symptomatic salmonellosis in adults.
Greenberg concludes that "direct fly transmission of enteric infection to human adults ap-
pears doubtful where generally high infective doses are required. On the basis of this
preliminary study, it seems likely that bacterial infections can occur through fly contam-
ination of food. Flies have manifold opportunities to serve as vectors where poverty main-
tains a close association between domestic animals and people augmented by exposure of
foods without refrigeration in market place and home. Fly mobility, demonstrated by
the rapid dispersion of contaminated slaughterhouse flies, to market place, dairies, resi-
dential sites, and a neighboring town three miles away, poses a health problem for the
entire community, transcending economic class and location."
Following his Mexican slaughterhouse study mentioned above, Greenberg, in asso-
ciation with Bornstein,7S traced the flies they had demonstrated to be contaminated by
Salmonella organisms to residential sites, market place, dairy, and a neighboring village
up to three miles from their origin. He concludes that this dispersal constitutes a health
hazard for the 100,000 inhabitants of the area.
Sacca77 made some interesting quotations from sources not accessible to this study
at that time. He states: "The fly's ability to transmit tuberculosis, leprosy, yaws, eye
infections, et cetera has been proved. The medical importance of this species is particu-
larly evident for the epidemics of trachoma: It has been shown that fly control alone is
more useful than the administration of anti-biotics and sulphonamides to the human
population." Brooke 553 considers that it is possible that flies may be involved in the trans-
mission of amebiasis in rural areas where there is considerable contamination of the en-
vironment. He does not believe, however, that the fly is of particular importance in the
spread of this disease.
In 1965, Moore, de la Cruze, and Vargas-Mendes conducted diarrheal disease
studies in Costa Rica. 538 They state: "Variations in fly counts or in the bacteriologic
quality of meat or milk, as determined, did not appear to be related to the variations of
diarrhea morbidity." Domestic animals were observed to harbor enteropathogenic bac-
teria on some occasions but they were not demonstrated to be related to disease episodes
in their owners. The authors felt that a bathing facility was needed to obtain the best
effect from piped water, with which 94 percent of the homes were supplied.
In 1966, Shaker and others691- P- 1586 reported finding a definite relation between
infantile diarrhea and fly population in Kuwait.
DISCUSSION
It was recognized as early as 1913 that much data — fly-control experiments, im-
proved bacteriologic techniques, and a better understanding of the epidemiology of the
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48 SOLID WASTE/DISEASE
diseases in which the fly was implicated as a vector — were necessary to demonstrate con-
clusively that flies were indeed transmitters of disease. It was not until modern pesticides
were available after World War II that fly-control studies were feasible, although, by hind-
sight, it appears almost certain that the conditions present in the Boer, Spanish-American,
and American Civil Wars permitted the dissemination of typhoid fever by flies. The con-
clusion is weakened, of course, by the presence of other avenues of infection, but the evi-
dence was and is convincing, especially following the experiments of Watt and Lindsay.38
The fall in incidence of morbidity and mortality due to shigellosis in the populations they
studied, following reduction in fly populations and their return to former levels with
discontinuing control or development of fly resistance, seems to be quite similar to the
reductions seen in typhoid fever when fly populations were reduced by natural causes.
When one considers the comparatively small doses of typhoid organisms needed to infect
susceptible individuals, the free access of flies to excreta and food in conditions of primi-
tive sanitation, the positive association of the fly with typhoid fever in such conditions
is difficult to question now that the relation to shigellosis is demonstrated. Nevertheless,
the unknowns of disease-agent ecology in the climatic changes associated with fly destruc-
tion and suppression of breeding have not been resolved, and so there remains the possi-
bility that the supposed relationship is coincidental.
On the other hand, there is no doubt that flies are mechanical carriers of a large
number of agents pathogenic to man. There is also a great weight of circumstantial evi-
dence (and a lesser amount of controlled research) relating to certain fly species that are
contaminated by, or bred in, solid wastes with the actual transmission of human enteric
and eye diseases, although infection may involve a number of factors other than that of
waste itself. Of course, distinction must be made between those species that breed in, or
feed from, wastes of human or animal origin and those that do not.
It is obvious that there is no simple relationship of flies to waste, but that species
adaptability and adjustment vary greatly and must be considered in assessing an associa-
tion.689 Nevertheless, there is sufficient evidence of the linkage to condemn practices in
the disposal of wastes which permit fly propagation.
Due to present United States agricultural and food-processing practices, fruit and
vegetable residues can overshadow animals' feces as sources of fly production. If the re-
sulting flies have access to human and animal wastes containing pathogens, a threat of
disease transmission exists. The marked adaptability of domestic fly species, however, to
many kinds of solid wastes for breeding or food supply does not permit oversight of any
waste supportive of fly populations.
The systematic study of fly/waste/disease relationships has been neglected. The
extent to which it must be conducted in respect to the solution of waste management
problems is probably a function of the economics and sociology of fly-control in general.
That is, the decision to support this kind of investigation will no doubt be determined
by the public's a priori assessment of the risk — a typical paradox in public health —
and therefore the degree of pressure exerted by the public, or the priorities established
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literature survey 49
from a systematic survey of all waste management requirements within the entire environ-
mental health field.
CONCLUSIONS
Domestic and some other species of flies are definitely established as transmitters
of disease. They are bred in enormous numbers in many types of solid wastes. However,
in only a small number of investigations176- 33> 92> 76- 75 have there been any results from
which a quantitative estimate of their part in disease causation was even remotely possi-
ble. It is highly probable that, in the presence of exposed human and animal feces, flies
contribute significantly to disease and mortality. This is particularly true among infants
and children; in some areas of the world, flies transmit typhoid fever and cholera, and on
occasion cause high death rates at all age levels. However, much remains to be learned
as to the contributions of numerous factors, such as the relation of seasonal changes on
disease agents and vectors and their individual or mutual effect on disease incidence. In
areas in which sanitation (safe water supplies, indoor washing and bathing facilities, waste
disposal, and refrigeration) and personal hygiene are at a high level, flies have little oppor-
tunity to transmit disease.
The role of flies in disasters which interfere with sanitation in developed areas can
only be surmised, but it could be a dangerous one in view of the probable low level of im-
munity to many enteric pathogens among the population in the United States (see refer-
ences 739, 740, 741).
Although much research is needed to clarify the role of flies even in those few
diseases in which flies associated with solid wastes have been determined to be transmitters,
the evidence overwhelmingly demonstrates that control of solid waste against the breeding
of domestic flies greatly limits their population. Present knowledge of the dynamics of
disease transmission, exposure, dosage, etc., permits the conclusion that such limitation
can contribute to the prevention of fly-borne disease.
RECOMMENDATIONS
The control or possible elimination of fly species associated with solid wastes and
human diseases requires expanded application of known methods of waste control and
research to increase knowledge of control. In the literature it was pointed out that fly
control is associated with reduction of morbidity and mortality from some infectious
diseases. However, it was noted that, even in developed countries, people are relatively
tolerant of flies. In this country, carelessness in regard to domestic garbage150' 391 and
the feces of domestic pets84- 391 is especially prevalent, and leads to significant fly
production.
From these observations it is possible to outline programs designed to help control
fly populations implicated in disease transmission areas in which research could be under-
taken include the following:
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50 SOLID WASTE/DISEASE
Fly ecology
Fly predators and other enemies or parasites
Fly attractants and repellants
Interference with reproduction of flies
Species-specific pesticides
Physical agents of destruction
Waste control (control of breeding media)
Waste disposal (contamination control)
Public motivation toward fly control (including educational material, effec-
tive means of presentation and the like)
It should be noted that problems of implementation are not taken into account
at this stage.
Of the items listed above, the last five are of most immediate concern to solid
waste in its varied forms. There is a need to keep wastes apart from flies, to destroy flies
finding access to waste, or to destroy the immature stages or eggs already in waste.
Another approach would involve implementing the following programs:
Known sanitary method of waste control and disposal
Expanded public education
Installation of full sanitary facilities in all homes throughout the country
(eliminating privies in favor of flush toilets, providing piped water of sani-
tary quality, instituting pollution control, and providing indoor washing and
bathing facilities)
All of these projects are of direct concern to solid waste management.
A solid waste/fly-borne disease relationship has been established to a degree suffi-
cient to prove the need for remedial measures in waste management when flies have
access to breeding media and fecal matter or other sources of pathogens. While there
needs to be more research on the actual role of flies and the degree understood to which
they contribute to any disease, this knowledge is not material to establishing the need
to control waste in relation to the fly hazard. Such a need has already been firmly
established.
Diseases Associated with Human Fecal Waste
GENERAL
1) Bacterial Injections. Typhoid fever, paratyphoid fevers A and B, cholera, and
bacillary dysentery (shigellosis) are the enteric bacillary diseases in which man is the
reservoir host (pp.258, 260, 172, 378). 324 Typhoid is apparently an obligate parasite of
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literature survey 51
man. 167- p-864 Paratyphoid C is thought to be primarily a disease of animals. 324> P 264
Paratyphoid B is sometimes excreted by animals. 324> P 26°
The role of other bacterial agents such as Escherichia coli is not entirely clear,
although they are implicated in diarrheal diseases of children, the malnourished, and the
aged.
It is probable that the only important route for infection by these diseases is ano-
oral, by either direct or indirect modes of transfer. Hand-to-mouth spread, directly or
through food contamination, is probably the common mode of infection in this country,
332, 536, 534, 537, 538, 541, 542, 549, 550 although waterbome dissemination occurs. 40- 53 However,
waterborne bacterial enteric infection due to municipal water-supply sources in the
United States is uncommon31- 143> 168; nevertheless, even in advanced countries, water-
borne contamination by bacteria from human fecal waste is common. 80> 103' 109> 586> 480>
584, 62
Transmission of these diseases by flies is considered elsewhere in this report.
2) Viral Injections. Clarke and others (1962) stated that in the preceding 15
years, 70 new enteric viruses had been demonstrated in human feces and that the hazard
of their waterborne transmission would increase as population growth caused greater
contamination of water supplies.755
The viruses of poliomyelitis, of Coxsackie infection, and of infectious hepatitis are
excreted in the stools of infected humans, but the modes of transmission are still being
denned. 6S1- P-S Fecal transfer of polio virus, however, direct or indirect, is claimed by
some to be the chief mode of infection for poliomyelitis517' p-32 and for Coxsackie dis-
ease. 417' P 35> 697' pp-8'9 Fecal transmission of infectious hepatitis is attested to by out-
breaks of waterborne disease, 529- 552- 554 although person-to-person contact has been the
chief means of spread in some epidemics. 528> 527 Chang31 believes that outbreaks from
municipally treated water supplies are unlikely. Weibel and others40 are of the same
opinion.
3) Protozoal Infections. Although intestinal protozoa of several species are found
in man, only one, Entamoeba histolytica, appears to be a significant pathogen in the
United States, unless other diseases, aging, or malnutrition exist.
4) Helminthiasis. The major worm infestations of human fecal origin are those
due to the cestodes or tapeworms, such as Diphyllobothrium latum (fish tapeworm),
Taenia saginata (beef tapeworm), Taenia solium (pork tapeworm), and those due to
certain nematodes such as the pinworm (Enterobius vermicular is). Also in this category
are the human roundworm (Ascaris lumbriocoides), the whipworm (Trichuris trichiura),
the human hookworms (Necator americanus and Ancylostoma duodenale), and certain
schistosomes.
All of these diseases depend on the transfer of the disease agent from human feces
directly or indirectly to a susceptible human for new infection to appear.
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52
SOLID WASTE/DISEASE
Gordon, quoting the 1959 World Health Organization Epidemiological and Vital
Statistics Report, (volume 12, p. 124), says that diarrheal diseases still rank among the
five principal causes of death of young children in the United States. He states also that
there is no guarantee that natural disaster or war will spare the United States, and that
these catasthophes are and have always been associated with devastating intestinal dis-
ease 552> P- 360; 548> 537> p-3i33
POSTULATION
The known or postulated paths of infection for fecal-borne diseases in which man
is the reservoir can be shown as illustrated in Figure 4. This diagram emphasizes the
diverse pathways involved. Four major routes are easily identified: vector-borne; soil-
borne; direct contact; waterborne.
FIGURE 4. Human fecal waste/human disease pathways (postulated).
One pathway is of special interest in that two biological agents potentially asso-
ciated with waste (that is, the disease agent itself, and a vector — the fly) are implicated.
Because of its still incompletely understood role and its possible importance to com-
municable disease, fly-borne disease will be considered as a special case.
EVIDENCE (SPECIFIC DISEASES)
1) Amebic Dysentery and Other Intestinal Protozoal Infections. Alone among
the amebas, Entamoeba histolytica is known to invade the intestinal wall of man. In
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literature survey 53
1935, Craig318 discussed the transmission of amebiasis through the use of night soil on
gardens (pp. 46-47), the importance of flies as transmitters of the disease agent (pp. 47-
48), and an epidemic of the disease observed by him and believed by him to be vectored
by flies (pp. 56-58). This latter observation he supported by various epidemiological
arguments.
In 1939, Manson-Bahr321 reviewed the epidemiology of amebiasis and quoted the
conclusion of Thomson and Thomson that houseflies (Musca domestica) could transport
cysts and pass them unchanged in their dejecta. Manson-Bahr concluded that, under
certain conditions, houseflies could act to disseminate amebic dysentery to a "somewhat
limited extent." He also felt that transmission was possible by human excreta through
the agency of vegetables and fruit grown where human "nightsoil" was used as fertilizer.
Craig and Faust319 stated in 1940 that "the transmission of E. histolytica from
person to person is usually accomplished through the ingestion of food or drink con-
taminated with feces containing the cysts of this parasite." They further stated: "The
usual methods of transmission of E. histolytica are by the contamination of food or drink
with the cysts by a polluted water supply; through the handling of food by infected indi-
viduals; by the droppings of flies and other insects; and through the use of human excre-
ment in the fertilization of vegetable gardens." They felt that fly-transmission was im-
portant in "military camps, work or recreation camps, and wherever large numbers of
individuals are gathered together and flies are prevalent."
In 1940, Tsuchiya, :u in a study of the incidence of intestinal protozoa among
medical and dental students, reported that the prevalence of 2 to 5 percent found was
approximately that discovered in New Orleans and Philadelphia in other studies. He
stated that, with one possible exception, those students harboring E. histolytica gave no
history of diarrhea or symptoms suggestive of clinical amebiasis. Tobie, 114 in 1940 used
isolates from apparently healthy carriers among humans to infect all of a group of 26
dogs. Amebic lesions were verified in the dogs at necropsy.
Faust113 in 1941 in necropsy examination of accident cases in New Orleans, found
E. histolytica in 13 of 202 cases. Other "parasitic infections" were found, and 42 cases
were positive for one or more parasites.
In 1942, Strong, 198 in reviewing amebiasis, referred to the fecal transmission of
the disease and gave the mode of infection as (a) contamination of food or water by feces
containing the cysts, (b) the droppings of flies or cockroaches, (c) human excreta used
as fertilizer, and (d) polluted water supplies (p.493). He quoted Lynch (1915) as find-
ing Entamoeba histolytica in rats in the United States, and quoted Tsuchiya (1939) as
indicating that the rat possibly infects man with this disease (p. 494).
In 1947, Roberts185 implicated several genera of flies in the transmission of amebi-
asis. This author stated, however, that it is now generally believed that, in urban areas,
polluted drinking water and food-handlers are the main sources of infection with amebic
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54 SOLID WASTE/DISEASE
dysentery, quoting Craig (1935) and the United States Public Health Service (1936).
This author also stated: "In rural areas, however, particularly in the tropics, flies may
prove to be a greater importance . . . having readier access to infected excreta. . . ."
In 1949, Pipkin27 concluded from his experiments with flies that the "external
carriage of stages of E. histolytica probably plays no important role in the transmission
of amebiasis except in cases of gross neglect of sanitary rules" and that "it seems safe to
conclude that although not impossible under usual circumstances, the ingestion of
trophozoites by flies and subsequent deposition in their vomitus on human food or drink
is not of great epidemiological importance." The author did indicate, however, that the
internal transmission of cysts of the ameba in the feces of the fly "offers a potential
natural method of transmission under conditions commonly occurring in backward and
rural sections, which might possibly explain community amebic infections."
In 1957, Neal 332> p-31 made the following statement: "Information concerning the dis-
persal of parasitic amoebae is almost entirely confined to the pathogenic species (Enta-
moeba histolytica, which infects man." Hunter and others, in 1960, referred to fecal
transmission of this disease. 517> p-271 These authors state that "while man is the principal
reservoir of infection, amoeba which are morphologically similar to E. histolytica have
been recovered from the dog, cat, rat and pig and various types of monkeys." Trans-
mission of the infection from one individual to another is said to be accomplished by a
variety of mechanisms. The housefly and cockroach are implicated, and it is said that in
some areas flies probably are important in the spread of amebiasis. Another mode of
transmission is the fecal contamination of water, either through surface streams, shal-
low wells, or springs. These authors also refer to the use of human excreta as garden
fertilizer, and transmission by means of contaminated vegetables and fruit.
Beye and others, 575 in 1961 found a 3.6 percent prevalence of E. histolytica in
Puerto Rican preschool children born in Puerto Rico but living in Philadelphia. It was
their belief that the overall intestinal parasite reservoir among domestic and foreign
agricultural migrants is large.
Chang 31 in 1961 refers to the fact that only four waterborne outbreaks of amebi-
asis had been recorded in the literature to that date. He stated that "the fact that the
ratio of cyst density to that of coliform organisms in sewage (estimated on the basis of
a 10 percent carrier rate) is approximately 1:100,000 and that cysts tend to settle out in
sewage, sewage effluent, and water may very well explain the unlikelihood of water-borne
amebiasis associated with municipal water supplies using even heavily polluted water as
their raw source." He went on to say that all outbreaks had been traced to sanitary
defects in the plumbing system, but the editor noted that involvement of organisms in
public water supplies was still "in most cases ... a matter of speculation."
In 1961, in the Proceedings of the American Society of Civil Engineers, 12 the
following statement is made: "The resistance of the spores of Entamoeba histolytica
to chlorine was so great that the absence of coliforms was no guarantee that the cysts
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literature survey 55
were also absent. . . . where chlorination was the sole method of water treatment, the
protection against amebic dysentery was nil."
Scott and Littig 395 in 1962 referred to the transmission by domestic flies of amebic
dysentery and the protozoan disease giardiasis.
In 1962, Hoare555 said: "Although [amoebiasis] is a typical anthroponosis, . . .
natural infections with E. histolytica have also been reported from rats and dogs. But,
since there is some evidence that the infected animals had been in contact with human
cases of amoebiasis, it is thought that they derived their infection from man. This view
was supported by the fact that rats and dogs are highly susceptible to infection with
human strains of the dysentery amoeba" (see also reference 310).
In 1964, Brooke553 reported that, on the basis of special classification of E. his-
tolytica, it was estimated that the rate of infection for the general population in the
United States was probably below 5 percent. However, he noted that the prevalence was
higher in Southern states, rural areas of the country, lower socioeconomic groups, pa-
tients in mental hospitals, and travelers from tropical countries. He quoted Dr. Elsdon-
Dew as stating that there may be very little correlation between the prevalence of the
parasite and the occurrence of amebiasis.
Brooke also said that a survey of four selected areas in and around Little Rock,
Arkansas, revealed 3.3 percent infection with E. histolytica. He stated that amebiasis
will be found wherever poor sanitation exists, and noted that many of the reported epi-
demics have been in the temperate areas of the world. He quoted a survey by the Com-
municable Disease Center on five Indian reservations in which ranges in prevalence were
from 1.5 to 33 percent. The survey did not permit correlation between any particular
environmental, social, or economic factor and the level of prevalence. He noted prevalence
of up to 70 percent infection with E. histolytica in wards of mental institutions. He felt
that the transmission of the parasite in rural areas is probably through direct contacts
with the fecal-contaminated environment. He stated: "The primitive sewage disposal,
surface or pit privies, or no facilities at all is undoubtedly responsible for the contam-
ination of the rural environment. In addition to the direct means of spread in the rural
communities, consideration must be given to the possibility that contaminated wells, flies,
and food-handlers may be involved in the transmission." He reported that for a nine-
member family in South Bend, there were eight E. histolytica infections, adding that
"upon investigation it was found that this particular family, unlike the others, was living
in crowded quarters and had an outside privy and a private well."
In 1964, Dixon and McCabe109 refer to the finding of E. histolytica cysts in
sewage.
2) Cholera. In 1911, Herms327 referred to the circumstantial evidence against
the housefly in connection with cholera. He stated that cholera was one of the first dis-
eases with which flies were associated as transmitters and "the experimental evidence
291-982 O - 68 - 5
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56 SOLID WASTE/DISEASE
that since has been produced is no less complete than in typhoid fever." He said also
that "Without advancing the evidence as presented by Nuttall (1899), the following
statement made by that eminent authority will serve the purpose, viz.; 'The body of
evidence here presented as to the role of flies in the diffusion of cholera is, I believe,
absolutely convincing.' " The data collected by Nuttall was not available in this study.
In 1913, however, Graham-Smith121 stated that he felt that further evidence was required
to make the fly-cholera association.
In 1931, Gill and Lai361 said in summary of their work: "The experiments re-
corded above are admittedly meagre, and it is not at present claimed that they justify
the conclusion that a true host-parasite relationship exists between the fly and the vibrio.
It would, however, seem in the first place that the vibrios are capable of surviving in the
fly for over a period of at least five days. . . . About the fifth day . . . the fly is capable of
infecting food by its faeces. ... It has been shown that the infection of milk via the pro-
boscis can take place up to 24 hours . . ." They also said that "it would be premature
at present to discuss the significance of these observations, but they seem to suggest
that . . . [the fly] may play a more important part in the transmission of cholera than
has hitherto been suspected." These authors conclude that "cholera may perhaps have
to be numbered among the insect-borne diseases" and that "it would moreover appear
that in hot countries, insect transmission is of predominant importance and that the
strikingly dramatic outbreaks associated with the massive pollution of water are rela-
tively rare incidents if not accidents in the natural history of the diseases."
Gill and Lai also state that "the provision of piped water-supplies and the rigorous
disinfection of the drinking water, combined with other routine measures, in the absence
of measures designed to eliminate the gravely insanitary conditions which almost uni-
versally prevail in Indian towns have proved of little value." They conclude that "one
of the most important, if not the most important, method of controlling cholera is the
provision of an efficient sanitary control, more especially in connection with the collec-
tion, removal and disposal of night-soil and refuse." In 1939, however, Manson-Bahr321
stated that he considered cholera to be mainly a water-borne disease.
In 1951, West90 made the following statement: "... cholera .... etc., are listed
as bacterial diseases with the implication (but no factual data of an epidemiological
nature) that they are transmitted to human beings successfully by flies."
In 1952, Coffey and Dunn, 46S without providing data, implicate the fly as a trans-
mitter of cholera.
In the report of a World Health Organization expert committee, 232 the following
statement is made: "Waterborne diseases take a major toll and overshadow other en-
vironmental health needs in importance; the enteric diseases, including cholera . . . are
the leading causes of death and disability in areas occupied by more than two-thirds of
the world population." The report further states ". . . the safe collection and disposal
[of solid wastes] is largely a problem of administrative willingness, of finance and of
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literature survey 57
priorities. The problem of night-soil, however, is an exception for which further research
is required. Research should continue in developed countries into improved methods of
disposal." Another World Health Organization report234 in 1965, states: "In one large
metropolitan area in the tropics, a focus of endemic cholera has maintained itself for
decades; it is believed that until adequate water supply and sewerage facilities are pro-
vided, this focus will continue to threaten other areas of the world with epidemics of this
serious water-borne diesase." The report goes on to say, "The Committee wishes to
draw attention to the need for organizing the transport of garbage in the most sanitary
and efficient way possible (especially in tropical countries), in order to assure proper
control of diseases such as typhoid, plague, dysentery, cholera, etc."
3) Coxsackie Disease. In 1954, Melnick and others28 recovered virus from flies
in residential areas "where no source of contamination was obvious". There was no evi-
dence of multiplication of virus within the flies, but it was found to remain in them or
their feces for up to two weeks. These investigators stated that the recovery of the Cox-
sackie viruses was more regularly accomplished from sewage than it was from flies. They
state that such virus had been found in the influent as well as effluent flow at sewage
disposal plants. However, at times, it apparently did not survive, in detectable amounts,
the trip from residential areas to the disposal plant.
In 1957, Smith332- quoting a 1954 report by Melnick, Emmons, Coffey, and Schoof,
stated that there was no evidence that infected flies played any part in the epidemiology
of Coxsackie virus infection.
Kelly and Sanderson18 reported in 1960, on isolating Coxsackie virus from sewage,
both raw and treated. Chang in 1961 described the fecal origin of 30 types of Coxsackie
virus, and expressed some amazement at the "complete absence of water-borne outbreaks
of Coxsackie . . . virus infections . . .".31
Clarke and others,21 in 1961, referred to the failure of activated sludge treatment
of sewage to remove Coxsackie virus if the effluents were unchlorinated. Clarke stated
that activated sludge would remove 90 percent or more of the enteric viruses added to
sewage, but that disinfection was necessary if a virus-free effluent were to be obtained.
On the possible infectiveness of sludge, he stated that only a very small amount of virus
could be recovered indicating that the sludge-virus complex is extremely stable or that
most of the virus is in some manner inactivated.21 A Committee of the American Society
of Civil Engineers reported in 196112 on the need to disinfect fecal-contaminated water.
In the face of Clarke's statement, it is interesting to see that Mack and others "noted
a higher percent recovery of viruses [polio virus, Coxsackie, ECHO] from settled acti-
vated sludge samples and from the liquid phase of sewage samples ..." This report also
refers to a "wide variation in virus removal efficiency of the flocculation process as
studied by several workers."
In a 1964 report by Lamb, 98 group B Coxsackie and polio viruses were said to
be most commonly found in sewage and river water collected in the period of July to
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58 SOLID WASTE/DISEASE
November, 1962, in a metropolitan area. Fifty of the samples collected were found to
contain virus. Dixon and McCabe, reporting in 1964, stated that "many enteric viruses
(Coxsackie, for example) may be present in domestic sewage ..." A report in 1964 by
McLean 3 is of interest in that it, like many others, indicates the difficulty of attempting
to control many diseases merely by attacking one phase of the total problem. He referred
to the spread of vesicular exanthem caused by Coxsackie A16 virus in Toronto, in 1957 —
an action which may have been aided by the use of backyard swimming pools. It was
also of interest that despite fairly heavy contamination on several occasions of one
Toronto Beach with sewage, viruses were not recovered from the polluted area.
4) Infectious Hepatitis. Fecal contamination of water supplies by the virus of
infectious hepatitis is evident in almost all studies of the transmission of this disease.
In 1959, Mosley344 commented on the probable water-transmission of infectious
hepatitis and the fact that the virus is excreted in the feces, but was puzzled by the com-
parative rarity of waterbome epidemics of the disease. Hunter and others in 1960517
referred to the experimental evidence that human feces "constitute a source of virus for
natural infection and limited explosive water-borne, milk-borne, and food-borne epidemics
. . ." (p. 54). These authors stated further that "epidemics are particularly prone to occur
under conditions of poor sanitation and hygiene which favor the dissemination of human
fecal material."
In 1961, Dauer168 stated that the total number of hepatitis cases reported in the
United States increased from about 23,500 in 1959 to about 40,000 in 1960. These cases
included serum hepatitis infections as well as infectious hepatitis. Dauer reported that
"Epidemiologic investigations indicated that three outbreaks could be classified as water-
borne and one as food-borne. Two of the three water-borne outbreaks occurred among
school children whose drinking water at their schools came from wells. In each instance,
contamination of the well with sewage was demonstrated."
In 1961, Chang made the following statement, "It appears that water-borne out-
breaks of infectious hepatitis resulting from the use of municipally treated water supplies
are unlikely. These outbreaks may occur, however, if the raw source is so grossly polluted
by domestic sewage that the concentration of viral agents is such that it cannot be re-
duced below infectious levels by the treatment procedures available to the local water
system . . . The great majority of cases (reported in 1960) were sporadic and of unde-
termined origin. At the present, epidemicological evidence points to personal contact as
the major route of transmission."
A Committee of the American Society of Civil Engineers reported in 1961,12 that
"complete control of the hepatitis virus ... in drinking water depends almost entirely on
the disinfectant, as the virus is not eliminated or inactivated by coagulation, settling and
filtration."
In 1962, in a discussion of a talk by Woodward,17 the comment was made,
"Cities with filtered water supplies show higher average morbidity rates than do cities
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literature survey 59
with ground water supplies. This suggests that hepatitis transmission may be through
water."
In 1962 Kabler13 stated: "Infectious hepatitis is currently the only viral disease
of humans for which the water-borne route of infection has been generally accepted,
although it is believed that person-to-person contact is the more frequent method of
transmission."
In 1962 Tarshis 53° quoted MacCallum and Bradley to the effect that human vol-
unteers were readily infected by human feces administered by the oral route. This author
also referred to his own investigations regarding fecal-transmission of the disease through
cockroaches.
In 1963 Langmuir88 referred to the initial establishment of raw shellfish as "an
occasional factor in the spread of infectious hepatitis ... in this country."
In 1963 Maynard, 528 reporting an epidemic of infectious hepatitis, stated: "There
was good evidence of transmission of infection through person-to-person contact and the
epidemic curve suggested this is the principal mode of spread." Where water barrels were
used as sources of water for homes, he stated that evidence of coliform contamination of
samples taken from these barrels indicated "the very real possibility of faecal contamina-
tion of water and possible spread of virus through this medium within the homes."
Mosley, in 1963, reported on outbreaks of hepatitis in urban areas and concluded that
there was a definite relationship between the incidence of the disease and the type of
sewage disposal available. "... It was demonstrated that the high rates were associated
primarily with the presence of privies." 529 He referred further to a report by Eaton of
the significance of municipal sewage disposal facilities in regard to a hepatitis epidemic
in Canada. The attack rate in families without sewage facilities was almost four times as
high as in those with municipal sewage facilities. However, the author commented further:
"The association of a higher attack rate with the presence of privies does not indicate that
the privy per se plays a direct role as a fomite in the transmission of the disease. Probably
more important is the lack of running water for washing at the toilet." He stated further
that the epidemiological patterns suggested that the intestinal-oral spread of the disease
is the major route involved and that "close personal and social contact with a case seems
to be required." 529
In 1964, Dixon and McCabe109 referred to the occurrence of infectious hepatitis
among construction workers at a sewage treatment plant but gave no data to support a
causative relationship, and stated "A search of the literature shows no extensive surveys
attempting to determine the actual incidence of infectious hepatitis in sewage workers
and treatment plant operators."
In 1964, Weibel and others referred to the transmission of hepatitis by means of
drinking water. 40
In 1964, McLean, 3 discussing contamination of water by viruses, said, "Epidemi-
ologic evidence gathered during several . . . outbreaks in Pennsylvania, New York, Ken-
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60 SOLID WASTE/DISEASE
tucky, Austria, India and Australia has strongly suggested that they were caused by
drinking water contaminated with infectious hepatitis virus. In this he quoted J. W.
Mosley in that fecal contamination of the water supply was noted in each of these studies.
In 1965, Lobel and Robinson 527 noted, both in review of the literature and on a
report of an outbreak of infectious hepatitis, a definite correlation between poor hygiene
and sanitation and the incidence of disease, especially among children.
In 1964, a World Health Organization Expert Committee on Hepatitis 6" referred
to the successful experimental transmission of this disease through the use of fecal filtrates
from infectious hepatitis patients to volunteers by the oral route. The report stated fur-
ther that "available data indicate that most cases of infectious hepatitis are due to per-
son-to-person transmission, the effectiveness of which appears to be related to the closeness
of contact. Persons living in the same household as a patient are at the greatest risk . . .
In most studies the lower socioeconomic groups have a higher prevalence of infectious
hepatitis in childhood, presumably as a result of greater crowding, poor sanitation, and
less adequate personal hygiene." Other means of transmission noted are waterborne and
food-borne mechanisms, including municipal water supplies, milk, raw shellfish, and pre-
pared foods. With regard to vectors, the report stated, "Mechanical transfer of the virus
from faeces to food or eating-utensils by flies and cockroaches has been suggested, but
there is no evidence that this mode of transmission has any significance."
In 1965, Burns83 stated, "The epidemic indications point to transmission (of in-
fectious hepatitis) by contact (oral or nasal?)." He refers to other work in which the
disease "has frequently been transmitted by feeding fecal suspensions to volunteers .. . ." 83
In 1965, a report of a World Health Organization Expert Committee 234 implicated
fecal contamination of drinking water in the spread of infectious hepatitis.
5) Poliomyelitis. In the period 1912 to 1913, there were a series of experiments
which, according to the experimenters, successfully established that the stable fly
(Stomoxys calcitrans) was capable of transmitting poliomyelitis to experimental ani-
mals. 36'369' 370'189
In 1939, Paul and Trask 233 stated that poliomyelitis virus could be readily isolated
from the stools of human patients and noted their own experiments in which monkeys
were shown to develop poliomyelitis following inoculation of material prepared from sew-
age. In 1941,367 the same authors referred to other experiments associating the polio-
myelitis virus with human feces and sewage. They stated that, in addition to person-
to-person, "there may also be a variety of other channels in which contaminated food,
milk and water, or conceivably insects, mammals, or birds, play a part. That water-
courses, and particularly water courses polluted with sewage, may be related to one of
these channels is suspected."
Sabin and Ward in 1942366 demonstrated the presence of poliomyelitis virus in flies
trapped during outbreaks of this disease. They were unable to discover the source of the
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fly-carried virus. The fly species implicated was Musca domestica. They also stated "that
. . . epidemiologically poliomyelitis seems more to resemble diseases like typhoid fever
and dysentery in which the chief reservoir of infection is in human excreta and both di-
rect and insect spread may be possible."
The fly was implicated further in the possible transmission of polio by Trask and
others159 in 1943, in which the virus isolated from flies was used successfully to transmit
the disease to monkeys. In 1949, Melnick365 also successfully infected monkeys with virus
recovered from flies.
In 1953, Francis and others364 referred to earlier recovery of the virus from stool
specimens taken from outdoor privies. In the current study, they reported the recovery
of polio virus from privies in four small Texas towns and stated: "A marked correlation
existed between the presence or absence of poliomyelitis virus isolations from privy speci-
mens and from the flies tested in a corollary study by Melnick and Dow."
In 1957, Dick332 stated: "Claims have been made that biting flies could transmit
polio virus (quoting the 1912 studies), but McFarlan, Dick and Seddon — 1946 — and
others have been unable to confirm this either experimentally or on epidemiological
grounds." This author also referred to the material quoted above in regard to polio virus
and flies. Dick stated further, "There is no evidence of multiplication of the virus in
flies. Whether or not the virus is carried purely mechanically is uncertain. Although most
laboratory studies suggest that internal contamination of flies is a possible mode of trans-
mission of poliomyelitis, there is no evidence that it is of any epidemiological importance.
The best field evidence in this respect comes from the work of Paffenbarger and Watt
(1953) who clearly demonstrated that fly control instituted before and during an out-
break of poliomyelitis failed to reduce the number of cases or to affect the time course
of an epidemic in fly-controlled cities."
In 1959, Mosley344 stated: ". . . [a waterborne route] has been postulated for
poliomyelitis, but no studies have been reported in which conclusive evidence was ob-
tained."
In 1959, Moore 584 reporting on studies in Britain relative to seaside bathing; stated:
"We have had very little success in isolating . . . pathogens [except bacteria] from sew-
age-polluted seawater, partly no doubt because of lack of suitable enrichment procedures.
Attempts to isolate polio virus failed." This author went on to say, "Study of bathing
histories of poliomyelitis patients strongly suggests that in poliomyelitis patients who have
bathed in the weeks preceding the onset of illness, the history of bathing is probably irrel-
evant."
The 1960 Manual of Tropical Medicine by Hunter and others517 has already been
quoted in regard to the indirect and direct means of transmission of polio from feces.
In 1960, Kelly and Sanderson18 reported the finding of polio virus in sewage.
In 1961, Herms195 referred to the fact that flies can harbor polio virus and, under
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62 SOLID WASTE/DISEASE
proper circumstances, can transmit it ... However, proof is lacking." In support of this,
the Texas studies of Watt and Lindsay were quoted.38
In 1961, Chang31 stated, "Of all the enterovirus infections recorded, only two
water-borne outbreaks have been reported, both of poliomyelitis."
In 1962, Wiley and others131 sampled sewage for poliomyelitis virus during an
epidemic and reported "Overall recovery rates in twelve sample series were: 59.6 per-
cent for polio virus type i, 7.4 percent for ECHO viruses, and 3.2 percent for type in polio
virus. Enterovirus isolations varied from zero to 100 percent by sampling area, corre-
sponding with case rates in the various socioeconomic areas. The recovery rates for type I
polio virus from sewage, varied from 37.5 to 75.0 percent in different weeks." Also in
1962, Kabler13 referred to the water-borne outbreaks of polio reported by Clarke and
Chang, but stated that poliomyelitis infections do not appear to be related to water trans-
mission.
In 1959, Downey began a study "To define more clearly the association of entero-
viruses and flies" and, in 1963, reported, "In an urban area . . . where fecal material is
disposed of in the sewage system, it is likely that virus can be recovered from flies only
in the presence of infection of epidemic or near epidemic proportions." 735 The author was
successful in recovering polio virus type i strains regularly in areas with a high degree of
polio virus infection as manifest by clinical disease. "The converse relationship was noted
in the second summer of the study when no clinical disease due to enteroviruses occurred
[in the study locale] and no enteroviruses were recovered from flies."735
In 1963, Horstmann697 stated: "The exact manner in which polio viruses are trans-
mitted from one person to another is imperfectly understood. Close association, however,
such as exists in the family setting, is important in giving rise to contact infections . . .
The main portal of exit is the intestinal tract and large quantities of virus can be found
in the feces often for many weeks and occasionally for many months . . . Whether virus
travels from the pharynx of one person to the oropharynx of another, or whether the
fecal—oropharyngeal circuit is the major one, has not yet been firmly established . . . How-
ever, although the evidence is not conclusive one way or another there is perhaps more
data to support the view that poliomyelitis is an enteric infection spread primarily by
contaminated excreta. Thus a poor sanitary environment is conducive to its dissemina-
tion, a feature which does not have a parallel in infection spread by the respiratory route
. . . Taking all the evidence together, the fecal-oral route seems the more important one,
although direct pharyngeal-oral pharyngeal spread may also play a role, particularly in
epidemic situations." With regard to other modes of spread of the disease, she said, "Extra-
human sources of polio virus spread . . . have never been regarded as being of particular
importance. Although many animal and arthropod hosts collected in nature have been
tested over the years, only flies and cockroaches have yielded polio viruses . . . The role
of flies in dissemination of polio viruses has not yet been clarified ... It is obvious, how-
ever, that flies are not essential to dissemination of polio viruses, since epidemics have
occurred in Arctic areas under climatic conditions which preclude the presence of these
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literature survey 63
insects . . . The interpretation of the findings is difficult, however, and at this stage we
are still unable to fit together the data in a satisfactory manner or to assess the importance
of flies in the over-all epidemiological picture." The author further stated: "Why epi-
demics of enterovirus infection and disease have such a striking seasonal pattern remains
unexplained." 697
In 1964, Lamb found that sewage and river water samples contained polio viruses.
"About one-fourth of the river water samples contained virus. Group B, Coxsackie and
polio viruses were most common . . . Raw sewage yielded the highest frequency of positive
samples (80% )."98
In 1964, Clarke and Kabler39 referred to the isolation of polio viruses from feces
of "both paralytic and nonparalytic poliomyelitis patients". They stated, "The fate of
viruses removed by activated sludge is not clear. Kelly's data suggests that viruses may be
inactivated by biological antagonists in the sludge complex, a suggestion substantiated by
the isolation from sludge of at least four strains of bacteria with antiviral activity. The
data of Clarke and others indicate that virus removal by activated sludge is an adsorption
phenomenon. They were able to recover only a very small percentage of virus from the
sludge-virus complex, indicating that the complex is very stable or that the virus is in
some manner inactivated . . . there are still wide areas of ignorance in our knowledge of
the effectiveness of modern sewage treatment process in removing or destroying viruses in
sewage."39
Weibel et al.40 reported in 1964 only one waterborne poliomyelitis outbreak in
the period 1946 to 1960. Hedstrom in the same year554 experimentally polluted oysters with
polio virus and indicated that they might "function as passive carriers of the virus."
6) Shigellosis. In 1942, Watt et al. 534 found a high rate (80%) of convalescent
carriers of Shigella organisms. The investigators concluded, "Individuals recovered from
diarrheal disease may continue to disseminate the infection days, weeks or even months."
These authors noted a marked variability in carrier rates, however, among various locales
in the United States. They state that the chronic carrier is uncommon and "of little im-
portance to the spread of Shigella dysenteriae." 534
In 1945, Hardy and Watt533 studied acute diarrheal diseases in four widely sepa-
rated regions. They reported that "in all areas investigated, Shigdla paradysenteriae
group was found most commonly in these diseases. No other recognized pathogen was
identified in a significant proportion of the cases studied." They found "for every known
infection (manifest source) there are numerous unrecognized infections (hidden source)."
They also found a very marked variation in the prevalence of the organism, varying from
0.1 percent in New York City to 100 percent in New Mexico, with 4 percent found in
Puerto Rico and 3 percent in Georgia. Deaths in positive cases were limited to infants
under two years of age. Case—fatality rates were widely variant, ranging from no deaths in
Georgia to 15.5 percent in New Mexico.
In 1948, Watt and Lindsay38 studied the morbidity and mortality rates from
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64 SOLID WASTE/DISEASE
enteric infections in towns undergoing fly control measures with controls provided by
towns not undergoing such controls. They concluded, "In the area of high morbidity
studied, a significant reduction in the amount of infection, disease, and death resulted
from the degree of control established. The effect on Shigella infections was greater
than on infections with the Salmonella group of organisms."
In 1951, Hawley et al.135 demonstrated multiplication of enteric bacteria, (Esche-
richia, coli, Salmonella schottmulleri, and Shigella dysenteriae) within flies fed these bac-
teria. There appeared to be a threshold below which the number of organisms fed did
not result in multiplication. In 1952, Dauer53 stated that "faulty methods of handling
food and poor hygiene on the part of food handlers were frequent findings in investigations
of outbreaks of food-borne disease, in which foods other than milk were the vehicles of
infection, according to 1951 reports of such outbreaks." There was only one report of an
outbreak of Shigella infection with indefinite evidence of transmission by food or water,
while seven outbreaks were thought to be person-to-person infections.
In another fly-control study in 1953, Lindsay and others76 found that during effec-
tive fly control in an area of moderate diarrheal disease morbidity, the prevalence rate of
Shigella and the morbidity rate from diarrheal disease was significantly lowered.
Investigating high infant mortality rates from diarrhea and enteritis in the San
Joaquin Valley, California, Watt et al.539 found a prevalence rate of 3.0 percent of Shigella
infection in the children of residents in labor camps and fringe areas of towns in the area
studied. These rates were considerably higher than that in children living in housing
projects with higher levels of sanitation. These authors noted, "Shigellosis has virtually
disappeared from the communities of the United States with a uniformly high level of
sanitation and housing. The relative influence of various factors has not been defined
because improvements in individual housing, water supply, garbage and sewage- disposal,
higher standards of living, and better education are usually concurrent and maybe ac-
companied by, or the result of, community-wide changes."
In 1958, Schliessmann et al. 545 studied the relation of environmental factors to^the
occurrence of enteric diseases in mining camps in eastern Kentucky from June 1954
through June 1957. High morbidity rates from diarrheal disease were found, with Shigella
isolation rates of preschool children ranging from 0.7 to 10 percent in individual areas.
The highest rates occurred in the four-year age group, while in the most poorly sanitated
areas, very early infection was found, with the highest prevalence rates in the two-year age
group. It was found that shigellosis "probably was responsible for the majority of acute
diarrheal disease experiences observed in poorly sanitated areas, but was not a primary
cause in the most well-sanitated area." They could not implicate the fly in the trans-
mission of shigellosis, but transmission of enteric pathogens by polluted water could readily
have occurred since water sources were subject to possible fecal contamination. They re-
ported, "There were, however, no instances in which water quality could be implicated
in disease outbreaks or correlated with seasonal differences in morbidity rates or Shigella
prevalence. Lowest rates of reported diarrheal disease, Shigella-positive cultures and
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literature survey 65
Ascaris-positive stools were recorded among study families served by complete community
sanitary facilities . . . The highest levels of [these] three indexes were reported from pop-
ulations living where community sanitary facilities were entirely lacking. Individuals liv-
ing at homes provided with inside piped water and privy excreta disposal reported approx-
imately twice the diarrhea, and twice the Shigella prevalence, and over three times the
Ascaris infection rate experienced by individuals using inside piped water and flush toilets.
For the population groups using privies, Ascaris infection rates and reported morbidity
rates were one-third lower, and Shigella infections were 50 percent fewer, among those
who had water inside the house than among those whose water source was outside. Where
the water source was outside the dwelling unit, Shigella and Ascaris infection rates were
comparable regardless of water source location or relation to the premises. There were
trends, however, to indicate that lower rates of Shigella and Ascaris infection accom-
panied the existence of installed bathing fixtures. Desirability of installed hot water
systems was also indicated . . . The results of this study strongly support the premise that
incidents of acute infectious diarrheal disease may be reduced significantly through selec-
tive modification of specific environmental factors within communities without regard to
etiological or sociological differences. It is concluded that specific environmental improve-
ments, based on a knowledge of local deficiencies, will invariably effect significant reduction
in enteric disease."545
Moore584 reported in 1959 on pollution of seaside beaches, "A colleague isolated
Shigella sonnei once from direct plates of sea-water at a time when an extensive outbreak
of dysentery was occurring in a community from which the sewage contaminating the sea-
water was derived." Restated: "We have had very little success in isolating [Shigella]
from sewage-polluted sea-water, partly no doubt because of lack of suitable enrichment
procedures."
In 1961 Dauer168 stated: "All outbreaks of shigellosis reported in 1960 were caused
by Shigella sonnei. One waterborne outbreak followed a breakdown in the water treat-
ment plant of a town . . . Another outbreak was traced to the water from a spring in a
picnic area. Another rather large outbreak was reported in which the epidemiologic evi-
dence pointed to some food eaten in a school cafeteria. In another instance students who
ate in a college dining hall became ill with diarrhea, which was confirmed as shigellosis
by laboratory tests of specimens. S. sonnei was isolated from the stools of a cook who
had gastroenteritis 5 days before the outbreak. In another outbreak, S. sonnei was also
isolated from a person who prepared potato salad for a buffet supper in a home."168
Sabin550 stated in 1963: ". . . the impression gained from recent reviews is that
the Shigella bacteria are presumably the chief pathogenic agents of morbidity and mor-
tality from diarrheal disease in populations living under conditions of poor sanitation and
hygiene . . . My own analysis of the available data led me to conclude that, particularly
in children under 2 years of age, the age group that is most important from the point of
view of mortality, the Shigellae and other specific bacterial pathogens, while still impor-
tant, may frequently constitute only a small proportion of the etiological agents." The
author noted that the high death rate due to diarrheal disease in general throughout the
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66 SOLID WASTE/DISEASE
world was in sharp contrast to the rates in this country, in reporting, "The extraordinary
low level of diarheal deaths in infants achieved in the U.S.A. and Canada by 1955 appar-
ently was associated more with other improvements in the standard of living than the mere
provision of water and sanitary disposal of excreta in the homes already in existence in
New York City between 1901 and 1920 . . . On the basis of present knowledge that infan-
tile diarrheal mortality has multiple causes, among which direct transmission of human
enteropathogenic bacteria and viruses by dirty hands, consumption of food that has served
as a culture medium for billions of bacteria, and malnutrition are perhaps the most im-
portant, it is not surprising that it remains an important problem until very high standards
of living are achieved in a population." 55° The author stated that malnutrition is of
especial importance in the rates of infection and mortality of diarrheal in general.
Gordon et al.537 reported in 1963 on the incidence of diarrheas and dysenteries
throughout the world beginning in the year 1900. These authors stated that "Shigellosis or
bacillary dysentery is the most common specific enteric infection among diarrheas of chil-
dren. In countries with good nutrition, . . . this infection (has been shown) to account for
% or more of cases . . . Shigella is less common in diarrheas of preindustrial countries
where diarrheal disease is more prevalent." The role of weaning and malnutrition in
underdeveloped areas is emphasized.
In 1963, Greenberg et al.544 were unable to recover Shigella organisms from flies
or livestock in a Mexican slaughterhouse.
In 1964, Nakamura et al.126 found that Shigella organisms did not survive as long
in natural untreated seawater as compared with autoclaved or filtered seawater. "There
was a wide variation in the ability of different strains to survive in untreated sea-water
. . . The Shigellae were quite resistant to the osmotic effects of high concentrations of
sodium chloride. However, survival depended a great deal on the holding temperature."
Reporting in 1964 on diarrheal disease in a children's home, Rosenstein found that
"while the majority of cases are not of specific bacterial origin, a large number of chil-
dren with Shigella and Salmonella enteritis continued to be seen . . ." 571
Guardiola-Rotger et al. 536 reported in 1964 on the incidence of enteric organisms in
Puerto Rico villages. Both villages studied had "poor living and unsanitary conditions."
The climatic conditions were quite different. "Bacterial enteropathogens were obtained
from 31.0 and 19.0% of the cases studied at Manzanilla and Cialitos, respectively . . .
The incidence of shigellosis was higher at Manzanilla (10.3%) than at Cialitos (3.7%).
Shigella sonnei was isolated from 6 of the 7 cases of shigellosis at Cialitos, whereas at
Manzanilla the Shigella flexneri group was more prevalent. Heavy infestations with other
parasites were also found."
In 1965, Schneierson and Bottone541' studied Shigella prevalence in an underprivi-
leged community by culturing the stools of patients admitted to the local hospital. The
findings indicated "a considerable prevalence of shigellosis in the community . . . Most of
the patients were children, 79% being under 12 years, and 60.6% under 5 years of age.
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literature survey 67
However, a greater degree of infection may be prevalent among adults (in the community)
than is indicated by these data. Adults do not seek medical care for themselves as readily
as they do for their children, especially since the disease is mild and self-limited in
nature."
7) Typhoid and Paratyphoid Fevers. Early observations established the fecal
transmission of typhoid or "enteric" fever and associated the spread with various direct
and indirect modes of infection.388- 548> 355> 354> 356- 360' 336 It was noted that failure properly
to dispose of fecal material and poor sanitation and crowding were associated with the
rapid spread of typhoid fever. Flies were noted to be present in large numbers where
"enteric" was found. These early observers could not dismiss as merely coincidental the
disappearance of enteric fever with the killing off of flies by seasonal change.
The circumstances under which these early observations were made are no longer
prevalent in the United States. According to Dauer in 1952, 53 there were slightly more
than 2,100 cases of typhoid fever reported in 1951 in the country as a whole, with only
three outbreaks of typhoid reported. In the period 1960 to 1964, 3,376 cases were reported
and, in the year 1964, reported cases were 486.351
The hazard of typhoid and paratyphoid infection as a result of bathing in sewage-
polluted sea water was reviewed by Moore.584 This author criticized earlier studies (New
York, 1930's) because of the lack of modern bacteriologic techniques at that time.
Moore examined 859 samples of seawater and stated, "The numerical preponderance of
paratyphoid strains greatly exaggerated their importance . . . The few isolations of typhoid
bacilli may, on the other hand, underestimate the numbers usually present because of the
greater technical difficulty of culturing this organism." Epidemiologic studies were con-
ducted, and it was reported that "An intensive effort has been made during the past four
years to keep track of enteric fever patients giving a history that pointed to an associa-
tion with sea-bathing. The medical officers of health of about 80 coastal administrative
districts kindly looked through their records of sporadic enteric fever notified in the
previous five years to see if the paratyphoid morbidity in costal areas differed signifi-
cantly from the national figures. No evidence of an increased paratyphoid incidence in
seaside residence emerged from a scrutiny of these figures, and surprisingly few of the
figures recorded have been in the age group associated with sea-bathing. As a result of
these inquiries, only four cases of paratyphoid fever giving histories that pointed to sea-
bathing infection have been detected in England and Wales during the past three years.
