The filtration of public water-supplies / Third edition, revised and enlarged. - Allen Hazen

The following is a list of the cities of 50,000 inhabitants and upward in the United States, with deaths from typhoid fever and the sources of their water-supplies. The deaths and populations are from the U. S. Census for 1890; the sources of the water-supplies, from the American Water-Works Manual for the same year. Four cities of this size—Grand Rapids, Lincoln, St. Joseph, and Des Moines—are not included in the census returns of mortality. Two cities with less than 50,000 inhabitants with exceptionally high death-rates have been included, and at the foot of the list are given corresponding data for some large European cities for 1893.

TYPHOID FEVER DEATH-RATES AND WATER-SUPPLIES OF CITIES.
City.		Population.	Deaths from Typhoid Fever.		Water-supply.
City.		Population.	Total.	Per 100,000 living.	Water-supply.
	Birmingham	26,178	69	264	Five Mile Creek
1.	Denver	106,713	232	217	North Platte River and wells
2.	Allegheny	105,287	192	182	Allegheny River
3.	Camden	58,313	77	132	Delaware River
4.	Pittsburg	238,617	304	127	Allegheny and Monongahela rivers
	Lawrence	44,654	54	121	Merrimac River
5.	Newark	181,830	181	100	Passaic River
6.	Charleston	54,955	54	98	Artesian wells yielding 1,600,000 gallons daily
7.	Washington	230,392	200	87	Potomac River
8.	Lowell	77,696	64	82	Merrimac River
9.	Jersey City	163,003	134	82	Passaic River
10.	Louisville	161,129	122	76	Ohio River
11.	Philadelphia	1,046,964	770	74	Delaware and Schuylkill rivers
12.	Chicago	1,099,850	794	72	Lake Michigan
13.	Atlanta	65,533	47	72	South River
14.	Albany	94,923	67	71	Hudson River
15.	Wilmington	61,431	43	70	Brandywine Creek
16.	St. Paul	133,156	92	69	Lakes
17.	Troy	60,956	42	69	Hudson River and impounding reservoirs
18.	Los Angeles	50,395	34	67	Los Angeles River and springs
19.	Nashville	76,168	49	64	Cumberland River
20.	Cleveland	261,353	164	63	Lake Erie
21.	Richmond	81,388	50	61	James River
22.	Hartford	53,230	32	60	Connecticut River and impounding reservoir
23.	Fall River	74,398	44	59	Watupa Lake
24.	Minneapolis	164,738	94	57	Mississippi River
25.	San Francisco	298,997	166	56	Lobus Creek, Lake Merced, and mountain streams
26.	Indianapolis	105,436	57	54	White River
27.	Cincinnati	296,908	151	51	Ohio River
28.	Memphis	64,495	33	51	Artesian Wells
29.	Reading	58,661	29	49	Maiden Creek and Springs
30.	Baltimore	434,439	202	47	Impounding reservoir
31.	Omaha	140,452	63	45	Missouri River
32.	Columbus	88,150	38	43	Surface-water and wells
33.	Providence	132,146	53	40	Pawtuxet River
34.	Kansas City	132,716	53	40	Missouri River
35.	Rochester	133,896	53	39	Hemlock and Candice lakes
36.	Evansville	50,756	20	39	Ohio River
37.	Boston	448,477	174	39	Impounding reservoirs
38.	Toledo	81,434	29	36	Maumee River
39.	Cambridge	70,028	24	34	Impounding reservoir
40.	St. Louis	451,770	145	32	Mississippi River
41.	Scranton	75,215	24	32	Impounding reservoir
42.	Buffalo	255,664	80	31	Niagara River
43.	Milwaukee	204,468	61	30	Lake Michigan
44.	New Haven	81,298	22	27	Impounding reservoir
45.	Worcester	84,655	22	26	Impounding reservoir
46.	Paterson	78,347	20	26	Passaic River (higher up)
47.	Dayton	61,220	15	25	Wells
48.	Brooklyn	806,343	194	24	Wells, ponds, and impounding reservoirs
49.	New York	1,515,301	348	23	Impounding reservoir
50.	Syracuse	88,143	18	20	Impounding reservoir and springs
51.	New Orleans	242,039	45	19	Mississippi River
52.	Detroit	205,876	40	19	Detroit River
53.	Lynn	55,727	9	16	Impounding reservoir
54.	Trenton	57,458	9	16	Delaware River
	London	4,306,411	719	17	Filtered Thames and Lea rivers and ¹⁄₄ from wells
	Glasgow	667,883	138	20	Loch Katrine
	Paris	2,424,705	609	25	Spring water
	Amsterdam	437,892	69	16	Filtered dune-water
	Rotterdam	222,233	12	5	Filtered Maas River
	Hague	169,828	3	2	Filtered dune-water
	Berlin	1,714,938	161	9	Filtered Havel and Spree rivers
	Hamburg	634,878	115	18	Filtered Elbe River
	Breslau	353,551	37	11	Filtered Oder River
	Dresden	308,930	14	5	Ground-water
	Vienna	1,435,931	104	7	Spring-water

