40–12K-25,000

lornajarrettblanchard January 1, 1910

–12,673-25,000 Blanchard.*

— 25,000 McLaughlin. Public Health Reports. V27, N12, 3-22-1912, p. 424.
— 12,673 Rate per 100K pop. 23.5; 1.6% of deaths. Census. Mortality Statistics 1910. 1913.

* We see a range of the 12,673 reported by the Census for registration areas in 1910 and McLaughlin of the U.S. Marine Hospital Service, who two years later, and apparently with access to additional nationwide information, reported approximately 25,000 deaths, while noting his belief that there were probably more.

Breakout of Fatalities by State (where noted):

State Death Deaths Registration city in nonregistration state
rate

Alabama 119
49.5 66 Birmingham
75.6 39 Mobile
36.7 14 Montgomery

California 19.2 460 Table 4, p. 252.

Colorado 41.9 337 Table 4, p. 252.

Connecticut 14.7 165 Table 4, p. 256.

Delaware 37.7 33 Wilmington

District of Co.23.2 77 Table 4, p. 256.

Florida 74 Table 4, p. 256.
102.3 60 Jacksonville
70.3 14 Key West

Georgia 94 Table 4, p. 256.
50.1 78 Atlanta
24.6 16 Savannah

Illinois 363 Table 4, p. 256. Also Aurora, Belleville, Decatur, Evanston, Quincy.
13.7 300 Chicago
52.0 37 Springfield

Indiana 34.0 919 Table 4, p. 256.

Iowa 15 Des Moines.
1 Charlton. Le Grand Reporter, IA. “Girl is Typhoid Victim.” 12-30-1910, p. 2.

Kansas 117 Table 4, p. 258.
95.5 79 Kansas City
74.9 15 Leavenworth
43.1 23 Wichita

Kentucky 104 Table 4, p. 258. Just four registration cities.
8 Covington
31.7 71 Louisville
32.9 10 Newport
65.7 15 Paducah

Louisiana 31.5 107 New Orleans Table 4, p. 258.

Maine 20.3 151 Table 4, p. 252.

Maryland 40.7 528 Table 4, p. 252.
42.0 235 Baltimore. Ford. “The Problem…Typhoid…Baltimore.” 1911, 351.
155.0 34 Cumberland
86.3 9 Frederick

Massachusetts 12.4 421 Table 4, p. 252.

Michigan 23.7 667 Table 4, p. 252.
— 8 Escanaba The Year McLaughlin. Public Health Reports. V27, N17, 26 Apr 1912, 603.

Minnesota 32.1 668 Table 4, p. 252.

Missouri 269 Table 4, p. 262. (Three registration cities.)
54.4 136 Kansas City
30 St. Joseph
14.9 103 St. Louis

Montana 39.9 151 Table 4, p. 252.

Nebraska 116 Table 4, p. 264.
8 Lincoln
86.7 108 Omaha

New Hamp. 10.7 46 Table 4, p. 252.

New Jersey 14.5 371 Table 4, p. 252.

New York 15.3 1,397 Table 4, p. 252.
556 New York City. Table 4, p. 266.

No. Carolina 57.7 209 Table 4, p. 252.

Ohio 27.5 1,314 Table 4, p. 252.
— 32 Chillicothe Bureau of the Census. Table 4, p. 268.
— 32 Cincinnati McLaughlin. Public Health Reports, V27, N17, 26 Apr 1912, 584.
–101 Cleveland Bureau of the Census. Table 4, p. 268.
— 33 Columbus McLaughlin. Public Health Reports, V27, N17, 26 Apr 1912, 585.
— 25 Dayton Bureau of the Census. Table 4, p. 268.
— 63 Toledo Bureau of the Census. Table 4, p. 268.
— 46 Youngstown Bureau of the Census. Table 4, p. 268.