It so happened that all four were associated with one or another of two beaches that had
been intensively studied by members of the committee, and from which paratyphoid
bacilli of the relevant phase types had been isolated beforehand. Both [beaches] were
grossly . . . contaminated with crude sewage . . . One may then sum up the evidence of
the risk of contracting enteric fever from sea-bathing by saying that less than one case
a year of those that have come to our attention have given a history that suggested a
sea-bathing infection." 584
Dauer in 1961,168 reported on four outbreaks of typhoid fever in I960: "... one
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68 SOLID WASTE /DISEASE
. . . was clearly waterborne, one . . . probably was waterborne, and two . . . were food-
borne. In the first outbreak, six users of well water developed the disease. Investigation
demonstrated that the well was contaminated from seepage from a septic tank used by
a known carrier. In the other small outbreak the two persons affected lived in crowded,
unhygienic surroundings, and had used water from a well that was susceptible to con-
tamination from a septic tank. A resident of the immediate area who used these sanitary
facilities was a typhoid carrier."
In 1964, Weibel and others40 reported that, in the 15-year period, 1946 to 1960,
there were 39 reported outbreaks of waterborne typhoid fever consisting of 506 cases.
Eight deaths resulted.
Hans Fey324 stated in 1964 that typhoid fever occurs partly through contact be-
tween persons, but chiefly through pollution of water and food. He stated that primitive
living conditions and insufficient waste disposal are major factors in epidemicity. He
stated further that paratyphus A infections had the same mode of transmission as of
typhoid fever. In paratyphoid B, man is considered the primary source of infection in
the great majority of cases; however, the disease organism is occasionally excreted by
animals and transmitted by means of food. The latter mechanism occurs but rarely in
Europe. This author considers paratyphus c as a zoonosis in that the organism is found
in meat animals rather than in man.
In the same monograph Lachowicz stated: "A very serious problem in the con-
trol of typhoid is sanitation, especially that of the water supply in the sewage disposal
in the geographic regions where water sources are scare and people are forced to use
surface water (for example, some middle Asian Republics of the U.S.S.R.)." 324
In regard to the presence of endemic areas of importance in this age of rapid
transportation, the following conclusion is drawn in the chapter "Les Salmonelloses en
Afrique": "Among the distribution of serotypes of salmonellae in the countries of Africa
cited in example, . . . S. typhi is the most frequent serotype in man."324 Also in this
reference, the effect of war on typhoid prevalence in Eastern Europe was noted: "Before
World War II typhoid and paratyphoid incidence in the U.S.S.R. had decreased to a level
of about 50 cases per 100,000 population as judged from figures available with respect to
the Ukrainian S.S.R. in 1940. There was a great increase in typhoid and paratyphoid
incidence during the war but it ceased soon, and not only the inter-war level but also a
further decrease in the incidence has been achieved. It may be illustrated again by the
typhoid morbidity rate per 100,000 population in the Ukrainian S.S.R. which amounted
to 57 in 1947, to 18 in 1950, to 13 in 1953, and to 12.3 in 1956. A decrease trend like
this, however, has not been observed in all the Republics. As a result the average typhoid
morbidity rate for all the country in the mid-fifties constituted about half of that in the
last inter-war years, probably about 25 per 100,000 population. The decrease trend
ceased in the 1950's." A similar decline of typhoid and paratyphoid incidence was re-
ported for Hungary and Romania but it was stated, "This is to a certain extent an
exception among the Eastern European States as there has been only little change in its
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literature survey 69
typhoid—paratyphoid morbidity rate during the last 40 years. If, however, typhoid and
paratyphoid are considered separately, a decrease of the typhoid incidence and an in-
crease in the paratyphoid is apparent." 324
In the same monograph, the decrease in "enteric fever" in Canada from the be-
ginning of the century was noted. It was pointed out that "with the improvement of
sanitation and hygiene, the wider distribution of pure (treated) community water sup-
plies and of pasteurized milk, the limited use of TAB vaccines, improved methods of
bacteriological diagnosis and a concerted effort on the part of medical officers of health
to search out 'carriers,' the enteric fevers . . . typhoid and paratyphoid . . . have been
slowly but steadily decreasing . . ." It was noted that in 1962, there were only 268 cases
of "typhoid and paratyphoid" for all of Canada or a rate of only about 1.5 per 100,000
population. 324
Middelkamp 541 stated in 1965 that, "Typhoid fever is still one of the most com-
mon febrile illnesses encountered in infants and children in tropical and subtropical coun-
tries. The most significant factors that effected the decrease in prevalence of this dis-
ease in the United States were: (1) The use of methods that provide us with sanitary
food, water, and milk supplies; (2) detection of carriers and prevention of their employ-
ment as food handlers; and (3) The administration of typhoid vaccine. This paper is a
current appraisal of our experience with typhoid fever in pediatric patients . . . during
the 15-year period 1950-1964. Over this 15-year period there is a decrease in the num-
ber of patients hospitalized with typhoid fever . . . Sixty-seven percent [were] under six
years of age. Twenty-eight of these children lived in the city while twelve were from
rural areas." The investigation of the cases showed that five Salmonella typhi carriers
were found in a survey of the contacts of the patients. Two of the carriers were the
patient's mother, one a grandmother, one an aunt, and one a neighbor. One child, an
infant, died. One child remained a carrier for five months following his discharge from
the hospital. This author quotes Ashcroft as stating that, "Protection by good vaccines
may be partial . . . The immunized individual may be protected against a small number
(of organisms), but such an immunity could be overcome when a large number . . . are
ingested." 541
In a 1965 report, Van Der Schaaf and Atteveld80 stated, "Biological sewage
treatment is applied on a large scale in the Netherlands. In most cases suspended and
dissolved organic matter is removed satisfactorily, but from the point of view of a vet-
erinary and medical bacteriologist, the removal of pathogenic bacteria is far from com-
plete. This causes contamination of the water in nearly all the canals, lakes, rivers, and
even small brooks." These authors make the following interesting comment: "Although
typhoid officially does not occur in Utrecht, S. typhi can be cultivated from nearly every
sample of effluent. Sometimes it was possible to isolate S. typhi for the first time from
samples which had been stored during one month up to six weeks in a refrigerator. By
that time quite a number of other kinds of salmonellae had already died off and conse-
quently no longer hindered the isolation of S. typhi."
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70 SOLID WASTE/DISEASE
8) Tuberculosis. Solid waste has been implicated in the spread of tuberculosis.23
Experimental transfer to culture media of the bacilli by flies was reported in 1907 by
Buchanan. 36° The relation of flies to waste has already been documented in this report.
Graham-Smith121 in 1913 noted that flies could carry tubercle bacilli but that "In con-
sidering this relation to infection in the human subject the influence of dose must be
taken into consideration" (p. 179).
In 1965, Szulga and others 6 were able to isolate human tubercle bacilli from the
milk of cows and from sewage used for fertilizing pastures. In the same year, Buczowska30
found that sedimentation and biologic purification did not remove tubercle bacilli which
had survived in the sewage during the flow to the treatment plant. This author reported
that disinfection of hospital and sanitarium sewage by means of discontinuous chlorina-
tion in "small, uncontrolled treatment plants" proved ineffective. It was noted that con-
tamination of the domestic sewage tested was derived from an area where the morbidity
index of active tuberculosis among the population was 124/10,000. The danger from the
use of sewage for the irrigation of forage-crop fields was noted. It was also stated,
"Slaughterhouse wastes may be regarded as contaminated if they are derived from
slaughtering cattle with a high percentage of tuberculosis infection."
9) Worm (Helminth) Infestations. Fecal-borne human helminthic infections
are well recognized. In 1940, Craig and Faust319 stated that "Sanitary disposal of human
feces containing the viable eggs of these tapeworms (Diphyllobothrium latum) will pro-
tect communities ... In all known tapeworm infections, except ocular sparganosis . . . the
portal of entry is the mouth. Sanitary disposal of human excreta and those of domestic
animals constitutes the more fundamental and more urgent public health problem." In
regard to Ascaris lumbricoides, the authors stated: "Man is apparently infected only
with eggs from human sources. Human infection is acquired by ingesting fully embry-
onated eggs which have been accidentally picked up from the soil polluted by the same
or other human beings, or from food or drink contaminated by viable eggs. Young chil-
dren are more commonly infected than adults and more commonly pollute the soil."
Schistosomiasis also arises from improper disposal of human feces. Although inter-
mediate hosts (snails) are involved in the transmission of this disease, their infection
derives from water polluted by human feces. The above authors stated that "All of the
snails involved are sewage-feeders." 319
In 1956, Lindsay and Scudder75 stated that "Without indicating the degree of
importance, it may be said that flies constitute one mode of transmission for the agents
of such diseases as ... helminth infections." The importance of improper disposal of
fecal waste is contained in a statement by Smith,332 who wrote in 1957, ". . . It has been
estimated that perhaps some 200,000,000 people may be infected (by shistosomiasis)."
This author also referred to the modern practice of crowding farm animals together so
that they become contaminated by their own feces, whereas, in nature, they tend to
avoid such contamination.
In 1958, Schliessmann and others 545 reported on the high rates of helminthic in-
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literature survey 71
factions among children in mining camp areas in the United States. They noted that the
incidence of infection was related to the method of disposal of human feces.
Hunter and others, in 1960,517 also relate diseases due to helminths to improper
human fecal disposal (pp.411, 412, 419, 420, 498, 503, 530, 547, 553, and 556).
In 1961, Chang31 stated, "Municipal water supplies are not known to be involved
in spreading infections by any nematode. But small rural supplies in certain endemic
areas could carry hookworm or strongyloidal larvae washed into the water from infected
soil. These supplies constitute a mode of transmission of minor importance as compared
to the soil itself." This author also speculated on the possibility of nonpathogenic nema-
todes ingesting pathogenic bacteria and so protecting these bacteria from sewage treat-
ment processes, so that they might survive and serve as sources of human infection. He
noted, however, that "The chances (for this) are so small that the possibility must be
considered as very remote." 31
In 1961, Beye and others575 reported on the parasite reservoir in the United
States and attested to the high incidence of helminthic infestations among the families
of migratory laborers and among residents coming from tropical and subtropical lands.
The possibility for spread to others in the community was noted. "Migratory agricultural
workers number 1.25 million individuals, approximately one-half nationals from outside
the United States and one-half workers from the Southern States. A population of
this size may present public health hazards with respect to protozoan and helminthic in-
festations and diseases." They go on to say that "Although there are as yet no docu-
mented instances of greatly increased transmission of protozoa and helminth associated
with agricultural migration, this does not mean that increased transmission is not occur-
ring. It could reasonably reflect that few are looking for signs of infection and the dis-
ease is not yet manifest." 57S
Jenkins227 stated in 1961 that ". . . the possibility of worm diseases being spread
by sewage sludge is considered." He said, "Digested sludge from Pretoria could suffer a
100 percent reduction in viable ova of Ascaris, . . . but sometimes only 85 to 95 percent
inactivation resulted." This author also quoted another study to the effect that digesting
sewage sludge for 20 days at 35° C was necessary to inactivate the eggs of Taenia sagi-
nata, the human beef tapeworm.
In 1962, Thomas W. M. Cameron558 had this to say: "Taking the world as a
whole, it was realized that parasitic worms had an importance comparable with the bac-
teria, the protozoa, the spirochetes, the rickettsiae, and the viruses; in fact, in everyday
deterioration of health, as causes of chronic debility, they are of more importance to the
world than the acute infections caused by the microbes." He went on to say that ".. . the
common pinworm Enterobius vermicularis . . . infects nearly 50% of individuals in tem-
perate climates, even when a relatively high standard of hygiene is maintained. The
trichina worm . . . can also be extremely common, as it is in the United States .... Hook-
worms and bloodflukes can be included among the causes of the half-dozen most serious
diseases of mankind. Ascarids are just as common although possibly less serious and are
291-982 O - 68 - 6
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72 SOLID WASTE/DISEASE
widespread." The authors repeatedly refer to the importance of fecal contamination as a
result of improper disposal, poor personal hygiene or other practices which lead to con-
tamination of food or other agents of transfer. 55B
In 1962, Chang and Kabler101 reported that ". . . The possibility that the effluent-
borne nematodes are carriers of human enteric pathogens is quite remote under normal
conditions."
In 1962, it was reported316 that "The life cycle of (the common tapeworms) is
maintained in areas where there is unsanitary disposal of human feces and access of the
domestic animals to feed or water that has been contaminated with the excreta of a
human being who harbors the tapeworm . . . The importance of the problem in different
countries varies with the extent to which sanitary disposal of human feces is practiced,
and with the meat eating habits of the people." This book quoted Schwartz (1956) as
saying that in the United States about 16,000 to 27,000 infected beef carcasses were
found annually in abattoirs under Federal inspection, "However, to point up the im-
portance of local conditions, Schwartz (1938) cited three examples of outbreaks of bovine
cysticercosis with high rates of infection due to contamination of the feed and water with
human excreta."316
The importance of fecal sanitation is indicated in a report (1964) by Guardiola-
Rotger and others 536 who found 80 percent of children in a village in Puerto Rico infected
with helminths.
Human fecal contamination of the soil has been found by Beaver (1964) to be re-
sponsible for occupational disease . . . creeping eruption . . . among workers who must
crawl over infected soil.557
In 1965, Fair and Geyer215 reported that "the utilization of sewage sludges is cir-
cumscribed by the hygienic hazards found. Pathogenic bacteria, viruses, protozoa, cysts,
and worm eggs, can survive sewage treatment and be included in the sludge. There, they
will persist for long times and cannot be fully destroyed by digestion or air-drying. Al-
though the numbers of surviving organisms decrease appreciably in the normal course of
events, only heat-dried sludge can be considered fully safe . . . Wet-sewage may be pumped
on to land and plowed under . . . Sewage sludges may be discharged into water. Sea
coast communities may transport . . . sludge to dumping grounds at sea. Wet-digested
sludge may be discharged into large streams (more particularly in times of flood runoff)
... or it may be pumped to deep lying and hydraulically active portions of tidal es-
tuaries."
In 1966, Walters and Holcomb 383 stated, "Nematodes ingest enteric bacteria in
certain sewage treatment processes and carry them out into the receiving streams. The
absolute number of pathogens found would seem to be of secondary importance. If any
enterics are ingested it seems logical to assume that enteric pathogens would be ingested
in large numbers if the concentrations were very great in the sewage as would be the
case in a local epidemic of a disease like typhoid fever."
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literature survey 73
DISCUSSION
1) Amebic Dysentery. Amebiasis due to E. histolytica is endemic in this country:
The literature does not permit a clear explanation of how it is maintained, but reservoirs
obviously exist in both large cities and rural communities. Carriers exist and presumably
transmit the cysts by direct contact and by contamination of food or water.
If, as has been stated,31 transmission by water from municipal treatment plants
is improbable, infections where treated water is provided must derive from gross fecal
contamination of food or direct contact.
These modes imply, where treated water is available, insanitary disposal of feces,
failure to use the water supply for washing, or both.
Increasing levels of infection are associated with heavy fecal contamination of the
immediate environment563; when this occurs, direct person-to-person or vector trans-
mission is said to take place.
2) Cholera. Cholera is not found today in the United States. It is a fecal-bome
disease in which fecal contamination of the environment and direct contact appear to be
the chief modes of transmission. It is frequently referred to as a water-borne disease.
Flies are implicated as transmitters where they have access to human excreta containing
the organisms.
There are endemic foci in the world which provide potential sources of dissemina-
tion to countries now free of the disease.
3) Coxsackie Disease and Poliomyelitis. Although the viruses of these diseases
are found in human feces and in flies having access to feces, the modes of transmission are
still somewhat obscure and will probably remain so for some time. The widespread but
incomplete use of polio vaccine serves to confuse epidemiologic investigation of polio-
myelitis spread. The consensus is that both diseases are fecal-borne rather than con-
veyed by the respiratory route. The degree to which they are transmitted by direct or
indirect means is unknown.
4) Infectious Hepatitis. Transmission of this disease is chiefly through direct
contact or fecal contamination of water supplies, with the former responsible for the
greatest number of cases. Since there is a higher morbidity rate reported from cities
using filtered water as compared to those using groundwater, there is a question as to
whether municipal and other water and sewage treatment is sufficient to remove or in-
activate the causative agent. (This comment applies to other viruses as well.) The failure
or lack of sewage treatment to inactivate the virus is borne out by the finding of out-
breaks traced to shellfish growing in polluted stream estuaries. Higher rates of infection
associated with the use of privies incriminates this means of fecal disposal.
5) Shigellosis. This disease is apparently of lesser virulence in the United States
than in countries of the Far East. Prevalence is related to overall sanitation, with the
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74 SOLID WASTE/DISEASE
lowest levels found where full sanitary facilities are available and the educational level is
high. The fecal source of the infection is obvious, although the mode of transmission
varies. Good personal hygiene, waterborne disposal of excrement, and indoor water sup-
plies and bathing facilities are all necessary for reduction of infection.
6) Tuberculosis. In the United States, there appears to be no evidence of fecal
transmisison of tuberculosis, although this mode of infection seems possible in other
countries.
7) Typhoid and Paratyphoid Fevers. In the United States, the typhoid carrier
is the chief source of infection, regardless of the exact mode of transmission from the
carrier to the victim. Carrier-contamination of well water from privies or septic tanks is
documented. Where flush toilets and adequate treatment of water supplies are not avail-
able, waterborne outbreak of typhoid is possible. That sewage treatment is not neces-
sarily dependable in suppressing typhoid is evident from European studies. Infection of
children by familial carrier contact is a significant mode of infection.
The incomplete protection from vaccines complicates the interdiction of trans-
mission and the development of the chronic carrier state is common.
8) Worm (Helminth) Infestations. The fecal transmission of human helminthi-
asis is well documented. Where environmental contamination by feces is permitted, high
infestation and prevalence rates persist. The hazard of failing to provide good sanitation
for migratory workers, both to themselves and to the general public, is made evident by
the high incidence of helminthic infection among these groups. Sewage sludges have been
found to harbor the eggs of pathogenic helminths, raising the question of the safety of
using unsterilized waste sludge as fertilizers or soil conditioners.
9) General Discussion. There are a number of unresolved questions about the
fate of fecal pathogens in the environment. The fact that typhoid organisms can be cul-
tured from refrigerated surface water specimens in which suppression of other organisms
has occurred, but not in unrefrigerated specimens, and the extremely low numbers of
typhoid bacteria necessary for infection of susceptible individuals, suggests that changing
environmental temperature in association with this organism following its excretion de-
serves further study.
Viruses provide a source of concern in that their fate in sewage effluents and sur-
vival in water ultimately used for drinking is not denned. It appears that some of them
may escape destruction in both sewage and water treatment operations. Further, dosage
factors are not well denned. The agent of infectious hepatitis has not even been
identified.
The morbidity of a number of human fecal-borne diseases in the United States
is high enough to suggest that considerable environmental fecal contamination occurs.
The contribution of individual modes of transmission to this morbidity is essentially un-
known. The influence of insanitary foci on the overall incidence of these diseases is also
obscure.
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literature survey 75
Laboratory and epidemiologic methods need further development to help in an-
swering the questions arising from these and similar gaps in our information. Further-
more, the relative importance of socioeconomic conditions and cultural practices in
contributing to dissemination of fecal-borne disease of human origin is not fully denned.
CONCLUSIONS (HUMAN FECAL-BORNE DISEASES IN GENERAL)
The worldwide misery and death due to diseases of human fecal origin have been
made evident. In the United States, infant mortality and adult morbidity are high in
certain populations lacking sanitary fecal waste disposal. These groups are a continuing
risk to themselves and to the remainder of the population.
Certain municipal areas, geographic regions and industrial and agricultural activ-
ities in the United States have entirely inadequate facilities for the proper disposal of
human feces and thereby provide a grave risk to the persons directly exposed. They also
constitute chronic reservoirs for the spread of infection beyond their borders. The Sta-
tistical Abstracts of the United States for 1962 (Bureau of the Census, Department of
Commerce) states that, of 59,326,000 housing units identified in the 1960 census, 18.2
percent (10,615,332) lacked or had dilapidated plumbing facilities. ["Plumbing facilities"
are defined as (1) hot and cold running water inside the dwelling; (2) flush toilet and
bathtub or shower inside.] A further 7.8 percent showed deterioration of facilities.
Nearly 6 million (10.3%) had toilet facilities other than flush toilets or none at all (see
p.xxxviu); 7.1 percent lacked inside piped water (p.xxxvi).
While other factors — water pollution, lack of washing facilities, human carriers,
personal hygiene, flies and possibly other vectors — contribute to the dissemination of
these diseases, failure to dispose of human excrement in a sanitary manner and to destroy
the contained pathogens is by far the most important factor.
RECOMMENDATIONS
In general, fecal wastes must be disposed of in such a way that they cannot con-
taminate the immediate environment; that vectors are denied access to them; and that
they cannot contaminate food or water supplies. Corrective measures must be applied
to the extent that these criteria are not met.
The literature makes clear that sanitary waste disposal alone will not realize
optimum prevention of disease. However, little can be accomplished without it. There-
fore, the first recommendation is:
1) Installation of Sanitary Feces Disposal and Treatment in:
Substandard permanent residential areas in or bordering municipalities
Rural residences
Migratory and construction labor camps and other transient residential areas
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76 SOLID WASTE/DISEASE
Municipalities where sewer overload and treatment plant bypass by sewage is
possible
Small communities lacking adequate sewerage or treatment plants
Industrial plants failing to supply or use adequate facilities
Special problems attendant on local economy, geology, water supply, governmental
jurisdiction and effectiveness of known methods of disposal and the like will have to be
overcome. An existing technology is available to provide sanitary waste disposal and
treatment, but other factors may interfere with its application, for example, the costs
per capita for sewerage in the small community, the isolation of rural residences and the
renovation and sewer installation costs in older community areas. New techniques may
be required and this suggests the second recommendation:
2) Research on Disposal of Fecal Wastes
While waterborne disposal of feces seems to be the most protective of the present
methods of disposal, especially of the immediate environment and individuals involved,
the prevention of more widely disseminated disease does not appear entirely assured under
present treatment methods.
Definitive, integrated studies on the fate of viruses and other fecal pathogens in
disposal systems should be instituted. The efficacy for the destruction of pathogens of
various treatment methods, both of sewage and of drinking water supplies, should be
investigated.
The use of fecal colon organisms is no longer dependable as the sole criterion for
water quality. A bellwether human virus, or bacteriophage, should be identified, if pos-
sible, to serve as the E. coli of the submicroscopic organisms.
Controlled studies on entire regional waste disposal and water supply systems
should be carried out to define fecal-borne disease hazards. They should include inte-
grated microbiologic and epidemiologic studies within the regional systems and among
insanitary foci and their environments.
Further, new methods of destruction of pathogens may be required. A recent
report by Allen and Soike (Science, 1966, 154:155-157, October 7) refers to complete
and almost instantaneous destruction of microorganisms, including a virus (the bacterio-
phage T-2), by electrohydraulic treatment of suspensions of these organisms. The ap-
plication of such innovations to sterilization of wastes or drinking water should be
studied.
Although not applicable at present in the United States composting of night soil
is of considerable interest to some countries. Its safety is not fully denned.
New and varied approaches may have to be used to correct deficiencies in fecal
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literature survey 77
waste disposal at places of rural, isolated and transient human occupation. Advance
biological treatment systems should be studied for use under these circumstances.
In summary, a large number of studies and research projects are needed to define
or refine our knowledge of fecal-borne disease. Presently available techniques of fecal
waste disposal and treatment however, are sufficiently dependable significantly to reduce
existing morbidity in areas lacking these techniques. Therefore, corrective action does
not always require the completion of extensive research projects. Nevertheless, the prob-
lems of the future — increasing populations, limiting pollution levels, costs of sewerage,
limited space and the like — require that systematic research be instituted in the near
future.
3) Public Education
Although some authors feel that much can be done to prevent human fecal-borne
disease without education, or that education will accomplish little, especially in the ab-
sence of disposal sanitation, these views may be prejudiced by the limits of present edu-
cational material or effort.
This education must begin with the very young and in the schools. It is recognized
that lack of sanitary disposal facilities and easily accessible water supplies can tend to
defeat education, but a demand among the instructed could develop for better sanitation
and hygiene. Much bad personal hygiene is due to familial and cultural practices or to
ignorance, yet good personal hygiene can exist with rather primitive sanitary facilities.
Joint research efforts are required to develop effective educational material and
effective means of teaching and motivating people in guarding against the spread of these
diseases.
4) Disaster Waste Disposal
What has been developed so far in this field should be summarized and made a
part of the total solid waste body of knowledge. In addition, criteria should be developed
and applied within the waste-disposal research program.
Disease Associated with Animal Fecal Waste
Other fecal-borne diseases in which man's domestic animals are the reservoir
hosts, or which can serve as hosts, are known to infect man. They comprise all of the
major categories of microorganisms noted above under diseases of human fecal origin.
Figure 5 shows possible modes of transmission.
GENERAL
Hull167 lists a number of zoonoses which are transmitted to man by way of animal
feces (pp. 915-924). He mentions first, the intestinal protozoan, Balantidium coli of the
pig (pp. 435-436); second, some of the helminths such as the pig Ascaris and animal tape-
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SOLID WASTE/DISEASE
worms (p. 444); third, the hydatid worm, Echinococcus granulosus (p. 445); fifth, the
salmonellae for which animals are the main reservoir (p. 210) etc., and fifth, a small num-
ber of other infective agents. He states that although there are large numbers of species
of protozoa found in vertebrate hosts, very few are known to infect man. The species of
helminths of animals transmissible to man were reviewed in 1962 by Reed and McMillan, s58
HUMAN INFECTION,
DISEASE,
MALNUTRITION,
DEATH
DIRECT CONTACT OR INOESTION
FIGURE 5. Animal fecal waste/disease relationships (postulated).
In view of the breadth of subject, it will be impossible in this report to review all
of the diseases in this group individually; it must suffice to show the complexity of the
problem of zoonoses in its association to waste by reviewing the subject of salmonellosis
and referring only briefly to some of the others. In this section, the salmonelloses of
human origin will not be discussed.
The relationship between flies, wastes, and the salmonelloses are covered elsewhere
in the report. In summary, flies are known to transport the bacteria; in some cases, the
bacteria have been shown to multiply within the fly.
EVIDENCE
1) Salmonellosis. In 1947 the medical research council of London reported on
the importation of strains of salmonellae to Britain during World War II.547 These
strains were noted not to have been found in Britain previous to the war. They were
traced to imported dried egg products from the United States, Canada, and the Argentine.
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literature survey 79
The report concluded that "the epidemiological and bacteriological evidence submitted in
this report leaves little doubt that the introduction into this country of American spray-
dried egg led to a considerable increase in the amount of food poisoning and other forms
of Salmonellae infection in the human population, and to infection of some, at least, of
our farm animals". In the United States, of 53 outbreaks of poisoning occurring in 1951
in which "poultry, meat, and eggs, were found or suspected to be the vehicle of infec-
tion," eight proved to be caused by salmonellae. 53 In that year, a total of 850 clinical
cases were reported.
In 1953, in a study of a California county, Watt539 and others found that salmonel-
losis was a relatively infrequent infection in all the California groups studied. The prev-
alence rate found was only 0.4 percent. The study groups were in labor camps and in
town fringe areas.
Hull,167 reporting on a study by McCullough and Eisely, stated that twelve strains
composing six types of salmonellae all caused illness in human volunteers when sufficient
numbers of the bacilli were fed. Within these types and strains, however, the infective
dosages ranged very broadly. Hull stated that most domestic animals and commensal
rodents harbored the infective agents. Man was also a host and could spread the disease
through his own feces. Hull also discussed modes of transmission through contaminated
meats and eggs. He stated that Hobbs in England incriminated boneless meats, carcass
meats, meat and bone meals for fertilizers, and animal feeding stuffs as providing sources
for salmonellae contamination. Canned meat, packaged mixes for the kitchen, bakery
goods, dried eggs, and many other food substances have also been determined to be
vehicles for transmission of the disease agent (pp. 210-231).167
Jellison reported in 1951 on attempts by others to transmit salmonellosis by means
of fleas.156 The pathogens were noted to survive in the fleas for up to 96 hours, but trans-
mission by bite was not demonstrated.
In 1958, Schliessmann and others 545 were able to demonstrate only rare salmonellae
isolations from over 11,000 rectal swab cultures collected from mining camp populations
in the United States.
In 1958, one text682 stated: "The source of all Salmonellae infections is a reservoir
or organisms living in the tissues of human beings or animals. Infections occur through
food, milk, or water contaminated with infected feces or urine, or by the actual ingestion
of the infected animal tissues. . . . Infection with most Salmonellae apparently requires
the ingestion of large number of organisms, but in the case of S. typhosa relatively few
bacilli are sufficient to cause typhoid fever." The means by which water may be con-
taminated by infected feces is discussed, and human infection due to shellfish contam-
inated by polluted waters is noted.
In 1959, Smith discussed the transmission of salmonellosis in association with
slaughterhouse procedures and the part played in salmonellae infection in animals by
infected feeding stuffs.
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80 SOLID WASTE/DISEASE
Harvey and Phillips695 noted in 1961 that a large bakery was demonstrated
to be regularly contaminated with salmonellae. Many serotypes were found in abattoirs.
They stated: "Parallel examination of abattoirs, swabs, and excreta from human infections
for S. typhimurium . . . provided information of the geographically local nature of much
sporadic illness due to this serotype . . . The phage-types of S. typhimurium isolated from
the slaughterhouses not infrequently corresponded with the strains isolated from human
infections."
In 1961, Anderson and others342 reported on a two-month period in 1958 in which
55 separate food-poisoning incidents, comprising 90 cases due to Salmonella typhimurium,
phage-type 20a, were reported in Southeast England. There was one death. It was stated
that "though not conclusive, the evidence strongly suggested calf meat as the vehicle of
infection in at least three-fifths of the incidents."
In 1961, Dauer168 stated that in disease caused by salmonellae organisms, "The
wide distribution of the many types of this organism in many species of animals with
which man has contact or may use as food makes it difficult to prevent transmission to man
... In addition to the animal sources of infection, human carriers and patients have many
opportunities to contaminate food ... it can be argued persuasively that there is a real
need to improve the reporting of both waterborne and foodborne illness as the first step
of the development of effective control measures. There is also real need to study more
intensively and extensively the epidemiology of ... Salmonella infections because these
causative agents are widely distributed and their ecologic factors are complex."
In 1962, Ayers 316 reviewed the material on salmonellosis due to contaminated food.
He noted the worldwide distribution of salmonellae types by the importation of animal
and human food stuffs.
Pratt and Wiseman stated in 1962 in regard to salmonellosis: "Meat and other
foods contaminated by unsanitary conditions, including infective feces of rats and mice,
are generally considered to be the prime source of human infections. It is possible that
human infection can be contracted directly from the bite of an infected flea or from food
stuffs contaminated with their feces." 398
In 1962, Galbraith and others104 stated that "survey of garden fertilizers in Eng-
land revealed 13 percent contamination with salmonellae." Concern was expressed for
permitting such fertilizers to be sold in shops selling food for human or animal consump-
tion. It was stated, however, that "the risk [of spreading infection] is probably small."
The hazard of using fish wastes and offal was discussed in 1962 by March and
others.583 In this report, Shewan stated: "From the small amount of data available, it
is clear that fish and fishery products can be the vehicle for all of the more important
types of bacterial food poisoning (including salmonellosis)." Shewan stated further that
"all the available evidence shows . . . fish normally do not suffer from salmonellae ... in-
fections. . . . They may well carry these infections if caught in polluted waters but this
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literature survey 81
risk is of much less importance in marine fish than in fresh water species for the dangers
of pollution in rivers and lakes can be very real." This author summarized data on infec-
tion of fish taken from rivers of probable high contamination with the disease organism,
and added that "although it is not suggested that the fish suffer from these infections,
they do appear to act as intermediate hosts for man, with the lakes themselves acting as
immense reservoirs." He stated also that fish caught in the open sea are free from sal-
monellae and the shigellas. "It is to be expected, however, that once the fish have been
handled on ship and on shore, some contamination from human sources is likely to ensue.
Fecal contamination, as evidenced by the presence of E. coli and fecal streptococci, in-
creases during handling and processing." Shewan also said that "in recent years there has
been an outburst of salmonellae epidemics, chiefly in West Germany, which could be
traced to imported fish meal. These salmonellae spread to humans via livestock."
In this same reference,583 Kawabata noted the high incidence of salmonellae food
poisoning in Japan where fish consumption is high. Cultural habits, particularly those of
eating fish raw, are noted as playing an important part in these infections. Guelin noted
contradictory findings among authors reporting prior to 1962 but stated that, "as a whole,
the results show the accidental character of the presence of Enterobacteriaceae in fish."
He then reported on experiments on the artificial contamination of a single species of fish
with E. coli. He found that the contamination by both the bacteria and by coli phages
was not of long duration, but stated that it would be necessary to repeat the experi-
ments with other species of fish and other enteric bacteria. In the same reference,
Buttiaux stated: "Recent publications have proved the negative results of studies under-
taken to find salmonellae and other enterobacteria of fecal contamination in marine fish
caught in the open sea. Certain observations indicate, however, their presence in fish
when they are marketed fresh or dispatched from the filleting or icing establishments."
He said that "edible oysters, mussels, and other shellfish are, on the other hand, very
often infected by salmonellae, because the indispensable sanitary precautions are neg-
lected in the cultivation areas." In regard to the survival of salmonellae and other entero-
bacteria in seawater, he stated: "The data hitherto collected are still highly inadequate.
... It is generally considered that salmonellae are no longer found where E. coli and coli-
forms are controlled or have disappeared. This reasoning results from the neglect of two
basic principles during experimental studies." He stated also that "[Some] publications
show that it is not exceptional to find viable salmonellae in seawater contaminated by
polluted water . . . Other authors have confirmed that fish never contain coliforms when
caught in the open sea . . . stated that on the other hand everybody recognizes that fish
may become infected through their intake of food when staying in seawater contaminated
by sewage water or polluted rivers. This rule applied also to freshwater fish." He noted
the problem of poor sanitation in the spread of salmonellae to fish, and added that
"salmonellae carried into the sea by an outflow of untreated sewage effluents may easily
contaminate mollusks and fish in adjacent waters. . . . Those [fish] caught in polluted
littoral zones may be contaminated by bacteria. Most salmonellae in fish are procured in
the handling, transporting, or processing operations when these are carried out under in-
adequate sanitary conditions. Edible mollusks concentrate salmonellae in their bodies . . .
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82 SOLID WASTE/DISEASE
such mollusks are readily infected when sewage effluents are not strictly controlled in
coastal areas where they grew."
Salmonellae infection and prevalence are noted to vary in various regions. 694-5SO'537
In 1963, McCoy 103 stated: "Of the pathogenic organisms present in crude sewage,
which consists essentially of human excreta suspended in the waste waters of the com-
munity, organisms of the Salmonella group, which are widely distributed in man and
animals, are by far the most common. . . . salmonellae of animal origin in towns are de-
rived from trades and industries processing animals and their products for human or
animal use. These sources include: abattoirs, butcher shops, the make-up meat industry,
poultry processing plants, egg breaking plants, bakeries, tanneries, knackers, knacker's
premises, animal fat extraction plants, meat-meal and bone-meal plants, animal feeding
stuffs plants, and fertilizer plants." This author stated that salmonellae can survive on
vegetation and in the soil from three to seven days and up to 280 days respectively. He
said "under natural conditions the disappearance of salmonellae from polluted vegetables
is slow and inconstant . . . experimentally, the numbers of bacteria contaminating the
vegetation or soil seemed to be the most important single factor in the disappearance of
salmonellae from them." 103
The proceedings of the March 1964 National Conference on Salmonellosis693
discusses the pervasive worldwide problem of the salmonellosis. In this reference, Ca-
nadian authors Yurack and Best of Canada state ". . . since 1955, there has been a steady
and marked increase in the reported incidence of human Salmonella infections other than
typhoid and paratyphoid . . .". They concluded that human salmonellosis in Canada was
steadily increasing and that greater numbers of salmonellae were being isolated from
animals in a wide variety of processed human foods.693
Newell693 noted that salmonellosis was an important disease in the United States
and in most countries of the world but that "the real human mortality related to this
cause is unknown." He stated that "most salmonellae can infect most hosts, but the
dose of organisms required to cause an infection in the occasional host may be very large
indeed." In one cycle of animal-to-man infection, he noted that an intermediate stage
was necessary, allowing multiplication of the organisms to take place. He thought it was
possible for some human infections to be caused by air-borne transport of the organism.
He concluded that "the prevention of man-to-man transmission by environmental meth-
ods or by the control of excreters or carriers is unlikely to result in a large decrease in
human salmonellosis. The education of whole populations about the dangers of certain
uncooked foods kept at room temperatures is unlikely to be successful in the short term
without a major change in food preparation and eating habits, and is impractical. That
certain direct and indirect contacts from animals to man can be made Salmonella-free
has been demonstrated in the United Kingdom egg legislation of 1963. However, it is
improbable that all such contacts can be policed in this way. Therefore, the most work-
able and immediate solution must be the selective breaking of the animal cycle starting
with the most controllable domestic animals whose specific salmonellae are most impor-
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literature survey 83
tant to the human population of a particular geographic area. I consider that such a
selective attack upon the animal cycle is both possible and economical in this country.
The host of first choice would probably be domestic poultry" (p. 42). In the same work,
Thatcher (p. 61) notes the problem of the modern mass-producing convenience food in-
dustry in the spread of salmonellosis.
Steele and Quist (p. 72) state that "there is a high prevalence of Salmonella in-
fection in a variety of pet animals including dogs, cats, birds, and reptiles. Little is known
about the potential spread of salmonellosis from animals to stockmen or pet owners by
contact."693 These authors also state (p. 73) that "to significantly reduce the human
incidence of salmonellosis, it is imperative that attempts be made to control the infection
in fowls and other animals." Pomeroy and others, noting the spread of Salmonella through
contaminated feeds, state: "Because of the wide host range of Salmonella and ubiquitous
nature of the organism, consideration should be given to the development of sanitary
methods that will assure the final complete feed to be free from pathogens. This may
require the 'pasteurization' of the feed in the final stages of manufacture."
In closing this particular conference, Langmuir noted the large number of ecologic
and epidemiologic questions regarding this disease that remained unanswered. He con-
cluded that better case reporting, tighter surveillance, and detection and management of
carriers were needed, as well as the elimination of Salmonella from foods and feeds, and
more cooperation in international surveillance.
In 1964 various authors324 discussed and published the general topic The World
Problem of Salmonellosis. They referred to an ever increasing spread of different species
among both animals and humans. Fey quotes Newell (p. 172) as demonstrating convinc-
ingly that the source of Salmonella (always apart from man-adapted typhoid—paraty-
phoid) ultimately lies in animals and that the long-range prevention of human salmonel-
losis is to be sought in an interruption of animal-to-animal contact and not of man-to-
man. The practice of man in herding and feeding animals as an agent in causing the
spread of the disease is noted (p. 178). The importation of new strains of the bacterium,
particularly from tropical countries, is also noted (p. 266). The contrived pathways of in-
fection leading from animal to man, and resulting in outbreaks of disease, is referred to
in connection with this disease (pp. 271-272). The importance of rodents in transmitting
the infection among domestic animals is referred to (p. 273).
In this same reference, it is stated that rats are recognized as being generally
fairly susceptible to Salmonella infections and develop severe typhoidal disease. They
live in very close association with human life. There are, therefore, many possibilities, not
only for human, but for domestic animal infections derived from rats carrying Salmonella
and transferred by direct or indirect contacts. In particular, the behavior of rats is an
important factor in the contamination of food utensils with infected excreta, etc.
The British, reporting in 1964 on a study of various food processing factories and
shops, made the following comment: "It was often shown that the same serotypes or
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84 SOLID WASTE/DISEASE
phage-types were occurring in abattoirs and in human cases in an area at the same
time." 133 In many instances of food poisoning, meat or meat products were suspected as
being the vehicle of infection. Cattle were implicated as the most important conveyors
of salmonellae, whereas sheep were not considered to be a source. In 1964, Rosenstein 571
reported on Salmonella infections among infants and children in a children's home, and
Hendrickson546 reported an outbreak of gastroenteritis from Salmonellae heidelberg
which was found to be contained in packaged angel-food cake mix used in the kitchen
of the construction camp where the outbreak occurred. Hendrickson also reported on an
outbreak of hospital infection with the same organism, apparently introduced by a
surgical patient. Schneierson and Bottone549 in 1965 reported that salmonellosis infec-
tions were only about one-fourth as great as Shigella infections among hospitalized
patients in an underprivileged community. VanDerSchaaf and Atteveld in 1965 reported
on the almost universal contamination of water in the Netherlands by salmonellae organ-
isms, in spite of the widespread biological treatment of sewage in that country.80
2) Balantidiasis. Craig and Faust319 in 1940 stated: "Man is infected by swal-
lowing the cysts of Balantidium coli in food contaminated by fecal material or by direct
transference of infected pig's feces to the mouth through soiled hands in handling pigs or
in slaughtering operations. Considerably over 25 percent of the recorded cases of infec-
tion give a history of direct contact with pigs, while the use of the excrement of pigs as
fertilizers may be the source of some infections" (pp. 217-218).
In 1942, Strong198 stated that this disease was a much rarer infection than amebic
dysentery in Texas, and in North and South Carolina. He stated that cysts were trans-
ferred to humans through the handling of infected gastrointestinal tracts of pigs, the
eating of raw sausage, or from pig manure (p. 445). He noted that the cysts survive for
weeks in moist feces (p.452).
Hull's book167 states: "Human infection is most probably acquired from the res-
ervoir host as a result of contamination of food or drink with pig droppings which contain
the encysted organisms. Patients with balantidiasis often give a history of close associa-
tion with pigs. . . . Once the infection has been established in man it may be either
chronic or acute and at times develops in epidemic form. Furthermore, there is no satis-
factory drug for the eradication in the human host."
In 1962, Hoare555 stated that human infections from this disease were relatively
rare, citing that "only several hundred cases have hitherto been recorded throughout the
world." He noted that the ciliate was a common parasite of domestic pigs, over 90 per-
cent of which may be infected in some countries. He stated that the disease "is prac-
tically an occupational disease among pig farmers, swine herds, slaughterers and sausage-
makers." He added that there was some evidence that this disease could also be trans-
mitted from man to man.
3) Diseases Associated with Dog Feces. In dealing with the general subject of
diseases arising from animal fecal wastes, one would be remiss in not discussing those of
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literature survey 85
the dog. In view of the very close relationship of dogs with humans, and especially with
children, the present urban practices in regard to disposal of dog feces deserve serious
consideration. 319
The dog suffers a number of diseases transmissible to man through the agency of its
167> PP- 893-894, 915-924 The foUowin ]ist ig fo^ from Hu]1: 167
Amebiasis; ancylostomiasis (dog hookworm); balantidiasis; echinococcosis (hyda-
tid cyst); fasciolopsiasis; larva migrans visceral; larva migrans, cutaneous; opistorchiasis;
paragonimiesis (lung fluke); salmonellosis; schistosomiasis; strongylodiasis; trichinosis.
Some of these [e.g., a nematode disease, dog hookworm, 167' P- 896 and the trenia-
todes] are apparently of little importance as human infections in the United States. 167'
p. 896
It is not possible to estimate the incidence of human disease due to dogs through
this route of infection.
DISCUSSION
In developed countries, the relative incidence, prevalence, and severity of human
infection due to animal fecal wastes is low if one looks only at reported outbreaks. The
suspicion is that the amount of disease is actually much higher.
If infection is to be reduced, consensus singles out animal-to-animal spread as the
primary point of attach — especially among food-source species. Human practices in
animal-source food production or processing, food storage and preparation, and food-waste
disposal are major factors in the chain of infection. Contamination of meat in the slaugh-
ter of animals and fowl or dressing of fish, of egg products for packaged foods, and of
other foods which support the growth of salmonellae typifies the extent of the prophy-
lactic problem. Yet animal wastes must in some way be controlled; apparently success in
preventing human disease by attacking the human aspect alone is less likely, according
to some authorities.
CONCLUSIONS
The fact itself, and some of the modes of transmission to humans of diseases asso-
ciated with animal fecal wastes, have been established. A few of these modes suggest
that waste control may be preventive of a limited amount of disease incidence in humans
in the United States.
One can refer to 'animal sanitation' in only a very relative way. As a goal, it must
await large-scale mechanization of animal breeding, controlled feeding and housing of
stock, and sanitary methods of feeding inclusive of sterilization of animal feed. While
all of these techniques are seen in practice at present, they are seldom found together.
Only inclusive application of these or similar practices, however, can help to prevent dis-
ease through animal waste control.
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86 SOLID WASTE/DISEASE
RECOMMENDATIONS
The vast amount of animal feces produced in this country demands further study
of a means for its management. Sanitary aspects of disposal should be included in such
a study. Comparison of existing composting methods should be extended to determine
their capacity in operational, as opposed to laboratory, status so as to destroy pathogens
and prevent vector propagation.
Public education should be directed at proper disposal of pets' feces. The hazard
of well contamination by animal feces in relation to infant methemoglobinemia needs pub-
licity in rural areas. The biological hazards of animal wastes require that additional edu-
cation of farmers and food processors be instituted; stricter surveillance of food handling
and processing is an obvious requirement.
Rodent-Borne Disease
GENERAL
The following is a list of zoonoses associated with the rat (taken from Hull, 167-
P.9is. echinostomiasis; hemorrhagic septicemica; histoplasmosis; lymphocytic choriomeningi-
tis; plague; rat-bite fever; rat-mite dermatitis; rat tapeworm infection; Rocky Mountain
spotted fever; salivary gland virus infection; salmonellosis; schistosomiasis; bilharziasis;
sporotrichosis; swine erysipelas; trichinosis.
To this list must be added leptospirosis, leishmaniasis, relapsing fever, tularemia,
rickettsial pox, murine typhus, and perhaps other diseases.166> 398 The house mouse is a
host of rickettsia. *»• 520' 574
Commensal or domestic rodent species, as these adjectives imply, live in close
proximity to man and his domestic animals, thus satisfying a primary requirement for
transmission of disease to man. 330> PP- 279-80' P- 370; 558- P- 356
In addition, the habits of commensal rodents are such as to permit contamination
with their excreta of man's food, clothing, utensils, or to subject man to direct contact or
attack.324- p-11- abstract
To associate rat-borne (domestic rodent) disease in man with solid waste, it is first
necessary to associate the rodents with the waste. It must further be demonstrated that
commensal rodents transmit disease to man.
Finally, all crucial epidemiological links in the postulated rat-to-man chain of dis-
ease must be demonstrated.
POSTULATION
The commensal rat is a known source of zoonoses (diseases of animals trans-
missible to man), and thrives wherever carelessness in food waste handling and disposal
is found. Because of its habits and close association with man, it exposes man to various
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literature survey
87
disease agents which are transferred by direct contact, ectoparasites of the rat, or by con-
tamination of the human environment.
Figure 6 illustrates postulated pathways for human infection by the disease agents
of plague for which the rat is a host or carrier, and can serve in part to demonstrate
pathways of some other rat zoonoses.
EVIDENCE
Rats are attracted to, and multiply in, refuse and associated residues. 49> p 21;
150, 165, 181, 465, 285, 291, 334, 379, 458, 565, 574, 544, p. 182
Rats have also been found at waste disposal sites such as stabilization ponds 6
poorly operated sanitary landfills. 91
8, 91,
and
As recently as 1964, citizens of the United States were observed throwing their
garbage and refuse along the roadside as they drove from rural homes to their work. 15°
Many smaller communities in the United States still dispose of their solid wastes in open
dumps. 91> 231
Rats harbor ectoparasites which are known vectors of disease, and exchange para-
sites with other animals that are hosts to disease agents transmissible to man 165- 313- 566
Fleas, ticks, and mites frequent rodent nests and burrows of both domestic and wild
rodents and are the means of transferring disease from one rodent to another. 162> 32° These
anthropods are frequent feeders on man when in proximity to him. Such proximity occurs
when man invades the wild reservoir territory or when domestic or wild rodents invade
man's domicile.165 The latter situation is encouraged by careless waste disposal, although
improper food storage or feed handling practices can attract rodents (p.2).520
DISEASE AGENT
PASTEURELLA
"ESTIS
ENZOOTICOR
EPIZOOTIC
SYLVATIC PLAGUE
SMALL
COMMENSAL RAT
POPULATION
REFUSE DUMPS
ENCROACHING ON
WILDERNESS AREAS
•URBAN
DEVELOPMENT
ENCROACHING ON
WILDERNESS AREAS
FOOD, HARBORAGE
(SOLID WASTE)
EXPANDING
COMMENSAL
RAT
POPULATION
FIGURE 6. Solid waste/plague pathways (postulated).
291-982 O - 68 - 7
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88 SOLID WASTE/DISEASE
Rats can serve as a major threat in transfer of zoonoses to man. While they are
not, at present, reservoirs of plague in the United States, they can serve potentially to
spread sylvatic plague which is now endem'c throughout this country. 165> 569 The mech-
anism is discussed under "Plague" and, in general, is similar for other arthropod vectored
disease of rats and wild rodents.
Rats can transmit disease by direct contact, as for example, in causing rat-bite
fever in man. 53> P- 198 In addition, by soiling food, clothing and eating or cooking utensils,
rats can probably cause human salmonellosis.544- 324- P 273' PP- 10- u (abstract); IBS, 398 They are
known to be involved in the Salmonella infection cycle in domestic animals. 324' p 273
Rat fleas can be significant pests and can cause flea or mite dermatitis. 319- 112- 156
Rat fleas are also true hosts of several tapeworms of lower animals which are known to be
transmitted to man, especially children.398- 156
At times, rats have been thought to be an agent in the transmission cycle of
human trichinosis. As recently as 1956, a significant number of trichina-infested rats were
found in village and city dumps in the American Midwest. The investigators state that
the role of rats and wildlife in trichinosis of swine is difficult to determine. 508 They
postulate, as possibilities, fecal transmission or direct transmission where pigs eat infected
carcasses. They were not successful in fecal transmission efforts, but quote Spindeler as
having obtained success in such transfer. Other authors state that there is no evidence
that the rat plays any part in the pig cycle, and by implication, none in the human cy-
cle B58- P 369 — at least in the United States.
Human leptospirosis has been traced to rats. 526- 517- pp- 901-908 Leishmaniasis, a dis-
ease rare in the Western Hemisphere and not found in the United States, has been found
in domestic rats of two genera, 556< p-316 and has been experimentally transmitted to rats. 319
Rickettsialpox in man has been traced to the house mouse; it is transmitted by a mite. 43-
399, 574 Murine typhus is known to be transmitted between rats by rat fleas 177> 156 and from
rat to man.156 Infection of man by the nematode Capilloria hepatica (a relative of the
trichina worm) by way of the rat is possible. 558> P- 375
Domestic rodents are stated to be donors in helminth cycles involving man. 558- p 356
Rats and mice are a constant source of infection in man of the dwarf tapeworm (Hy-
menolepis nana) and occasionally a source of Hymenolepis diminuta, a large tapeworm
(p.366).558
The rat lungworm, Angiostrongylus cantonensis, is widely distributed in rats in the
China-Pacific area, and in United States possessions and protectorates in that area.346>
P. 558; 377 jn some areas it is found in man, and has been implicated in the etiology of
human eosinophilic meningoencephalitis in Hawaii. 558- P 378 Mollusks are intermediate
hosts of this nematode and could serve as a source of human infection; pigs also are im-
plicated. 346 Whether or not the rat has a role in human infection is not clear.
