In this connection the following clipping from the Port Huron Daily Times of March 8, 1904, will be of interest: THE COST OF TYPHOID FEVER. In his address on the "Water Supply of Cities" before the Michigan Municipal League, at the meeting recently held at Ann Arbor, Dr. Victor C. Vaughan, Dean of the Medical Department of the University of Michigan, pointed out the loss to the country every year from typhoid fever. He said: "There die in the country every year from typhoid fever alone not less than 50,000 people. To get down to dollars and cents, which is the American way of figuring everything, say each man was worth a thousand dollars. With 50,000 deaths from this disease we are losing by death alone fifty million dollars every year. "Besides there are 500,000 others sick in this country every year from typhoid fever. Then we will say that the time of each one of these individuals is worth a dollar a day, also that there must be at least one nurse, and we will suppose that these services are worth one dollar a day. Then for each day that those 500,000 people are sick, the people of the United States are paying one million dollars. And forty days is certainly an average duration for typhoid fever. Then with this forty million and the fifty millions lost by death, it is interesting to note that the people of the United States are paying a tribute of $90,000,000 to our igorance for the existence of a disease which, if every man did his duty, would not exist at all." EPIDEMIC OF TYPHOID FEVER AT ESCANABA. Beginning in February, and continuing through March, April and May, 1904, an epidemic of typhoid fever, of unusual severity, prevailed in the city of Escanaba, Delta County, and resulted in 204 cases and 40 deaths. The reports to this Department relative to this epidemic were very meagre, the first information relative to the outbreak being obtained from the Daily News of March 10, 1904, in which it was alleged there had been at that time fifty cases of the disease. A newspaper report on March 24 placed the number of cases then present at two hundred. To the cases and deaths which occurred in Escanaba in 1904 should be added the 13 cases and 2 deaths, previously mentioned, which occurred in other jurisdictions but were directly traced to Escanaba as the source of infection. An article by Dr. O. C. Breitenbach, who was appointed health officer of Escanaba in July, 1904, on the subject of the epidemic and the general sanitary conditions at Escanaba, appeared in the Escanaba Daily Union of October 4, 1904, extracts from which are here printed: The high death rate of Escanaba, as well as the question of its causation, has received much honest thought at home, and by the people throughout the state. In any discussion of the subject, it must not be lost sight of that there are many factors, interdependent, that undermine the health of a city such as Escanaba. The growth of other sister cities has not been concomitant with ours. While these have decreased in population, or remained stationary, Escanaba was netted with a sudden influx, so that its population, numbering only 6,808 in 1890, now approximates 11,000. Improvements, by force of circumstances, naturally could not keep pace with such rapid growth. Thus was brought into existence the dominant factor of disease-defective sanitation. To adapt and shape the environment of a municipality characterized by this sudden influx of people, is not the work of a single year, or a single administration. Many demands for public funds showed themselves, not at all commensurate with the city's revenue. Public schools, police and fire protection, and at the present time and in an enthusiastic manner public highways, all call for large disbursements. The need of protection from a danger greater than any other the city need fear, behind which lurks the grim visage of Death, taking away from home the loved ones in childhood and adolescence, types of manhood and womanhood the city can ill afford to lose, becomes imperative with the sorrowful picture of the recent epidemic. Rural sanitation, as it exists in the city today, needs to be supplanted by a system more in accord with the needs of the community. Health work needs to be supported by those that grasp its full scope and possess intelligence enough to appreciate statistics. As a social unit, we all have duties placed upon us. Philanthropy finds expression in no more practical way than by united conscientious support of this work. The conditions holding forth in Escanaba representing the highest death rate of any city of its size in the State, are not what they might reasonably be. Health work, in its fullest meaning, needs to be put on a more economical and more efficient basis. То this end, the Mayor, Council and Board of Health are putting forth honest efforts. "Cleanliness is next to Godliness," and verily filth is the bulwark of germ growth. The dissemination of disease is controlled by all factors involving filth or pollution. Among the more important factors controlling an epidemic, are the following: 1. Infected water supply. 2. Defective drainage. 