Pennsylvania 24.6 1,892 Table 4, p. 252.
–1,892 State. Freeman. “Case Fatality in Typhoid Fever.” Public Health Rpts. 12-8-1916, 3358.
— 36 Johnstown Bureau of the Census. Table 4, p. 270.
— 28 McKeesport Bureau of the Census. Table 4, p. 270.
— 272 Philadelphia McLaughlin. Public Health Reports, V27, N17, 26 Apr 1912, 583.
— 149 Pittsburgh McLaughlin. Public Health Reports, V27, N17, 26 Apr 1912, 581.
— 31 Reading Bureau of the Census. Table 4, p. 270.
— 17 Uniontown Morning Herald, Uniontown. “Official Facts…” 12-27-1910, p. 2.
— 25 Wilkes-Barre Bureau of the Census. Table 4, p. 270.

Rhode Island 13.6 74 Table 4, p. 254.
40 Providence Bureau of the Census. Table 4, p. 272.

So. Carolina 56.0 33 Charleston Bureau of the Census. Table 4, p. 272.

Tennessee 102 Bureau of the Census. Table 4, p. 272.
12 Knoxville
27.4 36 Memphis
48.9 54 Nashville

Texas 61 Bureau of the Census. Table 4, p. 272.
12 Galveston
49 San Antonio

Utah 37.0 139 Table 4, p. 254.

Vermont 14.0 50 Table 4, p. 254.

Virginia 109 Bureau of the Census. Table 4, p. 272.
130.3 20 Alexandria
68.2 13 Danville
30.4 9 Lynchburg
23 Norfolk
21.9 Richmond

Washington 28.0 324 Table 4, p. 254.
34 North Yakima Bureau of the Census. Table 4, p. 274.
34 Seattle Bureau of the Census. Table 4, p. 274.
48 Spokane Bureau of the Census. Table 4, p. 274.

West Virginia 21 Wheeling Bureau of the Census. Table 4, p. 274.

Wisconsin 23.3 544 Table 4, p. 254.
37 Ashland Bureau of the Census. Table 4, p. 274.
172 Milwaukee Bureau of the Census. Table 4, p. 274.
34 Superior Bureau of the Census. Table 4, p. 274.

Narrative Information

Bureau of the Census, 1910: “Typhoid fever caused 12,673 deaths in the registration area during 1910, the death rate being 23.5 per 100,000 population. Although the number of deaths was only 1.6 per cent of the total number from all causes (805,412), this disease causes a much higher proportion of deaths of effectives, that is to say, men and women at the working ages when they are of the greatest economic importance….” (p. 23.)

“In the foregoing table [in original] rates of 40 or over per 100,000 for any of the years or periods are indicated by bold-faced type This is a somewhat high limit for a disease which is due to neglect of ordinary sanitary precautions and the mortality from which may be taken as a criterion of sanitary inefficiency….

“…the United States is far in excess of those of the majority of European countries. Compared with statistics for European countries and cities with modern sanitation, American rates are excessively high. The rate of the registration area for the year 1910 (23.5) is about the same as that of England and Wales 30 years ago. Some progress is being made, however, the rate for the quinquennium 1906 to 1910 (25.6) showing a marked decrease from that of the preceding quinquennium (32), and certain cities, some of which formerly had high death rates from typhoid fever, show unusually low rates for 1910, although such rates are not lower than those attained by European cities 15 or 20 years ago….” (p. 24.)

“The highest death rates for 1910 were those of Ashland, Wis. (322.6); North Yakima, Wash. (237.6); Virginia, Minn. (234.5); Great Falls, Mont. (201); Cumberland, Md. (155); Warren, Ohio (143.8); Alexandria, Va. (130.3); South Sharon, Pa. (117.8); Sharon, Pa. (117.2); and Billings, Mont. (108.1).

“Special investigations have been made of many of the epidemics of typhoid fever by officers of the United States Public Health Service. In the case of Ashland, Wis., for example, it is stated that the excessively high death rate resulting from the epidemic of 1910 ‘was due primarily, in all probability, to polluted water and poor efficiency of the filter plant.’