Tularemia is said to be naturally present in wild rodents, including wild rats 379'
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literature survey 89
sas, 156, 198. ^g natural vector is the woodtick, Dermacentor andersoni.198 Rats are stated
to be only slightly susceptible, however, to the disease.198- P 716 Experimentally, fleas and
mites have been found to be infected 398' 338 and to transmit the disease agent,198' pp- 714-715
However, they have not been shown to be important in the transmission of tularemia.156-
398 The tropical rat mite was shown to harbor the organism of tularemia and, in some
instances, to transmit it to the next generation of mites; it also transmitted tularemia to
normal mice on being crushed orally by the mice, but not on biting the mice.338 The in-
cidence of human tularemia recently has been described as paralleling the population of
"mouse-type rodents" during and after World War II in Russia; the author considers
bloodsucking arthopods worthy of investigation as vectors. 379 In Russia, it is claimed
that the basic intermammalian mode of transmission is via the tick. 38°
The rat is definitely associated with murine typhus; its ectoparasites — mite, rat
louse and rat fleas — spread the agent from rat to rat. 517- P- 80; 156- 177- 319- 394> 398 The trop-
ical rat flea, Xenopsylla cheopis, is the most important vector for rat-to-man trans-
mission. 339- 517> P 80 Fleas may not be the only, or even the main, transmitter, and rat
urine has been implicated via dust in human infection.156> p- 40°
Only 42 cases of human murine typhus were reported in the United States in
1961 52° and 29 in 1964. 351 This represents quite a drop from the 5,193 reported cases in
1945.517' p 80 The dramatic reduction in human murine typhus is believed to be due in
all probability to the coincident rodent control measures.398
In South Africa, the disease has apparently been introduced in recent years, and
is resulting in occasional human cases.339 Here, too, a domestic rat, Rattus rattus, is the
reservoir. The disease is considered more an occupational than a domiciliary disease.319
Lymphocytic choriomeningitis is a viral disease in man. The reservoir is the
mouse. Hypothetically, the virus is conveyed to man by way of contaminated food or
dust; human cases have been associated with infected mice.167' P 726
Hull167' P 922 lists rats as a factor in the transmission of Rocky Mountain Spotted
Fever (RMSF) to man, but does not support the association in the text. A number of
ticks are both reservoirs and vectors; others can be infected experimentally.167> p 701; 335
The vectors appear to prefer large animals, both wild and domestic. In Maryland, dogs
and field mice are said to be important in the epidemiology of the disease in that state.341
Experimentally, the rat has been found susceptible to the infeciton.167> P 703 However, no
evidence was found for implicating the rat in human infection. In the period 1960-64,
229 cases of this disease were reported in the United States.351 In none of these cases
is the rat mentioned. The postulated mechanism for transmission of RMSF to man by
way of the rat can be discussed in the general case of tick-borne disease. In the United
States, species of ticks are vectors of RMSF, tularemia, relapsing fever, Colorado tick
fever (CTF), and tick paralysis516-157> 335 The species for RMSF important to human in-
fection are Dermacentor andersoni and D. variabilis167> p 701 for tularemia. A number of
different tick species are vectors 167> P 592 for relapsing fever in which numerous subspecies
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90 SOLID WASTE/DISEASE
of Omithodoros are involved. 167- PP- 669-673; iss, P. aai For c^F, Dermacentor andersoni is the
only important vector167> p-789
The rat is not a normal host for any of these diseases except perhaps relapsing
fever in Panama. 167> p 671 The ticks themselves are commonly the main reservoir of the
disease agents.
It is possible that infected ticks from any of the wild reservoirs could feed on
domestic rats and transmit the respective pathogen to the rat. Except for perhaps the
case of relapsing fever in Panama noted above, there is no evidence that this occurs in
nature, or, if it does, that the rat could then be a source of infection for man. The vector
of RMSF in the Eastern United States — the dog tick — could infect the domestic rat,
but again there was found no evidence of such transfer.
Aside from the domestic rat, however, the small wild rodents attracted to wilder-
ness cabins, camps, or lodges by carelessly disposed garbage could convey infected ticks
to man's vicinity and thus bring about human infections. Deer mice and squirrels in
Montana for example, have been shown to have been infected with CTF serologically and
culturally. 157>174 Agents resembling those of relapsing fever were found in chipmunks
and Tamarack squirrels in California.161 The rodent and human strains were found to
be identical, and the rodent strains are directly transmissible to man. It can only be as-
sumed that human cases arising from the endemic foci associated with these rodents
were due to exposure to rodents.
Although echinostomiasis and histoplasmosis are tabulated by Hull167- p-918 as
zoonoses associated with the rat, there is no case to be made for rat-to-man transmission.
Transmission to humans of the remaining zoonoses listed as rat-associated by Hull was
not demonstrated in this study.
DISCUSSION
The commensal rat and his feral cousins have been shown to carry and transmit
disease agents infectious for man. They breed in, or are attracted to, food wastes. The
commensal rat can propagate in large numbers where food wastes and harborage are
available. (There appears to be some difference of opinion as to how large the waste-
dump rat populations can be — see references 181 and 622.)
The interchangeability of rodent ectoparasites under certain circumstances can
bring sylvatic disease conveyed by these vectors much closer to man through the agency
of the rat.
Furthermore, the rat by its habits can contribute to the contamination of the en-
vironment of man and his domestic animals and thus to a double threat to man by way
of infection of his animals.
Considering the adaptability of the rat, the numerous sources of food other than
wastes, and the obscurity of its contribution to human disease incidence, the relative
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literature survey 91
importance of solid waste toward this contribution is equally obscure. However, the fact
that there is a positive association, and that the rat is a dangerous enemy to man, have
been made evident.
CONCLUSIONS AND RECOMMENDATIONS
There is continuing threat of human infection by rat borne zoonoses in the United
States; while presently of relatively low or unknown degree, its containment requires a
higher level of waste management and rodent control than now exists, if only to decrease
risks of epidemics in disaster areas.
While the control of wastes is of greatest importance in controlling rats in centers
of large human populations, wastes are not the only source of food for these rodents.
Carelessness in warehousing of food supplies, in storage of food in the home, and in stor-
age and distribution of animal feeds, and the ability of the rat to find forage in the wild,
complicate the control problem. 165> 465> 565 In fact, some investigators feel that these
sources are more important to the propagation of rats than waste. It will be necessary,
therefore, to coordinate waste and other rodent-control studies and measures.
The prolific breeding capacity of the rat, however, permits its spread from garbage
dumps to homes, farms, and other areas where it may find other food sources, and
presents a higher risk of conveying infection by reason of its nearness to human habitats.
Various authors have advised adoption of the following procedures:
Development of more effective waste handling and management methods
Public education in food storage and garbage disposal
Increased research on domestic rodent eradication
Increased research on arthropod vector eradication
Development of more effective means of immunization against rodent borne dis-
eases
The wide distribution in nature of many of the zoonoses associated with the rat
will not, of course, permit elimination of the basic source of these diseases even if the rat
is controlled. However, the control or eradication of rats will drastically limit the oppor-
tunities for human infection from the disease agents represented.
SPECIFIC DISEASE
1) Plague. General. Because plague has been so devastating in the history of
man, and because the rat and its parasite, the flea, are suspect in other diseases trans-
missible to humans, plague is chosen as the first of two specific rat zoonoses to be consid-
ered in association with solid waste.
Postulation. Plague is capable of transference to human populations by the se-
quential events diagrammed in Figure 6 in which solid waste is a major factor.
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92 SOLID WASTE/DISEASE
Evidence. The commensal rat is firmly established as a source of human bubonic
plague. 172' 167' pp-527-532- pp- 902-903; 517> p-197; 190' 313' 319- 573 It is found throughout the United
States and the world682' p-417 In 1947, a rat cenus showed a ratio of 1 rat for every
36 persons in New York City, and 1 for every 15 people in Baltimore.167' P-903 Rats
are especially common where food is plentiful, particularly around open dumps6;
(also see references, section on rodent borne disease). Their usual ectoparasites infest
wild rodents, and they in turn can be infested by wild rodent ectoparasites.162'164-313- p-142>
see, 568, 682, p. 418 Transmission of plague from wild rodents to rats has been demonstrated,
569, 570 an(j nas resulted in human plague via the rat.172-164' 57°
The rat is highly susceptible to infection with the plague bacillus and following in-
fection often dies. The vector flea then leaves the body of the rat in search of a new host
and, given the commensal status of the domestic rat, this host often is man.517> p-201 If a
large rat population is present, the "dosage" of bacilli thus made available is high, and
human disease much more probable, than if the rat/flea population is low.
The vectors are the interchangeable ectoparasites.190' 191- 320' 340' 398- 569- 517- p-199
Many flea species are known to be infected with plague bacilli.313> p-142; 398> 567> 570> 573
Urban or port plague apparently was introduced about 1899 into the West Coast
of the United States, and by 1908 was established in western wild rodents. 573' 156' 172> p-456
However, some authors feel that sylvatic plague has existed among American rodents and
infected the American Indian in prehistoric times. 690' p 1566 Since then, plague was in-
creasingly found among wild rodents through the country 162> 190' 569> 682> p-418 and the
world. 573' 517' P- 199; 167> pp- 534~555. 563-568 Subsequently, it reappeared in rats from time to
time.162' 313 These wild rodents supply what is probably an ineradicable reservoir of
plague. 165> P-43; 164> 162 Plague has also been passed from wild rodents to humans.152> 319>
56? The flea vectors apparently increase in population with increase in numbers of the
rodent hosts. 566> 682' p-419 They are found on man in association with human plague. 568
(An excellent review of plague in the United States is given in reference 690.)
Discussion. All of the postulated links in the chain of infection involving a solid
waste/human disease relationship have been demonstrated. How meaningful are they
to an outbreak of epidemic of pandemic plague in man? In the last 30 years, only a
handful of human cases of plague has been reported in the United States166' 167> p-548;
(also see incidence figures below).
The breakdown of sanitation, however, due to earthquake, civil strife, strikes, war,
or the failure of authorities and citizens to plan and cooperate in the handling of the ever-
expanding solid-wastes problem may provide the elements necessary to domestic and wild
rodent expansion and subsequent epizootics. By the nature of civic disruptions, there may
then be interference with other means of containment once the disease is under way.
(See section on Disaster in this report.)
Once begun, human plague can spread by direct contact between humans. 167> 541-
568, 517, p. 201 American physicians "almost never see this disease" and significant human
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literature survey 93
spread of the agent may occur before the nature of the disease is recognized.165' P-43; 167>
P 557 There would appear to be no cause for complacency with regard to plague from any
source.165> p 42 The following quotes are found on page 529 of reference 167: "The seem-
ing disappearance in the middle of the 19th century is merely a phase in the natural
history of the disease itself. . . ." and "Knowledge acquired since 1900 leads to the con-
clusion that the decline of the plague at the end of the 17th century represents the op-
eration of the great natural law of the rise and decline of epidemics."
In reference 190 (p. 1152) the following statement appears: "It might appear to
some persons that too much prominence has been accorded plague and too much effort
devoted to it as a public health problem in this country; but it still holds our interest, be-
cause it scaled the barrier of quarantine, because of its persistence and gradual biological
and geographic spread, and because of the difficulty in eradicating it entirely in vast
areas of low biological density." Another statement from the same work (p. 1149) is as
follows: "When the situation is viewed in the light of the expanding areas in which
plague-infected wild rodents and insect parasites have been found in recent years, the
disease assumes significant public importance and becomes a problem fraught with poten-
tial danger." 19°
The ultimate threat of epidemic plague165- 682 comes from commensal rat popula-
tions (pp.417, 418), but the basic threat in the United States exists in the wild rodent
reservoir.165' 682' pp-417> 418; 69°. p-isss The first essential element for a human plague epi-
demic in this country — contact between commensal rats and wild rodents — is being
satisfied by encroachment of urban settlements on wild areas and the use of such areas
as dumps for solid wastes.165- 166- 569 In addition, the fact that more and more Americans
invade wilderness areas every year,165 exposing themselves to sylvatic plague and pro-
ducing tons of litter and garbage for which they assume no responsibility for proper dis-
posal, is of considerable importance. This can bring about avenues of transmission made
important by sheer numbers of potential victims, a growing population of wild rodents
attracted to (and nourished by) such wastes, and the increasing probability of involve-
ment of hitchhiking domestic rodents. 169> Pp 71°-7U
Uncertainty as to the factors underlying the great pandemics of plague is good
reason to avoid complacency in the face of its very low incidence in the United States in
recent years. Only six cases were reported for 1960 to 1964,361 eight cases during the pe-
riod 1930 to 1939,19° and 17 cases in 1932 to 1942.162 In the period between 1900 and
1940, 499 cases with 314 deaths were recorded. 19° Between 1908 and 1965, 111 cases of
human plague transmitted from wild rodents and other mammals or fleas — with 64
deaths — were reported. 690> P 1568
However, in a single Indian State, Uttar Pradesh, in approximately the same
period (1905-1954), over 3,000,000 deaths were ascribed to plague, of which approxi-
mately 390,000 were registered in the period 1930-1954. 567 The disease almost disap-
peared in 1954. During the same 50 years, it showed a short-term periodicity of 5 to 6
years. 567 In Mysore, another Indian State, plague persisted, with periods of absence, into
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94 SOLID WASTE/DISEASE
the 1960's, with progressively increasing human cases since I960.570 It is doubtful that
the disappearance of plague in these areas could be ascribed solely to the use of pesticides
or to superior sanitation; consequently the role of sanitation in the subsidence of the
plague in the United States is somewhat open to question.
The main consideration is that resurgence of the disease requires a host. In India,
in the two states noted above, plague was found in commensal rat fleas. In Uttar Pradesh,
wild rodent fleas were also infected with Pasteurella pestis. In the United States, sylvatic
plague is spread through the country. Presumably, recrudescence of plague among com-
mensal rodent populations, brought to large numbers by failure to control waste,167- P 90°
could be followed by human bubonic plague. 569- 573 One writer discounts the threat of
plague epidemics in civilized countries, although he accepts the possibility that rapid
spread to such areas exists. 573
Of interest to this subject are the increases in rat populations and numbers of cases
of human plague reported for the year 1966 by the World Health Organization. 692
It would seem obvious that a population careless of its wastes in normal times
would not be likely to exercise greater caution in waste disposal in the event of crises in
civil life and the ensuing interruption of disposal services. Human males are especially
intransigent when their "rights" are questioned to foul their homes, the surrounding land-
scape, and the wilderness areas with garbage and refuse. The author of this report has
observed otherwise intelligent persons (men and women alike) owning wilderness cabins
throwing garbage out the windows with the justifying statement that "the little animals
will keep it cleaned up."
The extent to which waste and rodent control might be practiced in disaster would
seem to be low, in view of the present level of hygiene actually practiced by the public
(as opposed to the level provided for it by municipal sanitation services and sewerage).
With the domestic rodent population out of hand and with waste accumulations attrac-
tive to wild rodents present, the threat of domestic rodent epizootics is increased. Dis-
ruption of water supply, and its interference with bathing and laundry, would encourage
infestation of humans with infected rat fleas and susceptible human fleas and lice —
both of which are suspect in plague transmission. 568' 573 Add to this the possible disrup-
tion of medical services and the stage is set for a human plague epidemic.
Conclusions. The rat has its greatest potential for killing humans through its role
in dissemination of plague. However, this potential is difficult to assess. The adage "bet-
ter safe than sorry" seems to have special significance where plague is concerned.
Recommendations. Although the epidemiology of plague sufficient to assess the
total risk to human populations is known, significant exposure to populations in the
United States must be through the domestic rat. General recommendations for its control
are contained in the conclusions and recommendations given for rodent-borne disease as
a whole.
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literature survey 95
2) Leptospirosis. General. Leptospirosis is a spirochetal disease of animals trans-
missible to man. 40- 517- P- 129- 682- P 547 It is not a single disease, but a group of diseases due
to a number of serologically distinct organisms.521 The principal hosts are wild or domes-
tic rodents and some domestic animals72- 517- p-130' 343- 524- 525- 382- 682- P M7 Distribution of
leptospirae is world-wide. 382
The commonly isolated leptospirae in North America are Leptospira icterohaemor-
rhagiae, Leptospira canicola, Leptospira pomona, Leptospira bataviae, and Leptospira au-
tumnalis. 531 Leptospira pomona is frequently the organism found in infected cattle.522-
382
Documented sources of human infection are rice fields,517- P- 131 swimming 'holes',521-
PP. U2-144-, 522, p. 950 sewers;109- 517- P- 131 a number of occupations in which exposure to in-
fected animals is intimate526- p-381; 517- p-131; 343- PP-862-863, 523, P.22 must aiso De included.
Between 1949 and 1961, 483 cases of human leptospirosis in the United States
were confirmed in the laboratory.343 In 1965, however, 1,077 serum samples from routine
hospital admissions showed antibody reactions to leptospiral sera in 2.6 percent of the
cases.523
Postulation. Rat populations increase greatly if food and harborage are made
available. The habits of rats expose them to leptospiral infection (sewer water, drinking
water contaminated by excreters, urine of other rats) in their foraging and nesting. They
come into contact with other rodents and domestic animals capable of harboring the in-
fection. They can contaminate human food, water supply, and household articles or
clothing with urine which contains leptospirae. They can contaminate water supplies from
which domestic animals and pets drink; in the case of cats or dogs, which kill rats, they
can serve as a source of direct contact and infection by this route. Rats thus could serve
as an important link in human infection by infecting other animals having contact with
humans.
Evidence. Rat populations increase greatly if given access to waste foods and
waste harborage (see references, section on rodent-borne disease). Rats travel widely for
food and water and to find harborage, and have migrated throughout the world. 526 They
are exposed to infection by the environment contaminated by other wild or domestic
hosts 382- 526- P 378 and are themselves "chronic carriers of many types of leptospirae" and,
"as a rule do not show clinically perceptible disturbance . . .".526- p 377; 517- p-130; 119- 389 A
lifelong carrier state is thus established. In other words, the rat population is not de-
creased by the disease, and their contaminating activities are not limited by the disease.
Commensal rats are found to be carriers of many different leptospiral serotypes all over
the WOrld. 526> P-377: 521- P-l*l; 382, p. 473; 389, pp. 2-3, abstract
The organisms are excreted in the urine and may contaminate the environment of
man, resulting in human infection and disease. 517- P- 129; 682- p-547 Rats are carriers and
probably the chief reservoir of Leptospira haemorrhagiae, the agent of Weil's disease
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96 SOLID WASTE/DISEASE
which is perhaps the most severe form of leptospirosis in man.115- 119> 95> 526- PP- 377-378; 522>
P. 950; 389, 682 Experimentally, ticks and horseflies have transmitted the disease by feeding
on experimental animals 517> P 130; 521- p 142 and naturally infected ticks have been found on
cattle in Russia. 521- p-142 "Despite this, endemiologic evidence would indicate that arthro-
pod vectors are not significant in the transmission of [this] infection from animal reser-
voirs to man." 517' PP 130~131
In the period 1955 to 1959, 130 cases in the United States were analyzed and 36
percent were found associated with farms or abattoirs. Some 26 percent were connected
with drinking, swimming, or other immersion in presumably contaminated water; 16 per-
cent with contact with dogs; 13 percent with rat contacts; 3 percent with wild animals;
and 6 percent with other animals or environment. 521
In the United States, according to one summary of 483 cases of leptospirosis in
man in the period 1949 to 1961, a probable infecting source was ascertained in 191 cases.
Sixty of these (31%) "involved contact with rats," and it was stated that ". . . infection
from rats occurred in a wide variety of situations."343' p-863
Decrease in cases in the period 1955 to 1965 might have been due to better sani-
tation and eradication measures in this country. 389
The domestic rat may play a much more significant role as an indirect cause of
human infection. It has invaded many areas to which it was not native (e.g., the Amer-
icas, Australia) and may have been instrumental in the introduction of leptospirae there.
The recent introduction of Rattus norvegicus to some countries of the Near East, along
with Leptospira ictohaemorrhagiae, is typical. 526 By such migrations and by virtue of its
habits — especially of infesting feed lots and stalls of domestic animals — it can dissem-
inate leptospirae to these animals. In turn, excretions of these latter animals pollute
waters from which humans may become infected by working or swimming in them. 343>
P ses; SIT, p 131, 521, 522, 523, 526 ]yiore human infection is due to transmission from cattle and
swine than from rats.523
The dog is a major source of human infection 521> P- 144; 343> P 863 and may well be in-
fected by the rat because of their cohabitation in the human domicile. Thus the rat may
be the primary source of canine infection, and hence in some cases human infection.
Some serotypes of leptospira are common to both animals, and are transmissible to
man 382> ?•473; 389' p 6; 523- P- 2l
Conclusions. There are important gaps in a postulated chain of infection leading
from the rat through domestic or other animals to man, although direct infection ap-
parently is verified. The difficulty arising from the discovery of the same serotype in
different animals is obvious — which source was the primary source? The fact that the
rat is a lifetime carrier of leptospires, 517' P 13° and that the carrier state in domestic
animals is relatively short, 517> p-13° lends importance to the rat as a reservoir. However,
according to one author, outbreaks of leptospirosis are traceable to domestic animals and
not to rats.343
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literature survey 97
In a disease as universally distributed geographically and biologically as lepto-
spirosis, the comparative importance of the commensal rat in transmission of this dis-
ease to man is difficult to assess. The commensal rat can cause human disease, and prob-
ably domestic animal infection. The evidence supports the conclusion that it is a sig-
nificant factor without whose control, or elimination, human leptospirosis cannot be
eradicated,528' P386 especially since broad protection from immunization has not been suc-
cessful.517- P L34: 682> p-548
Recommendations. The empiric involvement of the rat in this and other diseases
is sufficient to warrant action without further studies, which can be left to others con-
cerned more directly with epidemiology and medical ecology.
Mosquito-Borne Disease
GENERAL
Hunter and others517 in 1960 listed the following diseases as being vectored by
mosquitos: dengue (pp.17, 661), encephalitis (p.662), filariasis (p.658), malaria (p.317,
659), and yellow fever (pp.20, 661). 517
Hull167 adds tularemia, lymphocytic choriomeningitis, and melioidosis as zoonoses
in which mosquitoes can be vectors (pp. 593, 725, 846, respectively). Of these, only the
mosquito-borne encephalitides and malaria are mentioned in connection with the United
States.517
Philip was unsuccessful in transmitting Q fever by Aedes aegypti. 378
Shahan and Traum (1958) list Rift Valley fever as a zoonosis transmissible to man
by mosquitoes. They note, however, that this disease has not been identified outside of
Africa,57 nevertheless, there is a distinct possibility that it may be introduced to the
United States751 (p.358; see also pp.354-356).
Anderson,23 among others, has referred to solid wastes in association with mosquito-
borne disease. This presumptive association is due to the fact that some mosquitoes
breed in small collections of water, such as may collect during rainfall in cans, automobile
bodies, and other discarded potential containers. Many of these same mosquitoes, how-
ever, are known to breed in other fortuitous collections of water, such as those in hoof-
prints, roadside collections, irrigation water, and the like. Mosquitoes may breed in large
numbers in coastal brackish waters and salt marshes and in various types of natural
bodies of water, or, according to the species, in flowing streams. Thus, the contribution
that might be made by solid wastes to the total threat of mosquito-borne diseases, par-
ticularly in regions already provided with other collections of water, is difficult to esti-
mate. To produce disease, however, introduction of the disease agent into the vector popu-
lation must occur. Highly complex questions of mosquito ecology and other factors must
be accounted for.
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98 SOLID WASTE/DISEASE
POSTULATION
Solid wastes provide a source of breeding media for mosquitoes which are the
vectors of disease agents pathogenic for man. These mosquitoes will oviposit in rainwater
held in solid waste materials; the organic debris associated with solid wastes can serve to
nourish the mosquito larvae either directly or indirectly by permitting the growth of micro-
organisms upon which the larvae feed. In the presence of infected hosts, the emerging
adult mosquitoes will become infected and transmit the disease agent to human hosts.
EVIDENCE
Craig and Faust319 stated in 1940 that "some mosquitoes like Aedes aegypti, A.
albopictus, Culex fatigans, C. pipiens, and Anopheles stephensi are domestic in their
habits, breeding in household receptacles, such as cisterns, earthenware jars, gutters, etc.
Mosquitoes may fly distances of two miles or more or may be carried hundreds of miles
by wind and thousands of miles in trains or airplanes. In measures directed against
purely domestic Anophelines (that is A. stephensi), which breed in crockery, cans, etc.
around the home, careful inspection must be made by sanitary police to see that these
receptacles are kept empty, covered with kerosene, or adequately screened, just as in con-
trol of Aedes aegypti breeding."
These authors also state, in regard to filariasis and mosquito control, that "this
is essentially an urban problem. The mosquitoes are usually domestic, Culex fatigans,
C. pipiens, Aedes aegypti, A. variagatus (Anopheles stephensi) or are found in bodies
of water not far from human habitations." They state also that "man is the only defini-
tive host of Wuchereria bancrofti, a cause of filariasis. Man is inoculated with mature
larvae escaping into or onto human skin from the proboscis of infected mosquitoes . . . ."
Smith332 in 1957 made the following point: "Before incriminating an arthropod
as a vector of any specific disease there are certain essential requirements which must be
fulfilled. In the first place, the suspected arthropod must be associated in time and place
with the 'person' of the infected donor and recipient hosts. In the case of biting arthro-
pods, this association implies that the suspected vector must bite such hosts." 332 He then
pointed out that, in some cases, certain species of mosquitoes in certain locales did not
bite man, whereas in other areas the same species transmitted disease. He also noted that
mosquito species were not genetically uniform, and quoted Huff (1929) as showing that
it was possible to breed a strain of Culex pipiens which, after a few generations of selec-
tion, was able to act as a host in 91 percent of the cases to a disease agent, while another
line bred for insusceptibility was reduced to infection rates of the order of 7 percent. He
stated further that "mosquitoes entirely unrelated geographically to [a parasite] often
prove to be extremely efficient vectors . . . ."
In 1942, Hammon and others 16° reported on an epidemic of encephalitis in Wash-
ington State. They mentioned that in 1939, there had been a severe epizootic of horse
encephalomyelitis involving some 500 to 600 animals, and that this was associated with
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literature survey 99
about 35 human cases. In 1949 there were 86 human cases, although only about 50
horses appear to have been affected. The blood of a number of domestic and wildfowl
were found to contain antibodies against either the Western or the St. Louis viruses, or
both. Their own investigations revealed widespread evidence of infection among domestic
fowl and domestic mammals. Only 8 percent of the sera from wild mammals possessed
antibodies against encephalitis viruses. The authors concluded that "many of these birds
and mammals, principally the domestic fowl, probably serve as reservoirs for the infection
of mosquitoes."
Hunter and others (1960) identify two Anopheles mosquitoes in the United States
as capable of transmitting malaria. 517' P 32° These are Anopheles freeborni and A. quadri-
maculatus. The former species is reported to prefer fresh, clear seepage from ditches, rice
fields, edges of slow streams, and irrigation water. The latter species prefers fresh pools,
ponds, lakes, lagoons, swamps, slow flowing river in dense aquatic vegetation. Both of
these species enter houses and feed readily on man. A. freeborni is noted to be dangerous
in the interior valleys of the West Coast of the United States, while A. quadrimaculatus
is the "most important carrier in the Eastern United States." In regard to filariasis, these
authors state: "Complete development of the larval forms of W. bancrofti has been
shown to occur in over 50 species of mosquitoes including the genera Anopheles, Culex,
Aedes and Mansonia. However, these mosquitoes are not all necessarily concerned with
the transmission of the infection in nature. Some of the most important known vectors
are C. pipiens, C. quinquefasciatus (C. fatigans), C. pipiens, Anopheles gambiae, A.
funestus, A. darlingi, A. punctualatis, A. farauti, Aedes aegypti, and Aedes polynesien-
sis." These authors also note that "the importance of a particular mosquito will depend
to a large extent upon whether it feeds on human rather than animal blood and breeds in
areas in close proximity to man." r>17
In regard to dengue, these authors state that "epidemics due to the importation
of virus involving hundreds of thousands of people have occurred in areas where the
mosquitos capable of transmitting dengue fever were present, notably . . . the Gulf Coast
and adjacent Southern States of the United States in 1922." They list Aedes aegypti,
Aedes albopictus, and Aedes scutellaris as the only proved vectors of the virus. Sabin,
writing in this reference, says in regard to yellow fever: "Since 1948 yellow fever has ad-
vanced . . . northward through Costa Rica . . . and finally into Mexico . . . and an outbreak
of yellow fever was discovered in Trinidad in 1954." Urban yellow fever is described as
transmitted by Aedes aegypti. "This mosquito is domestic and is always found in close
proximity to man, breeding in and about houses" (pp. 20-21). 517
In 1961, Beye and others575 reported on the hazard of importation of diseases
new to the resident population of the United States by foreign migratory agricultural
workers and others; for example, W. bancrofti (an agent of filariasis) was found among
migrants in Idaho. It was noted that this agent was "once prevalent around Charleston,
South Carolina, presumably brought from Africa by the 'slave migration' ", and that "the
most universal mosquito vector, Culex quinquefasciatus, is prevalent in many parts of
the United States." Also, in the Idaho survey, two cases of malaria were found. To
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100 SOLID WASTE/DISEASE
Beye, the finding of seven cases in California "indicates the potential hazard of this well-
known parasite which was widely prevalent in the United States in the early part of the
Twentieth Century. Suitable mosquito vectors are still prevalent in some parts of the
United States." These authors quote Dunn and Brody, who reviewed malaria surveillance
in the United States in the period of 1956 to 1957, on their documentation of three cases
of primary indigenous malaria in Sacramento County, California, in 1956. Dunn and
Brody stated that these cases of malaria were "possibly associated with the importation
of the parasite by Mexican agricultural workers in the immediate area. Anopheles free-
borni were present in moderate numbers." He added that "the same authors discuss
four cases, three confirmed as vivax malaria in Sutter County, California. ... A. free-
borni were present. A farm labor camp for Mexican nationals was located about a
quarter of a mile from the ranch where the cases occurred, but it was not demonstrated
that anyone in the camp was the source of the infection." Beye also states that the list
of potential imported diseases "could be made large . . . including such possibilities as ...
yellow fever."
In considering one aspect of solid waste disposal, the hazard of creating breeding
places for mosquitoes through the use of manure lagoons was noted by Eby in 1962. 476
Hayes and others (1962) reported on 33 confirmed human cases of Eastern en-
cephalitis (EE) in New Jersey between August 17 and October 15, 1959. 5n They stated:
"The majority of the individuals stricken resided within communities situated adjacent
to woodlands and both salt- and fresh-water swamps. Arthropods were collected in the
vicinity of reported human, equine, or pheasant cases. The predominant mosquito species
were Aedes sollicitans, Aedes vexans, Culisets melanura, and Culex salinarius." These in-
vestigators also stated: "All available information supports the hypothesis that (1) the
swamp mosquito, C. melanura, served as the primary sylvan vector which carried EE
virus from enzootic swamp foci to peridomestic wild and domestic avian reservoir hosts in
both the epidemic (coastal) and epizootic (inland) areas; (2) A. solicitans served as the
primary epidemic vector in the coastal area where most of the human cases occurred,
obtaining its infection from the peridomestic avian reservoir hosts (including chickens)
and subsequently transmitting the infection to man; (3) A. vexans served as the primary
epizootic vector in the inland area of the equine outbreak, obtaining its infection from
peridomestic avian hosts and subsequently transmitting the infection to horses; and
(4) A. vexans may also have served as a vector for occasional human cases that occurred
in the inland area." The authors feel that they have suitably accounted for this hypothe-
sis in that they are able to reconcile it with the known habits of the vectors involved,
including their feeding on both animal hosts and human beings.
Pratt and others397 stated in 1963 that "epidemics of three types of encephalitis
continue to occur in many parts of this country and are the most important mosquito-
borne diseases in the United States today. Pest mosquitoes are important to human
health as their continued annoyance affects physical efficiency and comfort, mental equa-
nimity, and the enjoyment of life (Bradley, 1951)." These authors state: "Beginning
in 1958, less than 100 cases of malaria have been reported each year for the entire
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literature survey 101
United States, most of them contracted overseas, with only three or four primary in-
digenous cases reported in 1961 and 1962." They said also that although there are 15
Anopheles species (of mosquitoes) in the United States, only two seem to be important
in malaria transmission: A. quadrimaculatus east of the Rockies and A. freeborni west
of the Rockies. They stated that no epidemics of yellow fever had occurred in the
United States since the 1905 outbreak in New Orleans and that no major epidemic had
occurred in all of the Americas since 1942. They were of the opinion that the encepha-
litides found in the United States were caused by different viruses transmitted normally
from bird to bird, and less commonly from bird to man or his domestic animals by a num-
ber of species of mosquitoes. Suspected vectors were listed as Culiceta melanura, Aedes
sollicitans, and A. vexans, and Mansonia perturbans in the case of Eastern encephalitis.
Culex tarsalis was considered the most important vector of Western encephalitis. 397
In reference 397 it is stated that "members of the Culex pipiens-quinquefasciatus
complex are the chief urban vectors." These authors said that in the Tampa Bay, Florida,
epidemics of 1959, 1961 and 1962, Culex nigripalpus was the probable vector. They
stated also that "these three types of encephalitis are generally considered to be viral dis-
eases in which birds serve as natural hosts and mosquitoes as the most important vectors.
According to Hess and Holden (1958) the basic transmission cycle from bird to bird is
maintained by mosquitoes with the human and horse cises considered as accidents and
dead-end hosts in the chain of infection."
They say of filariasis: "Human cases of filariasis (are) not now known to be nat-
urally acquired in the United States." They quote other workers on the temperature
and humidity requirements for the successful infection by filarial worms and state: "If
this is true, only a relatively small area of the United States . . . those states bordering
the Gulf of Mexico, Georgia, and South Carolina ... is favorable for the establishment
of filariasis." They note as vectors Culex quinquefasciatus, C. pipiens, Aedes polynesi-
ensis, and Anopheles gambiae. They list Anopheles quadrimaculatus as the most impor-
tant vector of malaria in the United States, and state," [This mosquito] breeds chiefly in
permanent fresh water pools, ponds, and swamps which contain aquatic vegetation or
floating debris .... Breeding seldom occurs in stagnant waters heavily polluted with plant
or animal matter. Some of the common habitats are lime-sink ponds, pits, sloughs, bayous,
sluggish streams and shallow margins and backwater areas of reservoirs and lakes. (King,
Bradley and others, I960)."397
These authors state that Anopheles freeborni (the Western malaria mosquito)
"breeds in permanent or semi-permanent waters which are at least partially exposed to
the sunlight, and contain vegetation or flotage. It has for the most part adapted itself to
seepage, borrow pits, hoof prints, improperly irrigated fields and the edges of streams and
irrigation canals." They note that the breeding places for species of Aedes are quite
variable, and that "in general, they breed in temporary pools formed by rains or melting
snows. Some species breed in the coastal salt marshes which are flooded at intervals by
unusually high tides. Others have become adapted to irrigation practices. A few species
breed in tree holes, rock pools and artificial containers." They found that the vector of
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102 SOLID WASTE/DISEASE
urban yellow fever and dengue, Aedes aegypti "is thoroughly domesticated, breeding
almost exclusively in artificial containers in and around human habitations." They noted
that some 26 species of Culex had been reported in the United States. This group in-
cluded several important pest species and disease vectors.
In this work it was also stated that "Culex mosquitoes breed in quiet waters of
almost all types from that in artificial containers to large bodies of permanent waters.
Water in which there is organic material including sewage is often a favorite breeding place.
Culex nigripalpus is the proven vector of St. Louis encephalitis virus in the Tampa Bay
outbreak in 1962." They found that Culex pipiens, the northern house mosquito, occurs
throughout the northern United States and as far south as Georgia and Oklahoma, and
that Culex quinquefasciatus, the southern house mosquito, occurs in all the southern
states from coast to coast and extends northward to Nebraska, Iowa, Illinois and Ohio.
They stated that the members of this species complex "are important vectors in urban
epidemics of St. Louis encephalitis, particularly in the Midwest." Both species were noted
"to breed prolifically in rain barrels, tanks, tin cans, and practically all types of artificial
containers. These species do not migrate far except when great numbers are being pro-
duced. Culex tarsalis is believed to be the most important vector of encephalitis to man
and horses in the western states. It is essentially a rural mosquito. The larvae utilize
almost all types of water. These include canals, ditches, borrow pits, impoundments,
ground pools, and hoofprints, as well as artificial containers of various types such as cans,
jars, barrels, drinking troughs, ornamental ponds and catch basins." The species is noted
"to fly at least ten miles, although the majority of individuals probably remain within
a mile of their breeding places." In regard to the Culiseta group, "two species have been
found naturally infected with encephalitis virus but their relation to the epidemiology
of these diseases is not known."
Mosquito control is important in the disposal, stabilization, and treatment of solid
wastes by lagooning. 744
Thomas (1963) discussed dosage factors in the transmission of western enceph-
alomyelitis virus, and noted that a titer in the donor required to infect the salivary glands
of 7 percent of the mosquito population was 10~3-8. To infect the salivary glands of 50
percent of the mosquito population, a donor with a virus titer of 10"45 was required.
This investigator studied the distribution of western encephalomyelitis virus in the mos-
quito vector, Culex tarsalis. He stated: "The percentage of mosquitoes infected varied
directly with the degree of viremia of the donor. A single mosquito was capable of trans-
mitting virus to a 4-day-old mouse or a 9-day-old chicken." 51°
In 1963, comments of interest to the epidemiology of malaria were made by Lang-
muir. 88 "... new criteria soon revealed that malaria had disappeared as an endemic dis-
ease from the South, probably before the DDT program had gotten underway ... At
some time between 1935 and 1945, malaria mysteriously disappeared . . . The slight rise
in the morbidity curve in 1945 reflects the influx of infected veterans . . . The sharp
peak in the curve in 1951 and 1952 reflects the Korean War and the occurrence of several
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literature survey 103
thousand cases among veterans ... In the past five years, the incidence of reported
malaria in the whole country has remained below 100 cases a year."
Another reference to mosquito breeding in waste stabilization ponds was made by
Nemerow and Bryson 68 in 1963. Such ponds are used for the reduction of solid wastes
suspended in a liquid transporting medium.
In 1964, Garrison and others 15° noted that mosquitoes were attracted by wastes
discarded by rural populations along the highways.
In 1964, Reeves and others,60 reporting on 15 cases of Western encephalitis and two
cases of St. Louis encephalitis in Kern County, California, in 1958, referred to high water
levels following heavy rainfalls associated with an immense vector population of Culex
tarsalis. The relatively small number of cases, in spite of this epidemic potential, was
ascribed to "a combination of low temperatures in the early summer that delayed ex-
trinsic incubation of virus in C. tarsalis and successful control of the vector population in
the urban area by midsummer." In the same year, Aitken and others572 reported the iso-
lation of St. Louis encephalitis virus in Trinidad. In the years 1955 through 1962, there
was a total of 19 such isolations from birds, mosquitoes, and one human being. In the
same year, Dow and others 512 isolated St. Louis encephalitis virus on 22 occasions from
mosquitoes taken in the Tampa Bay area of Florida during the epidemic of 1962. The
mosquito chiefly involved was Culex nigripalpus. One other mosquito, Culex melanconion,
was also found infected. It was stated that "these isolations indicate that infected vectors
were prevalent over a vast area exposing the human population to infections throughout
the region."
The worldwide nature of mosquito-borne encephalitis in humans is reviewed in
the 1964 British Medical Journal. 5U
In the period 1960 to 1964, there were 464 cases of malaria reported in the United
States. In 1964 alone, there were 102 causes. 351
In 1965, Bond513 reported on the 1962 epidemic of St. Louis encephalitis in Florida
with the following comment: "There were 43 deaths, giving a case fatality rate of 22.2
percent. [The] virus was recovered from 4 human beings and from 42 mosquito pools,
of which 40 were Culex nigripalpus." Of interest was the high clinical disease rate among
elderly retired persons in the country. Bond stated, "Widespread viral activity in nature
was demonstrated by mosquito collections and serologic findings on wild or domestic
birds in each of the 4 counties. The geographic differences in human disease rates were
ascribed to differing exposure factors related to wild bird density and local vegetation,
and to variation in age composition, leisure time activities, or previous arbovirus experi-
ence in the human population." 513
The multiplicity of sources of water which serve as breeding places for mosquitoes
is referred to by Kimball396 in 1965: "Breeding sources within the drainage facilities are
perpetuated by accumulation of small quantities of community waste water resulting
291-982 O - 68 - 8
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104 SOLID WASTE/DISEASE
from irrigating lawns, washing sidewalks and streets, testing fire hydrants, . . . pumping
out swimming pools and, in suburban areas, from irrigation of citrus groves and other
agricultural operations. Natural breeding sources are creeks and ravines; natural depres-
sions and other low areas; and salt marshes. Potential sources are ornamental pools, plas-
tic swim pools, decorative vases, buckets, jars, cans, old tires, boats in storage, animal
water, watering containers, and almost anything that will hold water for a week or more."
Adaptability of mosquitoes to environmental changes effected by man is noted in
a World Health Organization Technical Report of 1965 234: "In certain large cities . . .
this threat (of mosquito-borne disease) has already become a reality, especially with re-
gard to the rapid increase of one insect, the mosquito Culex fatigans, a vector of ban-
croftian filariasis. This mosquito has established itself in the urban environment, adapted
itself to it, exploited it and turned its own peculiar characteristics to its own advan-
tage. ... It uses man-made breeding places to such an extent that its population density
is positively correlated with that of man. In particular, these breeding places tend to be
highly contaminated waters where the larvae are able to make maximum use of the or-
ganic pollution typical of an insanitary urban environment. The mosquito has the ability
to shelter in houses, often in places that are difficult to reach with insecticides. It feeds
on man and uses human blood for egg maturation." (See also reference 753, pp. 135-139.)
In 1965, Beaver and Orihel742 reviewed 18 previous cases of filariasis reported in
the United States, and added 21 new cases. These were due to filariae of animals. The
great majority of these cases were from residents of Florida. Two cases were reported from
Oklahoma and Missouri and one from Washington. In the previously reported cases,
Michigan, Massachusetts, Louisiana, Texas, Wisconsin, and New York were involved.
The agent of the disease, Dirofilaria, is noted by Hull167- P 92° to be transmitted by mos-
quito bite. Domestic pets, such as cats and dogs, harbor some of these forms. Beaver
and Orihel state that "at present, approximately half the known cases (in the world)
have occurred in the United States."
In regard to prevention of mosquito-borne disease, it has been shown that some
species have become resistant to insecticides. 234
These references, while not exhaustive, are representative of the available material
on possible relationship of solid waste to mosquito-borne disease. Other references of in-
terest to this subject are 751 (pp. 72-97), 752, and 753.
DISCUSSION AND CONCLUSIONS
The present importance and the potential for the spread to humans of mosquito-
borne disease due to solid waste are impossible to state quantitatively on the basis of
available information. Compared to breeding media provided by natural and man-made
bodies of water, storage reservoirs, irrigation and the like, solid wastes would seem to be
of little importance. However, where mosquito eradication is attempted, failure to con-
trol solid wastes as potential breeding places could well negate the program.
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literature survey 105
Under prevailing circumstances in the United States, solid waste is probably of
little importance in the transmission of mosquito-borne diseases to man. Should diseases
such as malaria, yellow fever, or dengue become endemic in this country, vector proximity
necessary to high rates of infection between hosts and vector would be established by
accumulation of solid wastes in communities or about homes. Certainly any attempt to
deny the mosquito access to human habitation, whether for its potential role as a vec-
tor of disease or its role as a pest, must include control of solid wastes.
RECOMMENDATIONS
To demonstate a solid waste/mosquito-borne disease relationship, investigation
would have to be done to determine (1) that infected mosquitoes are found associated
with breeding media afforded by solid waste and, (2) that they can reasonably be related
to human cases in the area of invasion by these mosquitoes.
The priority of this type of investigation, however, as opposed to that in other
aspects of mosquito control or of solid waste disposal studies, would not appear to be
very high.
Therefore, assuming that all potential mosquito breeding media are important in
the spread of such diseases as viral encephalitis in the United States, the following rec-
ommendations are made:
Public education on all aspects of waste storage, including that of water collection,
excessive moisture, and larval food sources conducive to mosquito breeding
Control of municipal, commercial, and industrial wastes and disposal sites in a
manner preventive of mosquito breeding
Research on chemical, bological, and other controls of mosquito propagation in con-
nection with solid waste stabilization and treatment ponds
Research on waste treatment methods preventive of mosquito propagation.
SPECIFIC DISEASE
Encephalitis (anthropod-borne). General
Anthropod-borne encephalitides are transmitted mainly by mosquitoes of various
species. Western encephalitis, for example, is transmitted largely by Culex tarsalis, al-
though other Culex and Aedes, Anopheles and Culiseta mosquitoes carry the disease
agents.167' p-736
In order to associate solid waste with this disease, linkage must be established which
will take into account the ecology of the vector.
Postulation. Solid wastes of the trash variety contain materials — tin cans, old
tires, plastic containers, automobile bodies and many miscellaneous items — which may
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106 SOLID WASTE/DISEASE
catch and retain rainwater or water from other sources. Mosquitoes breed in these re-
ceptacles which are often found in close association with human habitation. The mos-
quitoes thus bred may feed on domestic, avian, and other hosts of the virus, which have
been infected by sylvatic vectors, and in turn feed on humans to which the virus is trans-
mitted.
Evidence. There is no direct evidence in the literature — no tracing of human
encephalitis to mosquito to trash receptacle — for associating solid waste to mosquito-
borne human disease. House mosquitoes, however, which breed in such containers are
capable of transmitting the virus 167- PP- 733-748 and are known to feed on and become in-
fected by animal hosts of the virus. Other species, less selective, may breed equally well
in natural bodies of water, and in water made available by man through careless disposal
of refuse 167' pp-733-736> 74i,745-747-748, sis, p. 399
The epidemiologic evidence in human viral encephalitis often points to excessive
breeding of mosquitoes brought on by heavy rainfall,511- P 119 or improper irrigation
methods.
Although large mosquito populations seem to be required to result in human en-
cephalitis, the disease has been transmitted to small animals by the bite of a single in-
fected mosquito. 51°. P 164
In an area of endemic encephalitis, the appearance of a human epidemic can oc-
cur through the agency of a primary sylvatic mosquito vector spreading infection to
domestic animals and of a secondary mosquito transmitting the virus from these hosts to
man.511' PP "9-120 More than one mosquito species may take part in transmissions of this
type. As a final step, a mosquito is required which is capable of being infected by animal
hosts and passing the virus on to man. Some of these breed in waste containers and
are commonly found in human habitation (see Mosquito-borne Disease section). Little
investigation has been made on the infection and infectivity of such mosquitoes actually
trapped in residential areas or, specifically, in water contained in waste.
Miscellaneous Communicable Disease
FUNGUS DISEASE
General. Land fill disposal of avian manures and feathers raises the question of
maintenance and spread of pathogenic soil fungi by such operations. 500' 501- 502> p-6; 504>p-1034~
1035 Once infested, the soil may continue as a reservoir of mycotic infection for man for
many years.15S It is conceivable that disturbance of infested soils for the burial of solid
waste may create a hazard.
Postulation. It is possible for pathogenic fungi to cause disease in man through
the medium of solid wastes which provide the proper medium for growth of certain fungi,
or, indirectly through disturbance of infested soils in preparation for solid waste disposal.
It is further possible for sanitation workers handling waste contaminated by pathogenic
fungi to become infected.
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literature survey 107
Evidence. In 1954, Levan500 reported the following cases: (a) a fatal case of
coccidioidomycosis in a worker after the sorting of dusty wool from an endemic area; (b)
a case similar to case (a); (c) a crane operator who contracted the disease working on a
project at Muroc Dry Lake; and (d) pulmonary coccidioidomycosis in a man hired to
clear new land with a tractor and leveler. During this operation he was exposed to "a
very high concentration of dust." The case was accepted by the insurance carrier as
occupational.
Smith332 stated in 1957, that sporotrichosis causes disease in man by infecting
minor wounds. The infection was found particularly in male agricultural workers. Ex-
posure to dust in areas of endemic coccidioidomycosis is considered especially hazardous
because of the "vast numbers of dry (spores) which very readily become air-borne." Man
is said to contract the infection histoplasmosis "by the inhalation of dust derived from a
reservoir of fungus in soil." This author stated that "most of the evidence regarding the
dispersal of fungi pathogenic for man and animal is circumstantial. The reservoir of a
number of the major systemic mycoses is almost certainly soil, and for these conditions
air-borne dispersal of fungal spores or of contaminated soil particles appears to be charac-
teristic. The portal of entry of the soil-inhabiting pathogens is either the lungs (coccid-
ioidomycosis, histoplasmosis) or a chance injury (madura foot). . .".
In 1957, Emmons175 stated: "A factor common to many of these locations (where
Histoplasma capsulatum was found) was the presence of fecal material of chickens or
other birds, although the natural occurrence of the disease in birds has never been
proved. . . . The most probable explanation for the presence of histoplasma in these sites
is that the fungus grows as a saprophyte in a suitable soil and is quite independent of any
animal hosts. Histoplasma may persist in soil for long periods after the environmental
conditions with which its presence is usually associated has been altered. The fungus
has been isolated from garden soil, from heaps of chicken droppings left in exposed sites
on a hillside, and from beneath blue grass sod three years after the removal of a chicken
house on the site. . . . One can conclude that fungi capable of causing human disease are
frequently present in varied environments, that man must be frequently exposed to them
by inhalation or trauma and that such exposures probably lead only rarely to progressive
and fatal disease." 175
In 1958, Furcolow 173 stated: ". . . histoplasmosis and coccidioidomycosis appear
to be diseases of nature. The infecting organisms in these diseases grow freely in the soil
and are disseminated to human beings through the medium of inhalation of the spores.
. . . The present theory is that the fungus H. capsulatum appears to be limited to its pres-
ent geographic zone by conditions of temperature and humidity. It grows in localized
places where the microclimatic conditions of temperature and humidity are satisfactory
and not in any generalized manner. Finally, it appears to infect people who come to these
localized sites and inhale the spores. . . ."173
In 1958, Hosty and others35 quoted a report of Kier and co-workers who traced
histoplasmosis in an individual to the handling of chicken manure purchased by a city
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108 SOLID WASTE / DISEASE
dweller for use as a fertilizer for flower beds. Hosty reported on three cases of histo-
plasmosis which involved a father and his two children, and believed that manure — prob-
ably from chickens, which had been collected by the parents — was a possible source of
infection. The father's infection proved fatal.
The 1960 text of Hunter and others517 defines coccidioidomycosis as "an acute,
subacute or chronic infection of the lungs produced by Coccidioides immitis, acquired by
inhalation . . . Coccidioides immitis has been recovered from the soil . . . Infection of man
occurs by inhalation of dust containing the highly infectious chlamydospores . . . Primary
infections have a definite seasonal incidence, occurring predominantly in the hot dusty
autumn months." It was stated by Hunter that ". . . Histoplasma capsulatum has been
isolated from the soil from numerous animals. Infection in man probably occurs by in-
halation. There is no evidence of animal to man transmission."
In the book326 edited by Sweany (1960), the following points on histoplasmosis
are made: (a) In one study, the presence of the fungus in soil was associated with chicken
droppings, and all the evidence pointed to "a saprophytic reservoir of the fungus in soil or
organic debris from which man and animals . . . are infected," (b) Histoplasmosis should
be considered a disease of nature, found in certain regions and spread to humans from
some reservoir in the soil or in nature, (c) "There is no question that H. capsulatum is
disseminated in the air. In most epidemics, . . . air-borne inhalation of spores was re-
lated to activities at the point source," (d) "Mice infected with as few as 10 spores regu-
larly showed lesions and disease in experiments performed by Grayston and others in our
laboratory," and (e) "Our present knowledge points to the soil, particularly when en-
riched by chicken droppings as the major source of infection." 326
In 1961, Furcolow505 stated: "... It is ... clear that H. capsulatum can infect in-
tranasally with relatively small number of spores. . . . With half a million infections and
a thousand deaths a year in the United States, the importance of H. capsulatum to pub-
lic health is self evident. The serious nature of histoplasmosis is indicated by follow-up
of 100 untreated cases. With average follow-up of less than four years, one-third are
dead and two-thirds of those surviving are at least 50 percent incapacitated."
In 1961, Smith and others S01 stated: "We know that in the experimental infections
of animals, increasing dosage (of the spores)increases severity as indicated by deaths. . . .
In one point-source epidemic we investigated, a university student dug a rattlesnake
from a ground squirrel hole. Subsequently, the fungus was readily recovered from the soil.