Any full discussion of these data would require intimate acquaintances with the various local conditions which it is impossible to take up in detail here, but some of the leading facts cannot fail to be instructive.

Each of the places having over 100 deaths per 100,000 from typhoid fever used unfiltered river-water. Lower in the list, but still very high, Charleston, said to have been supplied only from artesian wells, had an excessive rate; but the reported water-consumption is so low as to suggest that private wells or other means of supply were in common use. Chicago and Cleveland both drew their water from lakes where they were contaminated by their own sewage. St. Paul’s supply came from ponds, of which I do not know the character. With these exceptions all of the 22 cities with over 50,000 inhabitants, at the head of the list, had unfiltered river-water.

The cities supplied from impounding reservoirs as a rule had lower death rates and are at the lower end of the list, together with some cities taking their water supplies from rivers or lakes at points where they were subject to only smaller or more remote infection. Only three of the American cities in the list were reported as being supplied entirely with ground-water.

It is not my purpose to make too close comparisons between the various cities on the list; some of them may have been influenced by unusual local conditions in 1890. Others have in one way or another improved their water-supplies since that date, and there are several cities in which I know the present typhoid-fever death-rates to be materially lower than those of 1890 given in the table. On the other hand, it is equally true that a number of cities, including some of the larger ones, have since had severe epidemics of typhoid fever which have given very much higher rates than those for 1890.

These fluctuations would change the order of cities in the list from year to year; they would not change the general facts, which are as true to-day as they were in 1890. Nearly all of the great cities of the United States are supplied with unfiltered surface-waters, and a great majority of the waters are taken from rivers and lakes at points where they are polluted by sewage. The death-rates from typhoid fever in those cities, whether they are compared with better supplied cities of this country, or with European cities, are enormously high.

Such rates were formerly common in European cities, but they have disappeared with better sanitary conditions. The introduction of filters has often worked marvellous changes in Europe, and in Lawrence the improvement in the city’s health with filtered water was prompt and unquestionable. There is every reason to believe that the general introduction of better water in American cities will work corresponding revolutions; and looking at it from a merely money standpoint, the value of the lives and the saving of the expenses of sickness will pay handsomely when compared with the cost of good water.

The reasons for believing that cholera is caused by polluted water are entirely similar to those in the case of typhoid fever. It was no accident that the epidemic of cholera which caused the death of 3400 persons followed the temporary supply of unfiltered water by the East London Water Company in 1866, while the rest of London remained nearly free, or that the only serious outbreak of cholera in Western Europe in 1892 was at Hamburg, which was also the only city in Germany which used raw river-water. This latter caused the sickness of 20,000 and the death of over 8000 people within a month, and an amount of suffering and financial loss, with the panics which resulted, that cannot be estimated, but that exceeded many times the cost of the filters which have since been put in operation. Hamburg had several times before suffered severely from cholera, and the removal of this danger was a leading, although not the sole, motive for the construction of filters.

How little cities supplied with pure water have to dread from cholera is shown by the experience of Altona and other suburbs of Hamburg with good water-supplies, which had but few cases of cholera not directly brought from the latter place, and by the experience of England, which maintained uninterrupted commercial intercourse with the plague-stricken city, absolutely without quarantine, and, notwithstanding a few cases which were directly imported, the disease gained no foothold in England.