“An invariably high annual death rate indicates a condition more dangerous, both to the community itself and to other communities to which infection may be taken than a higher rate occurring only occasionally. The only large cities with rates higher than 40 for a series of years ending with 1910 were Birmingham, Atlanta, Nashville, and Spokane; but several of the minor cities had such rates, notably, Fresno, Cal.; Jacksonville, Fla; Cumberland, Md.; Escanaba and Menominee, Mich.; Duluth, Minn.; Long Branch, N.J.; Cohoes, Niagara Falls, and Watertown, N.Y.; Wilmington, N.C.; Chillicothe and Portsmouth, Ohio; Braddock, Johnstown, and McKeesport, Pa.’ Charleston, S.C.; Petersburg, Va.; and Wheeling, W. Va. …” (p. 27.)

McLaughlin, 1912: “The excessive prevalence of typhoid fever in the United States has been characterized, and not without reason, as a national disgrace….

“It is useless to expect that the dejecta of all persons ill with typhoid fever or cholera will be properly disinfected before reaching the sewers, especially if the contributor is a carrier who shows no signs of illness. It is evident that the surest and most prompt protection against water-borne diseases can be afforded in each case by proper treatment or filtration of the public water supplies. With cholera, we have only the menacing possibility, but with typhoid fever we have the actual existence of the disease in such a high rate of prevalence that the United States suffers seriously by comparison with other civilized countries.

“The average American citizen displays toward sanitary problems a very dangerous apathy. It is difficult to arouse his interest in anything so well known as typhoid fever. Cholera or plague or any scourge which to him suggests a quick and mysterious death will awaken his instinct of self-preservation and arouse him to activity; not so typhoid fever. It has been all about him always, excites no terror, and is viewed indifferently as an inevitable visitation which comes every year and takes its toll from the community. He never asks himself, Is this visitation inevitable? Or, May not typhoid fever be prevented or reduced? Twenty deaths per 100,000 probably represent 200 cases of typhoid fever. Suppose 200 cases of Asiatic cholera occurred in any American city of 100,000 population, would not strenuous activity be displayed and very properly so for the eradication of the scourge? Although the case mortality rate of typhoid fever is lower than that of cholera, yet typhoid fever is transmissible in more ways, is more expensive in its lingering course, and more disastrous in its sequelae than Asiatic cholera. The mental attitude toward typhoid fever, displayed by many physicians and especially health officers, is scarcely more commendable. Their complacency in the face of typhoid fever rates of above 20 deaths annually per 100,000 population is difficult to explain….

“A conservative estimate for 1910 will place the deaths from typhoid fever above 25,000. When we consider that the smaller cities in America have in general higher rates than the larger, that the rural typhoid is high and in many sections higher than the urban, that in the sections not included in the registration area sanitary conditions are probably worse and typhoid fever rates higher than within the area, we are forced to conclude that a general rate of 25 is probably below the actual deaths from typhoid fever per 100,000 population in the entire United States.

“The excess of 18 deaths per 100,000 in the urban population alone shows that we have had in the 50 cities mentioned above, at least, 3,600 deaths and probably 36,000 cases of typhoid fever which were preventable and should never have occurred. For the whole United States the number of cases for each year preventable by methods within our grasp would probably reach 175,000, and the deaths so avoided would total 16,200. In 1909 there were more cases of typhoid fever in the United States than there were cases of plague in India in spite of the fact that India’s population is two and one-half times that of the United States.

“From January, 1907, to October, 1911, there occurred in Russia 283,684 cases of Asiatic cholera. This included the appalling epidemic of 1910. According to a conservative estimate there occurred in the United States during the same period one million and a quarter cases of typhoid fever, or more than 4 cases of typhoid fever in the United States for every case of cholera in Russia. We heard a great deal of the terrible ravages of cholera in Italy in 1910-11; yet in these two years there occurred in Italy about 16,000 cases of cholera, with about 6,000 deaths, and in the United States in the same period we had more than a half million cases of typhoid fever and 50,000 deaths.

“We are accustomed to speak of certain countries as pest ridden, and a residence in them or even a brief visit is considered with apprehension. But do we consider the prevalence of typhoid fever in our own country with sufficient seriousness? The annual 25,000 deaths from typhoid fever do not represent our total loss. At a conservative estimate they are accompanied by a quarter of a million of cases of the disease each year.