Of the seven students infected, six had symptoms and the student who wielded the shovel
had the most severe illness." These authors give the annual death rate in the United States
from coccidioidomycosis as ranging from 50 to 85, with an 8-year average of 64. "From
1956, when amphotericin began to be used, the number of deaths has reduced." They
further state: "The saprophytism of the fungus enables it to flourish over vast areas so
that eradication of it would be wholly unrealistic. Topsoil, from an Indian burial ground,
where several cases originated, caused infection of several San Diegans when the soil was
used for landfill. C. immitis was actually recovered from these fills."
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literature survey 109
In 1962, Emmons155 stated: "Soil and humus rather than diseased man or animals
are the reservoirs from which pathogenic species of Streptomyces and Nocardia entered
the respiratory tract or the subcutaneous tissues of the patient. It is a fundamental con-
cept . . . that the fungi . . . are normal components ... of the soil or of organic debris
in the soil." He also says that, once established, pathogenic fungi are capable of indefinite
growth as saprophytes in suitable soil. He also refers to the association of chicken ex-
creta and H. capsulatum. He states: ". . . We believe the contamination of the soil by
(starlings) provides the environmental conditions suitable for the growth of this patho-
genic fungus." He adds that aspergillosis is relatively rare in man. He found that "leaves
and branches of trees passed through 'chippers' yield a type of coarse mulch that provides
apparently optimum conditions for growth of A. fumigatus" — a matter of possible in-
terest in an association with waste. He says, however, that man appears to be highly re-
sistant to aspergillosis.
The pathogenic fungus Cryptococcus neoformans was reported as being isolated
from barnyard soil and found regularly in old nests and droppings under roosting sites
of pigeons. The author reported that "several outbreaks of pneumonitis in men exposed
to old accumulations of pigeon excreta had been recorded in medical literature. Men
were exposed to dust while cleaning or demolishing old buildings which had housed
pigeons for many years." Quoting Vital Statistics of the United States, the author
states that each of three mycoses (coccidioidomycosis, histoplasmosis and cryptococcosis)
kills 50 to 75 persons per year, and that "the actual numbers of diagnosed and undiag-
nosed fatal cases may be many times these numbers." In 1964, Harrell89 stated: ". . . One
should . . . expect to find histoplasmosis acquired by pulmonary inhalation in those in-
dividuals who might have the best opportunity for contact with soil contaminated by
these sources. . . . Minor epidemics of histoplasmosis have also occurred in laborers
handling . . . soil specimens. Coccodioidomycosis can be considered as occupational to
some extent in those whose work takes them into the desert areas of the lower Sonoran
Life Zone and most especially in the San Joaquin Valley. Sporotrichosis is almost in-
variably acquired by the cutaneous inoculation of the organism at the time of some form
of trauma to the skin."
In 1965, Campbell504 stated: "Histoplasma capsulatum is not diffusively dis-
tributed in soil even in those states or regions in which it is known to be most highly
endemic. To determine whether PI. capsulatum merits consideration as a potential cause
of infection in any region or community in which it has not yet been found, a more re-
fined tool than the skin test survey is required. This is the search for foci in the im-
mediate area. These foci are protected micropockets of soils which are heavily fertilized
with an accumulation of either the excreta and feathers of wild or domestic avian or the
guano of bats or both. Such micro-environments are found in ... deserted buildings . . .
town and city parks [or] any protective area where birds or bats habitually congregate
to nest, roost, or hibernate. Outbreaks of histoplasmosis in Mexico after manipulation of
soil indicate further that in some areas the endemic areas of histoplasmosis and coccidi-
oidomycosis overlap." This author implicates chicken feathers as an actual agent of
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110 SOLID WASTE/DISEASE
transmission of the organism from focus to focus. The bat is also implicated as a source
of the agent. 504
In 1965, Furcolow502 stated: "Histoplasmosis and the other pulmonary mycoses,
of which the most important are coccidioidomycosis, blastomycosis and cryptococcosis,
are environmental diseases acquired by the inhalation of the agent from the atmosphere
into the lungs. These fungi grow in the soil and are inhaled after the soil is stirred by
some activity which creates an aerosol. In general, these organisms are small, 5 microns
in size, or less, and thus readily penetrate the lungs and are retained there." He states
it has been estimated that "in the U. S. alone, 30 million people have been infected with
this fungus disease [histoplasmosis], and that half a million a year acquire the infec-
tion. . . . One of the most important [environmental conditions] is enrichment of the
soil with bird manure. The bird species which may have been involved in enriching the
soil have been extended to include not only chickens but other avians, such as starlings,
grackles, blackbirds, oil birds and pigeons. ... It is thus clear that the essential element
in the soil necessary for the growth of the organism is some extract of bird manure." 502
This author speaks of two methods of control for the disease (namely, vaccination
and eradication of the fungus from its natural sources). He states: "... the eradication
of the organism ... is extremely difficult, if at all possible." He then makes the follow-
ing statement of importance to solid waste landfill operations: "The method of covering
infected with supposedly uninfected soil has been suggested . . . but, in our experience,
has been only a temporary value, since positive cultures eventually reappear, probably by
the growth of the organism through the covering soil with the passage of time." He refers
then to very short exposure periods resulting in clinical disease. With respect to solid
waste disposal, he states: "... a wooded area along a creek . . . was cleared by bulldozer
operations for the construction of a bridge. . . . The bulldozer operator became ill and
subsequently died. A number of other persons were made ill and a clinical diagnosis of
histoplasmosis was made in 29 persons. Consideration of all the facts revealed by the
studies made it quite apparent that there had been a widespread aerosol created by the
felling of the trees and the activities of the bulldozer during the hot dry summer period
in which the clearing operation took place." 502
In 1965, Dodge et al. 503 reported an outbreak of histoplasmosis among school chil-
dren who had played in a school yard in which the ground had been contaminated by
bird droppings under a starling roost. These authors noted that "the absence of grass
may relieve the fungus of competition for food, especially for essential elements which
may be present in the bird droppings. The uses to which the school yard was put, both
as a playground and parking place, helped to create much dust with its load of spores
and put a high concentration of humans at risk of breathing the dust and spores."
In 1966 it was reported 10° that micro-epidemics of sporotrichosis can occur through-
out the United States. It was stated in that work that "Sphagnum moss apparently served
as the vehicle for the transmission of the disease." Material already quoted above was re-
peated in regard for histoplasmosis and aspergillosis.
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literature survey 111
In 1964, Dixon and McCabe stated109 that fungi potentially pathologic for man had
been isolated from sewage. Because of the low morbidity generally, the authors believed
that the presence of such fungi in sewage did not lead to a significant extra health hazard.
Fungi have been found in sewage sludges, but no mention was made as to whether
or not they were pathogenic.2U
Discussion. In all of the material cited, there is not a single reference to infection
by fungi of sanitation workers in association with sanitary landfills, dumps, or other
means of disposal of solid wastes. Neither is there any specific reference to parks or play-
grounds which have been formed over sanitary landfill. However, dumping of untreated
domestic avian manures in landfills, or scattering of this excrement as fertilizer in areas
which later could become used for recreational purposes, provides the potential means of
dissemination of the pathogenic soil fungi. In connection with the practice of covering
waste with soil in the sanitary landfill, it is of interest to note that histoplasma can pene-
trate soil after having been buried. 502- P 7
The potential hazard to landfill employees is suggested by the short exposure time
necessary for infection and the appearance of pulmonary infection in personnel associated
with bulldozing of infested soil. 502'p-8; 501-p-310 The hazard from histoplasma to com-
munities from nearby landfill operations is suggested by the evidence of widespread dis-
semination of the infection as the result of bulldozing and clearing operations. 502- p-9 The
use of bird manure as fertilizers in parks and playgrounds thus comes into ques-
tion. 502> pp-5-6
The fact that no infections due to soil fungi have been reported among sanitation
workers engaged in sanitary landfill operations, or in the general public using parks or
playgrounds developed from sanitary landfills, is no guarantee that infection has not
occurred due to pathogenic fungi resulting from the nourishment provided by organic
wastes.
Until attention was drawn to histoplasmosis and the existence of widespread foci,
it was thought that this disease was rare.
The extremely small dose or numbers of infectious elements of the fungi neces-
sary to cause disease505- p-304 suggests a definite potential for infection where avian
manures are disposed. In addition, it would appear that the pulmonary deposition of
the agent of histoplasmosis is not necessary, at least in mice, for the development of the
disease. 50S'P-304
A significant factor relating to the dissemination of pathogenic soil fungi in the
operation of sanitary landfills is the disturbance of the soil of the site in preparing
trenches or in moving debris and the frequently attendant dust raised by both trench-
ing and covering. Air-borne pathogens are thereby potentially introduced to unprotected
landfill workers.
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112 SOLID WASTE /DISEASE
It is interesting to speculate that if the bat is actually a carrier of Histoplasma
capsulatum,504- p-1335 and hence a disseminator for the development of foci, the proper
control of garbage could act to reduce the number of insects which provide the basic
food for this animal — an animal that is also a carrier of rabies and other zoonoses.
Conclusions. Present data do not permit any estimate of the possible hazard of
pathogenic soil fungi in association with solid wastes. On the one hand, the earlier con-
sideration of histoplasmosis as an uncommon disease, and its ultimate revelation as a very
widespread infection, does not permit an offhand dismissal of a significant relationship
between the diseases caused by these fungi and solid wastes handling. On the other hand,
the importance of the disease from the standpoint of morbidity and mortality should not
be over-estimated pending further research on its epidemiology and prevalence among
specific populations known to be directly or indirectly associated with solid waste dis-
posal.
Recommendations. In considering disposal methods, application of those forms of
treatment which destroy pathogens would seem highly preferable to those which merely
cause reduction in their numbers, or no reduction at all.
Since the fate of the pathogenic soil fungi in sanitary landfills is not known, both
current landfill operations and former landfill sites converted to recreational areas should
be studied. The suppression or multiplication of the agents by landfill methods would
have to be known if the potential for infection is to be estimated.
Epidemiologic studies of histoplasmosis in the general population should include
consideration of solid waste disposal sites in tracing the source of infections.
Sanitation workers should be screened to discover the prevalence of the infection
among them as opposed to that of the regional population in general. A careful determina-
tion of the presence of foci in the areas worked by sanitation workers should also be
carried out. [One author feels that population surveys alone are not dependable, at least
in the case of histoplasmosis. 504]
The use of sanitary landfills as parks and playgrounds perhaps should be prefaced
by investigation of the potentialities for culture and dissemination of pathogenic fungi.
Fertilizers prepared from chicken manure particularly should be examined for their
ability to create a favorable environment for the implantation and multiplication of fungi.
Similar investigations of other wastes may be required to determine if they support other
types of pathogenic fungi, or help to create favorable environment for their growth. Com-
posts and sludges used as soil conditioners also should be investigated. 502> pp-5- 6; 503- P- 1209
Consideration of pathogenic soil fungi would thus seem appropriate in selecting
sites for sanitary landfills and in the choice of the material to be disposed and used for
cover in the fills. A question for the future, in this regard, might be the following: Will
landfills in which large amounts of avian manure are disposed become eradicable reservoirs
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literature survey 113
of Histoplasma capsulatum? 15S The general question, of course, is this: Can waste create
the environmental conditions necessary to propagation of pathogenic soil fungi? The con-
cern here, of course, is that, once infested, the soil may continue as a reservoir of mycotic
infection for man for many years.15 It is therefore suggested that sanitary landfills used
as parks or other recreational purposes be maintained under surveillance, at least until it
is established that no risk exists of infection by fungi.
ANTHRAX
General. It has been suggested that anthrax may arise from contact with animal
wastes. 23
Hull167 states that anthrax is primarily a disease of animals; that secondarily,
man is infected from an animal, either by direct or indirect means (page 82); and that
it occurs in all parts of the world (p.88). He states that "practically all animals are in
some degree susceptible to anthrax. Cattle, horses, mules, sheep, goats and the wild
herbivores are most commonly affected. . . . Although anthrax in livestock in the United
States is principally confined to cattle, outbreaks in horses, mules, sheep, and swine are
also encountered. Infection in livestock usually is a result of grazing on infected pasture-
land rather than by contact. Infection may also be caused by contaminated fodder or
artificial feed-stuffs, such as bonemeal, fish meal or oilcake and tankage; by drinking
from contaminated pools; or by the bites of contaminated flies (pp.95-96) .... To prevent
the introduction of anthrax into the United States, Federal regulations governing the
importation of bones, or bonemeal for use in animal feeds or fertilizer are enforced by
the Department of Agriculture." 167
Postulation. Anthrax may be transmitted by indirect modes involving wastes. The
disease agents might be disseminated in animal excreta, by flies as universal carriers
of disease agents, in tissues of dead animals, or in wastes from animal product manufac-
turers such as the leather industry.
Evidence. In 1907, Buchanan 36° in investigating the carriage of infection by flies,
found that "a very profuse growth of Bacillus anthracis" resulted when flies contaminated
with the bacillus were permitted to walk on agar surfaces. In 1913, Graham-Smith121
stated in regard to anthrax," . . . under suitable conditions, which are not frequently
fulfilled, the bacillus may be distributed by flies in many ways, though no definite evidence
of infection either in men or animals has yet been obtained" (p. 186).
In 1914, Mitzmain 359 found that biting flies could not play a role in the trans-
mission of anthrax "until the peripheral circulation becomes invaded with tremendous
numbers of the anthrax bacterium." The stablefly, Stomoxys calcitrans, was found to
transmit anthrax when permitted to feed on animals recently dead of the disease (that
is, within the first few seconds or minutes following death). Guinea pigs exposed to the
bite of the flies died and "typical pictures of anthrax infection were presented at the
necropsy. . . . Pure cultures were obtained from the spleens of the dead animals." This
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114 SOLID WASTE/DISEASE
investigator also noted that "typical organisms were seen in the feces of horseflies at
various intervals up to 48 hours from the time the infected animal was bitten. The feces
of the stablefly were likewise found to be infected up to 24 hours after obtaining blo~d
from a sick animal." 359
West90 reported in 1951, that flies were capable of transmitting anthrax, but gave
no factual data of an epidemiologic nature. Similarly, Chandler implicates the Diptera
as a mechanical conveyor of anthrax (p. 663). In 1961, Herms195 stated: "It has been
amply proved that coprophagous fly larvae [maggots] . . . may transfer bacteria . . .
through the pupal stage to the mature flies. In this manner, the infection of anthrax
may be disseminated by flesh flies, bred in carcasses of animals that have died of this dis-
ease" (p.22).
In 1957, Smith 332 stated: "Spread of the disease from animal to animal by direct
contact rarely occurs; there is some medium through which infection most usually
occurs. Infection takes place by the alimentary tract and the bacilli are excreted by the
urine, faeces, and possibly the milk during the latter stages of infection. Bloodstained
infected fluid exudes from all orifices of the body at death, and the immediate surround-
ings may be heavily contaminated. The bacilli do not sporulate in the unopened carcass,
but when the bacteria are exposed to atmospheric conditions spores are produced and
these are resistant and may remain alive in or on infected soil for many, many years.
Animals may therefore be infected by feeding on contaminated pasture land and the
greater incidence of infection in swampy areas and during the summer months is asso-
ciated with the development of the spores and the multiplication of the bacteria on the
decaying vegetable matter in these areas. In Great Britain, outbreaks are associated with
feeding imported infected foods. The disease is therefore not only more common during
winter months when artificial foodstuffs are used but is clearly more frequently observed
amongst cattle which are fed on imported foodstuffs than amongst those cattle and sheep
which are fed in a different manner." 332 In speaking of this disease in 1958, Shahan and
Traum57 state: "In 1952 anthrax occurred extensively in animals in some areas of the
United States, particularly in the Middle Western states. It is believed that at least one
outbreak was caused by the feeding of imported bonemeal containing anthrax spores."
In 1962, Klein et al. quoted another author, ". . . Tannery wastes may con-
tain the very resistant spores of anthrax bacilli derived from hides." In 1965, Okum and
others70 quoted Jansky to the effect that he was able to recover hair and flesh from
tannery wastes.
In regard to incidence of the disease, both in animals and man, it has been stated
that in Iran during 1945, one million of a total of 15 million sheep died of anthrax. 682 In
the same work it is stated: "In the United States scattered outbreaks are widespread,
but the disease is not a continuing problem except in certain areas. During the period
1945-1954, 3,447 outbreaks were reported from 39 states with loss of 17,600 head live-
stock." In the United States, approximately 50 cases of human cutaneous anthrax were
said to be reported annually, with the probability that additional unreported cases occur.
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literature survey 115
It was further stated: "Man is infected by contact with infected animals (agricultural
anthrax) or contaminated animal products (industrial anthrax). Agricultural anthrax oc-
curs in farmers, veterinarians, and slaughterhouse workers. Industrial anthrax occurs in
persons whose work brings them in contact with contaminated hair, wool or hides although
other products have been responsible for scattered outbreaks. Dock workers are occa-
sionally infected while handling contaminated hair and hides." 682
In its report of vector-borne diseases in the United States, the Public Health Serv-
ice affirmed that there were 54 cases of anthrax during the period of 1960 to 1964. In
1964, five cases of vector-borne anthrax were reported. Hull stated that the yearly inci-
dence of anthrax in man for the period 1945 to 1960 was less than 70 cases. This author
reported that anthrax fatalities occurred in tannery industries in both Germany and the
United States in the period 1927 to 1932. This author quoted the Smith reports for the
period 1919 to 1943 in which human cases were derived from "hides and skins of cattle,
goats, horses, and mules, horse-hair, imported wool, blood meal, and fertilizer." Numerous
cases of occupational origin (none involving sanitation workers) were mentioned. Sug-
gested links, were noted, however; it was found that "other cases occurred in rendering
plants and from the use of fertilizers, the material in one instance being wool waste."
Economic pressures often result in the conversion of former wastes into by-products, as
in the case of food or other processing activities. Whereas bones formerly were disposed
of as waste, they are now converted into fertilizers and bonemeal. A number of fatal
cases were reported by Hull to have been the result of infection through bones, bone-
meal, or fertilizer. 167> P-102 Hull also mentions infections conveyed by biting flies (p. 103).
Since dead animals are a major waste source, the following quote from Hull is of interest:
"Bites from pets which have recently fed on the carcasses of animals dead of anthrax have
been known to cause anthrax infection" (p. 103). Also of interest is the statement: "Con-
tact may be more remote, as handling hides which have been shipped long distances.
. . . the contact may be very remote, as a man . . . becoming infected by a shaving
brush made from hair of an infected animal in China" (p. 104).
Hull also reports of a case of anthrax in a New York laborer cleaning out a sewer
(p. 107).
In 1960, Reed and McMillan531 quote a World Health Organization committee
report on anthrax to the effect that, while there are approximately 9,000 cases of human
anthrax reported annually, the actual incidence (due to underreporting) may be as much
as 90,000. These authors also note that tannery wastes may serve as a potential source
of contamination, as may artificial feeding stuffs such as bonemeal.
In 1964, Meyer581 stated that "anthrax is an occupational infection of ... handlers
of hides or fibers". He also made the following statements: "Asia has been distributing
contaminated animal by-products such as hair, wool, and skin, and this has reverberated
in industrial plants and in agriculture elsewhere through use of unsterilized boneflour and
bone, hoof or meatmeal as artificial feeds on farms. The U. S. Department of Agriculture
has established new requirements that have eliminated the risk from that source."
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116 SOLID WASTE/DISEASE
Discussion. Present laws and agricultural practices in the United States have re-
sulted in a very small number of cases of human anthrax in recent years. The present
total risk of anthrax as a possible disease of sanitation workers is implied in the one
quoted case involving a sewer worker. However, as pointed out by Hull167 (p. 106,
p. Ill), the hazard from dead animals which have succumbed to this disease is extremely
high. In fact, the extreme virulence of anthrax, as implied in the cases quoted above,
could easily result in the spread of infection to sanitary workers and others handling
waste animal products should anthrax become established on a broader scale in this
country among the animal population.
Conclusions. The present level of anthrax in animals and humans in the United
States is low enough so as to present little risk to American sanitation workers. To the
extent that the laws of the United States are not carried out with respect to introduction
of contaminated materials from foreign countries, there will be a certain risk. This risk
of becoming infected will extend to persons both within and without the animal products
industry through the handling of waste materials. The risk is especially high among
persons attempting to dispose of the bodies of animals dead of the disease, and very spe-
cial precautions must be taken in the event of suspected animal anthrax (Hull, p. 111).167
Recommendations. The virulence and infectivity of anthrax is well known, as are
other epidemiologic factors of concern to waste handling. The continued education of
the animal products industry, and the enforcement of existing laws along with inspection,
bacteriological testing of imported animal products, and testing by the industry of the
manufactured product should suffice to control anthrax. There is no further requirement
at the present level of anthrax in the United States.
TRICHINOSIS
General. Trichinosis in the United States is mainly transmitted to humans by in-
gestion of pork containing viable larvae of the nematode Trichinella spiralis. The dis-
ease is widely spread among carnivores and other animals of all types. It also is found
in aquatic mammals. 507- P 159; 508~ P- 314 The eating of such animals has led to trichinosis
in man.187> P- 438
Postulation. The epidemiology regarding the usual transmission of trichinosis to
man requires no postulation as far as solid waste is concerned.
Evidence. It is known that the feeding of raw garbage to hogs is the major factor
in the completion of the hog/human cycle. ™- p-16°; 167- pp-437- 438- *#>• 508> p-313 Larvae con-
tained in raw or improperly cooked pork scraps are consumed by garbage-fed pigs and
complete their encystment in the animal, whose meat is then eaten by the human. If the
larvae are not killed prior to consumption of the meat, the worm completes its human
cycle.
The evidence is twofold: first, the reduction in feeding of raw garbage to hogs has
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literature survey 117
resulted in a marked reduction in swine infections, 506' P 872 and, second, grain-fed animals
only rarely contain trichina. 508- P 316
The decrease in prevalence and degree of infection in man and pigs followed "en-
actment and enforcement of regulations prohibiting the use of uncooked garbage in swine
feed."506- P-872 It is ironic to find that these controls were instituted to control virus dis-
eases of swine and not trichiniasis in man.507' P 16° However, with only 2 percent of
slaughtered hogs fed on garbage, "the density of infection in them was sufficiently great
to contribute significantly to infection in man." 506' P 872 The continued feeding of raw
garbage to hogs still accounts for localized trichinosis,507' p-161; 508> p-314 and for infested
meat from slaughterhouses buying hogs from many sources. 509> P 237
Rats associated with dumps have been found infected, but the relationship of rats
to swine and human infection is not understood. 508- pp 317-318' 506' P 872
Discussion, Conclusions and Recommendations. The epidemiology and means
for prevention of trichinosis in humans is well understood. No further research on the
disease in regard to solid wastes is required.
TKYPANOSOMIASES
General. Chagas' disease in America, caused by Trypanosoma cruzi, is transmitted
by reduviid bugs. It is a typical zoonosis, and if man enters a natural focus he may acci-
dentally acquire the disease when attacked by the wild vector.
Raccoons can be spontaneously infected with T. cruzi. In the United States, rac-
coons raid human habitats in search of food, especially if reclamation of land by man
destroys the natural habitat (Hoare, pp. 288-291). 55S The attraction of house, garbage,
garbage dumps and indiscriminate litter of food, can — as in the case of rats — support
a raccoon population close to human habitat. In Chagas' disease, the vector has adapted
itself to the human domicile and feeds on human blood (p. 291). 555
Such adaptation is representative of the probable evolution of many diseases of
man, and there is certainly no reason to believe that such evolution has stopped. There
is no guarantee that new adaptations will not occur through man's activities in disturbing
the natural vector/feral animal relationship (pp.285-286, 291 ).555 Thus man's failure to
dispose properly of his wastes can contribute to increasing the number of disease agents
to which he is susceptible.
In the United States, clinical Chagas' disease, in spite of natural foci of infection,
is very rare. This may be due to a number of factors, including variation in the habits of
the local vector (p.292).555
Discussion and Conclusions. This material has been presented only to suggest the
extent to which solid wastes can provide a potential threat to man through adaptive or
evolutional mechanisms. Ecology is not a static phenomenon; on the contrary, it is ex-
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118 SOLID WASTE/DISEASE
tremely dynamic. Evolutionary changes can occur in very short periods — witness the
Australian experience with rabbits and myxomatosis.
The following references are given as evidence of adaptive and mutational changes:
560 (pp.340, 341, 355) 196
558 (pp.363, 366, 368) 234
57 (pp. 614-615) 313
555 (pp. 285-287) 319
581 331 (p. 2 of the abstract)
583 (pp. 468-469) 332 (pp. 5-6 of the abstract)
154 344 (p. 2 of the abstract)
155 391
156 587
162 591 (p. 1291)
163 592 (p. 287)
164 519 (p. 2 of the abstract)
168 (p. 2 of the abstract) 552 (p. 2 of the abstract)
174 561
195 567
569 (p. 2 of the abstract)
Recommendations. Those concerned with the public health aspects of solid waste
should give attention to the adaptivity of disease agents and animal hosts toward ex-
panding the number of infections to which man is subject or increasing the frequency or
degree to which he becomes infected.
CROP DISEASES
Although a number of disease agents associated with solid wastes do not attack
man, they may still have an adverse effect on his health or well-being. For example, cer-
tain disease agents attack the animals or crops which supply man's food. The former
have already been discussed in brief.
The intent here is to note, but not document in detail, the fact that there are crop
diseases for which crop wastes, or insects associated with waste, carry the disease agents
that damage or destroy the plant food products of man and his domestic animals.
Due to their enormous reproductive capacity, even small numbers of insects finding
harbor in waste can infect entire crops and herds the following season. However, critical
reduction in the wintering population can reduce the extent of insect damage.86
The following quotations pertinent to this relation are taken from Metcalf and
Flint: 86 "Many crop insects hide under surface trash such as boards, boxes, sacks, brush
heaps, stone piles, dense grass, fallen leaves and other dead vegetation" (p.410). "Stored
grain pests can maintain themselves in waste grains and screenings." (p. 933). "Bean
vines and other bean plant refuse help sustain the bean weevil" (p. 938).
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literature survey 119
Metcalf and Flint found that plant wastes harbor insect pests in various stages of
development (p. 932). Since fruit flies deposit their eggs in the rind, they suggested the
following control measure: "In infested areas fallen fruit should be collected daily and
buried to a depth of several feet or burned or cooked to destroy the larvae" (p. 814). To
control the peach bark beetle they advised that "all peach prunings and dying or diseased
trees ... be removed and burned during the winter" (p. 756).86
These comments are typical of those to be found in texts on insect pests and
plant diseases dealing with crop wastes.
E. injuries and safety considerations
General
Solid waste disposal comprises a number of occupations, including operation of
trucks, incinerators, bulldozers and other equipment, as well as various kinds of manual
work.
Solid wastes often are handled, either purposefully or accidentally, by householders
and their families. Exposure to hazards depends on the particular work performed, the
nature of the material handled, and the extent of protection provided and used — in-
cluding safety practices as well as equipment.
Postulation
In view of the spread of sources and kinds of solid wastes, as well as the variation
in methods of disposal, a priori statements on the hazards involved in their handling can
only reflect a feeling that risks are undoubtedly incurred. Some of these, other than
mechanical hazards, have been discussed elsewhere in this report.
The possible exposure, for example, of sanitation workers to biologic pathogens
when handling sludge can be inferred by the probable presence of disease agents in some
of these residues.16' 215' 658
Evidence
SANITATION WORKERS
Sliepcevich134 noted high-frequency rates (69.2) of injuries in "uniformed sanita-
tionmen" in New York City. She noted comparative excesses (relative to the national
average) in arthritis and in muscle and tendon disease — especially of the back — among
refuse collectors. Skin disease was not found to be excessive.
Except for the negative skin lesion correlation, this report does not refer to dis-
ease or injuries one might postulate as peculiar to solid wastes (that is, rat bites, enteric
diseases, chemical intoxication, and the like).
291-982 O - 68 - 9
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120 SOLID WASTE/DISEASE
One author speaks of the kinds of hazards present in refuse collection but offers
no data except the fact that accident rates were reduced following the institution of a
safety program. 447 Similar reports dealt with waste incineration hazards448 and street
sanitation. 449 The danger of soiled clothing to refuse collectors (skin rashes, irritations)
and potential infection of minor injuries from such clothing is described. 451
Van Kleeck445 states that sanitary landfills are hazardous to employees and the
public. Vehicular operation, dust, fires, contamination, explosives and mechanical hazards
are listed as the possible sources of risk. No frequency or severity data are given.
Wolfe quotes Mail as stating that the risk of poisoning by pesticide wastes among
refuse landfill employees is minimal.15
The American Public Works Association Committee on Refuse Collection and
Disposal made the following statement in its 1958 edition of Refuse Collection Prac-
tice 273: "While not a hazardous occupation, refuse collection has numerous perils and
dangers for workmen who are not alert or well trained." (p. 325)
The Committee also pointed out the dangers to workmen involved in refuse collec-
tion such as the lifting of heavy loads, the handling of defective containers, and the in-
curring of cuts and abrasions in handling the actual refuse.
Gotaas314 refers to special precautions to be taken to protect compost plant
workers when night-soil or sewage sludge is added in the operation, but gives no informa-
tion on histories of infection associated with such work.
Hand-forking to remove bed-dried digested sludge is mentioned, but no reference
is made to any hazard from such a practice. 21S
One report211 discusses the health hazards of sewage treatment workers, but does
not implicate sewage sludge in this regard. Other reports71- 73> 109' 222' 254' 445 deal with
sewer and sewage plant working hazards, but do not refer to any solid wastes in that con-
nection, except to say that sludge gas collection is hazardous. Another report on sewage
plant worker hazards states that leptospirosis and infectious hepatitis may be occupa-
tional diseases among employees.109 Personnel working with sewage solids or sludges are
not mentioned.
Demolition is implicated in cryptococcosis infection among building demolition
workers, but involvement of persons acting as "waste handlers" is not mentioned.155
THE PUBLIC
One report15 refers to pesticide fatality or intoxication in children playing with dis-
carded containers. Another lists the possible hazards to the public at the site of refuse
landfills. 445
Safety Survey
Since the literature contained very little on occupational hazards of sanitation
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literature survey 121
workers in general, and still less on those relating only to solid waste, a questionnaire
based in part on information given in reference 273 was sent to 500 municipalities, 325
industries, 10 industrial insurance companies, and 50 state health departments.
MUNICIPAL SANITATION WORKERS
Questionnaires. Questionnaires were sent to all cities in excess of 50,000 population,
in addition to a random selection of cities having populations between 20,000 and 50,000.
Of the 500 questionnaires distributed, only 97 (i.e., 19.3%) responded. Included in the
97 responses were 28 answers containing no information other than that solid wastes were
collected and disposed of by private contractors. A few responders in this group indicated
they were forwarding the questionnaire to the contractor, but no information resulted.
An additional 33 questionnaires contained only partial information (i.e., undocumented
estimates of injury and illness; data on number of employees, basic work week, tonnage,
etc., with no injury or illness figures, or the reverse). In the final analysis, 36 responses
(7.2%) contained sufficient data for review and comparison. Almost 93 percent of the 500
municipalities approached were either not capable of providing the information requested
or did not consider the subject important enough to be considered.
Injury Data. The information requested consisted of the number and types of in-
jury and illness recorded over as long a period as available, the number of tons of refuse
collected annually, the basic work week, the type of collection vehicles used, and whether
or not the organization operated a training program. After receipt of the information,
three additional variables were added from data contained in the APWA Refuse Collec-
tion Practice.273 These variables were (a) maximum container size, (b) whether or not
bulk material was picked up loose or tied, and (c) the requirement for furnishing of uni-
forms for the collection workers. Table 1 shows the variables considered in the analysis.
A series of regression analyses were run in an attempt to discover any possible relation-
ships between the various controllable variables and the dependent total injury frequency
rate (not the disabling injury frequency rates). Total injury frequency rates were 282,
and disabling injury frequency rates were 156.
The disabling injury frequency rates assume normal two-week vacations only, and
do not account for sick leave or holidays since such information was not available. The
results would thus provide a comparably more conservative rate than that obtained by
the Bureau of Labor Statistics.
Statistical Analysis. A series of regression analyses were run in an attempt to de-
termine factors affecting sanitation workers' injury frequency.
The first step in the analysis was to consider that subset of the data wherein com-
plete information was available for all variables. There were 32 observations of this type.
A multiple regression equation of the form:
Y = b0 + b1Xl + b2X2 + b3X3 + b,X4 + b5X0 + bcXG + b7X7 (1)
-------
122 SOLID WASTE/DISEASE
TABLE 1
EXPLANATION OF TERMS USED IN TABLE 2
Y = Injury frequency," number/10" man hours Xi = Training program
Yes — 2.0
Xt = Tons/worker No — 1.0
Xr, = Maximum container size, gallons
X2 = Basic work week, hours v 011 * • i
Xo = Bulk material
Tied — 2.0
Xj = Type vehicle Loose — 1.0
' X7 = Uniforms required
EN? - 2.0 Yes - 2.0
NO — 1.0 No — 1.0
a Injury frequency here refers to all injuries rather than
disabling injuries.
h CT = Compactor truck.
c EN = Enclosed, non-compactor truck.
d N = Open truck.
was estimated. The set of b coefficients was estimated by least squares. Notations for
the dependent and independent variables are defined in Table 1. Basic data are shown in
Table 2.
The fitted equation did not explain a large amount of the observed variation in in-
jury frequency. The multiple correlation coefficient was 0.56 and the accompanying co-
efficient of determination was 0.32 (i.e., the equation accounted for only 32% of the
variation). According to the results of the analysis, however, none of the partial regression
coefficients were individually significant.
This type of analysis is affected by correlation of the independent variables. Table
3 shows a matrix of simple correlation coefficients which was extracted from the multiple
regression computer printout. The matrix is symmetric around the diagonal, requiring only
the upper half to be shown. The circled coefficients are those which were significantly
large. A coefficient larger than 0.35 would be expected to occur less than one time in
twenty, and a value of 0.45 or greater would occur one time in a hundred by chance.
Table 3 indicates that the correlations of tons per worker, work week, type of
vehicle, type of material, and uniform required are not significant. However, the correla-
tion of 0.33 for training programs and 0.37 for large container size suggest a possible re-
lationship. The implicated association between tons per worker and container size deserves
further consideration. It is possible that some cities estimate their total tonnage on the
basis of container size as opposed to direct weighing of the disposed material. The correla-
tion between shorter work weeks and training programs could be meaningful since it
-------
literature survey
123
might imply recognition by some authorities that excessive hours worked can lead to
over-tiredness and consequent injuries. It might also, however, reflect labor union de-
mands. At any rate, this factor might lend credence to the rather insignificant correlation
between work week and injury frequency.
TABLE 2
SANITATION WORKERS' INJURY-FREQUENCY DATA *
Y
436
209
345
119
134
201
240
430
381
530
331
399
78
68
455
364
217
348
174
261
326
174
282
348
239
100
128
120
500
355
258
375
411
460
221
142
167
608
136
105
X,
580
1340
585
585
585
585
730
730
2000
740
450
665
610
610
610
610
610
610
610
610
610
_
_
_
395
1310
1370
1430
1490
1540
565
380
353
757
605
217
X,
40.0
40.0
40.0
40.0
40.0
44.0
40.0
40.0
40.0
40.0
40.0
40.0
48.0
40.0
46.0
40.0
40.0
40.0
40.0
40.0
40.0
40.0
40.0
40.0
40.0
40.0
40.0
40.0
40.0
40.0
40.0
40.0
40.0
40.0
40.0
40.0
40.0
40.0
40.0
40.0
X,
3.0
3.0
3.0
3.0
2.8
3.0
2.9
2.9
2.9
2.9
2.8
2.8
2.5
1.5
1.5
_
-
-
—
—
_
-
_
_
_
3.0
3.0
3.0
3.0
2.6
2.6
2.6
2.6
2.6
3.0
3.0
2.0
_
2.8
3.0
X4
1.0
1.0
1.0
1.0
1.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
1.0
2.0
2.0
2.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
2.0
2.0
2.0
1.0
2.0
2.0
2.0
2.0
2.0
2.0
1.0
1.0
2.0
1.0
2.0
xs
-
-
40
40
40
40
32
32
30
-
30
-
-
-
-
-
-
-
-
-
-
30
30
30
25
60
60
60
60
60
50
32
30
_
20
20
X.
_
-
1.0
1.0
1.0
1.0
2.0
2.0
2.0
-
1.0
-
-
-
-
-
-
-
-
-
-
1.0
1.0
1.0
2.0
1.0
1.0
1.0
1.0
1.0
2.0
2.0
2.0
-
1.0
1.0
X7
-
-
1.0
1.0
1.0
1.0
2.0
2.0
1.0
-
1.0
-
-
-
-
-
-
-
-
-
-
2.0
2.0
2.0
1.0
1.0
1.0
1.0
1.0
1.0
2.0
1.0
1.0
-
1.0
1.0
* Code to letters is given in Table 1.
-------
124
SOLID WASTE/DISEASE
TABLE 2 (cont.) *
Y
100
104
116
122
270
595
152
159
210
612
282
433
183
315
365
455
425
310
378
275
335
305
360
300
132
345
X,
218
222
226
236
1010
1640
1260
542
500
1420
600
1390
1220
480
480
480
480
480
820
755
755
755
755
755
480
200
X2
40.0
40.0
40.0
40.0
40.0
45.0
45.0
40.0
40.0
48.0
40.0
40.0
40.0
48.0
48.0
48.0
48.0
48.0
40.0
40.0
40.0
40.0
40.0
40.0
44.0
40.0
X3
3.0
3.0
3.0
3.0
3.0
-
3.0
3.0
3.0
3.0
2.8
3.0
-
_
-
-
_
_
—
1.5
1.5
1.5
1.5
1.5
2.7
3.0
X4
2.0
2.0
2.0
2.0
2.0
1.0
1.0
1.0
1.0
2.0
2.0
1.0
2.0
1.0
1.0
1.0
1.0
1.0
2.0
2.0
2.0
2.0
2.0
2.0
1.0
1.0
X.-,
20
20
20
20
_
-
30
-
60
-
-
-
-
_
-
-
—
_
_
30
30
30
30
30
60
60
X,
1.0
1.0
1.0
1.0
-
-
2.0
-
1.0
-
-
-
-
-
-
-
-
-
—
2.0
2.0
2.0
2.0
2.0
1.0
1.0
x,
1.0
1.0
1.0
1.0
—
-
1.0
-
1.0
-
-
-
-
-
-
-
-
—
—
1.0
1.0
1.0
1.0
1.0
1.0
1.0
* Code to letters is given in Table 1.
TABLE 3
CORRELATION COEFFICIENTS, SANITATION WORKERS' INJURY FREQUENCY
Y
X,
X2
X3
X4
X5
Xa
X7
Injury frequency
Tons/ Worker
Work week
Type vehicle
Training program
Container size
Material type
Uniforms required
Injury
frequency
1.00
-
-
-
-
-
-
-
Tons/
Worker
0.21
1.00
-
-
-
-
-
-
Work
week
-0.20
0.36
1.00
-
-
-
-
-
Type
vehicle
-0.24
-0.17
-0.12
1.00
-
-
-
-
Training
program
0.33
0.05
-0.37
-0.24
1.00
-
-
-
Container
size
0.37
0.45
-0.05
0.12
-0.04
1.00
-
-
Material
type
-0.01
0.12
0.12
-0.44
0.19
-0.34
1.00
-
Uniform
required
0.10
-0.03
-0.12
0.17
0.20
0.01
0.39
1.00
The two remaining circled coefficients are based on qualitative variables. Thus the
significance tests of the product-moment correlation coefficient may tend to be biased.
The relatively high correlation between vehicle type and material type possibly reflects
-------
literature survey 125
regulations necessitated by type of vehicles used. The possible relationship between ma-
terial type and uniforms defies explanation.
The next step in the analysis consisted of fitting a series of simple linear regres-
sions to summarize the marginal dependence of injury frequency on each independent
variable. These were of the form
Y = b0 + b,X, (i = 1.2....7) (2)
The sample sizes varied for each of these cases since data for each variable were not avail-
able in all instances. Only two of the fitted regressions explained a significant (approxi-
mately 5% level) amount of the observed variation in injury frequency. The resultant
regression equation for tons per worker was
Y = 225.5 + 0.09X! (3)
with a correlation coefficient of 0.27. The equation for container size was
Y = 125.7 + 3.7X5 (4)
with a correlation coefficient of 0.39.
Although these relationships are not highly significant, there are definite indica-
tions that injury rates may increase with greater total tonnage handled, or be reduced
by restricting the size of refuse containers. Because of the observed correlation of the
two variables mentioned earlier, it is difficult to determine whether one is more important
than the other. One would believe, a priori, that total tonnage handled should influence
the total injury frequency rate while container size would influence the specific incidence
of back injuries, strains and sprains, and lacerations. These injuries, incidentally, ac-
count for approximately 60 percent of the total injuries to refuse collection workers, ac-
cording to the survey data.
Additional insight into the relationships discussed, or their elimination from con-
sideration, is totally dependent on obtaining more accurate and valid data.
Individual Worker Analysis. Two responding cities — one with a collection force
of 23 and the other with 60 men — provided detail data of injuries, time lost, and type
of injury by individuals for nine and five years, respectively. The data are displayed in
Table 4. Columns 2 to 10 show number of injuries and total number of days lost for the
year. Column 11 provides the total number of injuries, total number of disabling injuries
and total days lost for the period of employment. Column 12 (f) gives a simple injury
frequency rate, while column 13 (F) provides the disabling injury frequency rate. Column
14 (S) shows the severity rate. The probable conservative nature of these frequency rates
compared to Bureau of Labor Statistics rates was previously explained.
Table 5 provides an injury analysis for these cities. During the year 1964, 48 per-
cent of the employees of City I were injured at least once. For City II, 73 percent were
injured. It would seem extremely unlikely that this many 'accident prone' individuals
could be hired by two widely separated cities.
-------
126
SOLID WASTE/DISEASE
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-------
literature survey
127
Illness Data. Organizations responding to the questionnaire submitted little in-
formation pertaining to illness. Only one municipality indicated type of illness and num-
ber of occurrences. Nine municipalities indicated only the amount of sick leave time.
The percent of sick leave noted for the above gives no indication of being in excess of the
normal amount expected for all industries. The average was 2.82 percent, with a minimum
of 1.67 percent and a maximum of 4.25 percent. The city reporting types of illness indi-
cated that 40 percent of their sanitary workers' illnesses were confined to flu or upper res-
piratory infections; there was a 22 percent incidence of gastritis. The remaining 38 per-
cent was scattered among various ailments.
TABLE 5
INJURY ANALYSIS FOR 1964
Item
Number of employees
Number of employees injured
Once
Twice
Three times
Total number of injuries
Frequency (f)
Total number of lost time injuries
Frequency (F)
Total lost time
Severity (S)
City I
23
11 (48%)
6 (26%)
5 (22%)
16
348
12
252
216
4,700
City II
60
44 (73%)
29 (48%)
10 (17%)
5 (8%)
64
532
36
300
334
2,780
CORPORATION WORKERS
Questionnaires were transmitted to 325 of America's largest corporations. The
response was limited to 69, or 21 percent of those contacted. One organization submitted
worthwhile and extensive information. The remaining 68 responses ranged from those
which contracted for refuse disposal and gave no data, to those which indicated that no
problem exists.
Discussion
The provision of adequate safety measures and controls for industrial employees,
of all categories, requires a basic understanding of what problems actually exist. From
the comments and lack of data received, the inevitable conclusion is that medical direc-
tors, safety supervisors, industrial hygienists, etc. of large corporations are not directing
attention to the potentially hazardous nature of solid waste collection and disposal. The
single exception was the reply of a safety supervisor for one large company, which segre-
gated and tabulated occupational disability among workers handling solid wastes in that
-------
128 SOLID WASTE/DISEASE
company. In spite of commendable attention to this group of employees, the company
was unable to reduce its accident frequency rates to less than three times the rates pub-
lished for miners (a high rate group) by the Bureau of Labor Statistics.
With this as an indication of the extent of the hazards involved in industrial sani-
tation work, the comments of other large companies may be revealing:
"We have no record of injuries or illness resulting to anyone from disposal of solid
wastes" (an oil company).
"None of us can recall any injury or illness from solid waste disposal."
"This isn't a large problem in our corporation" (a metal products company).
"We have never experienced any illness or any disability accident attributable to
this operation" (a meat packing company).
The majority of companies merely indicated their lack of any data concerning
injury or illness to their sanitation workers.
In summary, the survey revealed that, among organizations maintaining surveil-
lance on sanitation workers' occupational injuries, the average accident frequency rate of
156 was 414 times that of the highest rate (36.71) of any major industry (coal mining)
reported by the National Safety Council for 1965 (National Safety Council News, Sep-
tember 1966).
This finding would seem to contradict the statement previously quoted from the
American Public Works Association to the effect that refuse collection was not a hazardous
occupation. 273
Conclusions and Recommendations
There is strong evidence that solid waste handling is a hazardous occupation, both
intrinsically and because insufficient attention has been paid to prevention of injury
among sanitation workers. Definitive information is largely lacking. There is reason to
believe that some of the high rates referred to in investigations reported in the literature,
and implied in the survey just discussd, are due in considerable degree to the absence of
safety programs. For example, in this survey, only 53 percent of those municipalities pro-
viding sufficient data for analysis conducted some kind of safety program.
It is admitted that the statistical analysis of injuries in this report is highly sus-
pect: The response to the questionnaire was quite low, the questionnaire itself is suspect,
and the data provided are of questionable validity in most instances. Nevertheless, it is
not improbable that the data received represent a significant portion of the total available
material. It is therefore submitted that the results — particularly the accident frequency
rates — are sufficient to suggest a comprehensive investigation of sanitation safety to in-
clude not only municipal, but also industrial personnel, engaged in handling solid wastes.
Even without further investigation, the institution of safety programs by municipal waste
-------
literature survey 129
collection agencies and others would seem to promise some reduction in injury.447> 449> 451
Driving safety programs for sanitation workers also may prove promising. 45°
However, a high-quality safety program encompassing all sanitation work — vehicle
or equipment operation, manual labor and the like — should effect significant prevention
of disability. For these reasons, the following action is recommended:
Alert safety agencies to the high accident frequency rates
Increase the amount of safety education directed at agencies and industries han-
dling solid wastes
Institute plans for obtaining reliable data on all aspects of occupational injury and
illness in this work
Institute further studies on the nature of the hazards and means for their preven-
tion in sanitation work.
F. disaster
To obtain an estimate of the maximum effects of disaster on spread of disease
through solid wastes, three studies on the relation of nuclear attack to disease were re-
viewed. 739>740'74]
In the shelters, periods of confinement to enteric diseases were estimated to be
second only to respiratory diseases in incidence.740' PP 18- 22 This incidence was related to
crowding and lack of facilities for good personal hygiene — especially for handwashing
(pp.18, 23, 27). In reference 740 (p. 27) the following statement appears: "There will
be a very wide occurrence of more or less mild enteric disease within the shelter with the
way being paved for the dissemination during the postattack period of more serious enteric
disease such as typhoid fever and amebiasis." The possibility of the development of plague
is noted in that work (p. 27). 74°
Reference 740 (p.B-3) also refers to the lack of information permitting calculation
of acute as opposed to chronic disease prevalence. However, it was estimated that 94 per-
cent of the total shelter population would be exposed to some communicable disease.
Among the enteric diseases, greatest concern was expressed for the spread of shigellosis
(p. 23); some cases of amebiasis and viral hepatitis also could be expected to occur. In
those (probably) rare cases in which a typhoid carrier entered a shelter, the spread of in-
fection could lead to a serious post-shelter risk of dissemination of typhoid fever, and thus
could become a major problem in the population (p. 24).
It is stated in reference 740 (p. 27) that "arthropod-borne disease will not be a
problem within the shelter, but the lack of facilities for good personal hygiene will lead
to widespread louse and flea infestation which may well lead to the later development of
epidemic tyjjhus fever and plague in some parts of the country."
-------
130 SOLID WASTE/DISEASE
Of 51 diseases studied, 14 were considered to be related to environmental sanita-
tions that would be significantly influenced by nuclear attack and the related waste dis-
posal, pest, and vector conditions in the post-attack period. 739- p i Among the enteric in-
fections, shigellosis, infectious hepatitis, salmonellosis, typhoid fever, and amebiasis were
considered of special concern at such a time. The threat of mosquito-borne encephalitis
was considered to be of equal concern, at least on a selective seasonal basis and in those
parts of the nation where encephalitis is endemic. The difference in conditions conducive
to the spread of other environmental diseases, such as plague, malaria, murine typhus, and
the like were noted. It was stated that modification of the postattack environment as it
would be related to the transmission of disease could be accomplished by institution of
practices that have proven effective in the control of such diseases during peacetime.
These sanitary countermeasures were noted to include refuse sanitation, arthropod con-
trol, rodent control, and rabies control (p. j).
In reference 740 (p. 2) the following statement appears: "Post-attack conditions
may be favorable for a rapid increase in insect and rodent populations as a result of dis-
ruption of sanitary services and creation of extensive breeding and harborage areas. Sur-
vivors may be exposed to endemic diseases capable of rapid development in an uncon-
trolled environment. The surviving population (including sanitation workers) may be
confined to shelters . . . for many days during which time fecal material and other organic
wastes may accumulate in the shelter or in the area adjacent thereto, resulting in hazard
of exposure to the 'filth' diseases. . . . Flies, mosquitoes, and other disease vectors may
multiply rapidly as a result of cessation of controls and the creation of environmental
conditions favorable to their growth."
This study considers that enteric diseases are the most important ones in the post-
attack situation (p. 3). The providing of potable water for drinking and personal and
household hygiene, safe disposal of body and solid organic waste, the providing of foods
under sanitary conditions, and fly abatement measures were considered to be the most
important factors in prevention of disease (p. 10). Quantitative factors in the production
of solid wastes under various post-attack conditions were discussed (p.41 ff).740
The relatively high level of sanitation in peacetime in the United States has re-
sulted in a population which is lacking immunity to enteric diseases. The importance of
this lack of protection is discussed with regard to breakdown of sanitary control — espe-
cially in the disposition of solid organic wastes, including feces (p. 64). Rodent-borne dis-
eases are considered to be of relatively little importance in nuclear attack conditions. A
similar conclusion is drawn with regard to mosquito-borne disease, with the possible ex-
ception of viral encephalitis (pp. 68-76). 74°
In summary, this study reported: "The fly-borne enteric diseases . . . may become
a hazard in the postattack environment and will be limited only by the effectiveness of
measures for the handling for human feces and the control of adult flies in the early post-
attack. Also important in the early postattack environment is the control of mosquitoes
-------
literature survey 131
(encephalitides) and fleas and ticks (leptospirosis, typhus) in areas experiencing epi-
demic or endemic outbreaks at time of attack" (p.81).740
In another study, 741 crowding and bad sanitation following nuclear attack was
thought to be a potential source of enteric and rodent-borne disease. The breakdown of
public health controls was thought to represent a hazard in regard to malaria and other
epidemic diseases (p.v-3, 4).
Two random quotations having implications for disaster situations may be of in-
terest. In Eastern Europe, "the growing number of cases of Salmonella food poisoning
may be explained by the expansion of communal feeding." 324
In Russia, the German occupation created conditions for the mass reproduction of
"mouse-type rodents" associated with a considerable number of cases of tularemia. 379
With liberation of the area and resumption of normal household life, a sharp drop in the
morbidity of tularemia occurred. The author feels that the mice were involved in the
spread of tularemia.
Discussion
As previously stated in this report, the contribution of solid waste to disease
cannot be considered alone: solid organic waste disposal and sanitary water supplies for
drinking and personal hygiene share equal importance in the prevention of a number of
diseases.
In spite of the general quality of the study755 on waste disposal under conditions
of nuclear warfare, the conclusions expressed seem somewhat optimistic in regard to the
dissemination of disease under these conditions. In regard to civil disaster of limited or
far less severity, however, this report is encouraging, unless return to normal conditions
of sanitation were interfered with by prolonged strikes or civil strife.
In disaster situations, the setting up of food kitchens in a stricken area may help
create problems of sanitation among which improper disposal of refuse could add to the
total threat of disease.