3. Contaminated soil, such as cesspools, decomposing garbage, etc. 4. Failure to resort to proper preventive measures in the sick room. 5. Failure to notify proper authorities of any outspread of a communicable disease. The Philadelphia epidemic of 1898, and the more recent Butler epidemic, have demonstrated the importance of a pure water supply. When we consider the possible cause holding forth in water pollution, it becomes necessary to bear in mind the several sources of drinking water in a given locality. Faucet water and wells supply the householders in Escanaba. The possibilities of contamination of faucet water in Escanaba are many. Not alone is the city's sewerage of great danger in itself, but also the currents that are characteristic of Little Bay de Noc, that may carry pollution to the very mouth of the intake pipe. The demand for a purer water supply has led the Escanaba Water company to the construction of a new intake. The completion of this will obviate this to a degree, and its completion will therefore be looked forward to with interest. However, the great importance of filtration needs yet to be vindicated. When one calls to mind the fact that well water is affected by atmospheric conditions, by the soil it falls upon, and by the soil it percolates through, the dangers that lurk in cesspools, buried privy vaults and like nuisances, at once become apparant. Defective drainage is another factor in disease. Escanaba is yearly extending its system of sewerage and with periodical flushings, will in time be of inestimable benefit in lowering the death rate. A third source of disease is found in accumulated filth of every description. An outhouse is a plague spot in every community, unless cleaned and disinfected at regular intervals. Cesspools, decomposing garbage, and manure cast about at random, are other sources. The present method of dealing with these is daily subjected to criticism. The sanitary police, at the present time, appointed by the mayor, investigates these sources of filth, and when, in his judgment, they exist as a public nuisance, a notice for their removal, within twenty-four hours, is served. The city scavenger is allowed the maximum fee of $4.00 per cubic yard for the cleaning of vaults, and $2.50 per load for the hauling of garbage and manure. The fee allowed him is a fee common to all scavengers in other cities, and is not exorbitant for the work done. The rate, however, is objected to. A thoroughly practical and inexpensive system, needs yet to be devised. My criticism and suggestion on the plan in vogue is the following: Why allow garbage and filth to accumulate until these become a nuisance and dangerous to public health. Why not have some means at our disposal by which the community at regular intervals is rid of a possible cause. Are there not means whereby the Board of Health can have people cooperate instead of rebel, as is common with the form of notice served at the present? Any cesspool cleaned, or any source of filth removed, is done so for the common good. Why not establish a system in which the people of the city shall be the aggressive element, making overtures. This will be accomplished by a city garbage system, let out by contract. The system would imply the placing of garbage cans by householders, and a prompt installment of manure boxes. Collecting would be carried on by a minimum number of single-horse, covered wagons, who do their work of collecting garbage in wards, bi-weekly, and a team and two men, working nights excavating cesspools and the like. The city controlling the system, under jurisdiction of the board of health, would make it a comparative inexpensive way of dealing with filth within the precincts of the city, yet one allowing thorough work. The feature of such a system that makes the strongest demand, is the prompt cooperation of every taxpayer. Paying his fraction in support of a garbage system, he will demand prompt and efficient service, or know the reason why. A fourth common source leading to the dissemination of disease is the extreme carelessness manifest in some sick rooms, where an infectious disease exists. The advice of the physician is seldom adhered to. As a consequence, there is much careless handling and use of infected articles, and many times a criminal neglect shown in the failure to properly disinfect excreta. A fifth cause of an epidemic is the failure of the householder or physician to appreciate the fact that it is a duty that an average intelligence sanctions, and the law implicitly demands, for him to report outbreaks of communicable diseases, and thus allow every effort to be put forth towards the prevention of their spread. Those that are guilty of not so doing, be it householder or physician, are guilty in the eyes of every physician, of professional bearing, of a lawlessness exemplified by the stain of innocent blood. The duty is so readily realized by one possessing an average mental poise to wade through the statistics that preventive medicine furnishes. The state grants to the afflicted, gratis, quarantine and disinfection. Is there any reason why it should be withheld? The medical profession has thus many times prevented what might have been a scourge to