“These cases represent an average illness for each individual of four weeks and probably six or eight weeks enforced abstinence from any gainful occupation. The economic loss is appalling, and, computing the value of the lives lost to the community, the cost of medical attendance and hospital care, the loss of earning capacity for many weeks, the decreased earning capacity and impaired efficiency due to sequelae, would reach a sum of not less than $100,000,000 annually.

“To understand fully the menace of typhoid fever, one must remember that it can not be prevented by ordinary personal cleanliness as typhus fever may be prevented, and is not confined to the poor and dirty, but reaches all classes.

“It is not something we have in childhood and consign to history, as scarlet fever or measles, but a disease which attacks the most robust adult individuals during the period of their greatest activity and their greatest economic value to the community. Typhoid fever is a disease against which the individual is helpless, and protection of the individual can be effected only by sanitary control of the entire food and drink supply and the sanitary disposal of human excreta.

“Time will not permit the discussion of the whole problem of typhoid fever transmission, and I shall confine myself to the water-borne typhoid solely. This is done with a full appreciation of the great importance of the other factors in typhoid transmission, viz, milk, control of patients and carriers, contact, flies, and rural typhoid.

“No single measure in reducing typhoid fever on a large scale approaches the effect of substituting a safe for a polluted water supply. As an instance of this wholesale saving of human life, the reduction of typhoid fever in Pittsburgh may be cited. Since the installation of the Pittsburgh plants there has been an annual saving in the city of 400 lives from typhoid fever alone. Installation of safe water supplies in America has not always produced brilliant results, but the failure to reach the low figures attained by the Germans is due principally to three things: First, failure to supply pure water to all: second, imported cases, usually from communities which are typhoid centers; third, existence of insanitary conditions, such as contaminated wells, outdoor privies, and lack of control over milk and excreta.

“As an instance of high rate due to failure to furnish filtered water to all the people, the experience of Pittsburgh is interesting. The filter plant in Pittsburgh was first put in operation November, 1907. But a small portion of filtered water was supplied at first and this was mixed with the unfiltered supply. The amount of water filtered was increased until October, 1908, when the supply of that part of the city between the rivers—about three-fifths of the total population—was filtered.

“The south side, a little less than one-fifth of the entire population, was supplied with filtered water in March, 1909. The former city of Allegheny, recently annexed, is not yet supplied with filtered water. This part of the city includes a population of about one-fourth of the entire city.

“There was a remarkable decrease of typhoid fever in Pittsburgh progressively coincident with the increase of area supplied with filtered water. In spite of all this remarkable reduction two points stand out prominently: First, the rate is still high (1910), and, second, the seasonal distribution suggests water as a prime factor….

“The absolute necessity of a safe water supply—and by “safe” a supply is meant which is safe 365 days in the year—in seeking to rid ourselves of the odium of water-borne typhoid, is obvious. The installation of such a supply, however, has another powerful effect upon the typhoid-fever rate. The existence of a pure public water supply makes possible the elimination of the dangerous shallow well and filthy yard privy. With a contaminated or unsightly public supply a vigorous campaign against the insanitary privy and contaminated well is impossible. The householder is as a rule unwilling to close his well and connect his premises with the public water mains unless the city water appears to be better than that obtained from the well. When water connections have once been made, water closets or other suitable toilet facilities are usually installed as a matter of convenience and the yard privy is no longer needed and its use, therefore, is discontinued.

“The conditions which make disaster possible where the source of public water supply is polluted are two, viz:

1. Failure to purify.
2. Inefficiency of the purification.

“The failure to install a purification plant is usually due to an undue confidence in a water supply which is safe “most of the time.” It is difficult for some officials to understand, without a severe lesson, that it is not sufficient to have a water supply that is safe for 360 or 361 days in the year, and to these officials it seems scarcely justifiable to require expensive purification for the sake of the four or five days in the year during which, due to weather conditions, pollution may take place. Such a supply, with a favorably placed intake, may escape pollution for more than a year. There was no evidence of serious pollution of the water supply of the city of Erie during the year 1909, yet the appalling disaster of January and February, 1911, showed that pollution could take place under certain weather conditions.