Conclusions
Too little is known of solid waste/disease relationships to permit dependable predic-
tion of their incidence and seriousness under emergency conditions involving prolonged
disruption of services for the disposal of solid wastes. The studies reviewed seem not to
have taken into account other host and environmental factors potentially modifying sus-
ceptibility among the victims of disaster.
Since the methods now used in this country to minimize the effects of local emer-
gencies were not investigated, the degree to which they take into account the problems of
solid waste was not determined.
Where recovery would be rapid and effective medical care readily available, how-
-------
132 SOLID WASTE/DISEASE
ever, the spread of disease from all sources would appear to be containable in areas of
limited disaster.
Recommendations
British and German data on solid waste/disease relationships under wartime
bombing conditions should be obtained and summarized, if available. The British have
been relatively meticulous in their public health records, and may have such information.
Another source of information which should be summarized is that of the American
and International Red Cross activities in disaster areas.
It would also be advisable to assemble all studies made in regard to Civil Defense,
or on behalf of the Department of Defense on disaster sanitation.
Since something approaching the lack of sanitation in limited disaster can occur in
uncontrolled urban expansion among low-income groups and migratory laborers, and in
developing slum areas, greater information on the endemicity and epidemicity of disease
in such areas, and the status of solid waste and other sanitary conditions, is needed.
An additional source of information could result from the sending of public health
teams capable of studying the spread of disease in areas where disaster has disrupted
normal sanitation. One of the missions of these teams would be to define both the prob-
lem of solid-waste disposal and the contribution of solid wastes in such situations to the
dissemination of disease in the disaster populations.
Expanded reporting of diseases possibly related to solid waste should add to knowl-
edge of their transmission under both non-emergency and emergency conditions.
As the total information on epidemiology and medical ecology is expanded, it may
be possible to construct mathematical models or analogues from which the relative role
of solid waste sanitation can be estimated in the majority of situations, including dis-
aster. Coordination of epidemiologic and solid-waste research programming should be
instituted to encourage the development of such models.
-------
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120 Horafall, William R.
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1962
121 Graham-Smith, G. S.
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CAMBRIDGE PUB HEALTH SERV
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122 Metzler, D. W.
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123 Drew, E/A.
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12k Corran, J. W.
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125 Brues, Charlea T.
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CAMBRIDOE UNIVERSITY PRESS
1920
126 Nakanmra, M., R. L. Stone,
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MATURE
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127 Rubhun, M
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129 Blorck, Ounnar, Harry Bostron and
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ACTA MEDICA SCANDINAVTCA
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130 Hughes, 0. 0.
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131 Wiley, John S., Tom D. T. Chin,
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132 'Many Trace Elements Affect
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CHEM. & ENG. NEWS
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133 Report of a Working Party of the
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J. HYGIENE CAMS (Britain)
62, 283, 196U
13!. Sllepcevlch, Elema H.
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LIBRARY OF CONGRESS PUB,
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135 Hawley, J.E., L.R. Penn«r,
S.E. W dberg & W.L. Kulp
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"A Realistic Approach to Waste
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PROC. 9th ONTARIO INDUE. WASTE CONF.
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137 J«rl, K. and M. Tvelt
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by Symbiotic Cultivation of Yeasts"
SOCKEH
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138 Blanuccl, 0. and O.D. Stefanl
"Tannery Wastes"
EFFL. & WATER TREATMENT J.
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139 Wheatland, A.B, and B. J. Borne
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CHEM. & INDUSTRY
PP. 357-362, F«b. 29, 1964
ll*0 Madera, Vladimir, Vaclav Solln,
Mlroslav Space*
"The Removal of Waste* from
Pharmaceutical Plants' Effluents"
PUB HEALTH ENGK). ABSTRACTS
P- 367, 1959
ll*l Culpin, C.
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CHEM. & INDUSTRY
p. 350, F b. 29, 1961*
142 Shlrrefs, W. R.
"Leicester's Compost Plant"
ROYAL SOC. HEALTH J.
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11*3 Kabler, P W., S L. Chang,
N. A. Clark , H F Clark
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UNIVERSITY OF ILLINOIS BULLETIN -
CIRCULAR 81
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11*1. Shu Yen
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NATIONAL CANCER INSTITUTE MONOGRAPH #10
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COMPOST SCIENCE, SUMMER 196U
P. 8
ll*6 Caspar!, Fritz
"Capillary Drying of Mixtures of
City Refuse and Sewage Sludge"
COMPOST SCIENCE, SUMMER 1961.
P. 21
1*7 Randies, Lyle C., Jr.
"The Field of Refuse Salvage"
COMPOST SCIENCE, SUMMER 1963
P- 5
ll*8 "Municipal Incineration of Refuse:
Forevard *nd Introduction" (Progress
Report of the Committee on Municipal
Refuse Practices)
J. SANITARY ENQRO. DIV.
Proceedings of the Am. Soc. of Civil
Engrs., Vol. 90, No. EA3, June 196U
No. 39^2
149 Masch, Frank D.
"Mixing and Dispersion of Wastes
By Wind and Wave Action"
INT. J. AIR WATER POLL.
Vol 7, PP- 697-720, 1963
150 Garrison, W. T., Otis F. Oay,
and H. DeVon Bogus
"A New Approach to Rural
Refuse Collection"
PUBLIC WORKS FOR JUNE 19&.
P. 121
151 Ledbetter, Joe 0.
"Air Pollution from Aerobic
Waste Treatment"
WATER & SEWAOE WORKS
P. 62, Jan. 1961.
152 Slverly, R. E., H. F. Schoof
"Utilization of Various Production
Madia by Muscold Files in a Metro-
politan Area. I. Adaptability of
Different Files for Infestation of
Prevalent Media"
AHN. ENTOMOL. SOC. AM.
P. 258, July 1955
153 Btverly, R. E fc H. F. 8ehoof
"Utilization of Various Production
Media by Muscold Flies In a Metro-
politan Area. II. Seasonal Ivfluence
on Degree and Extent of Fly Production."
ANN. ENTOMOL. SOC. AH.
Vol. U8, p 320, 1955
151. Fuller, Henry 8.
"Veterinary and Medical Acarology"
ANN. REV. ENTOMOL.
P. 31*7, 1956
155 Ennons, Chester W.
"Boll Reservoirs of Pathogenic Fungi"
J, WASH. ACAD. OF SCI.
P. 3, Jan. 1962
156 Jellison, Wlllla* L
"Fleas & Disease"
ANN. REV. ENTOMOL.
P. 389, 1959
157 "Isolation of Colorado Tick Fever
Virus from Rodents In Colorado"
SCIENCE
P 1*13, August 22, 1958
158 Schueneman, Jean J
"Air Pollution Problems & Control
Programs In the United States"
J. AIR POLL. CON ASSOC.
Vol 13, Wo. 3, P 116, March 1963
159 Trask, J. D., J. R. Paul, and
J. L. Melnick
"The Detection of Poliomyelitis
Virus in Hies Collected During
Eplde«i«s of Poliomyelitis"
J. EXPER MKDICINE
Vol 77, P- 531, 19^*3
29L-982 O - 68 - 10
135
-------
1^0 Hsjnmon, W. McD , H. W. Lundy,
J. A. Gray, F C. Evans, F. Rang
and E. M Izuml
"A large-scale Rerun-Neutrali?atton
Survey of Certain Vertebrates as
Part Of an Epidemlologlcal Study
of EneephalitU of the Weetem
Equine and fit Louis Types"
J. IMMUNOLOGY
V. Ud, p. 7S, I'.lli?
161 Beck, M. Dorthy
"California Field and Laboratory
Studies on Relapsing Fever"
J. INFECT. DISEASE
Vol. 60, P- fill, 1937
162 Meyer, K. F.
"The Ecology of Plague"
MEDICINE
Vol. 21, P. 1U3, 19*«2
163 Wheeler, C. M. & J. R.Douglas
"Transmission Studies on
Sylvatlc Plague"
SOC. FOR EXPER. BIOLOOY
Proc. 1«7, pp. 65-6, 19>*1
16U Meyer, Karl F.
"The Natural History of Plague
and Psittacosis"
PUBLIC HEALTH REPORT
Vol. 72 Bo. 8, p. 705, Aug. 1957
165 Meyer, K. F.
"Th« Modern Outlook on Plague
1» California"
CALIFORNIA VECTOR NEWS
Vol. 2 No. 9, p. 1*2, Sept. 1955
166 Jones, Robert W.
"The Public Health Significance
of Rodents IB California"
CALIFORSIA VECTOR HEWS
Vol. 3 No. 7, Pp- 32-31*, July 1956
167 Hull, T. G.
"Disease* Transmitted from
Animals to Man"
CHAS. C. THOMAS, SPRINOFIBLD
5th EDITION, 1963
No. RC 112-H877, PP- XVII & 967
168 Dauer, Carl C.
"I960 3umary of Disease Outbreak*
and a 10-year Resume"
PUBLIC HEALTH REPORTS
Vol. 76 Mo. 10, P. 915, Oct. 1961
169 Halmos, E. E. Jr.
"HUalle Baae Water and Waste
Facilities"
WATER AHD SEWAGE WORKS
Pp. 176-179, April 1961*
170 Harta*n, RoUad C.
"Composting Control* File* (and
Save* Money) at Poultry Ranch"
COMPOST SCIENCE
Pp. 26-28, Spring 1963
171 Black, Ralph J. and Allan M.Barnes
"Effect of Earth Cover on Fly
Emergence from Sanitary landfills"
PUBLIC WORKS
Vol. 69, pp. 91-91*, Feb., 1958
172 Meyer, K. F
"Hie Prevention of Plague In the
Light of Sever Knowledge"
AHHAL6 H. Y. ACAD. SCI.
Vol. 1*8 pp. U29-67, 19«*7
173 Furcolow, Michael L.
"Recent Studies on the
Epidemiology of Hl»toplasmo*i»"
ANNALS N. Y. ACAD. SCI.
Vol. 72, Art. 3. PP- 127-16U
April 10, 1956
17lt Burgdorfer, Willy 4 Carl M. Eklund
"Studies on the Ecology of
Colorado Tick Fever Virus In
Western Montana"
AM. J. HYGIENE
Vol. 6'J, PP- 127-137, 1959
\T> ttwnons, C. W.
"Ecology of Hlstoplasma and Other
Pathogenic Fungi"
AM. J. PUB. HEALTH
Pp. 6)5-616, May 1957
Mf, Melnlck, J. L. , P. Ward, D.R, Lindsay
and P Earle Lyman
"Fly Abatement Studies In Urban
Pol lomypltti* Epidemics Durlag 191*5"
PUBLIC HEALTH RhrXJRTb
Vol fV, No 25, P ylO, 19*7
111 tyer, R E., E. T. Ceder and
W, 0 Workman
"Transmission of Endemic Typhus by
Rubblag Either Crusbed Infected Fleas
or Infected Flea Feces into Wound*"
PUBLIC HEALTH REPORT
Vol. H7, No. 3, P-131, J»n. 15, 1932
178 M»l«r, Paul P. and Walter C. BmXer
"Municipal F^v Control by Environmental
Sanitation'
MODERN SANCTION
Vol. 3, p 20, 1951
179 Pokrovsky, S.N and 0.0. Zlma
"Files as Carriers of Helminth Egg*
Under Natural Conditions"
MEDITSINSKAYA PARAZITOLOGIYA
i PARAZITARNYE BOLEZNl
Vol 7, p 26, 1938
180 Begble, R. S. and H. J. Gibson
"Occurrence of Typhoid-Paratyphoid
Bacilli in Sewage(Som« Further
Observations)'
J. BRITISH MED. ASSOC.
Vol. II, p. 55, 1930
181 Stead, Frank M.
"Public Health Aspects of Refuse
Disposal"
CALIFORNIA'S HEALTH
Vol. 10 Bo. 20, p. 153,
April 30, 1953
iflS Oreenberg, Bernard
"Persistence of Bacteria In the
Developmental stage* of the
Housefly I. Survival of Enteric
Pathogen* In the Normal and
Aseptlcally Reared Host"
AM. J. OF TROPICAL MED & HYOIEHK
Vol. 8, p. 1*05, 1959
183 Bang, F. B. and R. W. Olaser
"The Persistence of Poliomyelitis
Virus in Files"
AM. J. OF HYOIENE
Vol. 37, P- 320, 191*3
161* Oerberich, John B.
"The Housefly (Musca Donestlca Linn.)
a* a Vector of Salmonella Pullorum
(Retteger) Bergy, the Agent of White
Diarrhea of Chicken*"
THE OHIO J. OF SCI.
Vol. 52(5), P- 287, Sept. 1952
185 Roberts, Enid W.
"The Part P'ayed by the Faeces and
Vomit-Drop in the Transmission of
Entamoeba Histolytlca by Musca
Domestlca"
ANNALS OF TROP. MED. S. PARASITOLOOY
Vol. Ul, p. 129, 191*7
166 Hanec, William
"A Study of the Environmental Factors
Affecting the Dispersion of Housefiles
(Musca dome*tleal L.) In a Dairy
Ccmunlty Near Fort Whyte, Manitoba "
THE CANADIAN ENTOMOLOGIST
Vol. 88, p. 270, June 1956
187 Quarterman, K.D., W. Mathls, and
J. W. KUpatrick
"Urban Fly Dispersal In the Area
Of Savannah, Georgia"
J. OF ECONOMIC ENTOMOLOGY
Vol. 1*7 N . 3, p. 1*05, 1951*
188 Schoof, H. F. and R. E. Slverly
"Urban Fly Dispersion Studies with
Special Reference to Movement
Pattern of Muaca Domestlca
AM. J. TROPICAL MED. & HYOIENE
Vol. 3, pp. 539-n, 1951*
189 Brues, Charlea T.
"The Relation of the Stable Fly
(Stomoxys Calcitrans) to the Trans-
mission of Infantile Paralysis"
J. OF ECONOMIC ENTOMOLOGY
Vol. 6, pp. 101-110, 1913
190 Hampton, Brock C.
"Pla^ip In the United States"
PUBLIC HEALTH REPORTS
Vol 55, No. 26, June ?(,, 1 M»
191 Esltey, C.R.
"H«rc«nt Ifc-ve lopmentb In our
Knowledge of Plague Transmission"
PUBLIC HEALTH REPORTS
Vol. 53, P I*'?, iy3h
192 Clapham, Phyllis A.
"On Files as Intermediate Host*
of Synganua Trachea"
J. OF HEimWTHOLOGY
Vol XVII No. 2, pp. 61-61*
April 1939
193 Webb, J.E. and H. M. Orahan
"Observations on Some Filth File's
In the Vicinity of Fort Churchill,
Manitoba, Canada, 1953-51*"
J OF ECONOMIC ENTOMOLOGY
Vol. '19 No. 5, p 595, 1956
19l* Hewitt, C. Gordon
"The Housefly"
CAMBRIDGE UNIVERSITY PRESS
191 >'
195 Herma, Wm. B. (Revised by M.T.James)
"Medical Entomology"
THE MACMILLAN CO. OF NEW YORK
5th Edition, 1961
196 Ehlers, V.M. and E. W. Steel
"Municipal 4 Rural Sanitation"
McORAW-HILL, SEW YORK
5th Edition, 1958
197 Horsfmll, William R.
"Mosquitoes: Their Bionoslca and
Relation to Disease"
THE RONALD PRESS CO. NEW YORK
1955
198 Strong, R. P.
"Stltt's Dlag. Prev. & Treatment
of Tropical Diseases"
THE BLAKISTON CO., PHILA- PA.
Vol. I, 6th Edition, 19U2
199 Aln»worth, H. B.
"The Housefly as a Disease Carrier"
J. OF ROYAL ARMY MED. COBPS
Vol. XII, No. 5, P- 3*>, May 1909
200 Ournbam, C. Fred
"Principles of Industrial Waste
Treatment"
JOHN WILEY * SONS, NEW YORK
1955
201 Hart, Samuel A.- and Paul E.
Schleusener
"Rural Wastes and Agricultural
Engineering"
AGRICULTURAL ENGINEERING
Vol. Ill*, No. 3, p. ll*2, March 1963
202 Hardenbergh, W. A.
"Sewerage and Sewage Treatment (1950)
HADDON CRAFTSMEN, INC. PENNSYLVANIA
203 Committee on Potato Chip Wagtes of
the Potato Chip Institute Inter-
National Technical Task Committee
on Jndu.trlal W.Btea
"Potato Chip Industry"
PUBLIC HEALTH SERVICE PUB. NO. 756
U.S. Dept. of H.E.W. - 1960
2OU National Stream Sanitation Committee
of the American Assoc. of Textile
Chemist* & Colorlst* In cooperation
with the Natl. Task Committee on
Industr. Waste*
"Cotton Textile Industry"
PUBLIC HEALTH SERVICE No. 677
U.S. DEPT. H.E.W., 1959
205 Prepared through cooperation of
Natl. Csnnera. Assoc. & Natl Tech.
Task Committee on Industr. Wastes
"Fruit Processing Industry"
PUBLIC HEALTH SERVICE NO. 952
U.S. DEPT. H.K.W. - 1962
206 Committee on Meat Packing Plant
Waste Disposal of American Meat
Inst. In cooperation vlth Natl' Tech.
Task Committee on loduatr. Waste*
"Meat Industry"
PUBLIC HEALTH SERVICE NO. 386
U.S. Dept; of H.E.W. Reprinted 1958
207 Stream Pollution Abatement Committee
of Amer. Aasoc. of Textile Chemist*
and Colorlats, in cooperation with
Amer. In*t. of Laundering
"Commercial Laundering Induatry"
PUBLIC HEALTH SERVICE NO. 509
U.S. Dept. H.E.W., 1956
208 Subcommittee on Dairy Waste of the
D-ilry Industry Committee In coopera-
tion with Natl. Task Committee on
Industr. Waste*
"Milk Processing Industry"
PUBLIC HEALTH SERVICE NO. 298
U S. Dept. H.E.W,, Revised 1QC'
136
-------
209 Roberts, I. M.
"Agricultural Solid Wastes
Unpublished, May 20, 1965
210 Stead, Frank M.
"Social and Legal Implication* of
Organic Waste Management"
COMPOST SCIENCE
Vol. 5 Mo. 3, p. 11, Aut.-Wln. 1965
211 "Activities Report, Basic and Applied
Science* Branch, Division of Water
Supply and Pollution Control"
PUBLIC HEALTH SERVICE
U.S. Dept. H.E.V., July 1, 1963 -
June 30, 19ft
212 Jenkins, S. H.
"The Competition of Sewage and its
Potential U*e aa a Source of In-
dustrial Water - Re-uee of Water in
Industry, Part 2."
CHEMISTRY AND INDUSTRY
Vol. 50, pp. 2012-9, D c. 15, 1962
213 Boverman F. R. and Franklin D. Dryden
Garbage, Detergents and Severs"
J. WPCF
Vol. 34, No. 5, PP. 475-494, May 1962
214 Rlcklee, Robert N.
"Waste Recovery and Pollution
Abatement"
Reprinted fron CHEMICAL EHORO
Sept. 27, 1965
215 Fair, Gordon M. and J hn C. Oeyer
"Elements of Water Supply and Waste-
Water Disposal"
JOHN WILE t> SONS, N. Y.
1965
216 Subcommittee on Sludge Disposal
Comlttee on Severage.and Sewage
Treatment
"Advances In Sludge Disposal In the
Period from October 1, 1954 to February
1, I960, Progress Report"
J. SAN. EHORO. DIV.
Proceedings of A*. Soe. Civil Bngrs.
BA2, pp. 13-51, March 1962
217 Koenlg, Louis
"Advanced Waste Treatment"
CHEMICAL BIOBO.
pp. 210, June 10, 1963
318 Ellassen, Rolf
"Challenges in Research 4 Development"
J. WPCF
p. 26Y, March 1963
219 Llptett, Charles H.
"Industrial Waste* & Salvage; Conserva-
tion and Utilization"
ATLAS PUBLISHING CO. 1951, 1963
220 Pylut, Hugh S.
"Here's Hov Petrochemical Companies
Dispose of Wastes"
OIL 1 HAS JOURNAL
p. 118, Nov. 4, 1963
221 Oreen, H. L. and W. R. tane
"Partlculate Clouds: Dusts, Smoke*
and Mtsts"
D. VAN NOSTRAND CO. INC. 1957
Oeneral & Industrial Chemistry Series
222 Mana, Uhl T. and Ouy E. Griffin
"Cost of Safety"
J. WATER POLL. C0». FEB.
Vol. 36 No. 2, p. 168, Feb. 196k
223 Snyder, H. Jack
"Propertiea and Uses of Fly Ash"
BATTELLE TECH. REV.
Vol. 13 So. 2, p. 14, Feb. 64
224 Shannon, E. S.
"Handling and Treating Petrochemical
Plant Wastes: A Case History"
WATER J. SEWAGE WORKS
p. 240, May 1964
225 Klein, Louis, et al
"River Pollution. II. Causes and
Effect*"
BUTTEHWORTHS - London
P. 24, 1962
226 Darrah, W. A.
"Methods of Dust and Fume Disposal"
INDUSTRIAL HEATINO
Vol. 23, p. 70, I960
227 Jenkins, S. H
"Sewage, Tr-sde WasteD & River
Pollution"
Reports of Prog, on Applied Chem.
SOC. OF CHFM. INDUSTRY, LONDON
Vol. 4b, p. 1(0, 1961
228 Garrison, W. E., J [) Parkhuret,
and C. A. Nagfl
"One Reclrculatlon-Natural,
Artificial"
WATER WORKS & WASTES ENG.
p. 58, Feb. 1964
229 Kaibuchl, Yono.uke
"Research on Composting of City
Refuse and Blghtsoll"
J. SAN. EBO. DIV.
230 Lenehan, Joseph W.
Air Pollution Control in Municipal
Incineration"
J. OF AIR POLL. COB. ASSOC.
Vol. 12 So. 9, p. 414, Sept. 1962
231 Committee on Refuse Disposal, APWA
"Municipal Refuse Disposal, APWA"
Research Foundation Project 104
PUB. ADMIN. SERVICE, Chicago, 111.
Lib. of Cong. Cat. Card 161-17151,
1961
232 Report of a WHO Expert Committee
"Environmental Change and Re-
sulting Impacts on Health"
WHO Tech. Rep. Series No. 292
Geneva, 1964
233 Paul, J. R., and J. D. Trask
"Pollomyelltlc Virus In Sewage '
SCIENCE
Vol. 90, No. 2333, p. 258, Sept.1939
234 Report of a WHO Expert Committee
"Environmental Health Aspects of
Metropolitan Planning and
Development"
WHO Tech. Hep. Series Ho. 297, 1965
235 Skinner, John B.
"Tabulating the Toxics
CHEMICAL ENORO
Vol. 69 No. 12, pp. 183-186,
June 11, 1962
236 "Sludge Treatnent Plant at Sheffield"
THE ENGINEER
p. 997, May 31, 1963
237 "Report Urges Federal Experiments
In Waste Control"
ENGINEERING NEWS-RECORD
PP. T2-73, April 7, 1966
238 "Consuming Problem - Feed Pollution
Problem to Cattle, Meat Packers Told"
ENOIHEERIBO SIMS-RECORD
pp. 149-150, April 7, 1966
239 Wallier, Charles A. t> Walter Zabban
"Dlspocal of Plating Room Waste*
VI. Treatment of Plating Room Waate
Solutions vim Ozone"
PLATING
Vol. 40 Ho. 7, p. 777, July 1953
240 Watt, J. D. and D. J. Tnome
"Composition and Pozzolanic
Properties of Pulverised Fuel
Aehes. I. Comp. of Fly A.he*
J. APPL. CHEM.
p. 585, Dec. 15, 1965
241 "Treatment of Acid Wastes &. Water*"
ACID-MINE-DRAINAGE PROBLEMS, ANTHRA-
CITE REGION, PA. BUL. 508
BUREAU OF MINES
P- 60, 1951
242 Kel'ch, James L. & A. Kenneth Graham
"Electrometric System for Continuous
Control of Reduction of Hexavalent
Chromium in Plant Wastes"
PLATING
Vol. 36 No. 1, p. 1028, May 1949
243 "Dilution"
PLATING
Vol. 36 No. 1, M»y 1»U9
244 "Plating Plant Plays Off One
Waete on Another"
CHEMICAL ENGINEERING
Vol. 69 So. 12, p. 98, June 11, 1962
137
245 Hyde, A. C.
"Chemical Plant Waste Treatment
by Ten Method*"
J. WATER POU,, CON. FED.
Vol. 37, Ho. 11, p. i486, Nov. 1965
246 Beesellevre, Edmund B.
"Industrial Wa*te Treatment"
McORAW-HTLL BOOK CO. INC., N. Y.
First Edition, 1952
247 Eisenheuer, Hugh E.
"Chemical Removal of ABS from
Wastewater Effluents
J. WATER POLL. CON. FED.
Vol. 37 No. 11, p. 1567, Nov. 1965
246 Hart, Samuel A. ft Marvin E. Turner
"Lsgoons for Livestock Manure '
J. WATER POLL. CON. FED.
Vol. 37, No. 11, p. 1578, N V. 1965
24? McCs.be, Brother J. and Eckenfelder, W.W.
"Biological Treatnent of Sevage and
Industrial Wastes, Vol. II- Anaerobic
Digestion and Solids Liquid
Separation, 1958"
REIBHOU) PUBUSHINO COBf. 1958
250 Kershav, M. Arnold
"Developments In Sludge Treatment
and Disposal at the Maple Lodge
Works, England1
J. WATER POLL. CON. FED.
Vol. 37 No. 6, p. 674, May 1965
251 Nemerov, Nelaon Leonard
"Tneorls* and Practice* of
Industrial Waste Treatment"
ADDISON-WESLEY PUB. CO. INC.
1963
•252 Culotta, Joseph M.
"Treatment of Cyanide and Chromic
Acid Plating Wastes"
PLATING
p. 545, June 1965
253 Oreeley, Samuel A.
"Criteria for Municipal Incinerators
. . . Toe Designer's View"
MECHANICAL ENGINEERING
p. 1024, N V. 1956
254 "Metal Finishing Wastes*
METAL PROGRESS
Vol. 83 No. 6, p. 157, May 1963
255 "High Temperature Combuation of
Chemical Residues Solves Pollution
Problem"
J. AM. SOC. OF LUBRICATION ENORO.
Vo. 21 No. 10, p. 371, Oct. 1964
256 Porter, C.C. and Fred W. Bishop
"Treatnent of Paper Mill Wastes In
Biochemical Oxidation Ponds"
INDUS, ft END. CHEMISTRY
Vol. 42 No. 1, p. 102, Jan. 1950
257 Winton, Juhn
"Tne Detergent Revolution"
CHEMICAL WEBC
p. Ill, May 30, 1964
258 Walker, C.A. & J. A. Talljmadge
"Metal Flaiahlng Waste Reduction"
CHEMICAL END. PROGRESS
Vo. 55 No. 5, p. 73, May 1959
259 "Simple Blo-Aeratlon Kills Strong
Wastes Cheaply"
CHEMICAL EHOIHEERIBO
Vol. 70 Nu. 1, pp. 40-42
Jan. 7, 1963
260 Hettlg, S. B.
"'Waste Fans' Takes Care of
Phenolic Watte Disposal"
CHEMICAL ENGINEERING
p. 96, Dec. 24, 1962
261 "Incineration Gobble* Up Plant Wastes
Liquid Wastes Make up the Fuel mat
Fires a Rotary Incinerator Which, In
Turn, Swallows Everything but the
Kitchen Sink"
CHEMICAL ENGINEERING
p. 50, Oct. 1959
262 "Process May Reduce Pollution from
Burning Coal Refuse Piles"
CHiMICAL AND ENGINEERING NBJS
Vol 4j No.- 4, pp. 49-50
Jan. 25, 1965
-------
263 "Reclamation"
CHEMICAL AND ENGINEERING NEWS
Vol. l»3 No. k, p. 51
Jan. 25, 19^5
26U "Pesticide Residue Problems Probed"
CHEMICAL AND ENGINEERING NEWS
Vol. U2 No. 16, pp. 32-33
April £0, 1961*
265 "Pesticide Levels Lov In West
Coa*t Fish"
CHEMICAL AND ENGINEERING NEWS
Vol. 1*2 No. 16, p. 71
April 20, 196k
266 "ABS Content In Laundry Wa*tes Cut:
Method Lowers Alkyl Benzene Sulfonate
Content In Coin-Operated Laundry
Wastes to 1 to 2 ppm"
CHEMICAL AND ENGINEERING NEWS
Vol. 39 No. 51, PP- ^6-U?
18 December 1961
267 Moore, W. Allen and M.B. Ettinger
"Recent Trends In the Analysis
of Industrial Wastes"
ANALYTICAL CHEMISTRY
Vol. 28 No. 12, pp. 1819-1621
Dec. 1956
268 Thompson, Robert N., James E.ZaJlc
and E. Lichti
"Spectrogrmphlc Analysis of Air-
Dried Sewage Sludge"
J. WATER POLL. CON. FED.
Vol. 36 No. 6, pp. 752-759
June 196k
269 Guzman, Ration M
"Control of Cane Sugar Wastes
1» Puerto Rico"
J. WATER POLL. CON,'FED.
Vol. 3U, Mo. 12, pp. 1213-1218
Dec. 1962
270 Maehler, Claude Z. a*d
An*ld E. Greenberg
"identification of Petroleum
Industry Wastes in Groundwater"
J. WATER POLL. COM, FED.
Vol. 31* No. 12, pp. 1262-1267
Dec. 1962
271 Sen, B, P. Xt T. R. Bhaskaran
"Anaerobic Diateation of Liquid
Molasses Distillery Wastes"
J. WATER POLL. CON. FED.
Vol. & No. 10, pp. 1015-1025,
Oct. 1962
272 Morri«, J. Carrell and
Walter J. Weber, Jr.
"The U»e of Adsorption for the
Retioval of Blologically-Re*Utant
Pollutant.* fro» Waste Water*"
J. WPCF,
Voo- 3U Ho. 3, p. 235, March 1962
273 Clark*, N.A., G. Berg, et al
"Hunan Enteric Viruses; Source,
Survival, and Removability in
Waste Water"
J. WPCF
Vol. 3^ No. 3, P- 2**9, March 1962
273 Committee on Refuse Collection
and Disposal
American Public Works Association
"Refuse Collection Practice"
AMERICAN PUBLIC WORKS ASSOCIATION
1958
27U Francis, Robert L.
"Characteristics of Potato Flake
Processing Wastes"
J. WPCF
Vol. 3U No. 3, P. 291, March 1962
275 Burke, William J.
"Combating Health Hazards in the
Chemical Industry - Part I"
CHEMICAL INDUSTRIES (N.Y.)
Vol. 55, PP- 369-71*, Sept. 19UU
2lf> Report of the U.S. Public Health
Service
"Ohio Fiver Pollution Control,
Part 2 Supplements - An Industrial
Waste Guide to the Canning Industry
78th CONGRESS, 1st SESSION
HOUSE DOC. NO. 266
August 27, 19^3
277 Preul, Herbert Charles
"Travel of Nitrogen Compounds
In SolU"
PH. D. THESIS, UNIVERSITY OF
MINNESOTA, 19^U
,?78 Riffrnlmt-R, II.P. % U W. Allison
"Treatment, of Tannery Wastes
with FJue (*• K, l,| mV
INDUR & Vftf) CHFMir/TKY
P ftOl, .Tune I'J'H
2?Q Rhorl- Islsnd f.-clfon Wirommt tte.
on Btre»m PolinlIon
"TTie Will «r T'«1Ile Chemirajfi"
AMERICAN nVFoTUFF REPORTER
ftomroon, Harrj P
"oturUe* nn the Treatment ttnd
Disposal of Industrial Want-e.
3) PurlfirRtton of Tannery Wan*,*
PUB Mr: HFAI/TH BULLETIN NO. 100
191?
" rry B.
Dixo
"Wlia
ps P
Air PnlJuilo
Disposal of Industrial Wastes
M Purification of Creamery Wastes '
PUBLIC HEALTH BULLETIN NO. 109
19? 1
28? Gold, DnnaM D.
"Summary of Treatment Methods for
SlaiiRMrrhouBe and Packinghouse
Wast-e, IN: Tenn. Eng. Expert
Stall»n, Bulletin 10-IB"
em. mem. ;;TA., BULLETIN
NO. 17, UNIV OF TETCN.
1953
?83 Batz, M. E.
"Deep Well Disposal of Nylon
Waste Water"
CRI-MICAL ENGINEERING PROGRESS
Vol. 60 No. 10, pp. 85-68
Oct. lOf^l
28U "Pesticide Pollution Studies"
Progress R port
U.S. DEFT. HEW, DIV. OF WATER
SUPPLY fc POLL. CONTROL, REGION IV
Atlanta, Georgia, Mar. 1963
205 Foster, William 3.
"Nature and Magnitude of the
Municipal Solid Waste Disposal
Problem"
PROCEEDINGS - 3rd PITTSPURGH SAN.
£NO. CONF. MUNICIPAL SOLID WASTES
nifiPOSAL. PUBLISHED BY OHIV. OF
PITrSBUROH, pp. 1-7, Nov. U, 196!
28^ Rogn«, Casimir A.
"I»clneratlon"
PROC&EDINOS - 3rd PITTSBURGH BAN.
EP1, CONF. MUNICIPAL SOLID WASTES
DISPOSAL. PUBLISHED BY UNIV. OF
PTTTSBURa, pp. 2U S. 29, Nov. k, 196!
287 OoUas, Harold B.
"Planning Municipal Composting
Facilities"
PROTREDIHOS - 3rd PITTSBtfRGH SAff.
EKtl CONF- MUNICIPAL SOLID WASTES
f)TSPn,r;AL. PUBLISHED BY UNIV. OF
PITTSBURGH, p. bb, Nov. k, 1961
2H8 ftiuvml, Hlllel I.
"the Economics of Composting
Municipal Refuse"
PROCEEDINOS - 3rd PITTSBURGH SAN.
FNG. CONF. MUNICIPAL SOLID WASTES
DISPOSAL. PUBLISHED BY unv. OF
PITTSBURGH, pp. U7-57, Nov. U, 1961
PfttJ Stone, Ralph ajid F.R, Boverraan
"Incineration and Alternative
Refuse Disposal Processes"
AM- SOC. OF CIVIL ENGINEERS
Vol. 80 No. 1*71, Aug. 19^1|
290 Sanitary EUR Research Lab.
Univ. fio. Calif., Loe Angeles, Cal.
"Investigation of Leaching of
Ash Dumps"
CALIF. STATE WATER POLL. CON. BOARD
SWPCB Pub. No. 2, Ch. VI, pp. 79-^9
1952
?91 Dawenn, S. H. and W. H. Dunkley
"Pulverized-Fuel Ash Disposal"
PROG. INST. MECH. ENORS.
Vol. 176, No. 19, 1962
292 "New Incinerator Promises Leas Smog"
ENGINEERING NEWS-RECORD
pp. 1*7-1*8, Oct. 11, 1956
P93 Chambera, Leslie A.
"Where Does Air Pollution Come Fran?"
PROCEEDINGS, NATL. COWF. ON AIR
POLLUTION, Nov. 1^-20, 1958
PHR Ho. 651*, PP- 3*1-38, 1959
138
PROCt.FDJNfl'', NAT CONF- ON
AIR POI.IJITION, n«v. 18-, '0, 19^M
PHf. No hlkes
"Laboratt>rv Investigations on
the Rftlr rf Bird Mi ten In the
Transmission of Eastern and
W«atem B^uine Encephal I Us"
AM. J, OF TROPICAL MED. & KYOIEHE
Vol. U, pp. 106-18, 1955
306 Sulk lit, S, Rfvard, Charles L.
Wlaaeman, Jr., Rrnest M. Izuml
and Christine iarafonrtie
"Mitre as PoBe1ble Vectors or
Reservoirs of K ulne Kncephalo-
myeUtls In Texas"
AM. J. TROPICAL MHi & HYGIENE
Vol It, pp. L19-J5, 19S5
-------
30Q Hunter, V. D.
"American Interest In
Entomology"
J. ECOHOMIC EHTOMOIXX3I
Vol. 6, pp. 27-39, feb. 1913
310 Tsuchlya, H.
"Experimental Ameblasis la Rats
with Cysta of Human Carrier! with
Especial Reference to a Probable
Mechanism Involved"
AM. J. TROPICAL MEDICINE
Vol. 19, pp. 151-2, 158-162, 1959
311 Hudson, Ellis Herndon
"The Role of the Reservoir Host In
Tropical Diseasa"
AM. J. TROPICAL MEDICINE
Vol. 24, pp. 125-30, 1944
312 Trembley, H. L and
F. C. Bishopp
"Distribution and Hosts of Some
Fleaee of Economic Importance"
J. ECONOMIC ENTOMOLOGY
Vol. 33, pp 701-3, 1940
313 Macclavello, Atllio
"Reiervolra and Vectora of Plague"
J. TROPICAL MED, 1 HYOIENE'
pp. 1, 4-8, 45-8, 65-9, 88-94, etc.
1954
314 Ootaas, H. B.
"Composting: Sanitary Disposal and
Reclamation of Organic Wastes"
U.H.O. MONOGRAPH No. 31, 1956
pp. 19-22, 83-91, 195-99
315 GregBon, J. D.
"Host Susceptibility to Paralysis
by the Tick Demacentor Anderaoni
8tile« (Acarlna: Ixodidae)"
CANADIAN ENTOMOLOGY
vol. go, pp. 421-44, 1958
316 Ayres, J. C.
"Chemical and Biological
Hazerdi in Food"
IOUA STATE USIV. PRESS 1962
317 Vakley, Thomas H. and
Thomas Wnfcley, Jr.
"Typhoid Fever and the Pall
System at Nottingham"
THE 1ASCET VOL. II for 1902
pp. 1488-90, N v. 29, 1902
318 Craig, C. F.
"Amebiasls aad Amebic Dysentery"
(BOOK) LONDON, 1935
319 Craig, C.F. and E. C. Faust
"Clinical Parasitolegy"
Philadelphia, 1940
320 Fox, C.
"Insecta and Disease of Man"
PHILADELPHIA; P. BIAKISTON'S SON
« CO. - 1925
321 Maason - Bahr, P.
"The Dysenteric Disorder*"
LONDON, 1939
322 Logaa, J. A., P. Oppermams, N.E. Tucker
"Environmental Engineering and
Metropolitan Planning"
FIRST COST. PROC. 1962
323 Wiesner Report
"Use of Pesticides"
00V. PRINTING OFFICE 1963
(LC63-61540)
PR35.8:SC1 2/P43, May 15, 1963
324 Van Oye, E
"The World Problem of Salmonellosls"
MONOORAPHIAE BIOLOGICAE (DEN HAAG)
19o4
325 Page, H.O., C.H. Wayman and
iT.B. Robertson
"Behavior of Detergents (ABS),
Bacteria and Dissolved Solids in
Water-Saturated Soils"
GEOLOGICAL SURVEY RESEARCH
Art. 237 of Paper 450-E; pp. E179-181
1962
3?6 Eveany, Henry C.
"HistoplasmosiB"
1/1,0
327 Senas, William B.
"The Hous. Fly In Its R»0 Bacot, A.W. and C. J. Martin
"Observations on tile Mechanism of
the Transmission of Plague by Fleas"
J. HYGIENE 13 (PIAGUE SUPP..3)
pp. U23-39 + 3 plates, 19lli
3^1 Price, Winston H.
"Tne Epidemiology of Rocky
Mountain Spotted Fever"
AM. J. HYGIENE (LANCASTER, PA.)
Vol. 60, pp. 292-319, 195U
3^2 Anderson, E.S., B.S. G»lbraith,
C.E.D. Taylor
"An Outbreak of Human lafection Due
to Salmonella Typhlmurlum Phage-
Type 20a Associated with Infection
In Calves"
LANCET
p. 85lt, 1961
343 Heath, Clark W., Jr., Aaron D.
Alexander, Mildred M. Galton
"LeptosplroBis in the United States"
NEW ENOIABD J. MED.
Vol. 273, PP- 857-64, 1965
}kk Me sley, James W.
"Water-Borne Infectious Hepatitis"
TODICAL PROGRESS
Vol. 061, N". H, 1959
3tt5 Sveatman, Gordon K.
"Distribution and Incidence of
EcMnococcue Oranulosus in Man
and Other Animals ylUi Special
Reference to Canada"
CANADIAM J. PUBLIC HEALTH
Vol. 113, p U8o, 1952
3U6 Alicata, Joseph E.
"Notes and Observations on Murlne
Angiostrongylosls and Eoslnophillr
Menlngocephalltls In Micronesia"
CANADIAN J. ZOOLOGY
Vol. '13(5), PP. 667-672, 1965
3^7 Welll, Hans, Morton M. Zlskind,
Richard C. Dlckerson, Vincent J.Derbes
"Allergic Ai r Pollutants in Nev
Orleans"
J. AIR POLL. CON. ASSOC.
Vol. 15 (10), pp. Ii67-'i71, l'3f>5
3)t8 Ecke, Dean H.
"A Comparison of Fly larval Produc-
tion from Six Refuse Container
Systems"
AH. PUBUC WORKS ASSOC . YEARBOOK
1965
3l»9 Wednmn, «• E.
"Epidemiology - A Prerequisite to
the Eradication of Animal Diseases"
J. Ut VETERINARY MED. ASSOC.
Vol. Hl7('2), pp. 1550-5, 1965
350 "Diseases of Animal Origin or Common
to M-n and Animals In the United
States
PUBLIC HEALTH SERVICE, U.S. DEPT. HEH
Atlanta Georgia, Communicable Disease
Center, Aug. 1963
351 "Reported Cases of Vector-borne
Diseases 1960-196V
U.S. DEPT. HEK, Communicable
Disease Center, Training Branch,
Vector-borne Disease Section,
Atlanta, Georgia
352 McKee, M. E.
"Research Needs in Ground-Water
P'lllution"
J. WATER POLL. COB. FED.
Vol. 33, pp. 1227-1233, Dec. 1961
353 Walton, Oraham
"Survey of Literature Relating to
Infant Methemogloblnemla Due to
Nitrate-Contaminated Water"
AM. J. PUBLIC HEALTH
Vol. Itl, pp. 986-96, 1951
35l» Falchnle, Major N.
"Fly-Borne Enteric Fever: The
Source of Infection"
J. ROYAL ARMY UEDICAL CORPS
Vol. XIII, pp. 580-4, 1909
355 Aldridge, A. R.
"House-Flies as Carriers of Enteric
Fever Infection"
J. ROYAL ARMY MEDICAL CORPS
Vol. IX, pp. 558-71, 1.907
356 Rldlon, J. R.
"An Investigation of the Prevalence
of Typhoid Fever at Charlestown,
W. Va."
PUBLIC HEALTH REPORTS
Vol. XXVI No. 46, pp. 1789-99, 1911
357 OBtrolenx, Morris and Henry Welch
"Tne Fly as a Vector of Food Poisoning
Organisms in Food Producing
Establishments '
AM. J. OF PUBLIC HEALTH
vol. 32, pp. 487-94, 1942
358 Leboeuf, A.
"Dissemination of Hansen's BacillUE
by the Domestic Fly"
BULLETIN DE IA SOCIETE DE
PATHOLOGIC EXOTIqUE, IMSTITUT
PASTEUR, PARIS
Vol. 5, pp. 860-8, 1912
359 Mltzmaln, M. B.
"Experimental Insect Transmission
of Anthrax"
PUBLIC HEALTH REPORTS
Vol. 29, pp. 75-77, Jan. 9, 1914
360 Buchanan, R. M. and F.F.P.S. Glasg
"Ihe Carriage of Infection by Files"
THE LANCET
Vol. II for IV07, pp. 216-18, 1907
139
-------
U1I1. C A
"llif l''fi f l*>, pp. AW- }»>'), l'>M
Francis, Thomas Jr., Gordon C Hrovn
and J hn D. Alnelie
"Pollonvve] ltle in Hldnlho County,
TfX*B, 3f-AB, lYillomyeJlUR and
AH. J. HYGIENE
Vol V1, "P 110- 318, WM
Melnick, Jnsc.n L.
"Isolation ul Poliomyelitis Vims
from Single fipeci-R of Files
Collected puiing an Urbnn Fpldrmic"
AM. J. HYGIKNE
Vol. V_->, [ M-lA, 19Vi
366 SaMn, A B. aii'l H Wnrd
"Insects and t-pldeminlo^v of
Poliomyelitis"
SCIENCE
Vol . 95, pp. 300-01, 19''?
367 Paul, J.R. and J. D. Trask
"The Virug of Poliomyelitis In
Stoole and Sewage"
AH. MED. ASSOC. JOURNAL
Vol. 116, pp. liQ3-7, 19>tl
368 Anderson, J.F. and W. H. Frost
"TrmnsmlBBion of Poliomyelitis by
Mean" of the Stable Fly Stomoxys
Calcitrans"
PUBLIC HEALTH REPORTS
Vol. 27, pp. 1733-3^, 191?
369 Roeenau, M. J. and C. T. Bruce
"Some Experimental Observation
Upon Monkeys Concerning the Trans-
mission of Pollomyletuu through
the Agency of Stomoxys Calcitrans"
PUBLIC HEALTH REPORTS
Vol. 27, p- 1593, 1912
370 Brucs, Charles T. & Philip A.E Shepard
"The Possible Etiologlcal Relation
of Certain Biting Ineects to the
Spread of Infantile Paralysis"
J. ECONOMIC ENTOM.
Vol. 5 No. U, pp. 305-2lt, Aug. 191?
371 Wiley, John S.
"Pathogen Survival in Ccmpostlng
Municipal WaeW
J. WATER POLL. CON. FED.
p. 80, Jan. 1962
37 Huebner, R. .) . et al
"Q Fevpr Stu.lips in Gouthern
California"
PUBLIC HF.ALTI! liHXIRT
Vnl M, pp. t-'lW?, \4'i
37J Luoto, Lmurl
"The Epidemiolopy of Q Fever in the
United States"
AM. J. PUBLIC HEALTH
Vo) Jj'J, No. 3, pp, 33^-38, March I9li9
WB Pliilip, Cornelius B.
"ObaervRtlonE on Experimental Q Fever"
J. PARASITOLOGY
Vol. jli pp. h'ji-ftk, igltfl
IN Apekhtin, V. H
"Some Questions on the Epidemiology
and Parasltology of Vector Outbreaks
of TuJsremis"
ARMY BIOLOGICAL IA11S
180 Dyadlchev, ». R.
"EpldemiolORic Peculiarities of the
Plague and Tularemla Caused by
Different Ways of Infection"
J. MICROBIOLOGY, EPIDtHIOLOGY AWD
1MMUNOBIOUDGY
No. j, pp. 8-lfc, 1957
tf\ Braun, Albrecht
"Anthrax in Wuerttemberg, A
Statistical and Epidemlological
Study"
AHMY RIOLOGICAL LABS, FREDERICK MD.
Miac. TH I*BU (AD U6o 1'to), 1956
V? Eraanuel, Marie L., I. M Mackerras
and D. J. W. 3nith
"Trie Epidemiology of LeptOBpirosis
in North Queensland"
j. HYGJKNE CCAMPRIDGE)
Vol. 6?C*), pp. Ii3l-it81t, U85-U94, 19fA
10^ Walters, James V. 8e Robert R. Holcotnb
"Isolation of an Enteric Pathogen
from Srwage-borne Nematodes"
PRESENTED AT THE 5th ANNUAL MEETING OF
THE SOC. OF NEMATOLOCIISTS, DAyTONA
BKACH 1Q66
3^'( Fanleeet, J. C.
"Drug Residues in Animal Products"
CANADIAN VET JOURNAL
Vol. 6, pp. 7°-80, Mar. 1965
385 W.H.O Tech. Report
"Principles Governing Consumer
Safety in Relation to Per-tlcide
ReFiduee"
W,H.O. TECH. REPORT SERIES
Wo. 2*0, 196?
366 Durham, William F.
"Pesticides Residues in Foods in
Relation to Human Health"
RESIDUES REVIEWS
Vol. U, pp. 3'i-8l, 1963
^7 Hueper, W C
"CarcinogenB In the Human
Environment"
ARCH. PATHOLOGY
Vol. 71, pp. 237-67, 355-80, 1961
38fl Sternberg, George M.
'Sanitary Lessons of the War
THE PHILADELPHIA MED. JOURNAL
pp. 1298-1303, 13h6-n9,
June 10 and 17, 1099
3&3 Wojff, J. W.
"The Relation of Animal Hosts of
Parasitic J>ptoBpires in the
TOP. 4 GBOGH. MED., I (1965)
2- 0
H90 Meinhaue, L. A.
"insect. Microbiology"
COMSTOCK, NEW YORK
391 Behoof, H.F., F.A. Mail, and
E. P. Savage
"Ply Production Sources in Urban
Communities"
J. ECONOMIC ENTCM.
Vol 1*7, pp. ?U5-53i Api. 195!*
39^? Hubert, A.A and H. J. Baker
"Studies on the Habitats and Popu-
lation of Leptotrombidiiun (l^ptotrntn-
M'Uum) AkamuBhi and I, (L ) Dclieneis
In Mftl«y« (Ar*rli« Tromhicu] II}R^)
T!i^ /VM .t. HY'JTKNF
vi'i i • Mo. -', pp ni-iis, r-.etp. nf'."
3',)U Pratt, Harry D. & Kent S. Littig
"Lice of Public Health Importance
and Iheir Control"
COMMUNICABLE DISEASE CENTER
Atlanta, Ga., PHS 772 pt. 8, 196l
395 Scott, Harold G«org« 4 Kent S.Littig
"Flies of Public Health Importance
and Their Control"
COMMUNICABLE DISEASE CENTER
Atlanta, Ga., PHS 772, pt. 5 1962
396 Kimball, Jack H.
"Orange County Keeps Citizens
'Mosquito Conscious'"
PEST CONTROL
Vol, 33(8), pp. 28, 30, 32, 3^, 37,
ko - 1965
397 Pratt, Harry D., Ralph C. Barnes,
Kent S. Littig
"Mosquitoes of Public Health
Importance and Their Control"
COMMUNICABLE DISEASE CENTER
Atlanta, Ga., PHS 772, p. 6, 1963
398 Pratt, Harry D. & John S. Wiseman
"Fleai of Public Health Importance
and Their Control"
COMMUNICABLE DISEASE CENTER
Atlanta, Ga., PHS 772, pt. 7, 1962
399 Pratt, Harry D.
"Mites of Public Health Importance
•ad 'Their- Control'*1
INSECT CONTROL SERIES, US. DEFT. HEW
PHS 772, pt. 9, 1963
1*00 Adam*, H.M.
"Industrial Sources of Air
Pollution (5) - Chemical"
PROCEEDINGS, NATL. CONF. ON AIR
POLL., Hov. 18-20, 1958
PHS No. 651*, pp. 16V167, 1959
Uoi Johnson, Curtis A.
"Liquid Handling Processes for
Poultry Manure Utilization"
COMPOST SCIENCE
Vol. 5, No. 3, 1965
kQ2 Howe, Robert H. L.
"Chemical Values of Digested Sludge
and Activated Sludge for Chemical
Waste* Degradation and Stabilization"
WATER & SEWAGE WORKS
Nov. 30, 1965, PP- R-219
It03 "Waste Elimination-Incinerating
Plastics Waste Solves Manufacturer's
Refuse Problem"
PLASTICS WORLD
Vol. 22, No. 12, p. 52, Dec. 196t
kf)k Rogus, Casimir A.
"Refuse Collection «nd Refuse
Characteristics"
PUBLIC WORKS
Vol. 97 No. 3, pp. 96-99, March 1966
1*05 Whiten, George
"Treating Combined Sewage and
Poultry Wastes"
PUBLIC WORKS
Vol. 92 No. 12, pp. 98-100, Dec. ig6l
H06 Grindrod, J.
"6 Years of Refuse Composting in
Britain"
PUBLIC WORKS
Vol. 92 Ho. 12, pp. 110-111, Dec. 1961
1*07 CreiBler, Joe
"The Disposal of Dead Marine Mammals"
PUBLIC WORKS
Vol. 92, No. 12, p. 151, Dec. 1961
koB Ashe, William F
"Exposure to High Concentrations of
Air Pollution (l) - Health Effects
of Acute Episodes"
PROCEEDINGS, NATL. CONF. ON AIR POLL-
Nov. 16-20, 1950
PHS No. 6$h pp. 108-195, 1959
U09 Breslow, LeEter
"Exposure to Low Concentrations of
An Pollution (l) - Health Effects
from RepeaLed Fbtposure"
PROCEEDINGS, NATL. COHF. ON AIR POLL.