the city and state affected. For the sake of comparison, I append a compilation of the death rate for six consecutive years, during the months of February, March, April and May, the months during which the epidemic held full sway during this year, February, 1899, 17; 1900, 21. Eight deaths by violence, railway wreck at Ford River Switch; 1901, 14; 1902, 14; 1903, 19; 1904, 21. March, 1899, 18; 1900, 16; 1901, 15; 1902, 15; 1903, 22; 1904, 43. The high increase in mortality over previous years should readily aid in determining the factors that contributed to it. The fact that the epidemic spread far and wide, and was not at all respective of persons in any walk of life, is proof positive of a common cause. In this light, our several sources of drinking water are important. We anticipate the completion of the new intake pipe, as this may obviate this matter; yet Escanaba should always be in dire need of a filtration plant, for the removal of disease germs. Until that time, regular reports ought to be exacted, from time to time, as to the condition of the water supply. Well water must receive its due consideration, by rigid reforms and cleanliness of the city. In these several ways, another epidemic will be averted. "Every calamity is also a great opportunity." Let it be so in Escanaba, for the maintenance of a pure water supply. It has been shown that many factors contribute to the rise and fall in the mortality of water-borne diseases. The question why have not similar epidemics reaped a harvest in previous years, is often asked. One forgets the fact that Escanaba has always had an exceedingly high percentage of bowel diseases, and also a high mortality as a consequence. It simply remains for any one of the many factors influencing the water supply, to become aggravated. The outcome will be such an epidemic. It may be sewerage, stagnation of water source, faulty intake, lack of filtration, or infected reservoir; any one of these factors may lead to a veritable hotbed of germ growth. The more pollution in any water, the more sustenance for the multiplication of bacteria. The virulence in the human organism, and the fatality of the late epidemic, is readily explained by bacteriological data. The month of September shows a low mortality from acute diseases. Bowel disturbances netted the largest number of deaths. This statement may contain the prophecy of another severe winter. It may well be asked if bowel trouble being in the ascendancy now, what will be the condition when our main source of water is well nigh stagnant. TYPHOID FEVER AT GRAND RAPIDS IN 1904. Typhoid fever was unusually prevalent at Grand Rapids during each month of 1904, and resulted in a total of 659 cases and 61 deaths from this disease. The time of greatest prevalence of the disease occurred during the week ending February 27, when 40 new cases were reported. This was followed by reports of 36 new cases in the week ending March 5, and 25 new cases in the week ending March 12, after which time the disease began to decrease somewhat. During the latter part of October the number of new cases began to increase, and reached the number of 28 in the week ending December 17, and 26 in the week following. To the cases and deaths reported as having occurred in Grand Rapids should be added the 39 cases and 2 deaths, previously mentioned, which occurred in other jurisdictions but were directly traced to Grand Rapids as the source of infection. During the first week in February, 1904, Dr. T. M. Koon, the health officer of the city, called the attention of the board of health to the unusual prevalence of typhoid fever in the city, and made a number of timely suggestions relative to the restriction of the disease by the placarding of houses, the fumigation of houses where the disease occurs, and the adoption of rules for the disinfection of the excreta of patients. Some time during the month of February the board of health issued the following warning, which was published in the local newspapers: BOARD OF HEALTH BULLETIN. Owing to the prevalence of typhoid fever in the city, the public is warned against drinking water that has not been boiled. This applies particularly to water from wells and the river. It would also be safer to boil water from springs while typhoid fever is so prevalent. By order of Board of Health. T. M. KOON, Health Officer. It was not, however, until the month of November, 1904, that action was taken by the board of health relative to the placarding and fumigation of premises in cases of typhoid fever, as shown by the following letter received by this Department: BOARD OF HEALTH, Grand Rapids, Mich., Nov. 16, 1904. Dr. Henry Baker, Sec. State Board of Health, Lansing, Mich.: Allow me to inform you that beginning with the 11th inst. our local Board has commenced placarding and fumigating the premises for typhoid fever. We have already placarded twelve houses without any opposition on the part of the people. Very respectfully yours, . The unusual prevalence of typhoid fever during the early part of 1904 was not confined to Escanaba and Grand Rapids, as shown by the fol lowing warning sent out by this Department at that time: |