“There is also too much confidence placed in unfiltered surface supplies from inhabited watersheds. Even where there is alleged control of the watershed and ample storage, pollution may occur. In regard to unfiltered surface supplies the need of bacteriologic control is very evident. Dangerous pollution may be present only for a few days or for a few hours. This is most likely to be disastrous in time of drought or low water. At such times the diluting effect of the inflow and the purifying effect of storage are both reduced to the minimum. The bacterial count per cubic centimeter is valuable, but the quantitative estimation of B. coli is of far greater importance. A low count does not necessarily imply a safe water, but a low count, coupled with absence of B. coli, may be considered an index of safety.

“The typhoid epidemic in Baltimore 1 in 1910 was coincident with a prolonged drought. The run-off from the watershed of the Gunpowder River was reduced to the minimum. The sewage pollution was thus concentrated and gross pollution was evident upon bacteriologic examination. B. coli was frequently found in 0.1 of a cubic centimeter, and sometimes in 0.01 cubic centimeter samples. When the run-off increased, affording greater dilution and increased storage, the water returned to normal and the typhoid fever dropped to a minimum.

“In Europe surface supplies are almost invariably filtered, and eventually such supplies m America will be treated or filtered.

“Poor filter efficiency is often responsible for disaster in the shape of typhoid outbreaks and may be due to several causes. The slow sand type may give poor filter efficiency when sufficient extra units are lacking, necessitating excessive rates and placing of “green” filters in service. Excessive rates, too little coagulant, insufficient sedimentation capacity, and insufficient storage are common operating and structural faults of the mechanical type. Sometimes a properly constructed plant is struggling with a raw water which has a high bacterial content and even with fair filter efficiency yields an unsafe effluent. Probably the greatest single cause of a poor effluent from filter plants is inefficient operation by unskilled men. It is absolutely essential for good results that bacteriologic examination, including B. coli estimation, be made at least once daily, and in slow sand plants from each unit separately.

“The man in charge must be able to do this. In mechanical filter plants or with hypochlorite plants he must also have the necessary skill to adjust his chemicals with nicety according to the changes in the raw water. With such a man in charge of a properly constructed plant a safe effluent is assured at all times. When struggling with a bad raw water, he will use hypochlorite as an adjuvant with good results. He will study the peculiarities and fluctuations of the constituents of the raw water and adjust his treatment accordingly.

“The most serious defect in sanitary control of our water supplies is the lack of proper daily bacteriologic examination of the water and quantitative estimation of the B. coli content. In some of the lake cities there is proper daily bacteriologic examination of the water supply, but in many of them there is either an imperfect examination or none at all. One city with a slow sand filter plant of three units and a consumption equal to the safe filter capacity of the beds operates these without rest, putting the units in service “green” and with an occasional examination of the water once or twice a month. As a result this city in 1910 had a typhoid-fever death rate of over 300 per 100,000. One large city using unfiltered lake water is so sure that the water is pure that examination is made only occasionally. One of the largest lake cities using an unfiltered supply exposed to sewage pollution makes a bacterial count daily, but restricts its effort to detect sewage pollution to the antiquated and indefinite test of inoculating a guinea pig occasionally with a small portion of a broth culture.

“It is the plain duty of a municipality to provide its citizens with pure water. It is not sufficient to warn against a supply as dangerous and advise its use only for fire, lawn sprinkling, or factory purposes, as at Flint or Saginaw. There are many people in every city who are like children and must be protected even against themselves. The lazy, poor, and ignorant will drink and use the polluted public supply from a convenient tap rather than travel a considerable distance to a pump or buy bottled water which they can ill afford. Neither is it sufficient to have a safe supply for 360 days out of the year, warning the people to boil the water on the other 5 days. The notice to boil the water is based on bacteriologic findings which are 24 hours late. The notice is often ineffective, and by some ignored….” (US PH&MHS. “The Necessity for Safe Water Supplies in the control of Typhoid Fever,” Allan J. McLaughlin, Public Health Rpts. V27, N12, 3-22-1912, 421-429.)

Newspapers

Illinois

Nov 19: “Hoopeston, Ill., Nov. 19. – ‘Typhoid Mary,’ a famous New York medical curiosity, may have a counterpart in a Hoopeston woman, designated as ‘Mrs. X,’ in the official bacteriological report on the typhoid epidemic here. She had typhoid fever in 1886 and has ben assisting in preparing milk, carrying colon bacilli to 66 victims.” (Fairfield Daily Journal, IA. “Carries Fever to Fifty-Six.” 12-29-1910, p. 7.)