Nov. J3-PO, iy^
PHS Ho. 65*-, PP 197-201, 1959
MO Nelson, Noiton
"How Air Pollution Has Its Effects
on Health ( ) - The Irritant Action
of Air Pollutants"
PROCEEDINGS, NATL. CONF. ON AIR POLL.
Nov. 1ft-?0, 1953
PHb CM, pp. 210-^lU, 1959
140
-------
1*11 Kotin, Paul
"Air Pollution and Cancer (2) -
Experimental Tumor Production with
Air Pollutants"
PROCEDDINGS, NATL, CONF. ON AIR POLL.
Nov. 18-?0, 1958
PHS 6^, pp. 22R-P31, 1959
1*12 Stenburg, Robert L.
"Modem Incineration of Combustible
Material - Industrial and Commercial"
ROBERT A. TAFT SAN. ENGEG. CENTER
U.S.DEFT. HEW, CINCINNATI, OHIO
Air Poll Con. Asaoc. Meet.
Sept. 20, 1962
1»13 Glace, I. M. Jr.
"A New Typ» of Municipal Incinerator"
THE AMERICAN CITY
pp. 89-93, N v. 1959
1*1U Hutchison, Dale H.
"Preliminary Analysis of Domestic
Incinerator Emissions"
REPORT NO. 3: CONF. ON INCINERATION,
PUBBISH DISPOSAL & AIR POLL. AIR
POLL. FOUNDATION, LOS ANGELES
p. 17, Jan. 1955
U15 Bush, Albert F.
"Physical Characteristic! of Municipal
Incinerator Emissions"
REPORT NO. 3: CONF, ON INCINEKATIOH,
RUBBISH DISPOSAL AMD AIR POLL. AIR
POLL. FOUNDATION, LOS ANOELE3
p. 19, Jan, 1955
M6 HcKee, J. E.
"The Impact of Industrial Wastes (on
the Water Quality Equation)
PRESENTED AT THE "CONF. ON PRACTICAL
SOLUTIONS TO THE WATER QUALITY EQUATION"
SANTA ANA RIVER BASIN WATER POLL. CON.
BOARD, 17 October 1963
klj Edmison, Marvin T.
"Mobil* Laboratory for Assaying
Refinery Wastes
INDUST. 4 ENGRQ. CHEMISTS*
WORKBOOK FEATURES
Aug. 59, P. 69A
IH8 Harris, B. T-
"Disposal of Refinery Waste Sulfuric
Acid"
I/EC, WORKBOOK FEATURES
p. 8lA, DPC. 1958
1*19 Phllllpt, Cecil, Jr.
"Treatment of Refinery Bnulslons
and Chemical Wastes"
INDUS. & EHO. CHEMISTRY
Vol. U6, No, 2, pp. 300, 195^
U20 Turnbull, Harry, et al.
"Toxicity of Various Refinery
Materials to Fresh Water Fish"
INDUS. & EXG. CHEMISTRY
Vol. k6 No. 2, p. jsk, 1951*
Ii21 Hurwltz, Emanuel, R.E. Beaudoln et ftl
"The Need for Conservation and Disposal
of Oils and Qreasea at the Source"
LUBRICATION ENGINEERING
Vol. 19, pp. lno-*tl3, Oct. 1963
tiPP Dorris, Troy C. et al
"Oil Refinery Effluent Treatment in
Ponds"
J. WATER POLL. CON. FED.
p. 939, July 1963
Ii23 Ruchhoft, C. C., et al
"New Method* Proposed for Solving
Industrial Waste Problems - Investi-
gations Disclose Successful Disposal
Methods for Synthetic Rubber Waste"
CIVIL ENQRa. FOR FEB. 19^7
Vol. 17, No. 2, p. 59
U2U Serbst, George H.
"Unusual Hazard in a Fertilizer
Factory"
IHDUST. HED. t SUBGERY
Vol. 13, P- 522, July 19UU
1*25 Baiter, Robt. M. &
C. J. Schollenberger
"Farm Manure" tn Progress of
Agricultural Research in Ohio
1937-1938
OHIO AGRI. EXPER. CTA. BULL. 605
Feb. 1939
U26 Mancuso, Thomas F.
"Air Pollution and Cancer (l) - The
Relation of Air Pollution and Cancer"
PROCEEDINGS, NATL. CONF. ON AIR POLL.
Nov. 18-20, 1958
PHS 65U, pp. 221-227, 1959
UP? Mounton, E. Q.
"Tne Aild Mine-Drain^- Problem
in Ohio"
OHIO STATE UN. EU. fcJfPER. fiTA, BUM,.
No XXVI Nn. S, pp ',-''?, Nnv I ^ /
kP_P "Fill RTuae DUpoml Fraurfue-
Renewed in Gin !• inner soo"
ENGINEERING NFWfj-HhT'OUn
Vol. 13f, v ?/', i;T' *>, 19^
!i29 "Manufacturer Pays Ohio for Waste-
Killed Fish"
ENGINEERING NEWS-RECORD
VoJ. 337, P- 695, Nov. 21, 19*16
1*30 "Ground Water Pollution in California
Points to Induetrial Waste Dischargee"
ENGINEERING MEWS-RECORD
Vol. 137, P- 785, Dec 1?, 19l»6
*»31 Sax, N. Irving
"Handbook of Dangerous Materials"
REINHOLD PUB. COHP. N. Y., 1951
l»32 Dunn, Walter L.
"Settlement and Temperature of a
Covered Refuse Dump"
THE TREND IN ENGRG. AT UN. OF WASH.
ENG. EXFJT*. STA.
Vol. 9 No. 1, pp. 19-21, Jan. 19^7
1*33 Eiaenhud, Merril
"The Principal Health Hazards in
Metal Finishing Departments and
Their Control"
METAL FINISHING
Vol. U?, No. 1, pp. 602-60t>, Oct.l9Mi
1*3!* Bottenfield, William
"Putting Industrial Waste to Work;
Mead's New Lime Kiln Recovers
Waste L5me Mm]"
INDUST. WATER & WASTES
Vol. 9(j), PP- lB-?L, Jan.-Feb. L9^'i
'435 Lamb R.
"A Suggested Measure of Toxicity
Due to Metals in Industrial
Effluents, Sewage and River Water"
INTERNATL. J. AIR ft WATER POLL.
Vol. 8(3-U), PP- 21*3-1*9, Mar.-April
196U
^36 "Industrial Determatitufl"
SAFETY ENGINEERING
Vol. 91 j PP- 78-9, Jan. 191*6
U37 Qreenburg, Leonard, ftivl
Samuel Moskowitz
"Save Your Breath"
SAFETS ENGINEERING
Vol. 92, pp. kz-k6, Sept. 19^6
^38 Feldstein, M., S. Duckworth,
H. C. Wohlers and B. Linsky
"The Contribution of the Open
Burning of Land Clearing Debris
to Air Pollution"
J. AIR POLL. CON. ASSOC.
Vol. 13, pp. 5*»2-5, "ov. 1963
fc39 McCord, Carey P.
"Graphite, (Plumbago, Black Lead),
as a Source of Dusty Lung Disease"
INDUSTR. MED. & SURGERY
Vol. 18, pp. U83-6, Nov. 19(19
UUO Ellsworth, Bichard D. and
Edward P. Bellinger
"Preliminary Survey on Development
of an Incinerator for Removal of
Combustibles from Scrapped Automobile
Bodies - Final Report lo Institute
of Scrap Iron ft HI eel, Inc."
BATELLE MEMORIAL INSTITUTE
COLUMBUS, OHIO
Aug. 30, 1957
fiU] Chanin, Gerson
"Decomposition Efficiency of
Sanitary land till a"
PUBLIC WORKS
Vol. Bf{?>, p. 103, Feb. Wyn
kk? Black, Rnlpri J. an
1*MJ Miles, E. J
"iHfiinfestation and Control of
Peels on Refuse Tips"
ROYAL SOCIKiy OF HEALTH JOURNAL
Vf.l 7r'(0. I'P- ''(>*-T\, Jur»- 3y^9
H)|S Van Kleeck, I*>roy W.
"EaJety PractireK at Sanitary
Lnmllills"
PUBLIC WORKS
Vol. 90(8), p. 113, Aug. 1959
kk6 "Hazards in oewage Works Operation"
PUBLIC WORKS
Vol. 7^, PP- H, 18, ^2, 53
April 191*5
UU7 Jchnson, Worth
"Long Beach Uses 'Mock up Area' to Test
Safety Operations in Refuse Collection"
WESTERN CITY
PP- 37-30, DPC. I960
liUB Dunn, Richard J.
"Maneuverable Safety Belts"
THE AMERICAN CITY
Vol. 7lU), P- 16, Feb. 19^6
kkneJl'aui;l(, !(. J.
"Modern P<-fure Collodion Ei,u> rxuen
Payt- Olt foi the Small Coirununlty"
FUBIJC WORK"
Vr>1 M'jf1;) , [,. IOS, May I'fyk
141
-------
^6j "An Analysis of Refuse Collection
and Sanitary landfill Disposal"
SAN. ENG. RES. PROJECT;
IWIV. OF CALIF.
Tech. Bull. Ho. 8, Series 37
Dec. 1952
464 "More on Grinders In Los Angeles"
THE AMERICAN CITY
Vol. LXVII, No. 1, p. 19, Jan. 1952
465 Coffey, J. H. & w. L. Dunn
"How to Make Refuse Collection
Sanitary"
THE AMERICAN CITY
Vol. LXVII, No. 1, p. 91, Jan. 1952
**66 "How Refuse Sanitation Looks In Ohio"
THE AMERICAN CITY - JAN. 1952
Vol. LXVII No. 1, p. 90,
Feb. 1952 Issue
467 "Metropolitan Refuse Disposal
Problems"
THE AMERICAN CITY - JAN. 1952
Vol. LXVII No. 1, p. 10U
Feb. 1952 issue
468 Bowerman, F.R. & B. F. Ludwig
"What Cities Use Incinerators -
and Why?"
THE AMERICAN CITY - JAN. 1952
Vol. LXVII No. 1, p. 100
March 1952 issue
469 Foster, William S.
"Let's Think straight - about
Refuse Disposal"
THE AMERICAN CITY
Vol. LXVII No. 1, p. 112
May 1952 issue
470 Nolte, George S.
"Refuse Disposal Study
Preliminary Report"
REPORT TO BD. OF SUPERVISORS
SACRAMENTO COUNTY
Doc. 7595, Feb. 2, 1965
471 Heukelekian, H.
"Certain Organic Constituents of
Fresh and Ripe Sewage Sludge"
ANNUAL REPORT OF CEPT. OF SEWAGE
DISPOSAL, July 1, 1928
Bull. 502
472 Jeffrey, Edgar A., Ralph Rlcketts,
and William C. Blackraan, Jr.
'Aerobic and Anaerobic Digestion
Characteristics of Livestock Wastes"
UN. MISSOURI BULLETIN) ENOR. EXP.
STA. SERIES NO. 57
Vol. 65 No. 2, Bo. 57, pp. Ill 4 16
Janl 16, 1964
473 San Engr. Res. lab. Eng. Center;
use
"Final Report on the Investigation
of Leaching or a Sanitary Landfill"
STATE WATER POLL. COM. BOARD
SACRAMENTO, CAL.
Pub. Mo. 10, p. 13, Aug. 19511
klb Hart, Samuel A.
"Digestion Tests of Livestock
Waste*"
J. WATER POLL. CON. FED.
Vol. 35 B . 6, pp. 748-57, June 1963
475 Hart, Samuel A.
"Thin Spreading of Slurried Manures"
TRANSACTIONS OF AM. SOC. AGRI. HIGHS.
Vol. 7 II . 1,. pp. 22-5, 28 1961t
476 Eby, Harry J.
"Manure Lagoons - Design Criter.
and Management"
AGRICULTURAL ENGINEERING
pp. 698-714, Dec. 1962
477 Mendoza, Ed
"Factors in an Efficient Refuse
Collection System"
PUBLIC WORKS
Vol. 9U, pp. 128-29, Jan. 1963
1*78 Task Group Report
"Underground Waste Disposal
and Control"
J. AM. WATER WORKS ASSOC. 1957
pp. 1334-42
4 T9 Weston, Roy F
"Laboratory Waste Disposal"
ARr?:. ranaKON. HEALTH
Voi. 0, pp. 550-53, April 1965
4Hu Klein, Louis
"River Pollution; III. Control"
WASHINGTON, BUTTERWORTHS, 1966
481 Committee on Hospital Facilities
"Hospital Solirt Wftstes and Their
Handling"
AM. j. PUB. HEAL™
p. 357, March 195
-------
516 JelHeon, &J.D. Gregaon
"Tick Paralysis In Northwestern
United otatee and British Columbia"
KOOKY MT. MED. J.
Jan. 1950
517 Hunter, G.W., W. W. Frye
and S. C. Swartzwelder
"A Manual of Tropical Medicine"
W. B. SAUNDERS CO., PHILADELPHIA
510 Knyvelt, A.F, and Dorothea F. Sandars
"North Queensland Tick TyphyB: A Case
Report Defining a New Endemic Area"
THE MED. J. OF AUSTRALIA
p. 952, Oct. 10, 196U
519 Work, Telford H.
"Tick-borne Viruses"
BULL. W.H.O.
No. 29, PP- 59- 7V 1963
520 Fox, John F.
"Rickettsial Diseases Other than
Q Fever as Occupational Hazards"
INDUSTRIAL MED. & SURGERY
p. 301, May 1961*
521 Qalton, Mildred M.
"The Epidemiology of Leptosplrosis
in the United States"
PUBLIC HEALTH REPORT
Vol. Ik No. 2, p. lUl, Feb. 1959
522 Gillespie, R.W.H. and Joanne Ryno
"Epidemiology of LeptoBplrosis"
AM. J. PUB. HKALTH
Bo. 6, p. 950, 1963
523 Goldberg, Herbert S. et al
"Leptospirosie in Random and
Select Population*"
ARCH. ENVIRON. HKALTH
Vol. 10 (l), pp. 21-23, Jan. 1965
52l» "Leptospiroeie in Wild Mammals from
Southwestern Georgia"
AM. J. TROPICAL MED.
Vol. 11, p. 518, 1962
525 Chemukha, Y.G. & E.V. Karaseva
"Leptocpira Infection of Serotype
Lora (Australia Group) Found in
the U.S.S.R."
TROP. GEOG. MED., I.
pp. 22-25, 1965
526 Der H(,eden, J. V-n & E. Szenfcerg
"Leptosplra Infection* in Rats in
Israel"
TROP. & GEOG. MED.
Vol. 16(U), PP- 377-3&, 1965
527 Lobel, H. 0. & Roger F. Robinson
"Epldemiologic Aspects of an Outbreak
of Infectious Hepatitis In Albany, N.Y.'
AM. J. PUB. HEALTH
Vol. 55 No. 8, p. 1176, 1965
528 Maynard, James E.
"Infectious Hepatitis at Fort Yukon,
Alaska - Report of an Outbreak
1960-61"
AM. J. PUB. HEALTH
Vol. 53, pp. 31-39, Jan- 1963
529 Mosley, Wiley H. et al
"Epidemlologic Studies of a Large
Urban Outbreak of Infectious
Hepatitis"
AM. J. PUB. HEALTH
Vol. 53 (1), p. 1603, 1963
530 Tarshia, I. Barry
"The Cockroach - A New Suspect in the
Spread of Infectious Hepatitis"
AM. J. TROP. MED.
Vol. 11, pp. 705-711, Sept. 1962
531 Peed, Roger W., Gardner C. McMillan
"Bacterial Infections of Animals
TransmisBible to Man"
(ProgresB of Medical Science)
AM. J. MED. SCI.
Vol. 239, P- 3^7-36?, March I960
532 Reed, W., V. Vaughn, E. Shakespeare
"Origin and Spread of Typhoid Fever In
U.S. Military Camps during the Spanish
War of 1898"
WASH. - U.S. GOVT. PRINTING OFFICE
Vol. 1, 1904
533 Hardy, A.V. and James Watt
"Studies of the Acute Diarrheal
Diseases XII., Etiology"
PUBLIC HEALTH REPORTS
Vol. 60 No- 3, P- 57, Jan. 19, iyi*5
531* Watt, JameB, A.V. Hardy, and
T. M. DeCapito
"Studies of the Acute Diarrheal
Diseases VII. Carriers of Shlgella
Dysenteriae"
PUBLIC HEALTH REPORTS
Vol. 57, pp. 52U-29, April 10, 19^*2
535 Watt, James
"An Outbreak of Salmonella Infection
in Man from Infected Chicken Eggs"
PUBLIC HEALTH REPORTS
Vol. 60 Part 2, No. 27-62
pp. 835, July-Dec. 19U5
536 Guardiola-Rotger, Aida, et al.
"Studies on Diarrheal Diseases, II.
Survey on the Incidence of Enteric
Organisms in the Pediatric Popula-
tion of Two Isolated Communities in
Puerto Rico"
AM. J. TROPICAL MED. & HYGIENE
Vol. 13, p- M7, 196k
537 Gordon, J hn E., et al
"Weanling Diarrhea"
AM. J. MED. SCI.
Vol. 21*5, PP. 3^5-377, March 1963
538 Moore, Helen A., Enrique de la Cruz
and Oscar Vargas-Mendez
"Diarrheal Disease Studies in Costa
Rica. The Influence of Sanitation
upon the Prevalence of Intestinal
Infection and Diarrheal Disease"
AM. J. EPIDEMIOLOGY
Vol. 82, No. 2, 1965
539 Watt, James, A. C. Hollister,
M. D. Beck and E. C. Hemphill
"Diarrheal Diseases in Fresno
County, California"
AM. J. PUBLIC HEALTH
Vol. 1*3, pp. 728-1*1, June 1953
5UO Na«h, J.C.T.
"The Etiology of Summer Diarrhoea"
THE LANCET
Vol. I for 1903, p. 330
51*1 Middelkamp, J. Seal
"Typhoid Fever in Infants and
Children"
MEDICAL TIMES
Vol. 93 No. 9, PP. 957-62, 1965
5^2 Ravenholt, R.T. and S. P. Lehman
"History, Epidemiology, and Control
of Typhoid Fever in Seattle"
MEDICAL TIMES
Vol. 92, No. 1*, pp. 31*2-52, 196U
5**3 Greenberg, Bernard
"Experimental Transmission of
Salmonella Typhlrnurium by Houseflies
to Man"
AM. J. HYGIENE
Vol. 80 No. 2, pp. 1^9-56, Sept. 196U
'jUk Greenberg, Bernard, Oerardo Varela,
Alexis Bornstein & Homero Hernandez
"Salmonellae from Flies in a Mexican
Slaughte rhouae"
AM. J. HYGIENE
Vol. 77, PP. 177-183, 1963
!?J*5 Schllesemann, D.J., F.O. Atchley,
M. J. Wilcomb, & S. F. Welch
"Relation of Environmental Factors
to the Occurrence of Enteric Diseases
In Areas of Eastern Kentucky"
PUBLIC HEALTH MONOGRAPH NO. 5U
Nov. 1958
51*6 Hendrlckson, E. Deane
"Hospital Epidemic of Salmonella
Heidelberg Infection"
CANADIAN J. MED. TECH.
Vol. 26(5), pp. lUU-152, 1961*
5U7 Various Authors
"The Bacteriology of Spray-dried
Egg with Particular Reference to
Food Poisoning"
MED. RESEARCH COUNCIL, LONDON
Spec. Report Series 260, 19^7
^U8 Bowlby, A.A. et al.
"A Civilian War Hospital"
LONGMANS, GREEN AND COMPANY
New York, London, 1901
549. Schneierson, S. Stanley,
and Edward Bottone
"Endemic Shigellosls In the
Underprivileged Community Served
by Greenpoint Hospital"
J. MT. SINAI HOSPITAL
Vol. 32{l), pp. 31-35, 1965
143
550 Sabin, Albert B.
"Cause and Control of Fatal, ^
Infantile Diarrheal Dleeasee"
AM. J. OF TROPICAL MED fc H10IEHE
Vol. 12, pp. 5I/>-^., July iy'>3
551 Bruch, Hwne A., Werner AfccoLI , et 9.1.
"Studies of Diarrli-al Dioease En
Central America, V. Environmental
Factors In th« Origin and Trans-
mission of Acute DJarrheal Disease
in Four Guatemalan Villages"
AM. J. TROPICAL DISEASES
Vol. 12, pp. 567-79, 1963
552 Gordon, John E. and Theodore H.Ingall
"ProgresB of Medical Science - Pre-
ventive Medicine and Epidemiology
Acute Diarrhea] Disease"
AM. J. MED. SCI.
Ho. 2lvB, pp. 3lv6-65, Sept. 19^
553 Brooke, M. M.
"Epidemiology of ftmebiasi*
AM. J. GASTROFJflTEROLOGY
Vol. 'U(i0, PP. 371-70, 196U
55l* Carl-Erik Hedstrom & Erik Lycke
"An Experimental Study on Oyster*
as Virus Carriers"
AM. J. HYGIRNE
Vol. 79, PP- iV'-lte,
555 Hoare, Cecil A.
"Reservoir Hosts and Natural Foci
of Human Protozoal Infections
ACTA TROPICA BULL.
No. 19, PP- 281-317, 1962
556 Johnson, Carl M.
"American LeiBhrnaniasle"
INDUS. MED. & SUPG.
p. 315, May 196U
557 Beaver, Paul C.
"Cutaneous Larva Migrans
IHWST. MED. Sc SURGERY
pp. 319-21, May 1961*
558 Reed, R. W., 0. C. McMillan
"Progress of Medical Science
Helminths of Animals Transmissible
to Man"
AM, J- MED. SCI.
Vol. ?li3, Pp. 35^-81, March 1962
559> Baldwin, Helen* L. and C.L. McGuinness
"A Primer on Ground Water"
U.S. DEFT- INTERIOR, OBO. SURVEY
1963
560 Gordon, John E. n
"Medlral Ecology and the Public Health
AM- J. MED. SCI.
Vol. 235, PP- 337-59, "arch 1958
561 Roaen, George
"Human Health, Community Life, and^
the Rediscovery of the Environment"
AM. J. PUBLIC HEALTH
Vol. 5Ml), PP- 1-6, Jan. 196U
5h2 "Nation-wide Inventory of Sanitation
Needs"
SUPPLEMENT 20k TO PUB. HEALTH REPORTS
April 1956, p. 1
563 Steed, Henry C., Jr.
"Environmental Health Research"
AM. J. PUB. HEALTH
Vol. 55 No. 1*, p. 600, April 1965
56U Dunsmore, Herbert J.
"Criteria for Evaluation ef Environ-
mental Health Progress"
AM. J. FUB. HEALTH
p. 7, Jan. 19$*
565 Rumrelch, A. S.
"A Study of the Rodent- Ectoparasite
Population of Jacksonville, Florida"
PUBLIC HEALTH REPORT
Vol. 60 No. 31, p. 885, Aug. 3, 19^5
566 Stark, H. E. and V. I. Miles
"Ecological Studies of Wild Rodent
Plague in the San Francisco Bay Area
of California, VI. The Relative
Abundance of Certain Flea Species
and Tuelr Host Relationehips on
Coexisting Wild and Domestic Rodents"
AM. J. TROP. MED.
Vol.11, pp. 525-531*, 1962
567 Bhatnagar, J.K. and B.O. Praead
"Certain Epidemiological Features
of Plague in Uttar Pradesh - A
Study in Retrospect."
IND. J. MED. RES.
Vol. 53, P- 1^9, Feb. 2, 1965
-------
Donn, R. W
Pirns
) Il^.to
THE CANADIAN ENTOMOLOGIST
Vol. ')(), pp. Vj-l'»i, l-jO
5^j Kartman, Leo, Fmnk H. Prince
Stu*rt F. Quan and Harold E. GUnk
"New Knowledge on the Ecology of
Sylvmtic Plague"
ANN. NEW YORK ACAD. SCI.
Vol. ?0, pp. 6h}nr
Pffltrict (Mysore State)"
INDIAN J. MALARIOLOGY
Vol 12, '.'-}, pp. 179-fV
June-Sept. J9^>3
5 H Rosenstein, Beryl J.
"Shigella and Salmonella Enteritis
In Infante and Children"
JOHNS HOPKINb HOSPITAL, BALTIMORE
BULLETIN NO. 115
pp. 407-415, Nov. 1964
572 Altken, T.H.G., W. G. Downs,
L. Spence and A. H. Jonkers
"St. Louis Encephalitis Virus
Isolations in Trinidad, West
Indten, 1953-1962"
AM. J. TROPICAL MKD. fc HYGIENE
Vol. 13(3), PP- 450-451, 1964
573 Qirard, GeorgeB
"Plague"
ANN. REV. MICRORIOL.
Vol. 9, PP- 253-76, J955
574 Nichols, Edward, Mila E. Pindge
and G. Gardiner RuseeJl
"The Relationship of the Habits of
the Houa* Mouse and the Mouse Mite
(Allodermanyssus "Jangiuneue) to
the Spread of Rlckettslalpox"
ANN. INTERNAL MED.
Vol. 39, pp. 9^-102, 1953
575 Beye, Henry, Charles Brooks and
Elizabeth Oulnn
"Protozoan and Helminthic Infesta-
tions Among Migratory Agricultural
Workers"
AM. J. PUBLIC HEALTH
Vol. 51, pp. 1862-71, Dec. 1961
576 Clark, J.W. and W. VieBsman, Jr
"Water Supply and Pollution Control"
INTERNATIONAL TEXTBOOK CO.
P- 53, T-965
577 Dingle, John H., et al.
"Water Composition and Cardiovaecula
Health"
ILLINOIS MEDICAL JOURNAL
Vol. 1?5, No. 1, p. 25, Jan. 1964
578 MUSG, David L.
"Relationship Between Water Quality
and Deatho from Cardiovascular
Disease;
J. AM. WATER WORKS ASSOC.
Vol. 54, p. 1371, 1962
579 Kobayashl, Jun
"On Geographical Relationship
Between the Chemical Nature of
River W ter and Death-rate from
Apoplexy (Preliminary Report)"
BERICHTE d. OHARA INSTITUTE
Bd. H. Ht. 1, pp. 12-21, 1957
580 ZoBell, Claude E.
"Marine Microbiology; A Monograph
on Hydrobactertology"
CHRONICA BOTANIC COMPANY
WALTHAN, MASS.
1946
58l Meyer, K. F.
"Evolution of the Problems of
Occupational Diseases Acquired
from Animals"
INDUSTR. MED. AND SURGERY
Vol. 33, PP' 286-95, May 1%4
582 All red, Dorald M.
"Mites as Intermediate Hosts of
UTAH SC. ARTS AND LETTERS PROC.
Vol. 31, pp. 44-51, 19511
583 March, P. E.
"FUh H.S Food, V. II., Nutruion,
ACADEMIC PRESS, NEW YORK AMD LONDON
Ho. (/i^.g B, p. 370, 196?
584 Moore, B
"The Rink of Infection thiough
Bathing in Sewage-Polluted Water"
FROC. FIRST INT. CONK. ON WASTE
DISP. IN MARINE ENVIRON. U.C.
BERKELEY
,TuJy 1'W
5«5 Sler,arenko, V.V., K.A. Dunaeveky
"Traneovarlal Tranemiesion of Tick
Relapsing Fever Spirochaetae in Ticks
Alectorobius Aflperus"
MEDITSINSKAIA PARAZITOLOGUAI
FARAZITAPNY f HOLEZNI (MOSCOW)
Vol. 33 No. f>, pp. 7UU-H5, 1964
5^6 "Water Pollution - Great Lakes (Part I
Lake Ontario and Lake Erie)
u.s. CONGRF;SS (aqth), ?nd SESSION HEARING
BEFORE A SUBCOMMITTEE ON TKE COMH. ON
GOVT. OPERATIONS, July 2?, 3966
GPO 67-M?
r)8? Salmon, Raphael J
"Final Report R-UO-197, Environmental
Health PI (inning for Postattack Conditions-
Somr Problems, Programs and Prioritiee"
RESEARCH TRIANGLE INST-, UURHAN, N.C.,
OFF. CIVIL DEFENSE, U,S. ARMY, U.S.
PHS, 1966
580 Havlik, 0. & V. Chladek
"Protection of Health in
Biological Warfare"
ARMY FOREIGN SCI. & TECH. CENTER
FSTC-3Gl-T61i-53, 07-1050, Jan. 1965
AD '(75-91?
5»9 Kier, John H. et al
"Acute Bronchopneumonlc HletopJasmOHls
Following Exposure to Infected Garden
Sol t"
J. AM. MED. ASSOC.
p. 1?30, July 31, I'M
590 Donisthorpe, Horace
"Ante as Carriers of Disease"
ENTOMOLOGISTS MONTHLY MAGAZINE
ENGLAND
Vol. 81, p. 185, 19U5
591 Pollard, M rris
'Chemical Induction of Mammary
Ceneer in Germ-Free Rats"
NATURE
No. 11913, p. 1289, D c. 28, 1963
592 Tftrzwell, C.M. & C. Henderson
"The Toxicity of Some of the LCBB
Common Metal* to Fishes
AEC TID 7517 (Ft. 1A)- "SAN.
ENG. ASPECTS OF THE AEC"
p. 266, Dec. 1955
593 "Agricultural Pesticides - Introduc-
tion: Guidance to Manufacturers on
Necessary Toxicity and Residue Data"
COUNCIL OF EUROPE, DOC. PREPARED BY
WORKING PAMY ON POISONOUS SUBSTANCES
IN AGRIC-, SUBSIDIARY ORGAN OF THE
PUB, HEALTH COMM. (P.A.) OF THE
COUNCIL OF EUROPE, STRASBOURG, 1962
59U Quinby, Griffith E. & Allen B. Lemmon
"Parathion Residues as a Cauee of
Poisoning In Crop Workers"
J. AM. MED. ASSOC.
Vol. 166, p. 7Uo, Feb. 15, 1958
595 Johnston, J. Monte
"Parathion Poisoning in Children"
j. PEDIATRICS
Vol, 1*2, pp. 286-91, 1953
596 Caldwell, Elfreda & Leland W. Parr
"Ground Water Pollution and the
Bored Hole Latrine"
,T. INFECTIOUS DISEASES
Vol. 60 No. 3, pp. 1U6-83, May-June 1937
597 Caldwell, Elfreda Larson
"Studies of Subsoil Pollution in Rela-
tion to Possible Contamination of the
Ground Water from Human Excreta De-
posited in Experimental latrine"
J. INFECTIOUS DISEASE
Vol. 62, pp. 272-92, 1938
598 Caldwell, Elfreda Larson
"Pollution Flow from a Pit Latrine
wnen Permeable Soils of Considerable
Depth Exist Below the Pit"
J. INFECTIOUS D1SEASFG
Vol. 62, pp. -225-56, 1938
599 Dyer, Brian R., T.R. Bhaskaran,
C. Chandra Sekar
"investigations of Ground-Water
Pollution, Part III; Ground-Water
Pollution In West Bengal, India"
INDIAN J. MED. RES.
Vol. 33, PP- 23-62, May 1, 19^5
600 Aust, Alden
"Waste Treatment in Today's
Urban Area"
COMPOST SCIENCE
Vol. 5 Wo. 3, p. 2k, 1965
601 Totah, S. J.
"Agricultural Value of Dried
Poultry Manure and Bedding"
COMPOST SCIENCE
Vol. 5, No. 3, P- 29, 1965
602 Wiley, John S. & O.W. Kochltitzky
"Composting Developments in the
United States"
COMPOST SCIENCE
Vol. 6, No. 2, pp. 5-9, Summer 1965
603 Reeves, James B.
"Studies of Sewage Sludge and
Sawdust Compost"
COMPOST SCIENCE
Vol. 6 No. ?, p. 1?, Summer 1965
'iM Beckett, John Leslie an-t
Horace Roy Oakley
"Sewage Disposal and RefuBe Com-
posting in Leicester, England"
COMPOST SCIENCE
Vol. 6 No. 1, pp. 5-8, Spring 1965
6O5 Farksfidi, G.
"Do Additives Affect Windrow
Composting of Refuse and Sludge?"
COMPOST SCIENCE
Vol. 6 No., pp. 11-13, Spring 1965
606 Schaffer, H. 0.
"And Jersey Keeps on Composting"
COMPOST SCIENCE
Vol. 6 No.l, pp. 14-15, Spring 1965
607 Lindstrora, Rlkard
"A Simple Process for Composting
Small Quantities of Community Waste"
COMPOST SCIENCE
Vol. 6 No. 1, pp. 30-32, Spring 1965
608 Purlow, H.G. and H.A. Zolllnger
"Weatlnghouse Enters Composting
Field"
COMPOST SCIENCE
Vol. k No. k, pp. 5-10, Winter 196^
609 Hart, Samuel A.
"Sanitary Engineering in
Agriculture"
COMPOST SCIENCE
Vol. It No. k, pp. 11-15, Winter 196U
610 Clark, J. W.
"Composting Domestic Refuse in a
'Home Unit'"
COMPOST SCIENCE
Vol. U No. k pp. 16-17, Winter 196^
6ll Bell, John M.
"Characteristics of Municipal
Refuse"
PROCEEDINGS, NATL. CONF. ON SOLID
WASTE DISPOSAL. AM. PUB. WORKS ASSOC
SPECIAL REPORT
No. 29, pp. 26-36, Feb. 1964
612 Wiley, John S.
"A Report on Three Manure Com-
posting Plants"
COMPOST SCIENCE
Vol. 5 No. 2, pp. 15-16, Summer 196U
613 Franz, Maurice
"Larjie^scale Composting in the
Soviet Union"
COMPOST SCIENCE
Vol. 5 N . 2, pp. 19-20, Summer 19&4
611* Rogus, Casimir A.
"Refust Quantities and Characteristic
PROCEEDINGS, HAT. CONF. ON SOLID
WASTE RES. AM. PUB. WORKS ASSOC,
SPEC. REPORT
Vol. 29, pp. 17-27, Feb. 1Q64
615 Stead, Frank M.
"Solid Waste Collection and
Disposal Systems Ecology,
Administration, Research"
COMPOST SCIENCE
Vol. 5 No. 1, pp. 5-6, Spring 196^
144
-------
616 Tletjea, Cord
"Conservation a»d Field
Testing of Compost"
COMPOST SCIENCE
Vol. 5 Ho. 1, pp. B-H, Spring 196
617 Xtherton, H. I
"Oregon Farmers Save Money by
Composting"
COMPOST SCIENCE
Vol. 5 Ho. 1, pp 2O-21, Spring 19
n 618 Henderson, John H.
"Refuse Composting In India"
PUBLIC WORKS
Vol. 60(11), pp. 99, 176-7
HOY. 1957
619 Westrate, V.A.O.
"Refuse Composting Experience In
the Hethtrlnnds"
j. SAB. an. rav. OF ASCE
Vol. 1610, p. 8U-SA2, Apri. 1958
620 "Tacoma Discontinue! Composting
Operations"
Ttffi AMERICAN CITY
Vol. 73 (7), p. 15, July 1958
621 Anderson, H. S
"Compost as a Mean* of Garbage
Disposal"
PROC. FLORIDA SOIL * CROP SOC.
pp.l3«->U, Nov. 29, 1956
&>2 Oolueke, Clan-nee 0. and
Harold B. Gotaas
"Public Health Aspects «f Haste
Disposal by Composting"
AM. J. PUB. HEALTH
Vol. 4M3), pp. 339-U8, M»r. 195U
623 "Compoitlng Fizzle"
EHO. NEWS RECORD
p. 33, Jan. 16, 1958
fell Kay, T.
"Disposal of Refuse by Comporting
the DB.no Plant at Radcllffe"
THE CHARTERED MUNICIPAL ENGINEER
Vol. 89, pp. 361, 2, k, Oct. 1962
625 Golueke, Clarence 0., et. al.
"A Critical Evaluation of
Inoculum! In Composting"
APPLIED MICROBIOLOGY
Vol. 2, pp. l»5, 52-3, Jan. 195k
626 Roue, Walter R-, Jay Cfaapnan
and Halter A. Mercer
"Composting Fruit Watte Solids"
OREGON STATE UK. EWJ.EXP. STA.
Clrc. 29, pp. 32-63, Sept. 1963
627 Miller, Lynn M. , et al
(Task Group Report)
"Underground Waste Disposal and
Ground Water Contamination"
AM. WATER WORKS ASSOC.
Vol . 52, PP. 619-22, May 1960
628 Ettlnger, M. B.
"Proposed Toxlclty Screening Procedure
far Use In Protecting Drlnklng-Water
Quality"
J. AH. WATER WORKB ASSOC.
Vol. 52, H«. 6, pp. 689-911, June I960
629 Stekinger, Herbert E. and
Richard L. Woodvard
"Toxlcologlc Methods for Establishing
Drinking Water Standards"
AM. WATER WORKS ASSOC.
Vol. 50, pp. 515-29, April 1958
630 Ellassen, Rolf
"War Conditions Favor landfill
Refuse Disposal"
ENGINEERING NEW RECORD
pp. 912- 1^, June It, 1942
631 Goldsmith, John R. & Lewis H.Rogers
"Health Hazards of Autmnblle.
Exhaust"
PUBLIC HEALTH REPORTS
Vol. 7><, »°. 6, pp. 551-55, Jun« W59
632 Schrauf nagel , F. H.
"Disposal of Industrial Wastes
by Irrigation"
PUBLIC HEALTH REPORTS
Vol. 7"t «o. 2, pp. 133-lkO, Feb. 1959
633 Mechem, O.E. and J.H. Oarrett
"Deep Injection Disposal Well for
Liquid Toxic Waste"
J. CONST. DIV., ASCE
Vol. 89(C02, »«. 3650), pp. 111-21
Sept. 1963
63U Henderson, John M.
"Agricultural lend Drainage
and Stream P-llutlon"
J. SAN. ENG. DIV. AECK
Vol. 88(SA ft), pp. t'l-V*, 1962
635 Burke, Willlasi J.
"Combating Health Hazards in the
Chemical Industry - Part II"
CHEMICAL INDUSTRIES
Vol. 55, pp. 5fa5-b8, Oct. 1944
636 Eng. Science, Inc., Arcadia, Calif.
"Effects of Refuse Dumps «n
Ground Water Quality"
STATS WATER POLL. CON. BD., CALIF.
Calif. State Printing Off.
Aug. 1961
637 Stead, Frank M.
Public Health Aspects »f
Water in California"
CALIF. WATER RESOURCES LECTURE
Jan. 4, 1966
638 Ournham, C. Fred
"Control of Water Pollution -
Water Pollution Problems Can be
Solved by i Carefully Planned
Program of Waste Controly and
Treatment"
CHEMICAL ENGINEERING
pp. 190-204, June 10, 1963
639 Hanson, H.Q, and Bernard B. Berger
"Where Does Research Stand In
Water Pollution Control?"
J. WPCF
Vol. 33 No. 5, PP- 477-84, May 196l
640 "California Zeroes in on Ground-
water Problems"
ENGINEERING NEWS RECORD
pp. 32-36, Oct. 18, 1962
641 McKee, Jack Edward and
Harold W. Wolf
"Water Quality Criteria, 2nd Ed."
THE RES. AGENCY OF CAL. STATE
WATER DUALITY C0». BD.
3-A, 1963
6U2 McLemore, L-s
"Houston Sets up Research Program
for Wastes"
COMPOST SCIENCE
Vol. 6, No. 1, pp. 9-10, Spring 1965
643 McMlchael, Francis Clay and
Jack Edward McKee
"Report on Wastewater Reclamation
at Vhittler Barrows"
W.M. KECK LAB., CAL. INST. TECH.,
also, STATE WATER QUALITY CON. BLD.
SACRAMENTO, CALIF.
Sept. 30, 1965
M McKen, J. E.
"Dimensions of the Solid Waste
Problem"
PROCEEDINGS, NAT. CONF. ON SOLID,
WASTE RESEARCH, AM. PUB. WORKS
ASSOC. SPECIAL REPORT
Vol. 29, pp. 1-7, Feb. 1964
645 Talnganides, E. Paul
"Agricultural Solid Wastes"
PROCEEDINGS, NAT. CONF. ON SOLID
WASTE DISPOSAL, AM. PUBLIC WORKS
ASSOC. SPECIAL REPORT
Vol. 29, pp. 39-50, Feb. 1964
6k6 Mercer, Walter A.
"Induetrlal Solid Wastes. The
Problems of the Food Industry"
PROCEEDINGS, NAT. CONF. ON SOLID
WASTES DISPOSAL, AM. PUBLIC WORKS
ASSOC. SPECIAL REPORT
647 Lynn, Walter R.
"Systems Analysis for Solid
Waste Problems"
PROCEEDINGS, HAT. COSF. OB SOLID
WASTE DISPOSAL, AM. PUBLIC WORKS
ASSOC. SPECIAL REPORT
Vol. 29, pp. 69-7U, Feb. 196U
6U8 Bowerman, F. R.
"Transfer Operatione"
PROCEEDINGS, NAT. CONF. ON SOLID
WASTES DISPOSAL, AM. PUBUC WORKS
ASSOC. SPECIAL REPORT
Vol. 29, pp. 75-79, Feb. 196U
145
,(•,149 Siayne, Philip E.
"Cuntalneiiintion"
FROCEKTONOS, NAT. COOT. 0»
SOLID V.ASTES DISPOSAL, AM.
PUBLIC WOliKS ASCOC. SFKCIAL REPORT
Vol. .*'>, IT- !M>-t'^, Feb. 1^*^
650 Kuehn, Otto
"Equipment Development"
PROCELPINGS, NAT. CONF. ON SOLID
WASTES DISPOSAL AM. PUBLIC WORKS ASSOC.
SPECIAL REPOUT
Vol. >>, pp. , Feb. 19oli
tVil Ooode, C. S.
"Utilization of Sanitary Landfill Sites"
PROCEEDINGS, NAT. CONF. ON SOLID
WASTES DISPOSAL, AM. PUBLIC WORKS
ASSOC. SPECIAL REPORT
Vol ??, pp. 128-135, Feb. 196k
652 Weststrate, Ir. W. A. 0.
"Composting of City Refuse"
PROCEEDINGS, NAT. CONF. ON SOLID
WASTES DISPOSAL, AM.PUBLIC WORKS
ASSOC. SPECIAL REPORT
Vol. 29, pp. 136-JU7, Feb. 196k
653 Hanks, Jamet J. & Harold D. Kube
"Industry Action to Combat P llutlon
Solid Wnste - Used Containers -
DlsposRbility, DegradabilUyl"
HARVARD BUSINESS REVIEW
pp. *19-o?, Sept.-Oct. 1966
65*4 "Reclamation of Municipal Refuse
by Composting
SAN. ENO. RES. PROJECT
UN. CAL. AT BERKELEY
Tech.Bull. No. 9, S ries 37
June 1953
655 Davles, A.Q.
"Future Trends in Waste
Storage and Disposal"
ROYAL SOC. HEALTH J.
Vol. 82, pp. 289-95
Nov.-Dec. 19&
656 Wylie, J. C.
"Fertility from Town Wastes"
FABER «. FABER LTD., 2U RUSSELL Sq.
London, 1955
657 Proceedings of the 8th Southern
Municipal «. Industrial Waste Conf.
Sponsored by Duke University, North
Carolina State College & Univ. of
North Carolina. Held at Dept. of
San. Eng. School of Pub. Health,
UNIVERSITY OF NORTH CAROLINA
April 2-3, 1959
6^3 Schillei, E ftrett. & Robert Rausch
"A Vole (Microtus) an Important Natural
Intermediate Host of Echinococcus
Granulosus"
ARCTIC HEALTH RES. CENTER, U.S. PUBLIC
HEALTH SERVICE
ANCHORAGE, ALASKA, 1950
659 Allcata, Joseph E, fc Robert W. Brown
"Observation* on the Method of Human
Infection with Anglostrongylus
Cantonensis in Tahiti"
CANADIAN J. ZOOLOGY
Vol. W, pp. 755-760, 1962
660 Mackerras, M. Josephine and
Dorothea F. Sandars
"The Life History of the Rat Lung-
Worm, Anglostrongylus Cantonensis
(Chen) (Nematoda: Metastrongylldae)•
AUSTRALIAN J. 2OOLOOY
Vol. 3, pp. 1-25, 1955
661 Smith, H. Willalms
"The Effect of Feeding Pigs on
Food Naturally Contaminated with
Pilmonellae"
J. HYGIENE
Cambridge Vol. 58, pp. 381-389
I960
662 DeCaplto, Tnelma
"Isolation of Salmonella from Files"
AM. J. TROPICAL MED.
Vol. 12, p. 892, Nov. 1963
663 Chase, F.E. and M.L. Wright
"Salmonella in Dried Eggs"
CANADIAN J. RES.
Vol 2liF, pp. 77-80, Jan. 1946
661! Anonymous
"Epidemic Cholera"
BRITISH MED. J.
Vol. 5466, pp. H3?-jj), iyni
-------
«.r- Eaton, R.D.F.
"An Outbreak of Infectious Hepatitis"
CANADIAN J. PUB, HEALTH
Vol. 5-, PP. 217-303, 19ol
ix'0 Paul, John R. & Horace T. Gftiijner
"EmlemlolOtjlc Aspects of
Hepatitis In U.S. Troop* In
Germany lolio-lOJO"
AM. J. mo.
Vol. 8, p. 565, 1;>50
667 S,v\eitoii, Jerome T., Robert 0.
Fischer, Sidney A. Smith, Richard
P. Dow, Herbert Schoof
"Hie Cockroach AS a Natural Extra-
liunmn Source of Poliomyelitis Virus"
FEU. PROC.
Vol. II, p. W3, 1*>5?
008 Paffeubarger, Ralph S., Jr.
ami James Watt
"Poliomyelitis in Hidalgo Covmty,
Ttf-cM), I'llt;1' Epldemlolotflc
Olveervatir-ns"
AH. J. HYGIENE
Vol. r,8 No. 3, pp. 2C9-207
Hoi,. 1953
669 Tisdale, E.S. and C. H. Atkins
"•Hie Sanitary Privy and Its
Relation to Public Health"
AM. J. PUB. HKALTH
Vol. 33, P- 1319, 19't3
670 Schroeder, Henry A.
"Relation between Mortality from
Cardiovascular Disease and
Treated Water Supplies"
J. AM. MED. AGGOC.
Vol. 98, p. 1902, April 23, I960
671 Sharp, R. D.
"Rodent Control at Refuse Dump"
SOAP 8. CHEM. OPEC.
Vol. Ill, pp. llO-llll, Sept. 1965
672 Allcato, Joseph E.
"Pigs and Calves as Carrier Hosts
for the Infective larvae or Angio-
strongylu* Cantonenfls"
J. PARASITOL.
Vol. 50 (3 sect. 2), p. 39, lex*
673 "What th« Engineer Should Know
About Tropical Disease"
PUBIJC UOHKS
Vol. 75, pp. 1U-5 1 W-U6, April
67*1 Melnlck, Joseph L. and
lAwrence R. Penner
"Tne Survival of Poliomyelitis and
Coxbackie Viruses following Tiieir
Inaction by FUe«"
J. EXP.MED.
Vol. 96, pp. 255-271, 1952
675 Furcolow, M.L., F.E. Tosh,
H.U. Larsh, H.J. Lynch, Jr., G.Shav
"The Emerging Pattern of Urban
Hlstoplasmosis Studies on an
Epidemic in Mexico, Missouri"
NEK ENO. J. MED.
Vol. 264, pp. 1226-1230, 1961
676 Crulokshank, Robert
"The Problem"
MILBAM KiK. rWD OVAKTSKLI SUPPL.
Vol. >I3, pp. 215-17, 2W-57
April 1965
677 Wolf, Harold w.
"Housefly Breeding in Savage Sludge"
SEWAGE AND INDUST. WASTES
Vol. 27, pp. 172-6, Feb. 1955
676 Cox, 0. Lissant, Frederick C. Lewis
and Ernest E. Olynn
"The Number and Varieties of
Bacteria Carried by the Common
Housefly in Sanitary and
Insanitary City Areas"
J. HYGIENE
Vol. 12, pp. 290-319, 1912
679 Knuckles, Joseph Lewis
"Studies on the Role of Fhormla
Regina (Melgen) as a Vector of
Certain Enteric Bacteria"
DISSERTATION ABSTRACTS
Ph.D. THESIS UNIV. OF CONK. 1959
vol. ?o(i»), pp. 11,90-91, 1959
6flO Nash, J.T.C.
"House Flies as Carriern of Disease"
J. HYGIENE
Vol. -1562
Sept. 1966
f.91 Shaker, Yehia, Raouf Aziz, and
Amal Abu El Naga
"A Preliminary Study of Infantile
Diarrhea in Kuwait"
AM. J. PUB. HEALTH
Vol. 56 (9), pp. 1580-87, Sept. 1966
692 "Alarm Sounded Plague Increase
Triggered by Fats"
GENEVA (AP) L.A. TIMES
Oct. 27, 1966
693 "National Conference on Salmonellosia,
Atlanta, Georgia, 11-12 March 196U"
U.S. DEPT. HEALTH, ED. Si WELFARE
PHS
1961,
69>l Richardson, N.J. & V. Bokkenheuser
"Saljnonellae and Shlgellae in a Group
of Periurban South African Bantu
School Children"
J. HYGIENE, CAMBRIDGE
Vol. 61 No. 2, pp. 257-263, 1963
695 Harvey, R.W.S. and W.Powell Phillips
"An Environmental Survey of Bakehouses
and Abattoirs for Salmonellae"
J. HYGIENE, CAMBRIDGE
Vol. 59, pp. 93-103, 1961
696 Smith, H. William
"Tne Isolation of Saljnonellae from the
Mesenteric Lymph N des and Faeces of
Pigs, Cattle, Sheep, Dogs and Cats and
from Other Organs of Poultry"
J. HYGIENE, CAMBRIDGE
Vol. 57, pp. 266-273, 1959
697 Horstmann, Dorothy «.
"Epidemiology of Poliomyelitis
and Allied Diseases - 1963"
YALE J. BIOL. MED.
Vol. 36, pp. 5-26, Aug. 1963
698 Report of a WHO Expert Comnltt.ee
on Helmlnthlaees
"Soil-Transmitted Helminths"
W.H.O. TECH. HEPORT SERIES
Vol. 277, 19*
699 WHO Expert Committee on Hepatitis
(2nd Report)
"Epidemiology of Viral Hepatitis
W.H.O. TECH. REPORT SERIES
Ho. 285, pp. 8-21, 196U
TOO Mclaughlin, A. 1,0
"Tne Dust Diseases In Great Britain"
A.M.A. ARCH. INCUST. HEALTH
Vol. 12, pp. 83-98, 1955
701 Vlntinner, Frederick J.
and Anna M. Baetjer
"Effect of Bituminous Coal Dust
and Smoke on the Lungs - Animal
Experiments"
A.M.A. ARCH. INDUST. HYGIENE
& OCCUP. MED.
Vol. U, pp. 206-16, Sept. 1951
702 Marks, J. and C. Nagelschmldt
"Study of the Toxlcity of Dust
with Use of the Vitro
Dehydrogenase Technique"
A.M.A. ARCH. IRDUST. HEALTH
Vol. 20, pp. 383-9, Hov. 1959
703 Gross, Paul, et al
"Glass Dust: A Study of Its
Biologic Effects"
A.M.A. ARCH. INDUST. HEALTH
Vol. 21, pp. 10-23, Jan. I960
10k Currle, A. N.
"The Pole of Arsenic in
Carclnogenesis"
BRITISH MED. BULL.
Ho. U, pp. It02-li05, 191,8
705 MacMahon, H.E. (k H.O. Olken
"Chronic Pulmonary Beryllosis in
Workers Using Fluorescent Powders
Containing Beryllium"
A.M.A. ABCH. IBDUST. HYGIENE
pp. 195-211, Feb. 1950
706 Rlddell, A. R.
"Pulmonary Duet Disease"
INDUSTfl. MED.
Vol. 17, PP. 168-170, May 19W
707 Bayonet, Natalie, Rafael Lavergne
"Respiratory Disease of Bagasse
Workers A Clinical Analysis of
69 Cases"
INDUST. MED.
Vol. 29, pp. 519-522, Nov. I960
708 Vorwald, Arther J., James D.
MacEwen, Ralph 0. Smith
"Mineral Content of Lung In
Certain Pneumoconioses"
ARCH. PATHOLOGY
Vol. 7U, pp. 267-7ll, Oct. 1962
709 Comly, Hunter H.
"Cyanosis in Infants Caused by
Nitrates in Well Water"
J. AM. MED. ASSOC.
Vol. 129, pp. 112-16, Sept. 8, 1945
710 Jenkins, S.H. , D.O. Height and
Avrll Ewlns; S. H. Jenkins and
J.S. Cooper
"The Solubility of Heavy Metal
Hydroxides in Water, Sewage and
Sewage Sludge - II (t III; The
Precipitation of Metals by Sewage;
The Solubility of Heavy Metals
Present in Digested Sewage Sludge"
INT. J. AIR WATER POLL.
Vol. 8, pp. 679-693: 695-703
711 Cherry, A.B., A.J. ftabaccla
and H. W. 6enn
"Tne Aeelmllation Behavior of
Certain Toxic Organic Compounds
In Natural Water"
EEWAOE AND INDUST. WASTES
Vol. 28, pp. 1137-46, 1956
146
-------
'il.J Ettinger, Morris B.
"Developments In Detection of
Trace Organic Contaminants"
,T. AM- VJATBP WORKS ASSOC.
Vol. 51, No. U, pp. ^53-57, April 1965
713 Affel, HarmanA., Jr.
"System Engineering"
INT. SCIENCE & TECH.
Vol. 35, PP- l8-?<5, Nov. 196U
fl'» "Watrr Pollution in Europe"
W.H.O. BULLETIN
Vol. Lk No- 5-6, PP- 950-1005
1956
715 Kartnvm, Ifo
"Plague Infection In Rattua
rattws In San Francipco"
ZOONOSES RESEARCH
Vol. ?, p. 67, April 1%3
H6 Burke, 0.
"Summary of Recent Abstracts:
Plague"
TROPICAL DISEASES BULL.
Vol. 62 Ho. 7, P- 60>, 1965
717 McCabe, L. J. & T. W. Halnes
"DiarrJieal Bieeace Control by
Improved Human Excreta Disposal"
PUBLIC HEALTH REPORT
Vol. 72, pp- 9?l-28, 1957
718 Carter, William C.
"TrichinoBia - An Epidemlological
Report
PUBLIC HEALTH NEWS, HEW JERSEX
STATE DEPT. OF HEALTH
Vol. 3^(6), P- 205, June 1937
719 "Combating Diarrhoeal Disease in
Latin America"
W.K.O. CHRONICLE
Vol. 10, pp. 260-6U, July 196J»
7?0 Lofton, C.B,, S.H. Morrison fc
P.O. Leiby
"The Enterobac'teriacea* of Some
Coloraao Snail Mammals and Birds,
and Their Possible Role in Gastro-
enteritis in Han and Domestic Animals"
XOOSOSEE RESEARCH
Vol. 1 Wo. 15, PP- 227-293
Dec. 30, 1962
721 AJello, Von L.
"Hietoplasma Capsulatum Roil Studies"
MYKOSEN
Vol. 3, pp. 'tS-'iS, 1960
722 Proceedings, 65th Annual Meeting
"Further Studies on Salmonella in
Human and Animal Foods and in the
Environment of Processing Plants"
U.S. LIVESTOCK SAN. ASSOC.
MINNEAPOLIS, MINN.
Oct. 31, Nov. 1,2,3, 1961
723 Carrell, J. J.
"Safety in Refuse Collection"
PUBLIC WORKS
Vol. 91<
-------
148 SOLID WASTE/ DISEASE
APPENDIX A: RESEARCH
recommendations
TABLE A-l is a summary list of research topics discussed in succeeding pages of
this appendix. Some are quite specific and deal with problems which can be clearly
defined. Others are nebulous or sufficiently complex that no easy solution can be visu-
alized. In any case, it is an imposing list because of the wide range shown. It may be
best to consider the various research topics as 'a shopping list' for scientists and engineers
who are interested in the field of solid wastes and public health. It would seem that
almost everyone could find a research area which might benefit from his attention.
The list may also be considered as comprising a set of recommendations for future
research and development work on recognized, real-life problems facing the country today.
As such, the various research topics can serve as a guide for formulating and funding
specific projects. A deficiency in the list is created by the fact that there was not time
available to develop criteria necessary to permit assigning a priority to each topic.
A discussion of the material on which the list is based follows Table A-l
TABLE A-l
RESEARCH TOPICS (REPRESENTATIVE)
Systems Aspects
System analysis of solid waste management, including disease
Solid waste management criteria
Formulation of a clear objective of solid waste—disease control measures
Criteria and methods for measuring success of a system
Consequences of failure of parts or all of a solid waste management system
Requirements analysis for monitoring system
New analytic procedures for identification and measurement of components, including microflora
(monitoring)
Methods for rapid screening of solid waste components for toxicity and disease potential
Information storage and retrieval system for solid wastes
Mathematical model of urban—rural interface emphasizing diseases and solid wastes
Chemicals (see section on diseases associated with chemical wastes: Recommendations)
Chemical factors in solid waste leading to disease (epidemiologic studies to identify hazards)
Toxicology of components of solid waste
Study of leaching and migration of chemical species through soil
Study of chemical contamination of soil by specific problem compounds (e.g., heavy metals, ni-
trates)
Study of waste contamination of air
(continued)
-------
literature survey 149
TABLE A-l (continued)
Chemicals
Ways of using land disposal of wastes without affecting ground water quality (e.g., in landfills or
gas-off)
Methods for tracing sources of chemical pollution
Microbiological Disease Agents and Disease Processes
Survivability and growth of mycotic disease agents in conjunction with sites of avian manure
disposal; evaluation of potential hazards of using such areas for parks, etc.; migration of
bacteria and viruses through soil from leached solid wastes
Methods for more rapid detection of pathogens
Survival and transmission of pathogens in solid wastes; treatment methods and factors effecting
destruction
Occupational hazards study in sanitation and agricultural workers from waste handling
Role of solid waste in transmission of viruses into ground water
Effects of various treatment methods on virus removal from wastes
Mechanism of sludge—virus complex formation
Investigation into the bacteriocidal nature of seawater and survival of pathogens in seawater
Study on dispersal of solid wastes in the ocean and their possible relation to disease in marine
organisms and in man
Interruption of cycles of zoonotic diseases, animal-to-animal and animal-to-man
Epidemiology of diseases having potential association with solid wastes
Vector control
Ecology of waste disposal sites in relation to fauna, flora, and disease agents
Waste Management
New concepts for isolating solid wastes from the environment
Solid waste management problems of small communities
Solid waste treatment system for communities of less than 10,000
New concepts for garbage disposal
Research into improved methods of treatment of specialized wastes
New uses for sludges and specialized wastes
Individual household treatment units
Education
See Recommendations under the various sections in disease
Safety
Disease spectrum of sanitation workers in comparison with general population
Accident causes among sanitation workers
Waste-handling hazards among other than sanitation personnel (agriculture, injury, households)
-------
150 SOLID WASTE/DISEASE
general considerations
THIS PORTION OF THE REPORT is concerned with a review of existing and past re-
search activities relating solid wastes to public health problems, and with recommenda-
tions and conclusions for future research efforts. It is hoped that the organization of the
material has permitted a logical and meaningful presentation of the more important areas
needing attention. The level of effort devoted to this section did not permit a uniform
breakdown to specific needed research projects; some of the work proposed for future
includes additional surveys, literature reviews, and analyses to identify other specific re-
search tasks.
Gilbertson749 cites the fact that solid waste disposal has long been a neglected area
of research as evidenced by the small amount of funds made available to workers in the
field. Review of the literature makes this apparent — especially in the field of solid
waste/public health interface. Since solid waste management is such an extraordinarily
complex problem, systematic technical and socioeconomic approaches will be required to
gain and maintain control of the undertaking. To date, no adequate inputs have been
developed for a definitive systems analysis, and much research will be required before
progress can be made in this area. Not only are health hazards difficult to establish in
many cases, but goals have been stated only in general terms. These goals must be con-
verted into waste management criteria and related to control of health hazards. In this
respect, it is interesting to note237 that the need for criteria has been recognized in a
recommendation for the development of an integrated program of waste management in
a new community.
Some general statements about research in solid waste/public health relationships
deserve mention. The public health problems are more severe in the smaller communities
than in large urban areas. There is thus a real need for a complete study of environ-
mental sanitation on a national scale. 562 Furthermore, a great deal of information is in
the literature. Considerable information is available about how to solve many of the
problems. What is required is research on how to apply what is already known.661
An inescapable conclusion reached in the literature review is that some form of
systematic information gathering activity in solid waste technology should be continued;
perhaps an annual annotated bibliography, up-dating previous years, would be in order.
This activity should be broadened to include aspects not encompassed in the current
project.
systems analysis
SYSTEMS ANALYSIS has been used extensively by government agencies and industry
in choosing among alternative approaches to various complex problems. In general, the
techniques are used to deal with problems in which it is desirable to minimize or maximize
an objective which is subject to requirements or constraints. The logic of systems analysis
-------
literature survey 151
allows an ordering of the total problem, the incorporation of nontechnical factors, and
the presentation of alternatives to the decision-makers in clear and unambiguous terms.
A clear lay presentation of the subject of systems analysis, and how it may be applied to
complex problems, has been published.713
The recognized complexity of the overall waste management problem, now, and in
years to come, led to consideration of the use of systems analysis techniques in develop-
ing solutions to the waste management problem in the State of California. In an initial
study736 it was concluded that perhaps the only successful approach to waste manage-
ment would be through the avenue of systems analysis. Lynn647 discussed the use of
systems analysis in solid waste problems. He pointed out that solutions based on systems
analysis provided sound bases for reaching decisions.
Supporting the contention that systems analysis has an important role to play in
solid waste management, is a project being supported jointly by the State of California
Department of Public Health, and the Solid Wastes Program of the U.S. Public Health
Service. This study (contract NO. 15100), being conducted by Aerojet-General Cor-
poration, involves the systems approach to the solution of the solid waste problems in
Fresno, California, and is considered a demonstration program.
The lack of analytical data makes it clear that there is a need for research to obtain
data to be used as input for systems analysis. One result of the systems analysis approach
is the identification of fruitful areas of research and development.
Certain important aspects of systems analysis stand out, about which comment
should be made. These relate to system evaluation and offer several important areas of
needed research. System evaluation has been stated to consist of four steps:564
1) Formulation of the objective
2) Identification of the proper criteria to be used in measuring success
3) Determination and explanation of the degree of success
4) Recommendations for further program activity.
Each step is, of course, extremely important, and much could be written about
each one and the need for investigations. Concerning the first step, it is necessary to
decide, in terms of public health, the goal to be reached according to some time frame.
This is a complex problem; insofar as the available literature is concerned, it has not been
adequately considered from a systems viewpoint.
The identification of the proper criteria is, if anything, more complex than the
first — mainly because of the myriad of constraints which exist. These constraints also
have an influence on a practical objective. Costs, public interest, political, social and
economic considerations, technological limitations — these and other factors all influence
criteria, as well as the objective.
291-982 O - I
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152 SOLID WASTE/DISEASE
The third step offers fairly clean-cut areas for specific research tasks in identifying
products (organisms or chemicals) which are undesirable, and in developing techniques
for quantitatively determining them. The possibility of developing a rapid screening
method for potentially hazardous waste materials has been suggested. 218 Other sugges-
tions include a systematic monitoring system for pesticides to detect incipient prob-
lems, 264- 385 a method for evaluating the performance of an incinerator,28S new analytical
procedures for measuring industrial wastes,267 and methods for detecting and measuring
microflora.33 The foregoing is not an exhaustive list, but demonstrates the type of re-
search recommended in the literature.
The last step mentioned above would receive attention after operational systems
were available.
Very little other evidence of direct application of systems analysis to waste man-
agement was found in the literature surveyed. There were found, however, indications
that more organizations are considering the value of a systems approach, and of developing
some of the data required as input for such analyses.749 The need for mathematical
models has been recognized in the context of a systems analysis approach to urban plan-
ning. 234 The advantages of an optimized system are also discussed. The stated need for
planned management of natural resources as a total system615 implies the use of the
techniques being discussed. Engineering parametric studies are also desirable.145
It is believed that the main contribution of the systems analysis approach to solid
waste-public health relationships may be in the development of criteria and in identifying
interface problem areas, such as is being done in the Fresno project mentioned earlier.
Furthermore, such analysis should be one concerned with the total solid waste manage-
ment problem of which one part is that concerned with public health. Thus, it is recom-
mended that in a systems analysis program dealing with solid waste management, full
recognition of the public health aspects be included.
disease agents and solid wastes
DISEASE AGENTS, as used here, fall into two categories: chemical agents and bio-
logical agents. There is a continuing need in both categories to catalog specific agents
and components of solid wastes which may offer potential hazards because of the changing
nature of solid wastes over a period of years.
Chemical Agents
Research on chemical wastes has been concerned mainly with identifying etiologic
agents, factors involved in dispersion of agents, and prevention of dispersion. It is
through chemicals that the greatest interfaces exist between solid wastes and pollution
of soil, water, and air. Various investigations have demonstrated specific problems which
may be directly related to solid wastes. They are important to the present discussion be-
cause they point out certain research needs.
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literature survey 153
Thus, infant methemoglobinemia has been cited as being caused by polluted water
(wells) contaminated from solid wastes. 277< 353 A need for further study to permit verifi-
cation and development of comprehensive preventive measures is required, as are investiga-
tions of other factors influencing the occurrence of the disease. 3S3
There have been several investigations concerned with the importance of leaching
in landfills in polluting groundwaters. It has been stated that if a landfill does not inter-
cept ground water, no impairment of water supplies will occur. 473 Pollution will occur in
the immediate vicinity if there is contact. Apparently, leached inorganic materials pose
more of a problem than organic wastes because they tend to migrate farther.416- 576
Ground water pollution sources are difficult to trace and may ruin an aquifer for years, or
permanently. 43° This potential indicates a real need to examine solid waste disposal tech-
niques and sites to assure that leaching will not produce public health problems. There
are a number of investigations dealing with the topic of effects of solid waste disposal on
water quality, but these efforts do not deal with specific disease or public health prob-
lems. 10- 105' 559> 576' 636 It is also in this area of concern that differences between liquid and
solid wastes begin to disappear. The problem is one of water pollution — no matter
what the source. Once the pollutant is in the water, it may never be known whether it
entered the water originally as liquid or as solid waste.
Land areas suitable for sanitary landfill are becoming more and more difficult to
find. Research has been recommended to find ways to use abandoned gravel pits and
underground cavities without endangering the quality of ground water. 211- 478' 636
The types of information needed in the future to evaluate specific problems of land
disposal and public health problems relate to a number of different disciplines. There is
need for epidemiologic studies to identify public health problems.478' 634 Identification
of potential hazardous waste components has already been mentioned. Ways of render-
ing chemicals innocuous should be investigated, or easily degradable materials devel-
oped. 209' 247> 257 Chemical reactions during migration in the soil may change the chemical
species of concern 385> 416; thus there is a need to investigate the ultimate fate and nature
of materials leached from solid wastes. Factors influencing leaching and movement of
compounds through soil need also to be studied. 559 An important area of concern is the
determination of acceptable or tolerable levels of the myriad of materials which may escape
into the environment316' 629; new materials, about which little or nothing is known, are
being introduced at a rapid rate and many contribute to solid wastes. 628
Two types of chemicals are of special concern: carcinogens and pesticides. Car-
cinogens, arising in water supplies contaminated either from liquid or solid wastes, have
received considerable attention. 44- 45> 46' 61' 132> 144' 316' 387' 704 Specifically, the literature
points out the requirement for studies of movement of carcinogenic materials through
soils,44> 4S because of the conflicting nature of the data and lack of full definition of the
problem.
Aromatic hydrocarbons have been shown to be leached from macadam roads, and
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154 SOLID WASTE/DISEASE
also to occur in sewage sludge when treatment is incomplete.3 Hueper points out that
most proofs of carcinogenesis in humans are limited to occupational exposures but that
there is most probably a general population exposure of unknown magnitude.387 Other
reports51- 67> 79 substantiate this claim in one way or another and give emphasis to the
urgent need for comprehensive chemical, experimental, and epidemiologic studies to de-
termine actual hazards.
Pesticides may find their way into solid wastes by three principal routes: con-
tainers containing pesticides,15 in food wastes, 385 and by direct application to wastes to
control pests. 209 Once in the wastes, they are subjected to leaching as are other com-
pounds. Although there is little or no medical evidence that adverse effects have occurred,
there is cause for concern. 102> 264- 323' 395 The Secretary of the Interior has been quoted
as stating, "Not until we have a systematic monitoring scheme, designed to tell us how
much of what is where, will we be able to detect incipient problems early enough to pre-
vent damage." 264 Additional investigations are needed to determine safe limits of life-
time exposures to toxic materials, the nature of injuries if excessive amounts are absorbed.
means for detecting subclinical effects, and therapeutic measures.385 This particular
reference is concerned primarily with pesticides in foods, but most of the discussion is
equally applicable to solid wastes. Possible chemical changes in pesticide residues are
also of interest, and there is a definite requirement for better analytical methods and
schemes for detection and identification.
In a discussion concerning water quality and goiter,14 additional studies are recom-
mended on the nature of chemical pollutants and their physiological significance. By im-
plication, the role of solid wastes should be included in such studies. From other re-
ports85- 132> 577- 578 although they do not deal with solid wastes specifically, requirements
can be derived from investigations of the role of solid wastes in other disease or nutri-
tional problems involving trace elements.
Insofar as air pollution by solid wastes is concerned, the main routes are via burn-
ing or bacterial activity within a disposal site. Specific respiratory disease occurrence has
been cited as due to burning in dumps,4-347 but the evidence is circumstantial — pointing
up the need for more exhaustive investigations. The desirability of an impervious barrier
in landfills to prevent escape of obnoxious gases has been discussed. 445 Few other spe-
cific solid wastes-atmospheric-borne disease investigations have apparently been done,
though air pollution by burning is widely recognized.
Biological Agents
Disease is not a result of simple contact between host and disease agent. Health
and disease are results of complex interplay among many factors. Frequently, some or
many of the factors are unknown. In many reports, the connection between a waste
treatment process and disease is not mentioned; yet, implicit in selection of the process
is the knowledge (or hope) that "proper" treatment will decrease the number and inci-
dence of disease organisms. Thus, much of the surveyed literature dealing with waste is
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literature survey 155
only indirectly concerned with disease. On the other hand, the medical literature deals in
great detail with specific diseases, their diagnosis, causative agents, intermediate hosts,
and therapy, but is rarely concerned with any solid waste aspects.
Of primary concern (in regard to free biological agents of disease) is whether or not
the method of disposal, or the products of treatment which are to be used in agriculture
or other industries, permit survival and transmission of disease organisms to humans,
plants, or animals. 48°
An important factor at disposal sites is the possibility that organisms may migrate
through the soil as a result of leaching and movement of ground water, and pollute water
supplies. This process appears to be a more important problem for chemical contaminants
(see the next section) than for organisms because of natural mortality and/or removal
of viruses and cells by filtering processes. However, as early as 1927 E. coli was known to
remain viable for 31 months in experimentally polluted ground water.43 Later studies325-
478 provided data concerning movement of bacteria through soils and factors affecting it.
There have been a few investigations which indicate that detergents affect movement of
bacteria through soil.257 This topic is one which should receive additional attention in
research.
Viruses are said to survive better in treated water than in polluted water.12 This
rinding has been confirmed by Clarke et al. who found that viruses survive longer in rela-
tively unpolluted waters,16 whereas bacterial survival is directly related to pollution levels.
This finding might prove to be the basis for an imaginative new approach to waste
treatment.
The sludge from various types of sewage treatment presents a solid waste problem
of considerable magnitude. 216 Sludge may be used directly in agriculture or in a process
such as composting. In agricultural use of sludges, viable organisms may be carried to
water supplies by surface runoff629- 634; the pathogens may offer an occupational exposure
to agriculture or sanitation workers,11- 2n 324- 48° or may contaminate foodstuffs.480 Be-
cause of these potential problems, the study of pathogen survival and methods for assur-
ing their destruction become important.
Various studies 16- 21- 33> 39- ^-^ 80- 2l5' 216- 48()- 491- 494 indicate that the activated sludge
process removes a high percentage of pathogens but that the sludge must receive addi-
tional treatment to be considered safe. Special sludges (e.g., sludge containing copper)
may pose few problems as far as disease organisms are concerned215; however, they may
create a toxic hazard. This report and other sources 480' 491 indicate that only heat-dried
sludge may be considered free of biological disease agents.
Research is needed in methods of economically dehydrating sludge, so that its
fertilizer potential can be realized. 494 Additional information on removal of pathogens by
various treatment processes is still required. 21 • 3!l Better methods for detection and enu-
meration of pathogens are also needed. 3:! Other processes such as anaerobic biological
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156 SOLID WASTE/DISEASE
treatment249 and lime softening19 have been investigated as removers of pathogens. It is
apparent from the literature that there is still opportunity for advances through research
in the removal or destruction of pathogens in sludges.
Farm manures are a source of transmission to man of some animal diseases 6- 324'
425; one preventive suggestion found was to burn suspect manures. 425 There appears to be
a need to evaluate further the magnitude of this problem and to develop simplified con-
trol measures. Avian manures pose a special problem in histoplasmosis transmission (see
section on fungus disease). Histoplasmosis is considered a 'disease of nature', localized to
certain regions of the country and spread to humans from a reservoir in the soil.326 The
occurrence of the disease organisms has been correlated with avian or bat droppings.35-
89, 173, 175, 326, 502, 503, 504 However, there is a question as to whether or not the organism
can be supported within the avian body 504; it may be that soil enriched with manure pro-
vides an appropriate ecologic niche for the organisms. 503 Histoplasmosis has been found
to persist in manure-enriched soil for as long as three years, 326 and there are various
theories as to how it is disseminated. Since it is unlikely that the disease agent can be
eradicated, the only feasible method of control is through vaccination.602 A skin test is
currently in use for epidemiologic study, but a more refined tool is needed for adequate
surveys. 504
The literature on histoplasmosis, and other mycoses as well, shows the need for
additional research in certain areas related to solid wastes (for example, more thorough
investigation of the environmental conditions required for survival, persistence and growth,
and methods for eradication). The true role of avian and bat manure needs to be de-
termined. Since, in landfill disposal methods, the reclaimed area may be later used for
other purposes involving contact by humans, the persistence and movement of the fungi
and subsequent hazards need also to be determined.
Composting solid wastes, either singly or in various combinations, has been or is
being done at various sites. Pertinent to the present discussion, however, is the potential
hazard that compost may present to the public health.
Golueke and Gotaas622 point out that the temperature produced in proper com-
posting exceeds the thermal death points for common pathogens and parasites, and that
no public health problem then exists. Many references recognize that the heat produced
in composting, when properly carried out, may be expected to kill pathogenic bacteria,
viruses, fungi, protozoan cysts, and helminth eggs. 371' 406' 613- 642- 652 There appears to be
an occupational hazard to compost workers in adding night soil or sewage sludge.314 The
same report indicates that improper composting produces a health hazard (flies) almost
as at a garbage dump. Suitable microbiologic tests must be performed to demon-
strate that a given process of composting does, in fact, destroy undesirable organisms.602
Various studies have been concerned with survival or destruction of pathogenic
or parasitic organisms in composting, and in developing ways to assure their destruction.
Thus, when Salmonella and Shigella organisms were not killed in a sawdust-sludge com-
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literature survey 157
post process, adding well-rotted barnyard manure resulted in higher temperatures which
did destroy these organisms. 602 In windrow composting of refuse and sludge, on the other
hand, additives had no effect. 504
One of the advantages of composting is the avoidance of public health problems by
disposing of special wastes. Thus, a disagreeable fly problem is avoided 626 by composting
fruit processing wastes, as well as poultry and other animal manures.170' 612
There are a few claims of exceptional value of composting in improving livestock
growth, 652 and in controlling nematodes which attack potatoes and tomatoes, 606 perhaps
by unknown antibiotics produced in compost.
Extensive research in the field of composting, insofar as disease is concerned, does
not appear to be needed. If the procedures are properly carried out, there appears to be
little hazard. The problem seems to be primarily one of proper equipment design, train-
ing operators in the efficient running of the plant, and reliable monitoring of the process.
Studies of occupational exposures might be desirable if composting plants become eco-
nomical in the United States and more such plants are built. Some research on methods
of detecting and identifying pathogens might be profitable, as in other areas of waste
management.
Exceptional effects on growth of cattle through the feeding of compost materials
are claimed. The evidence seems tenuous, but may warrant further investigation, par-
ticularly of the possibility that production of antibiotics is involved.
As an aside from disease, the problem in composting is to make it economical
since this is the usual failing of the process. To this end, research to find uses for com-
post appears to be most needed — a development that would help greatly in the overall
solid waste management problem.
Some consideration should be given to certain marine aspects of disposal of
sludges. In using ocean disposal methods, it is important to dilute the wastes and dis-
pose of them so that they do not return to shore. Research to gain an understanding of
the action of waves, currents, and winds in the dispersion process is thus important.149 In
addition, there are a number of reports indicating that seawater apparently has bac-
teriocidal properties 126> 372' 853; research in this area is required. In addition, E. coli may
not be the indicator organism of choice in marine pollution studies because it does not
survive well in seawater.42 Fecal streptococci may prove superior, but proof is required.
There are animal reservoirs of disease agents which can attack man. Some of these
animals (e.g., the rat) are associated with solid wastes. Similarly, there may exist, in
solid wastes, disease organisms which may be carried by arthropods (especially flies) to
human beings.
One way to reduce the disease hazard is to prevent vermin from utilizing solid
wastes for either harborage or for nutrients (i.e., to control the environment). Landfill
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158 SOLID WASTE/DISEASE
operations (with or without compaction or shredding), disposal into sewers after grinding
and subsequent sewage treatment, incineration, composting, and ocean disposal are com-
monly used to keep refuse away from vermin. Any improvements in, or more widespread
use of, these techniques may be expected to improve the public health. Among these
might be listed better waste collection and transportation systems.
Fly control has been recognized as a major problem relating to refuse and public
health,75 thus, research in this area may be expected to assume a high priority. In con-
sidering controls from the solid waste point of view, there are several possible categories
for research:
1) Totally new concepts for garbage collection and disposal or treatment
2) Better means of isolating garbage (e.g., better containers)
3) More adequate pesticide application wherever wastes are stored (e.g., some ac-
ceptable means of pesticide application or other treatment at the household
level)
4) Development of a continuing program of education of the public so that ade-
quate procedures will be followed
5) Improved methods of treatment of specialized wastes (e.g., manures, food-
processing wastes).
Much research has been conducted on various facets of zoonoses (animal diseases
transmissible to man). This includes such items as descriptions of life cycles, host-dis-
ease relationships, epidemiologic studies, and determinations of geographical limits of par-
ticular foci. In this work, however, very little reference is made to solid wastes. It has
been noted that contact occurs between commensal rodents (which live in part on solid
wastes) and wild (rural) rodents.I65- 172> 569' 570' 566 The cited reports deal with investiga-
tions on plague.
Stark and Miles 566 determined that when commensal and wild rat populations in-
termingled, there was an interchange of fleas — suggesting that the plague could thus be
transmitted from a wild population to the commensal one, with subsequent increased
hazard to man. In their research these authors worked with eleven species of fleas and
nine species of mammals, further indicating the complexity of the problem. Kartman et
al.569 also demonstrated the transfer of fleas from wild to domestic rodents. It has been
stated172 that an outbreak of plague in Los Angeles in 1924 was due to a transfer of the
disease from ground squirrels to domestic rats. Several reports165' 172> 573> se6- 569 state or
strongly imply the need to keep wild and commensal populations separated. The prob-
lem is well described by Meyer165 who points out that during urbanization of an area,
there is a period of joint tenancy by humans and by wild and commensal rodents — a
situation theoretically conducive to the transmission of plague to humans.
Since the contribution of solid wastes to potential disease transmission is not de-
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literature survey 159
fined, research is needed to develop models of the urbanization phenomenon (which in-
clude the ecologic aspects of zoonoses and wastes) for later use in investigations of
potential epidemic hazards. A number of suggestions for purely biological or medical in-
vestigations into zoonoses are beyond the scope of this report in that they may be only
remotely (or not at all) related to the role of solid wastes in public health problems.
Although arthropods other than flies may act as carriers of disease organisms, flies
by far overshadow the others. Because of this, the present discussion will be limited to
flies, although it is possible that the same statements could apply to other arthropods
(see sections on fly- and mosquito-borne disease).
Although flies are seldom true intermediate hosts in a disease cycle,72 they are re-
sponsible for dispersal of pathogenic agents; they may be used as indicator organisms,
reflecting the sanitation level of a community. 75> ^ The use of insecticides such as chlor-
dane and DDT have proven only temporary measures for fly control since resistant
strains of the insects arise. 75 The control of flies within a community requires such inti-
mate intervention into the lives of residents that adequate methods for complete control
have never been developed. Current practices (namely, education on how to handle
garbage and on the importance of using tight containers for garbage) are unsatisfac-
tory. 348 The use of garbage grinders — eliminating garbage storage and collection —
appears to be the best present solution to the problem in residential areas.
Flies, being the problem they are, receive continuing attention in studies relating
to specific problems e-g- 76> 188> 301' 391> 544 and in more general treatments. e-B- 75> 77 Special
note should be taken of the use of radioisotope-labeled flies in a study of dispersal in a
metropolitan area187 — one of the first field applications of radioisotopes. Studies have
been carried out on the persistence of disease organisms in various stages of fly develop-
ment. Larvae grown in contaminated media have been found to retain viable disease
organisms through various stages of metamorphosis.184> 30°
Additional suggestions for research related to vectors are contained in the main
sections of this report dealing with fly- and mosquito-borne disease.
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APPENDIX B: SOLID WASTE
SOURCES AND CONSTITUENTS
MUNICIPAL REFUSE 2S1
Source
Waste
Composition
Means of treatment
or disposal
Households, restau-
rants, institutions,
stores, markets 231
Garbage 231
Rubbish 231
Wastes from preparation, cooking Grinding, incineration,
and serving of food; market landfill, composting,
wastes from handling, storage hog feeding 231
and sale of food 231
Ashes "•231
Paper, cartons, boxes, barrels,
wood, excelsior, tree branches,
yard trimmings, wood furniture,
bedding, dunnage, metals, tin
cans, metal furniture, dirt,
glass, crockery, minerals 231
Residue from fires 231
Salvage, incineration,
landfill, composting,
dumping 231
Landfill, dumping 231
Streets, sidewalks, Street refuse 231
alleys, vacant lots 231
Dead animals 231
Sweepings, dirt, leaves, catch
basin dirt, contents of Utter
receptacles, bird excreta 231
Cats, dogs, horses, cows, marine
animals, etc. 231
Abandoned vehicles 231 Unwanted cars and trucks left
on public property 231
Incineration, landfill,
dumping 231
Incineration, rendering,
explosive destruction 231
Salvage, dumping 231
Factories, power
plants a"
Industrial wastes b'231 Food processing wastes, boiler
house cinders, lumber scraps,
metal scraps, shavings, etc. 231
Incineration, landfill,
salvage 231
Urban renewal, ex-
pressways, etc.231
Demolition wastes 231
Lumber, pipes, brick masonry, Incineration, landfill,
asphaltic material and other dumping, salvage 231
construction materials from razed
buildings and structures; bat
guano, pigeon excreta 231
New construction,
remodeling231
Construction wastes 231 Scrap lumber, pipe, concrete,
other construction materials 231
Incineration, landfill,
dumping, salvage 231
Households, hotels, Special wastes 2S1
hospitals, institutions,
stores, industry 23i
Hazardous solids and liquids,
explosives, pathologic wastes,
radioactive wastes 231
Incineration, landfill,
burial, salvage 231
Sewage treatment
plants, lagoons,
septic tanks 231
Sewage treatment
residue c>231
Solids from coarse screening
and grit chambers, sludge 231
Incineration, land-
fill, composting,
fertilizing 231
a See "Fly Ash" under Waste Treatment Products for Chemical Composition. 223
b See "Industrial Wastes" for detail characteristics and composition.
c See "Sludge" under Waste Treatment Products for Chemical Composition.
160
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literature survey
161
AGRICULTURE REFUSE
Farms, ranches, live- Crop residue :
stock feeders, and
growers 20°
Means of treatment
Source
Farms, ranches,
livestock feeders,
and growers 2°9
Waste
Refuse
Composition
Same as Municipal Refuse
or disposal
Same as Municipal
Refuse
Animal manure 248
(Paunch manure) 24S
Poultry manure248
Cornstalks, tree prunings, pea
vines, sugarcane stalks (bagasse),
green drop, cull fruit, cull
vegetables, rice, barley, wheat and
oats stubble, rice hulls. Ferti-
lizer e and insecticide e residue 209
Lignaceous and fibrous organic
matter, nitrogen, phosphorus,
potassium,24S volatile acids,
proteins, fats, carbohydrates 238
Same as animal manure 248
Plowed back into the
land, incineration,
stock feed209
Fertilizer, composting248
Stock feed 238
Fertilizer, composting,
lagooning 248
INDUSTRIAL WASTES
Food and
kindred product
industries 205
Canning 205
Vegetable oil
refining
Dairy 208' 231
Fruit, vegetable
and citrus 215
Cobs, shells,
stalks, straws 20=>
219
Dilutions of whole
milk, separated
milk, buttermilk
and whey 251
High in suspended
solids (liquid waste)
colloidal and dis-
solved organic
matter 246- 205
High in dissolved
organic matter,
mainly protein, fat,
and lactose 251
Hull, rinds, cores,
seeds, vines, leaves,
tops, roots, trim-
mings, pulps, peel-
ings, hydrochloric
acid 251 (used in
processing)
"Still pitch" —
tarry residue, fatty
acids, sodium hy-
droxide, trichol-
ethylene 21fl
N, CaO, K,O, P 0 ,
£, £, 0
Fe, Cl, Si02 281
Screening, lagoon-
ing, soil absorption,
spray irrigation,
reclamation 219>
215, p. 6
Reclamation 219
Aeration, trickling
filter, activated
sludge 251
e See "Industrial Wastes" for characteristics.
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162
SOLID WASTE/DISEASE
INDUSTRIAL WASTES (continued)
Source
Slaughtering of
animals, rendering
of bones and fats,
residues in con-
densates, grease
and wash water 251-
282
Breweries
and distil-
leries 251> 215
Pharma-
ceutical 251
Textile mill
products 251
Cooking of
fibers, desizing
of fabrics 251
Waste
Manure, paunch
manure, blood,
flesh, fat particles,
hair, bones, oil,
grease 282
Spent grain, spent
hops, yeast, alka-
lis, amyl alcohol,
dissolved organic
solids containing
nitrogen and fer-
mented starches 215
Microorganisms,
organic
chemicals 251
Textiles, i.e.,
cotton, wool, and
silk 2*6
Rayon, other
man-made ma-
Characteristics
High in dissolved
organic solids, con-
taining nitrogen
and fermented
starches or their
products 251
High in suspended
and dissolved or-
ganic matter,
including
vitamins 251
Highly alkaline,
colored, high BOD
and temperature,
high suspended
solids 2»i- 2«
Same as textile
mill products
Acidic, alkaline,
inorganic 246
Composition
N, NH3, NH2, N03,
NaCl 2»2
Amyl alcohol 235
(from processing)
Aniline, phenols 235
H2S04,NaOH, ani-
line chlorine 235
Starch, malt, tin &
iron salts, dyes,
bleach, fibers,
minerals 246
For complete list
of chemicals used
in textile industry,
see reference 279
Sulfides and poly-
sulfides, colloidal
Means of treat-
ment or disposal
Reclamation,
screening, trick-
ling filters, 251
chlorination 2*6
Recovery, centrifu-
gation and evapora-
tion, trickling filtra-
tion, stock feeds, 251
fertilizer215
Evaporation, in-
cineration, stock
feeds 251
Neutralization, pre-
cipitation, trickling
filtration, aeration,
recovery 219- 251
Reclamation, neu-
tralization trickling
terials, i.e., Acri-
lan, Dynel, Orion,
Nylon, etc. 279
sulfur, NaOH,
H2S04, ZnSO4,
HC1, NaHSO4,
H2S, CaSO42«;
acrylonitrile, phe-
nol, HNO3 235; am-
monia, adiponitrile,
hexamethylenedia-
mine, sodium car-
bonate, alcohols,
ketones 28S
filtration, lagoon-
ing 2«. 21»
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literature survey
163
INDUSTRIAL WASTES (continued)
Source Waste
Laundry *«• 25i
Lumber and Pulp and
wood products paper 251> 215
(forest, mills,
factories) 2". 215-
219, 246
Characteristics
High turbidity,
and alka-
linity 24<). 25i
High or low pH;
colored; high sus-
pended, colloidal,
and dissolved
solids; inorganic
fillers 2Si
Composition
Spent soaps, syn-
thetic detergents,
bleaches, dirt and
grease2^. 2«
Sawmill usage
(sawdust, shavings,
wood chips) , wood
flour219; soda, sul-
fate, sulnte2"6
Means of treat-
ment or disposal
Screening, precipi-
tation, notation,
adsorption 251
Reclamation, in-
cineration, soil
conditioning 219
Organic, inor-
ganic, toxic, sus-
pended and
dissolved solids
of lignin, resins,
soda, ash, fiber,
adhesives, ink,
fats, soaps,
tallow M(i
Sodium lignate,
sodium resinate,
complex organo-
sulfur compounds,
some fiber in
relatively dilute
solutions,256 sul-
fites,225 mercap-
tans, sulfides, disul-
fides, sulfates,
terpenes, carbohy-
drates, CaO, SO2,
N, PO4 24e
Reclamation,
settling, lagooning,
biological treat-
ment, aeration
219, 251
Chemical plants
(general)
Toxic 2*«-235
Fumes and/or
dust ™*
Acrylonitrile, ani-
line, * amyl alco-
hol, carbon disul-
fide, carbon tetra-
chloride, chlorine,
hydrogen cyanide,
hydrochloric acid,
phenol, sulfuric
acid, toluene,
xylene, dinitroben-
zene, dimethyl sul-
fate, ethylene,
chlorohydrin, ben-
zene, metallic com-
pounds of lead,
arsenic and
mercury 235
Arsenic704
Reclamation,
lagooning and all
other known
methods of
treatment245
f Most common and troublesome toxics.
-------
164
SOLID WASTE/DISEASE
INDUSTRIAL WASTES (continued)
Source
Chemical plants
(continued)
Aircraft manu-
facturing
industry 478
Waste
treatment
plants 402
Petroleum
industry 251
Drilling
Storage
Distillation 251
Waste
Particulate
clouds and
dusts 221
Weed killer «o
Cyanide
waste 243
Plastics, synthetic
resins
Cd and Cr+6. 47»
Well-digested
sludge 402
Spent
chemical 419
Muds, salt, oils,
natural gas 251
Acid sludges,
miscellaneous
oils 251
Characteristics
Toxic to
aquatic life 243
Traces of
metals 47S
Blackish, amor-
phous, nonplastic
material 402
Liquid wastes with
oil, acid and alka-
line solutions, in-
organic salts, or-
ganic acids and
phenols, etc. 419
Oil, brine,
chemicals 24G
Insoluble organic
and inorganic salts,
sulfur compounds,
sulfonic and nap-
thenic acids, in-
soluble mercaptides,
oil-water emul-
sions, soaps, waxy
emulsions, oxides of
metal, phenolic com-
pounds 2?6- 251
Composition
Mn, Va, Cd, Be,
Fe, Zn, and their
oxides 221
2-4-D430
Cyanides2*3
Acrolein, acrylo-
nitrile, formalde-
hyde, phenols,
trichlorethy-
lene 235
Cd and Cr+a. 4>s
Mg, Ca, Zn,
Cr, Sn, Mn, Fe,
Cu, Pb402
Clays, H2S04,
H3PO4419
Sodium, calcium,
magnesium, chlo-
rine, SO4, bro-
mine 246
Na2C03, (NH4)2S,
Na2S, sulf ates, acid
sulfates, H2S,
NaOH, NH,OH,
Ca(OH)2,
(NH4)2S04,
NH4C1,
phenols 251
Means of treat-
ment or disposal
Sewage430
Ponding 243
Reclamation,
incinera-
tion 219
Leaching
pits478
Anaerobic de-
composition of
organic waste
solids 402
Streams ««
Separation,
evaporation, la-
gooning 246
Separation,
evaporation, la-
gooning 24e
Settling, filtra-
tion reclamation,
evaporation 246
-------
literature survey
165
INDUSTRIAL WASTES (continued)
Source Waste
Treating -51
Recovery ->r>l
Leather and Tanneries 2*°
leather prod-
ucts -'*"• 2"'i
Energy pro- Fly-ash 223
ducing in-
dustry 223.
207, 240
Pulverized coal-
fired plants; stoker-
fired, cyclone-
fired plants; and
wet-bottom
pulverized coal-
fired plants
Electrical Ash 298
industry 29S
Metal finishing Pickling and
industry 215> 258> washing
242, 254, 435 llQUOrS 215
Acid wastes 254
Rubber and Rubber 251
miscel. plastic
products 251
Characteristics
See "Distilla-
tion" 2T«- 25i
See "Distilla-
tion"; also organic
esters 2'<'>.25i
Organic and inor-
ganic, high BOD —
lime sludge, hair,
fleshing, tan liquor,
bleach liquor,
salt, blood, dirt,
chrome 24°
Hollow spheres of
fused or partially
fused silicate glass
or as small solid
spheres of fused
silicates, iron ox-
ides or silica, un-
burned carbon and
mineral 223
Dust 298
Toxic, waste
waters 215
Harmful to aquatic
life, 254 salts of
metals 25(1. 2*2> 254-
435
High BOD, odor,
high suspended
solids, variable pH,
high chlorides 251
Composition
See "Distilla-
tion"; also lead,
copper, calcium 251
See "Distilla-
tion"; also
iron251
Chromium, sulfu-
ric acid, nitrogen,
CaC03, D,05,
K.,O, Fe 2«"°
Silicates,
iron oxide,
silica 223
Silicates and
alumninates of
Fe, Cu, Mg with
small percentages
of Na, K 29S
Cu and Cu
alloys215
Cu, Ni, Zn, Cr,
Pg258, 242,
254, 235
Sulfuric acid, tri-
chlorethylene, xy-
lene, amyl alcohol,
aniline benzene,
chromium formal-
dehyde235
Means of treat-
ment or disposal
Reclamation,
settling filtration,
evaporation,
neutralization 246
See "Treating" 246
Sedimentation,
lagooning 246
Sold for use in
concrete, 223
landfills, etc.
Sewage 216
Sewage 268' 2*2-
254, 435
Aeration, chlo-
rination, sulfona-
tion, biological
treatment 251
-------
166
SOLID WASTE/DISEASE
INDUSTRIAL WASTES (continued)
Source
Waste
Characteristics
Composition
Means of treat-
ment or disposal
Washing of latex;
coagulated rubber;
exuded impurities
from crude rubber;
rejects, cuttings,
mold flashings,
trims, excess ex-
trusions 219> 251
Scraps from
molding, extrusion,
rejects, trimming
and finishing 219
Explosives 251
Washing TNT and
guncotton for
purification,
washing and
pickling of
cartridges 251
Phosphate and
phosphorous 251
Fertilizers
Coke by-products
Industrial, not
otherwise identi-
fied 416, 293,
200, 279
Washing, screen-
ing, floating
rock, condenser
bleed-off 2«
Slag from ovens,
ammonia still
waste, spent acids
and phenols
Inorganic indus-
trial waste or
stabilization 416
Metallic fumes
and dusts 293
Industrial
wastes 20°
TNT, colored, acid,
odorous, and con-
tains organic acids
and alcohol from
powder and cotton,
metals, acid, oils
and soaps 251
Clays, slimes,
tallows, low
pH, high sus-
pended solids 251
Suspended solids,
volatile suspended
solids, organic and
NH3-N, phenol,
cyanide, acids,
alkalis 2«
Metals and com-
pounds thereof 416
Mineral fines 20°
H2S04, HN03,
NO2SO3, picric
acid, TNT
isomers, copper,
zinc, nitrogen,
toluene 246
Phosphorous,
silica,
fluoride
Nitrogen, phos-
phorous, potassi-
um, sulfuric acid,
traces of other
chemicals
Ammonia, ben-
zene, H2SO4,
phenol "6, 251
Na, K, Ca, chlo-
rides, sulfates,
bicarbonates, ni-
trates, phosphates,
fluorides, borates,
chromates, etc. 41e
Pb, Va, As, Be
and compounds
thereof293
Chromates, heavy
metals 20°
Dilution, neu-
tralization, lagoon-
ing, flotation,
precipitation,
aeration, chlo-
rination 261
Settling,
clarification
(mechanical) , la-
gooning 251
Discharged to
sewers, dumped,
incineration 276
Underground
aquifers 20°
-------
literature survey
167
INDUSTRIAL WASTES (continued)
Source
Waste
Laboratory
wastes 4r9
Characteristics Composition
Metallic ions,
phenolics, cya-
Means of treat-
ment or disposal
Landfill or
dump 479
nides, oils, syn-
thetic fibers, phar-
maceuticals, rubber
chemicals479
Industrial wastes Toxic metals235 Pb, Be23
Insecticides
Washing and
purification of
products 251
High organic mat
ter, toxic, acidic251
Chlorinated hydro-
carbons:
toxaphene, ben-
zene, hexa-
chloride, DDT,
aldrin, endrin,
dieldrin, lindane,
chlordane, meth-
oxychlor, hepta-
chlor 323
Organic phosphor-
ous compounds:
parathion,
Malathion, phos-
drin, tetraethyl,
pyrophosphate323
Other organic com-
pounds 323
Carbon, hydrogen,
chlorine, carbon di-
sulfide, carbon
tetrachloride
Phosphorous,
oxygen, carbon,
hydrogen, carbon
disulfide, carbon,
tetrachloride323
Carbonates, din-
itrophenols, or-
ganic sulfur com-
pounds, organic
mercurials, rote-
none, pyrethrum,
nicotine, strych-
See Chemical
plants (general)
Inorganic
substances 323
Copper sulfate,
arsenate of lead,
compounds of chlo-
rine and fluorine,
zinc phosphide,
thallium sulfate,
sodium fluorace-
tate 323
291-982 O - E
-------
APPENDIX C: DESCRIPTOR GLOSSARY
primary search descriptors
FIRST ORDER
Refuse
Waste
SECOND ORDER
Ashes Litter
Cinders Manures
Compost Garbage
Dirt Sewage
Dust Sludge
Garbage Trash
Junk
secondary search descriptors
FIRST ORDER
Disease Terminology
Bacteria Parasites
Bacteriology Pathogens
Disease Pathology
Fungi Protozoa
Helminths Rickettsia
Microbiology Viruses
Moulds
Disposal Terminology
Collection Processing
Disposal Sites (Disposal, Treatment, etc.)
Dump (s) Treatment
Landfill (s)
Host Terminology
Animals (Other) Rats
Host(s) Rodents
168
-------
literature survey
169
Vector Terminology
Arthropod (s)
Entomology (Medical)
Fleas
Flies (Fly)
Lice (Louse)
Safety Terminology
Accident
Frequency Rate
Hazard (s)
Injury
General Health Terminology
Epidemiology
Environmental Health
Health
Hygiene
Chemical Terms
Carcinogens
Chemical (s)
Insecticides
Intoxicants
Mosquitoes
Tick(s)
Vector
Vermin
Safety
Sanitation Men
Severity Rate
Workers (Sanitation, Sewage
Treatment Plant, etc.)
Preventive Medicine
Public Health
Sanitation, Sanitary
Sanitary Engineering
Pesticides
Poison (s)
Toxicology
Toxins
Miscellaneous Items
Chlorination
Components
Constituents
Contamination
Decomposition
Demolition
Dump(s)
Fertilizer
Harbor (age)
Humus
Incinerator(s)
Irrigation
Lagoon(s)
Landfill(s)
Leaching
Pond(s)
Reclamation
Soil
Utilization (use)
Wrecking
SECOND ORDER
Second-order descriptors in this category are included in the body of the glossary
which follows.
-------
DESCRIPTOR GLOSSARY
ABATEMENT
ABATTOIRS
ABATTOIR WORKERS
ABORTED FETUS
ABSORPTION
ACAROLOGY, MEDICAL
ACCELERATED SLUDGE DIGESTION
ACCEPTABLE DAILY INTAKE
ACCIDENTS
ACBTALDEHYDE
ACETIC ACID
ACHROMBACTER SPECIES
ACID (ITY)
ACID CALCIUM SULFITE LIQUORS
ACID MINE DRAINAGE
ACID-FAST BACILLI
ACIDIFICATION
ACRYLONITRILE
ACTINOMYCES
ACTIHOMYCETBS
ACTINOMYCOSIS
ACTIVATED
ACUTE
ADAPTATION
ADDITIVES
ADENOVIRUS
ADMISSION
ADMIXTURES
ADRENAL CORTEX
ADSORBENTS
ADVANCED WASTE TREATMENT
AEDLS AEGYPTI
AEDES ALBOPICTUS
AKDES SOLLICITANS
AEDES VEXANS
AERATION
AEROBES (BIC)
AEROSOLS
AESTHETIC
AGE
AGE GROUP
AGENCY (AGENCIES)
AGEHTS
AGGREGATE (LIGHTWEIGHT)
AGAUTI
AQRASULOCYTOSIS
AGRICULTURE (AL)
AIRBORNE
AIR POLUTIOI
AIR STRIPPING
AL, SEJ ALUMINUM
ALCES AMERICANA
ALCOHOL (S)
ALDRJN
ALKALI (S)
ALKALICJEHES
ALKALIHB (ITY)
ALKALOIDS
ALKYL BENZEHE SULFONATES (ABS)
ALOPSX LAGOPUS
ALTITUDE
ALUMINA
AUMIHUM
AMEBAS
AMEBIASIS
AMERICAN CUTAHEOUS AND MUCOCUTAHEOUS
LEISHMANIASIS
AMINO ACID (S)
AMINOAZO DYES
AMIKQTRIAZOLE
AMMONIA
AMPHIZENOSES
ANAEROBIC
ANAEROBIOSIS
ANALYSIS
ANALYTICAL PROCEDURES
ANALYTICAL TECHNIQUES, SEE ANALYTICAL
Fp;CEDURES
ANCHOf-ERCA
ANCYLC^TOMA CANI'JM
ANCYLOSETOMA BRAZILIE2TE
ANCYLOSTOMA CEYLANICAM
ANCYLCSTOMA DUOBENALE
ANEMIAS
ANGIObTRGNGYLUS CANTONEUSIS
ANHYDROUS HCE
ANIMAL
ANOZEMIA
ANOPHELES
ANOPHELES STEPHENSI
ANTHRACITE
ANTKRAFOZGGhGbSS
ANTHRAX
ANTHRAX BACILLI
AIJTHROPONO, ES
ANTIBODIES
AKTIBIQTIC INHIBITORS
ANTIGEN
ANTIGEKIC COMPONENTS
AMTGENICITY
ANTIMONY
ANTISEPTIC
ANTS
API SEPARATORS
APLASTXC AVEMIA
APODEMUS FLAVICOLLIS
APO PHALLUS
AQUEOUS COMBUSTION
AQUIFERS
ARAMITE
ARBO VI RUSES
ARCTIC
AREA
ARGON
ARID AREA
AROMATIC AMINES
AROMATIC RING COKPQUHDS
ARSENIC
ARSENIC TRIOXIDE
ARSENICAL EPITHELIOMA
ARSENICAL INTOXICATION
ARSENIOUS ACID
ARSENIOUS ANHYDRIDE
ARTESIAN WELLS
ARTHROPOD (S)
ARTHROSPORES
ARTIFICIAL FEEDING STU?FS
ARTIFICIAL TOPEOIL
ASCARIE EGGS
ASCAFIASIS
ASPECTS
ASPERIGILLJS NIGER
ASPERIGILLUS EYDOWII
ASFHYXIATIufc
ASTHMA
A1NC .PHERIC CGMTAMIHAiJT''
ATriUPII.F
ATTAC.-: HATE
AiRECBA^IDU- FJLLILA'^
Ad^TRALI? GROUE
AJIUMGDILE ffliiAL,SI
AVIA^ SPECIE1"
AVIANS
A .W I.