Iowa

Dec 31: “(By Iowa Evening Press.) Des Moines, IA., Dec. 31. – Officials of the state board of health today threatened to take charge of the typhoid fever epidemic unless the city board makes better progress. They urge that steps be taken to cut off the sewer at Valley Junction which empties into the Racoon river above the water works.” (Iowa Evening Press. ”State Board May Take Fight in Hand.” Muscatine Journal, 12-31-1910, p. 1.)

Ohio

Dec 24: “A general warning has been sounded all along the valley to boil the river water [Ohio River] for drinking purposes. There is an epidemic of typhoid fever in many of the towns in the section of the valley and most of the sickness is attributed to the water from the Ohio river which is unfit for drinking purposes.” (Steubenville Herald-Star, OH. “Boil the Water.” 12-24-1910, p.3.)

Sources

Bureau of the Census. Mortality Statistics 1910. Eleventh Annual Report. Washington: Department of Commerce (Government Printing Office), 1913. Accessed 3-19-2020 at: https://www.cdc.gov/nchs/data/vsushistorical/mortstatsh_1910.pdf

Evening Press. “Typhoid Fever at Des Moines.” Waterloo Evening Courier, IA, 12-30-1910, p. 10. Accessed 3-19-2020 at: https://newspaperarchive.com/waterloo-evening-courier-dec-30-1910-p-10/

Fairfield Daily Journal, IA. “Carries Fever to Fifty-Six.” 12-29-1910, p. 7. Accessed 3-19-2020 at: https://newspaperarchive.com/fairfield-daily-journal-dec-29-1910-p-7/

Ford, William W. and E. M. Watson. “The Problem of Typhoid Fever in Baltimore.” Pp. 351-356 in Bulletin of The Johns Hopkins Hospital (Vo. 22, No. 248, Oct 1911). Digitized by Google: http://books.google.com/books?id=zGtNAAAAYAAJ&printsec=frontcover&source=gbs_atb#v=onepage&q&f=true

Freeman, A. W. (U.S. Public Health Service). “Case Fatality in Typhoid Fever.” Public Health Reports, Vol. 31, No. 49, 12-8-1916, pp. 3356-3358. Accessed 9-9-2013 at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2013823/pdf/pubhealthreporig03379-0006.pdf

Iowa Evening Press. ”State Board May Take Fight in Hand.” Muscatine Journal, 12-31-1910, p. 1. Accessed 3-19-2020 at: https://newspaperarchive.com/muscatine-journal-dec-31-1910-p-1/

Le Grand Reporter, IA. “Girl is Typhoid Victim.” 12-30-1910, p. 2. Accessed 3-19-2020 at: https://newspaperarchive.com/le-grand-reporter-dec-30-1910-p-2/

McLaughlin, Allan J. “Sewage-Polluted Water Supplies in Relation to Infant Mortality.” Public Health Reports, Vol. 27, No. 17, 4-26-1912, pp. 579-612. Accessed at: http://books.google.com/books?id=GgE4AAAAYAAJ&printsec=frontcover&source=gbs_atb#v=onepage&q&f=false

McLaughlin, Allan J. “The Necessity for Safe Water Supplies in the Control of Typhoid Fever,” Public Health Reports, Vol. 27, N, 12, March 22, 1912, pp. 421-429. Digitized by Google at: http://books.google.com/books?id=GgE4AAAAYAAJ&printsec=frontcover&source=gbs_atb#v=onepage&q&f=true

Morning Herald, Uniontown. “Official Facts About Uniontown.” 12-27-1910, p. 2. Accessed 3-19-2020 at: https://newspaperarchive.com/uniontown-morning-herald-dec-27-1910-p-2/

Steubenville Herald-Star, OH. “Boil the Water.” 12-24-1910, p. 3. Accessed 3-19-2020 at: https://newspaperarchive.com/steubenville-herald-star-dec-24-1910-p-11/