BABOON
BABY
BACILLI
BACILLUS COLI COMMUNIS
BACILLI DYSEKTEPIAE (SHIGA)
BACILLI PARATYPHOSUS B. SCHOTTMULLER
BACTERIA
BACTERIA, MESOFHILIC
BACTERIA, PATHOGENIC
BACTERIA, SAPROPHYTIC
BACTERIA, THERMOPHILIC
BACTERIOLOGY (ICAL)
BACTKRIOLOPHAGE (S)
BAGASSS
BAOGAOE
BAKERS
BALANCE
BALANTIDIOSIS
BALANTIDIUM COLI
BALING
BANDICOTA BEHGALEHSIS
BANGALARE PROCESS
BARHACLEE
BAT
BDELLONYSSUS BACOTI
BEARS
BED BUGS
BEDDING
BEEF
BEETLES
BEHAVIOR
BENZENE
BENZOL
BENZANTHRACSNE, 1, S , y,
DIMETHYL
BENZPYRENE, 3, k
BERYLLIUM
BHC
BIOCHEfJCAL DEGRADATICh
BIOCfaEMICAL DISTURBANCE
BOD
BOD REMOVAL
BIOLOGIC INLRTNESE
BIOLOGIC LAW
BIOLOGICAL
BIONOMIC0
BlUTIC
BIRD
BISON
BITES (BITING)
BITUMINOIS COAL
BLACK ASH
BLACK LIQUOR
BLASTOMYCOSIS
BLEACH LIQUORS
BLEACHES (ING)
BLOCKIHG
BLOOD
BLOOD DYSCRASIAS
BLOOD SUCKING ARTHROPODS
BLOW FLY
BLUEBOTTLE (FLY)
BONE MEAL
BORATES
BORIC ACID
B. SEE BORON
BORON
170
-------
literature survey
171
BORRELIA
BORRELIA BUTTON!
BOTULISM
BOVINE AWIMA1S
BREAST USEPIMG
BREEDING
B' ID"",
BHOIJCiilAL ^T.n.IAL ^'F^TLA^'*
3R.r,C.IIlIE
B^CELU^
BUI^hTC t LAj *
d'JrFAI* "
^inil, A- -M-:
uj, luvjy
-,. .M..J
3..-WS
buRil..^ , -. I4L, LJRIEn,
BUSINESS
JLTCuEP ShOPC
LUTCHZRS
3JTYL ALCOiiOL
BY-fononr
CA, SEE CALCIUM
CEC, PREPARED ANTIGEh
TABLE °Y TEMS
CADAVER PROCESSING PLANTf
CAKE
CALCIFICATION
CALCIUM
CALCIUM OVIDE
CALF (CALVES)
CALIFORNIA
CALLIPir PS
CALLITROGA MACELLARIA
CAMP ACTION
CAJTCER
CABKFIELDS
CANE SUGAR
CANIS LATRANS
CANIS LUPUS
CAPACITY
CAPILLARY
CARBOHYDRATES
CARBON
CARBON DIOXIDE
CARBON DISULFIDE
CARBON FILTER TECHNIQUE
CARBON MONOXIDE
CARBON SLURRY
CARBON TETRACHLORIDE
CARBONATE
CARCINOGENIC AROMATIC HYDROCARBONb
CARCINOGENIC EFFECT
CARCINOGENS
CARCINOMA o* THE BRONCHIAL GLANDS
CARCINOMA OF THE PLEURA
CARCINOMA OF THE RIBb
CnRUIOV,,bCUL R UlbJuaiij
C..HIBOU
C,RJ,1VUHO^ M.J«.Lb
C KXIkH
C,.0l K..UO
C.,
CnTERERb
CnTTLB
CnUfaTIC
C«VK.
CiWTfUL EUROPE.^ ENCEPHALITIS
CENTRAL EUROPE^* HCK-BORMi
ENCEPHALITIS
CKRAMIC PRODUCTS
CENTRkUiiTION
CKJTi'RIFUGEi) (AL, INGJ
CERATOPHYLLUS ACUTUE
CERATOHPYLLUb FASCIATUS
CERATOPHYLLUS SILVANTIKH1
CERATOPHYLLUS SPECIEb
CgRNUS CANADENSIS
CESIUM
CESSPOOLb
CESTODES
CilAlM
CHEESE
CHELATION
CH1MICAL ('&]
CHEMICAL INDUSTRY
COD
CHSMO PROPHYLAXIS
CHEMOTHERAPEUTIC AGENTS
CHICKEN
CHICKEN HOUSES
CHIGGERS
CHILD (CHILDREN)
CHILOMASTIX
CHIPMUNK (S)
CHLORAMIKE
CHLORAMPHENICOL
CHLORDANE
CHLORIDES
CKLORI SATED
CHLORINATED HYDROCARBON (S)
CHLORINE (ATION)
CHLORTHION
CHOIANTHRENE, 20- METHYL
CHOLERA
CHOLERA INFANTUM
CHOLESTKROL
CHROMATIS
CHROMIC ACID
CHROMIUM
CHRONIC
CHRYSOMYIA BEZ^IANA
C I LUTE
CITELUJb LATERAL! S TESCORUM
CITRUS CROP
CITY DUMPS
CLARIHER
CLEAN LIN SSS
CLETHRIONOMYfa bAPPERI
CLIMATE
CLINKER
CLOGGING
CLONORCHIS SINENslS
CLOSTRIDIA
CLOSTRIDIUM PERFRINGENS
CLObTRIDIUM WELCHII
CLOTHING
CMC
C K RATIO (CARBON-NITROGEN RATIO)
CO, SEE CARBON MONOXIDE
CO^, SEE CARBON DIOXIDE
COAGULATION
COAL
COALFIELD REGION
COASTAL WATERS
COAST DEER
COBALT
COBALT AREAS
COBALT ARSENIDE
COCCIDIODES IMMITIS
COCCI DIOIDOMYCOSIS
COCHLIOMY1A HftCBLLARIA
COCKROACHES, BROWN BANDED
COCKROACHES, GERMAN
COCKROACHES, ORIENTAL
COEXISTENCE
COFFEE
COLIFORM
COLIFORM INDEX
COLIFORM ORGANISMS
COLITIS
COLLAGEN FORMATION
COLLECTION
COLLOIDAL SYSTEM
COLLOIDS
COLONIES
COLORADO TICK FEVER
COMBUSTIBLE
COMBUSTION
COMFORT
COMMENSAL (ISM)
COMMERCIAL POIbONi,
COMMINUTE (COMMINUTOH^, ING,
COMMUNAL FEEDING
COMMUNICABLE DIoiAbi, CuNTHOL
COMMUNITY (TIES, ^fti MJtTHOPOLl'L,
COMPACTINti
CUMPEI'ITIVS BIDDING
COMPLEMENT FIXATION
COMPLEX LnNGnT NEGI-jHI
COMPOSITION
COMPOsk (INGJ
COMPRESSION
COMPUTER
CONCENTRATION
CONCRETE
CONCURRENT ILLNESS
CONDEMNED MEAT
CONDENbATE
CONDITION (ING)
CONDUCTIVE
CONFECTIONERS
CONFINBtEHT
CONJUNCTIONAL FLUID
CONJUNCTIONAL SURFACE
CONJUNCTIVITIS
CONTACT
CONTAINERS
CONSTITUENTS
CONSTRAINTS
CuNoTRUClION
COhbTRUCTIUH «URK
CONbUMER
CONTACT rtiAiTIoN
CONTAINER
CUNTAMINANl (=>, /.TIOWj
CONTROL
CONVALkSCENI1 CARRIER
CONVERTING
CONVEYANCE
CONVEYANCE TO 1HE OCEAN
COOKs i I'M
CUPPEH
COPPER CYANIDE
COPROHrtGONS BEETLEo
CuSTLY
COST (s), SEE ECONOMICS
COTTON-TAIL RABBIT
COUGAR
COUNT
COUNTRY
COWbHEDS
COXSACKIE VIRUS
-------
172
SOLID WASTE/DISEASE
COYOTE (S)
CRAGS
CRANE OPERATOR
REATININE
CRESOLS
CRICKETS
CROP
CROWDING
CRYOGENIC SCRUBBING
CRYPTOCOCCOSIS
CRYPTOCOTYLE
CRYSTALLIZATION
CTSNOCEPHALIDEb CAN IS
CTENOCEPHOLUS CANIS
CTENOPbYLLUS MUSCULI
CTENOPbYLLUS SEGNIS
CTF VIRUS
CULEX AJIJWLIROSTRIS
CULEX FATIGANS
CULEX NIGRIPOLFUS
CULEX SALINARIUS
CULEX TARSALIb
CULICONE MOSQUITOES
CULISITA MALANURA
CUIM
CULTIVATION
CULTURAL SOPHISTICATION
CUTANEOUS CREEPING ERUPTION
CUTANEOUS HOOKWORM INFECTION
CUTANEOUS, INNOCULATION
CUTANEOUS LEISHMANIASIS
CUTANEOUS LARVA MIGRANS
CYANIDES
CYCLONES
CYCTICERCUb CtLLULO ,rtL
CYST'S
D-.I-'Y Ci*HjMTY
iui"Y
DAN< DI^bTER
D«W PL/. NT
L)I)T
DDVP
DEAD
DEATH b
DEBRIS
DECANTED
DECOMPOSITION
DEEP FREEZE fcTUHA'jfc
DEi.Pi.ELL INJECTION
DEHYDRATED ( T10R)
DELIVERY
DEMETON
DENGUE
DENGUE COMPLEX
DEHSITY
DENTAL EPIDEMIOLOGY
D.O.
DEBMACEHTAR ANDERSONI
DERMACEHTOR VARIABILIS
DERMATITIS HERPETIFORMS
DESERTED BUILDINGS
DETECTION
DETERGENTS
DEVELOPMENTAL STAGES
DEWATSRED (ING)
DEXTRIN
DIAGNOSIS
DIALYSIS
DIAPKRS
DIAPHRAGM
DIARRHEA
DIARRHEA, -HITE
DIARRHEAL DISEASE
DIAZINON
DIBENZANTHRACENE, 1(£;,5,6,
DICROCOKLIUM DENDRITICUM
DI CHROMA TE VALUE
DIELDRIN
DIFFERENTIAL DIAGNO^Ib
DIGESTER (s, TIONj
DIIbOPROPYL t LUORUPHObPH/iTE
DIMETBYUJUNE
DIMETHYL NITROSAMINS
DIUiTIGN
DIPHTHKRI/.
DIPHYLLUBOThRIUM L..TUM
IJlPYULJlUM C«NIUM
DIREC'I COMbUoTlUN DEVICi.
DIKT
DlbC
UISKkSi,
DISEASfi, FOOT «ND MOU'iH
DI^INFKCTION
DISPERSION (DISPERSAL)
DISPOSAL WELL
DISSEMINATION
DISSOLVED SOLIDb
DISTILLATION
DISTILLERS SLOPS
DISTILLERY
DOG
DOMESTIC, (RESIDENTIAL, HOUSEHOLD)
DOMSSTIC CARNIVORSS
DONORS
DOSAGE DELIVERY
DOSE (DOSAGE)
DOUGLAS SQUIRREL
DRACUNCULUS HOSPES
DRACUNCULUS MEDINENSIS
DRAINAGE
DRINKING
DROPPINGS
DROSOPHILA
DRUGS
DRY SEASON
DRYING
DUCKS
DUMP (ED)
DUNG
DUODENITIS
DUST
DYSENTERY
DYSENTERY, AMOEBIC
DYSEWrm, BACILIARY
DYSPEPSIA
EAR INFECTIONS
EARTHWORMS
EASTERN ENCEPHALITIS
EATING
ECHINOCOCCUE
ECHINOCOCCUS GRANULOSUS
ECHINOCOCCUS MULTILOCUIARI^
ECHO VIRUS
ECOLOGY (ECOLOGICAL, ECOLOGIC;
ECOLOGY, LAWS 01-
ECONOMICS
ECOSYSTEM
ECTOPARASITES
t-DIBLL OIL
EDUCATION
EUIWGRM
EFFLCT (S)
EFFICACY
EFFLUENT (b,
EGG BRLAKING
EGG POWDER
EGG PRODUCTS
EGG SALAD
EGGS
ELECTRIC DUSTER
ELECTRICAL COALESCENCE
ELECTRICAL DISCHARGE
ELECTRICAL FORCES
ELECTRICIANS
ELECTROCHEMISTRY
ELECTRO DIALYSIS
ELECTROENCEPHALOGRAMS
ELECTROLYTIC
ELECTROSTATIC
ELEMENTS
ELIMINATING
ELK
ELUTRIATION
EMUSIONS
ENCAPSULATION
ENCEPHALITIS
ENDAMOEBA HIbTOLYTICA
ENDEMIC
ENDEMIC AREA
ENDEMIC CHAIN
ENDEMIC FOCI
ENDEMIC TYPHUS
ENDEMICITY STUDIES
ENDOBRONCHIOLAR
ENDOGENOUS OXIDATION
ENDOGENOUS RESPIRATION
ENDRIN
ENRICHMENT
ENSILAGE
EJTEAMOEBA HARTMANNI
ENTERCOLITIS
ENTERIC FEVER
ENTERITl^
ENTEROBIUS VEBMICUUKl^
MTEROCOCCI
hNIEROPnTHOutNlC b^LTbUl
tMLRuPAIliOGLNlC El.CHLUlCIil, COLL
Li.rtHuP, IiltXlENS
ENaEKUVlRUsLS
Vti'l\JM\ LvAjl
JihTRnlNED «1H
tNViRUNMLNT (,->L,
LNiXJUTlC
tN.iYMt. ACTION
EOblNOPHILIC MENINGOENCEPHnLITI^
WIDBMICo
fcP!UmiOLLCIC«L
EPI/AXJTIC
vLAoTLHN A -EoTkRN)
k(,UlNE ENCliPlL,LUMYbLIlIb
IkKnDlLATION
tRIPYSELOID
WUSTrtLIS TKN^Y
ERYPYfaELOTHRIX IN&IDIOSA
IvRYblPKLAS
ESCHERICHIA CDLI
ESHINObTOMES
ESTABLISHMENT, SEE AbSTHETIC
-------
literature survey
173
ETHER
ETHIONIIE
ETHNIC ORIGIN
EUROPEAN TICK
EUTECTIC
EVAPORATION
EVIDENCE
EXAMINATION
EXCREMENT
EVOLUTION
EXCRETA
EXPERIMENTS
EXPLOSION (S)
EXPOSURE
EXTRACTION
EYE
F, SEE FIUORINE
FABRIC COLLECTORb
FACILITY
FACTORS
FAECAL MATTER (SEE FECAL MATERIAL)
hAECAL POLLUTION (SEE FECES, POLLUTION
FAMILY (IESJ
1-AMILY IXODIDAE
KANNIA CANICULARIS
FANNIA DUSIO
FARM (ING.
FASCIALOPT.IS
FAoCIOLA HtPATTCA
F«T (b]
NATALITY RATE (SEL D^ATH RATE)
FATERA INDICA
FATIGUb
FAUNA
FE, SEE IRON
FEATHERS
fSCAL MATERIAL
FECAL STREPTOCOCCI
FECES
FECES TRANSMITTING INSECTS
FELDSPAR
FELIS CONCOLOR
FERAL MAMMAUi
FERROUS OXIDE
FERTI LI ZEK
HBROUS MATERIALS
FIELD SPREADING
FILARIASIb
FILLER
FILTER (S)
FILTRATION
FILTRATION RESISTANCE
FIRST-AID ROOM
FISH
FISH, (TROUT)
FISHER (FISHERMEN)
FLAKE
FLASH DRYING SYSTEM
FLEA
FLEA POOL
FLEA, RAT
FLEAS AMD FLEA SPECIES
FLESH
FLESHINGS
FLIES, SEE FLY
FLOATING POLYMER
FLOCCULATION
FLOORS
FLOTATION
FLOW
FLUKE
FLUORIDE
FLUORINE
TLUSH TOILETS
FLY ;FLIES, MUSCA DOMESTICA)
FLY AbH
FLY-MICROBE ASSOCIATION
FOAM [FRAMING)
FOCUS (FOCI)
FODDER
FOOD
FOOD-BORBE INFECTION
FOOD POISONING
FOOT AND MOUTH DISEASE
FORESTS
FORMALDEHYDE
FORMIC ACID
FOWL
FOX (FOXES)
FRACTIONATION
FREEZING
FRESHWATER
FRIJOES
FRONT EMD LOADING SYSTEM
FROTHING
FUME
FUNAMBULUS
FUNABULUS PENENTII
FUHGUS (FUHGI)
GALLUNM ELLIOTE
GAXE HANDLERS
GANGRENE
GARBAGE
GAS (ES)
GASOLINE
GASTRITIS
GASTRODISCOIDES
GASTROENTERITIS
QASTRO- INTESTINAL DISEASE
GASTHO-IIITESTIIIAL INFECTIOUS
GEOGRAPHIC DIFFERENCES
GEOGRAPHIC LOCALIZATION
GEOLOGY
GEOTRICHUM CAHDIDUM
GERBIL
GIARDIA INTESTINALIS
GIARDIA LAMBIA
GIARDIASIS
GLANDERS
GLASS
GLUCOSE
GNATHOSTOMA
GNATHOSTOMA HISPIDIUM
GNATHOSTOMA NEOPLASTICUM
GNATHOSTOMA JPINIGERUM
GOATS
GOB
301 TER
30ITROGENIC SUBSTANCES
GONGYLONEMA
GOUT
,3 RAIN
GRAM -NEGATIVE
GRANARXba
SRAhS LAND TREATMENT
GRAVITATIONAL FORCE
GRAVITY SEPARATORS
GRAY FOX
GREASE
GREEN DROP
GRID COUNTS
GRINDERS (GRINDING)
GRIT DEPOSITS
GROUN WATER
GROUP (S)
GROUP BARBOVIRUSES
GROWTH
GUINEA PIGS
GUINEA WORM
GUMS
HABIT
HABITATION
HAEMAG-GLUTININ-INHIRITION
HAIRS
KAMMERNILL SYSTEM
HAMSTERS
HANDLERS
KANSEN BACILLI
HARDNESS
HAZARDOUS OPERATION
HAZARDS
HEALTH
BEAT
HELMINTH DISEASE
HELIMINTHOLOGY
HEIMINTHS
H EMI CELLULOSES
HEMOLYTIC ENTEROCOCCI
HEMOLYTIC STREPTOCOCCI
HEPATITIS
HEPTACHLOR
HERBICIDES
HEfiBIVAROUj MAMMALS
HERD
HEREDITARY
HERMETIA ILLUCi-NS
HETEROPHYIDAfc
HLXANE
HEJUVALENT CHROMIUM
HlGH-RsTE
HI PRELATES PUblO
HIPPURIC r,CID
dlSTOPI^SM,,
HISTUPLASMA C^PSUUIUM
nIS1X.PL.SMlN TE..TS
HISTOPUSMOSIS
HISTORY
H^ CnOLER^
H^H^IR
HOJo, SEE b«INE
HOLISM
HOME *>CClDEMi.
HOMibTEADERS
riOOKTuORM
HOOVES
HOPLOP.YLLU, ^ONULU.
HORMiT PROCES ,
HORNS
HORSEFLIES
HORSES
HORTICULTURE IAL)
HOSPITAL
HO^T (bj
HOST CONTAMINANT RELATIONSHIP
HOUSEFLY
HOUSEHOLD
HOUSE (HOUSING)
HUMAN
-------
174
SOLID WASTE/DISEASE
HUMITDITf
HUMUS
HUNTERS
HYDATIDOSIS
HYDRATION
HIDRAULIC STRUCTURES
HYDROCARBONS
HYDROCHLORIC *CID
HYDROFLUORIC
ACID
HYDROGEN SULFIDE
HYDROSTATIC PRESSURE
HYGIENIC
HYMENOLEPIS NASA
HYPERENDEMIC SENSITIVITY
HTPEFKERATQSES
HYPERS ENSITI VI TY
HYPOCHLORITE PROCESS
HYSTRICHOPSYLLA LIHSDALEI
ICE
IMMUNE SERA
IMMUNITY
IMMUNIZATION
IMPURITY
INACTIVE DUSTS
INCIDENCE
INCINERATE (INCINERATING, INCINERATION)
INCINERATORS
INDEXES
IHDOLES
INDUSTRY (IHDUSTBIAL)
INFANT (S)
I WANT
INFANTILE DIARRHOEA
INFANTILE GASTRO-ENTERITIS
INFANTILE PARALYSIS
INFECTING DOSE
INFECTION
INFESTATION
INFILTRATION
INFLUENZA
INFORMATION SERVICE
INGESTION
I*HALATIQF
INHIBITORS
IHJECTI OH
INJURY
INOCULATING AOEBTS
INOCULUMS
INORGANIC
INORGANIC ACIDS
INORGANIC ARSENIC
IBSANITATION
INSECTS
INSECTICIDES
INSOLUBILITY
INSPECTION (OR5)
INSTITUTIONS
INSTRUMENTATION
INTERFERENCE
INTERMEDIATE HOSTS
INTERNAL
INTESTINE (S, INTESTINAL)
INTERSTITIAL PNEUMONITIS
INTERSTI1TCAL PUIMONARY FIBROSIE
INTRAFUIWONARY RETENTION
INVESTIGATION
ION EXCHANGE
IONIZED ORGABICS
IRAN
IRON
IRON OXIDE
IRRADIATION
IRRIGATION
ISOBUTYLENES
ISOPROPYL-N-FHENYL CARBAMATE
ISRAEL
IXODES MARX I
IXODES PERSULCATUS
IXODES RICINUS
IXODIDAE
JACKALS
JUNGLES
JURISDICTION
K SEE POTASSIUM
K 0 (DIPOTASSIUM OXIDE)
KALA-AZAR
KERATOSIS
KIDNEYS
KITCHEH WORKERS
KNACKERS
KRAFT (PULP MILLS)
KYASAHUR FOREST DISEASE
LABOR CAMPS
LABORATORT
LACQUERS
IAOOOH (S, LAGOONING)
LAJTD
LAND DEVELOPMENT pnaOOEX.
LAMDFILL (IHO)
lAIUriLLS, SANITARY
LANDSCAPE
LARGE AlttMAL HOSTS
LARVAE
LARVAL ASCAROIDS
LARVAL STAGE
LATRINES
LAUNDRY
LAW
LEACH (LEACHING)
LEAVES
LEGAL RESTRICTIONS
LEGISLATION, SEE LAW
LEISHMAMIA BBAZIUBISIS PIFAHIO
LZISHMAH1A DONOVAJII
LEISHMANIA MEXICANA
LEISHMANIA TROPICA
LEISBHAJIIASES
LEISURE TIME ACTIVITIES
LEMMINGS
LEMMUS TRIMUARONATUS
LEOMOPSYLIA CHEOPIS
LEPERS
LEPROMATOUS LEISHMANIASIE
LEPROSY
LEPTOSPIRA AUSTRALIS
LEPTOSPIRA AUTUMNALIS
LEPTOSPIRA BALLUM
LEPTOSPIRA CANICOLA
LEPTOSPIRA GEORGIA
LEPTOSPIRA GRIPPOTYPHOSA
LEPTOSPIRA ICTERHEMORRHAGIAE
LEPTOSPIRA POMONA
LEPTOSPIRA SEJRAE
LEPTOSPIRA SEROTYPES
LEPTOSPIRES
LEPTOSPIROEIS
LEPUS AMERICANUS {SNOWSHOE RABBITS)
LESIONS
LEUKEMIA
LEVEL
LICE
LIFE
LIGHT
LIGHIN
LIGHIN DERIVATIVES
LIME
LINDAHE
LINE
LINK
LI HO LEW
LIPIDS
LIQUID
LIQUOR
LISTER! OSIS
LITERATURE REVIEW
LITTER
LIVE STOCK
LIVER FLUKE
LIVING STANDARDS
LOA LOA
LOAD
LOBELINE
LOCALITY (LOCATION)
LOGGERS
LONG RANGE PLANKING
LOSS OF LIFE, SEE DEATH
LOUPING-ILL
LOUSE
LUBRICATING GREASES
LUCILIA CAESAR
LUCILIA SERICATA
UMBER PUNCTURES
LUNGS
LYMPHATICS
LYMPHOCYTIC CHORIOMEHIBGITIS
LYMPHOSORCOMA
LYSTSPIRA BATAVIAE
Mg SEE MAGNESIUM
MAGGOTS
MAGNESIUM
MALADJUSTMENT
MALARIA
MAMMALS
MAN
MAJIAGEMENT
MANGANESE
MANHOLES
MANIPULATION
MANURE
MARINE
KAPKET (MARKETING)
MARMOT
MARNOT, SIBERIAN
MARSUPIAL
MARTES PENMAHTI
MASS BREEDING
MATERIALS
MATHEMATICS (AL)
MEADOWS
MEAL
MEAT
KECHAHICAL yiLTRATIOII
MECHANISM
MEDIA (MEDIUM)
MEDICAL CARE
MEDICINE (MEDICAL)
-------
literature survey
175
MZLABOCORIOR
MELAROSIS
KEMBRATCS
MENTAL
MERTAL DISORDER
MERCERIZIEO HASTE
MESERTERIES
METAL (S)
METALLIC COHSHTUHITS
METEOROLOGICAL FORBCASTIRQ
METEOROLOGY
METHARE
METHAMOL
METKEMOGLOBIBJ
MEITOttaLOBIiratlA
METHODS
METBOXYCHLOR
METHYL MERCAFTAKS
METHYL SULFIDES
METRQPOLITAR ARIAS
MICE, DEER
MICE, FIELD
MICE,. HOUSE
MICE, RED-BAKED
MICHOBIAL GROWTH
MICROBIOLOGY
MICROEHVI ROIKERTS
MICROOROARISMS
MICROTOS
KICROTUS CAUFOMIICUS
MICROTUS OLCOHOMUS
MICROTOS PEFRSYLVARICUR
MIGRATE (MIGRATIOH)
MIUTART IRSTALLATIORS
HI IK (IHQ)
MILK-BORRE
MILL
MILLARDIA HELTADA
MILLIPEDES
MIKE (R)
MINERAL
MIVERAL IOMS
MIMERAUZAflOH
MIRK
MISSILE
MI5SIOHARIES
MISSISSIPPI RIVER
MITES
MITES, BIRD
MITES, CHICKEK
MITES, HARVEST
MITES, ITCH
MITES, MBSOSTIOMATIC
MITES, TROHBICULID
MITES, TROKBIDIFORM
MITES, WILD BIRD
MIS (in)
MODE OF SPREAD
MODEL
MOISTURE
MOLDS
MOWOT KIWEf
MOIIKEYS
MOOSE
MORBIDITY
MORTALITY
MOttTICIAH
MOSQUITOES
MOTHERS
MOTHS
MOTOR VEHICLE EXHAUST
MOUSE EXCEPHALOMYELITIS
MUCOSA
MUCOUS MEMBRAHES
MULTI-CYCLOHE COLLECTOR
MULTIPLICATIOI
MimiCIPAL, SEE METROPOLITAll
MURIHE AHGIOSTROHGYLOSIS
MURIME FLEA-BORKE TYPHUS FEVER
MUS MUSCULUS
MUSCA DOMESTICA LIHB
MUSCIMA STABULAMS
MUSTY ODOR
MUTATIOHS
KUTTOH
MYCOLOGY
MYCOSES
MY1ASIS
MYCOBACTERIUM ARIUM
KYCOBACTERIUM BOVIS
MYCOBACTERIUM TUBERCULOSIS
R SEE HITROGEH
Ha SEE SODIIM
HAPHTHA LHIES
lUPBTflEBATE
•ASAL SYSTEM
MATURE (HATURAL)
HECATAR AMERICARUS
HEED
REMATODES
HBUTODES, FREE UVTHQ
nopLASiA- inuciin
HlUROTOXrciTY
HEUTRALIZATIOI
irSMBORHS
IRCKEL
RICKEL COBALT
IK3HTSOIL
VITRAT2
OROARIC ELECTRODE REACTIOIIS
ORaARIC-IIOROAlUC MIXTURES
ORGABC PHOSPHORUS COMPOUUDS
OROARICS
OPICTTAL SORE
ORLOI
UTRATE ACCIMULATIOB, SEE nTRIFICATZOI ORPHAXAOES
KTRIC ACID
IHTRIFICATIOH
KITRITES
nTROOER
UTROQEI COMPOUMI6
HITROOEH GAS
RITROOEH OXIDE (S) SEE HTROOEX
coMPoume
4-IITROQUIJtOLIire R-OXIDE
SOCARDIA
BOISE
WOHADULTS
HOH-BITIHG
RON- COMBUSTIBLE
BOB-DEGRADABLE ORGftHICS
HOHFERROUS METAI£
HOSOSYLLUS FASCIATA
MURSERIES
RURSIHG PERSOHHEL
WJTRIERT AVAILABILITY
HUTRITIOH
HUI SAUCE
HUTRIA
HYLOH
0 , SEE OXYGEH
OCCUPATIOHS
OCEAR
ODOR
ODOCOILEUS VIRGIHIAJrUS
OESOPHOGOSTOMUH
OFFAL (REFUSE)
OIL (S)
OIL FIELD
OIL RIG WORKERS
OLEFIHS
OMSK HAEMORRKAQIC FEVER
OPEH FOREST
OPER TREICH
OPERATIOIi (im, OR)
OPHTHAIMIA
OPISTHORCHIDAE
OPOSSUM
ORDIRAHCES
OROABIC
OROAHIC DYES
OM1TBODORES
OUTBREAKS
OUTFALLS
OVA
OVERBOLD PROCESS
OXIMTIOI
OXIDATIOR REDUCTION POTEITIAL
OXYCHLORIRATIOR PROCESS
OXYGEH
OYSTERS
OXIDES
OZORE
PACKIHG HOUSE (S)
PAIL- CLOSETS
PAIL SYSTW
PAIHT MARUFACTURE
PAPER
PARAFFIRS
PARALYSIS
PARAMETERS
PARASITES
PARASITIC CYCLIRG
PARASITISM
PARATHIOR
PARATHYROID
PARATY
PARATYPHOID A
PARATYPHUS A
PARK IRQ
PAR1CLES
PARTTACOSES
PASSIRE CARRIER
PASTEURELLA MULTOCIDA IRFECTIORS
PASTEURELLA PESTIS
PASTEURELLA TULARELISIS
PASTEURELLA TULARERSIS
PASTEURIZATIOR
PASTURE
PATHOOER (S)
PATHOOERIC
PATHOLOGY
PATHWAYS
PATIERTS
PATTERR
-------
176
SOLID WASTE/DISEASE
PAUNCH CONTENTS
PEA CULTURE
PECTIN
PEDIATRIC, SEE CHILD
PEMPHIGUS
PERCOLATION
PERFUME
PERIBRONCHULAR
PERIODICITY
PERIDOMESTIC AVIAN RESERVOIR HOSTS
PERMANGANATE
PERMISSIBLE LEVEL
PERCMYSCUS
PERCMYSCUS MANICULATUS (DEER MICE)
PERSONNEL
PEST
PESTICIDES
PETROCHEMICAL (S)
PETROLEUM
pH
PHAENTCIfl
PHAENICIA SERICATA
PHAPMACSUTICAL PUNTS
PHARMIA REGINA
PHEASANT
PHENOL (£/, 3EE PHENOLIC COMPOUNDS
PHENOLIC COMPOUNDS
PHENOLIC CONTAINING LIQUORL
PHIALOPHORA TEOBSELMET
PHLEBOTOMUM
PHLESOTOMUS
PHOMA HERBARUM
PHOSPHATES
PHOSPHOLIPIDS
PHOSPHORIC ACID
PHOSPHORUS PEHTAQXIDE
PHOTOCHEMISTRY
PHYSICAL
PHYSICIAN
PHYSIOLOGICAL EFFECTS
PICK LINO
PICKLING BATH
PICKLING LIQUOR
PIGEONS
PIGS (PIGGERIES)
PIN WORMS
PIPE
PINKEYE
PIT
PLACENTAS
PLAQUE
PLAQUE INFECTION RATES
PLAJOniO
PLANT
PLATE COUNT
PLASKODIA
PLMTNOSOMA FANTOSUM
PLAYGROUND
PLUMBERS
PNEUKOCONIOSES
POISONING
POISONOUS GASES
POLAR BEAR
POLICEMAN
POLIOMYELITIS
POLIOMYELITIS VIRUS
POLLENIA FUDIS
POLLUTANT, SEE CONTAMINANT
POLLUTION
POLYCYCLIC AROMATIC HYDROCARBONS
POLYSUCLEAR HYDROCARBON
POLYSULFIDE RUBBER
POLYVINYL CHLORIDE
POOL (PONDING)
POPULATIOH
POPULATION DYNAMICS
POPUUTION EQUIVALENT
PORCUPINES
PORK
PORTAL OF ENTRY
POTABLE
POTASSIUM
POTASSIUM ARSENITE
POTATO STARCH
POTENTIAL
POTENTIATION
POULTRY
POULTRY FLOCKS
POULTRY RANCH
POVERTY
POWASSAH
POWASSAN DISEASE
PRACTICES
PRAIRIE DOGS
PRAWNS
PRECIPITATES (TTON, TORS)
PRECOHCENTRATIHG
PREDATORS
PREFERENCE
PRE-KATAL
PREPARATION
PREVALENCE
PREVENTIVE MEASURES
PRIMARY
PRIVY
PRIVY-MI DDEBS
PRIVY SPECIMENS
PROBLEM
PROCEDURES
PROCESS, A.D. LITTLE (THE)
PROCESS, INSTITUTE (THE)
PROCESS, MKAD (THE)
PROCESS, PRITCHARD-FRAXON AND ABIPERM
PROCESS, SDA SHAKE FLASK (THE)
PROCESS, SIVOLA (THE)
PROCESS, STORA KOPFARBERG (THE)
PROCESS, SULFOX (THE)
PROCESS, WESTERN PRECIPITATION
(BRADLEY) (THE)
PROCESS, ZIMMERMAN (TBE)
PROCESSED PORK
PROCESSES (TREATMENT, ING)
PROCESSING
PROCESSING METHODS
PRODUCT (PRODUCTION)
PROGRAM
PROJECTS
PROPERTY APPRECIATION
PROPERTY DWWGE
PROPHYLACTIC MEASURES
PROPINQUITY
PROTECTIVE CLOTHING
PROTEINS
PROTEUS
PROTOPHORNIA TERRAE-NOVAE
PROTOPLASMIC IRRITANT
PROTOZOA ( L)
PROVIDENCE GROUP
PRURITIS
PSARIATICS
PSITTACOSIS
PSEUDOFOCI
PSEUDOMOJTES
PSYALOPERA CAUSASlA
PSYCHOLOGICAL RESPONSES
PUBLIC FACILITIES
PUBLIC HEALTH
PUBLIC INTEREST (KUISANCZ)
PUBLIC POLICY ( SOCIETY , PLANNING,
SOCIAL GOALS)
PULEX IRRITANS
PULL ON
PUIMOHARY HAZARD
PUIMOKARY TUBERCULOSIS
PULP MILLS
PULPINO LIQUORS
PUMPS (S) (PUMPING)
FURIFICATI01I
PUTRBTACTION
PYRIDIIE
Q FEVER
QUALITY
QUANTITATIVE ANALYSIS
QUANTITATIVE ASPECTS
QUANTITIES
QUEENSLAND TICK TYPHUS
RABBITS
RABIES
RACCOONS
RADIOACTIVE (ITI)
RADIOLOGICAL HEALTH
RADIUM
RAGS
RAILROAD CONDUCTOR
RAIN FOREST
RANGIFER ARCTICUS
RASPING SUXTEM (THE)
RAT BITE FEVER
RAT LUNGWORM
RATE
RATE OF INFECTION
RATS
RATS, BLACK
RATS, BROWN
RATS, COMMENSAL
RATS, COTTON
RATS, DOMESTIC
RATS, GRAY
RATS, KANGAROO
RATS, POLYNESIAN
RATS, ROOF
FATS, SEWER
RATS, SPINY
RATS, WATER
RATTUS HARVEGICUS
RATTUS RATTUS
RATTUS RATTUS ALEXAKDRHfUS
RAW
RAW COKE
REACTION RATE
REAL ESTATE VALUES
REAR LOADER
RE-CHARGE
RECIRCULATION
RECIPROCITY
RECLAMATION
-------
literature survey
177
RED FOX
RELAPSHO FEVER (S)
RECOVERY
REDUCING AGENTS
REDUCTION
REFINERY
REFRACTORY SUBSTANCES
REFUSE
REGENERATION
REICHEXSTEII CAJKEB
REINDEER
REITHRODOMTOMYS
RELAPSING
RELATIONSHIPS
RB40VAL
RENDERIXO FLAWS
REO VI RUSES
REPELLENT AGENTS
REQUIRBfENT
RESEARCH AMD DEVELOPMENT
RESERVOIRS
RESIDENCE
RESIDUE (S)
RESIDUAL
RESINS
RESTAURANTS
RETAIL SUPPLY
RETROSPECTIVE
REVERSE OSMOSIS
REVIEW
RHABDITTDAE
RICE
RICE FIELDS
RICKETS
RICKETTSIA AUSTRALIS
RICKETTSIA TYPE
RICKETTSIALPOX
RICKETTSIAE
RIDGE AND FURROW IRRIGATION
RIVER
ROAD
ROAD BINDER
ROCKY MOUNTAIN SPOTTED FEVER
RODENTS, COLONIAL
RODENTS (BATS, MICE)
ROENTGENOLOGIC EXAMINATIONS
ROTARY DRIERS
ROUNDWOm
RUBBER
RUBBISH
RWINANT
RUNOFF WATER
RURAL ARRAS
RURAL ERERPRISK
RUSSIAN SPRHO-SUMIER
ENCEPHALITIS
SAFI DESIOI
SAFETY
SATETI CODES
SA7ETT EQUIPMENT
SAFROLE
ST. LOUIS COMPLEX
ST. LOUIS ENCEPHALITIS
SALIVARY 01A1DB
SALMOKLLA
SALMONELLA ARAMIENBURO
SALMONELLA BLOCK LEY
SALMONELLA HEIDKLBERO
SALMOBSLLA INFAHTES
SALMONELLA INFECTION
SALMOJTELLA KENTUCKY
SALMONELLA- LIKE
SALMONELLA PARATYPHI
SALMONELLA PARATYPHI B
SALMONELLA PULLDRIN (RXTTBGER)
SALMONELLA SAINTPAUL
SALMONELIA THOMPSON
SALMONELLA TYPHI
SALMONELLOSIS
SA1MONELLOSIS EHTERITIPIS
SALT CAVERN STORAGE
SALT (SALINITY) (SALINE)
SALVAGE
SAJfD
SAND BEDS
SAND STOWS
SANDFLY VECTOR
SANITARY (SANITATION)
SANITARY FACILITIES
SANITARY IAMDFILLS
SANITARY SEWAGE
SANITATION MEN
SARCOPHAGA
SARCOPHAOA HA9IORRHOIDALIS
SARCOPHAGA SUETA
SARCOPHAOULA
SARCOPTES SCABIE I
SAPROPHYTIC RESERVOIR
SATURATED FLOW CONDITIONS
SAUSAGE
SAUSAGE MAKERS
SCAVENGERS
SCHISTOSOHA 5QVIS
5CH1STOSCMA HAMATOBIW
SCHISTOSOMA IRERCAUTtM
3CHISTOSOMA JAPAVICtM
saasToscMA MABSONI
SCBIST06GMA KATHK
SCHISTOSOMIASIS
SCHOOL (SCHOOL TARE)
SCHRADAN
SCIENTISTS
SCOURING
SCRAPS
SCRSEN (s) (SCREENING:)
SCRUBBER (SCTOBBIBQ)
SCUM (8)
SEALS (SEALING)
SEAPORTS
SEASONAL INCIDENCE
SEASONAL INFLUENCE
SEAWATER
SECONDARY TREATMENT
SECULAR TREND
SEDIMENT (S) SEDIMENTATION)
SEGREGATION
SEIZURE
SELENIUM
SELENIUM COMPOUNDS
SELF PURIFICATION
SEMECIO ALKALOIDS
SEHCIVITY
SEPARATION
SEPTIC
SEROLOGIC PROCEDURES
SEBOTIPE FREQUENCY
SEHOTTPES
SETTLEABLE SOLIDS
SETTLING BASINS ( TANKS }
(CHAMBER)
SEVERITY
SEVIN
SEWAGE
SEWERAGE
SEWERS
SHAKER SCREENS
rro
SHEEP
SHELL BOGS
SHELLFISH
SHELTER (S)
SHEPHERDS
SHIOELLA AIXALESCEKSDISPAR
SHIOELLA AJATUM
SHIQHJA BACTERIA
SHIOELLA BOTDII
SHIOELLA DERBT
SHIOELLA DTSEffTERIAE
SnaiLLA PLEXXERI
SHIOELLA OXORA
EHIOELLA MOITCVIDEO
SBIOKLLA HEWCASTLE
8HJOELU PARADYSENTKRIA1
SHIOELLA SONTO
SHORT TEIM
SHORTAGE
SHOWER BATAS
SHREDDING
SHREWS
SIBERIA! MOWOT
SIBLINOS
SIDE LOADER
SIEVIHG
SIGMODON H. HISPIDUS
SILAOE (LIQUOR)
SILICA
SILICA AEROGEL
SILICATE
SILICATES, FUSED
SILICIC ACID
SILICON DIOXIDE
SILOS
SILVERFISH
SINK
SINTERED
SITE, SEE LOCATION
SIZES
SKA IDLES
SKIN
SKIN TEST
SKUNK, SPOTTED
SKUNK, STRIPED
SLAUGHTERHOUSE HOFXERS, SEE ABATTOIR
OPERATORS
SLAUGHTERHOUSES, SEE ABATTOIRS
SLAUGHTERING PROCESSES
SLUDGE
SLUDGE CAKE
SLUDGE DISPOSAL FACILITIES
SLUM AREAS
SLURRY
SMALL MAMMA LIAR HOST
SMALLPOX
SMELTING
SMOG
SMOKE
SMCKED MEATS
SNAIL
SHOWSHOE RABBITS
SOAP
SOCIAL
SOCIAL DEVELOPMENT
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178
SOLID WASTE/DISEASE
SOCIAL EQUILIBRIUM
SOCIOECOHOMIC
SODA ASH
SODIUM
SODIUM SULFATE
SOIL (S)
SOIL EROSIOR
SOLAR RADIATIOR
SOLDIER FLY
SOLID
SOLUBLES
SOLVERTS
SORE
SOURCE
SOUTH HEW BRURSWICK
SOUTHEHR STATES
SPACE ERVIROHMERT
SPAEROCERIDS
SPECIES
SPECIMER
SPOTT
SPERMOPHILE
SPHAEROTILUS HATARS
SPHERULES
SPIDERS
SPIOOT
SPIROCHETES
SPORADIC CASES
SPORE BEARERS
SPORES
SPOROTRICHC6IS
SPOTTED FEVER
SPRAY
SPREADIR5
SPRINGS
SPUTUM
SQUIRRELS
STABLE
STABLIZATIOR
STAFF
STAGHAIIT PORDB
STALL
STARDARDS
STARDARDB OF LJVIRG
STAPHYLOCOCCAL ABSCESS
STAPHYLOCOCCUS
STARCH
StARLIRO ROOST
STARLIHOS
STATIORARY PACKER
STATISTICAL ARALYSES
STEARIC ACID
STILL BOTTOMS
STILLAOE
srzLLMG MSIR
STOCK FEED
STOCKTARD6
STQMAXYS CALCITRAHS
STOMOXYS CALCITRAHS L.
3TOOL (S)
STOOL CULTURES
STORAGE
STORE
STRAIR
STREAM BIOTA
STREAMS
STREET
STREPTOBACILLUS MORILIFORMIS HARES
STREPTOCOCCUS
STREPTCIfYCES
STRESS
STRORGYLOIDES
STRORGTLOIDES STEROCORALIS
STRORTTUM
STUDY
SUBSERIOTYPES
SUBTROPICAL
SUBTROPICAL COURTRIEE
SUBURBARIZATI01I
SUGAR
SUGAR-CAKE FIELDS
SULFATE
SUIflDES
SULFITE LIQUOR
SULJ-UR
SULFUR COMPOURPS
SULFUR DIOXIDE
SUMMER DIARRHEA
SUMMER SAUSAGE
SUPERCH LORIRATIOR
SUPPLY
SURFACE
SURFACE DAMAGE
SURVEY
SURVIVAL
SUSCEPTIBILITY
SUSPERSIOH
SWAMP
SWMCER'S ITCH
SWDMIRO POOL LIFE-GUARD
SWIRE
SWIRE ERYSIPELAS
SWIRE FEVER
SWIRE HERDS
STLVATIC DISEASE
SYLVATIC PLAGUE
SYLVATIC MECHARISMS
SYLVATIC PLAQUE FOCI
STMPTCMS
SYRBROISM
SYVOAMUS TRACHEA
SYRTHKTIC
STSTEM
TAERIA SAOIHATA
TAMASCIURU5 HUT60WICUS
RICHARDSORI
TARK (ERS)
TARRERY
TAPEWORM (S)
TAPEWORM, DWARF
TAR (S)
TAPEWORM, BEEF
TAPEWORM, BROAD-FISH
TAPEWORM, HUMAR BEEF
TAPEWORM, PORK
TAX REVEHUE
TAXI DRIVER
TDE
TEA
TECHROLOGY
TEMPERATURE
TEJWIDESS
TERRAIN
TETARUS
TEXTILE
THERAPY
THERMAL
THICKERERS (IRQ)
THIOCYARATES
THIOUREA
THRESHOLD
THRESHOLD LIMITS
THROAT IRFECTIOH
THRCMBOCYTOPERIA
THYROID PATHOLOGY
TICK(S)
TICK-BORRE EUCEPHALITIDES
TICK-BORRE HBMORRHAQIC FEVERS
TICK FEVERS
TICK PARALYSIS
TICK TOXIR
TICK TYPHUS
TIDE(S)
TIPPI»0
TISSUS CULTURE
TI (TITARIUM)
TOLZHAJCES
TOLUERE
TOPOGRAPHY
TOIDUDOES
TOURISTS
TOWER
TOWR(S)
TOWR FRIRGE AREAS
TOXASCARIS LBORIRA
TOXIC
TOXI CARTS
TOXICITY
TOXICOLOGICAL nrVESTIOATIOR
TOXICOSIS
TOXIRS
TOXOCARA CAKIS
TOXOCAJW CATI
TOXOCARA MYSTAX
TOXOPHERE
TOXOPLA3MA
TOXOPLASMA GOHIHI
TOXOPLASKOSlS
TRACE ELEMERTS
TRAIRIRG
TRARSFER STATIORS
TRARSMISSIOII (TRAR5MITTEH)
TRAKSPIRATTOR
TRARSPORTATIOR
TRARSPORTATIOR RUSIARCES
TRAPPERS
TRASH
TRAUMATIC EFFECT
TRAVELERS {SEE TOURISTS)
TREATMERT
TREES
TRH4ATODES
TRICHIRELLA SPIRALIS
TPICHIHOEIS
TRICHOMA
TRICHOMORAS
TRICHLOROPHEROL, 2,k, 6
TRICHOSPHORA CUSTAREUM
TRICHOSTRORGYLUS
TRICHURIS
TRICHURIS TRICHURA
TRICK LIRG
TRIORTHOCRESTL PHOSPHATE
TRCKBIDIUM
TROOP BIVOUAC SITES
TROPICAL
TROPHOZOITE
TROUT
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literature survey
179
TRYPAJIOSCMES
TRYPAMOSCNIASIS
TSETSE FLIBS
TSUTSUOAMUSHI DISEASE
TJBKRCUU3SIS
TUBURCLE BACILLI
TULAREMIA
TUMMARIGENIC ACTIVITY
TUNDRA VOLES
TURKEYS, SEE POULTRY
TYPHOID FEVER
TYPHUS
TYPHUS, KUBIHE
TYPHUS, SCRUB
ULTIMATE DISPOSAL
ULTRA-FILTER (FILTRATION)
ULTRASONICS
ULTRA-VIOLET RADIATION
UHCINARIA STERACYSHALA
UNCOOKED
UNDERDEVELOPED COUNTRIES
UNDERGROUND CAVITIES
UNDERPRIVILEGED
UHD1G1STED CELLULOSES
UITOOIAIIT FEVER
UMIT
UNITED STATES
UHI VERSE
UHSAKITART COHDITI01K
URSKILLED LABOR
UHTREATED
URBAN AREAS
URBAHIZATIOR
UREA
URETHAH
URIC ACID
URIITC
UTEHSILES
\JTILIZED (wnuzino,
UTILiaATIOH)
VACUUM
VALUE (SEE BCOHOMICS)
VAJf HAANEff SYSTEM
VAPORIZATIOH
VAPOR PRESSURE
VASCULAR DISORDER
VECTOR POTEHTIAL
VECTORS
VEGETABLE
VE0ETATIOX
VEHICLES
VBMIR
VERTEBRATES
VETERIIIAIIIAN^
VISICylAB H>AHTHBttA
VTBRATIOH
VIBRIO
VIBRIO CHOLERAE
VIBRIO FETUS
VIWIOSIS
VILLAGE
VHTEIARDS
VHTTL ACETATE
VIRAL
VJRULEBCE
VIRUS (ES)
VIRUS TITER
VISCERA
VISCERAL LEISHMAHIASIS
VITAMIJI
VOLATILE
VOMIT
VUEPES FUERA
WALRUS
WAPITI
WAR (WARFARE)
WAR-TIME
WAREHOUSE
WASH SINK
WASTE
WASTES, BEAMHOUSE
WASTES, BREWERY
WASTES, CANNERY
WASTES, CHROMIUM- BEARING
WASTES, CREAMERY
WASTES, DEMOLITION fc COHSTPUCTIOF
WASTES, ELECTBOPIATnKS
WASTES, FAT REFINING
WASTES, FOOD INDUSTRY
7^ STBS, FOOD PROCESSING
WASTES, GAS & COKE PLATE
WASTES, HYDROGEN CHLORIDE
WATER
UATER-BOKNE
WATER-CLOSETS
WATERCOURSE
WATERCRESS
WATER-FRONT ZONE
UATER-QUALITT STAVDARD6
WATER RESOURCES MAMAGEMEHT
WATERSHED KAN A 0 BENT
WAVE ACTION
WAX (IS)
WZANLUO DIARJOZA
«ED(S)
WEEP SEEDS
WEIL'S DISEASE
WELLS
WESTER! EQUINE ENCEPHALQKYELITIS
WESTERN HEMISPHERE
WET
WHALES
WHIFWORM
WHITE ARSENIC
WHITE- TAILED DEER
WILD
WILDCAT
WILDERNESS RECREATIONAL AREAS
WIND ACTION
WINDOW SCREENS
WINDROW
WINE RESIDUES
WINTER DIARRHEA
WOLF (WOLVES)
WOOD
WOODCUTTERS
WOODLANDS
WOOL
WOOL GREASE
WOOL WASTES
yOOLSORTER'S DISEASE
WORK (WORKER, WORKING)
WORM
WOUNDS
WUCHEREFIA BANCROFT!
WUCBERERIA (BRUGIAI MAUYI
XENOPYSYLLA ASTIA
XEBOPSYLLA CHEOPIS
XYLENE
X-RAYS
YAWS
YEAST(S)
YELLOW FEVER
YELLOW FEVCT VIRUS
YIELDS
YOUNG CHILDREN
ZINC
ZOHB(S) (ZONING)
ZONE OF INFECTION
ZOOANTHROPONOSES
ZOONOSES
ZOOPLANKTON
U. S. GOVERNMENT PRINTING OFFICE 1968 O - 291-982
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