One family, consisting of father, mother and five children, managed ordinarily with a bed for the parents, a child's bed for the eight year old girl, a two-third size bed for the eighteen and sixteen year old daughters, and a cot for the fourteen year and ten year old sons, one sleeping at each end. First the mother and one of the boys were taken sick, and during the early part of their illness, no one was disturbed. But within a month, and before the first two patients got well, the four other children came down with typhoid, making six in the family sick together. Then the father slept on the floor and the sick mother got out of her bed to give place to two of the children, she, herself, sleeping at the foot of the bed until one of the children became delirious. After that she moved to the foot of the two-thirds bed. In the day time she had no place to lie down, and sat all day in a chair until she became so weak that she could hardly walk. Occasionally she helped her husband who did the cooking and cared for the patients, by paring potatoes and doing other small work about the kitchen. No one had time to keep the kitchen sink clean, and the accumulation of vegetable matter became so filthy that it had to be reported to the Bureau of Health. With family income cut off, and with nothing saved, the family would have been penniless had it not been that the doctor made his bill moderate; the family was trusted for groceries, milk and ice; friends gave about twenty dollars in cash, and Columbian Settlement furnished bedding and the services of a visiting nurse. The mother did not fully recover for about six months. The father, who suffered a good deal from loss of sleep and exposure while caring for the patients, contracted a cold. This developed into a serious case of asthma from which he died.
To these and many similar families there were more serious results than the debts incurred. A school girl's unrecovered health, a stogie roller's reduced speed, a blacksmith's and a tailor's loss of strength, a case of tuberculosis developed, a boy become a truant, a family broken up and deserted, a baby's death,—all are of tremendous concern as items in the annual wear and tear of the city's potential resources. They are items of "economic cost" that cannot be handled by the statistical method. They are, after all, the real human finger marks that typhoid leaves when its clutches are loosened.
Such a showing, then, of actual economic and personal loss as this study of six Pittsburgh wards brought out, is offered as a final leverage to those who in other American cities may be endeavoring to dislodge inertia and clear their water supplies. This investigation of typhoid fever, however, as it was found in the households of the wage earners of Pittsburgh, had its immediate practical bearings. The sanitary facts it brought out showed unequivocally the necessity for ridding the city of other sources of infection at the same time that the water supply was cleared.
There was evidence that many of the after cases in the families studied, were due to conditions existing entirely apart from the water. Reports on housing conditions in Pittsburgh show that a favorable laboratory for the growth and dispersal of germs exists in the city's unsanitary dwellings. Insufficient water supply renders cleanliness almost impossible. Overcrowding means increased possibilities of infection through contact with food and drink in the combined family kitchen, pantry, dining-room, and bedroom. Pittsburgh's thousands of open privy vaults afford ideal conditions for the spread of disease by flies and other insects, and by personal contact. Such plague spots as Saw Mill Run, with its string of double-and triple-decker rear privy vaults discharging on the banks of a stream which are flushed off only when the water rises after a rain, afford further examples, deplorable and disgusting.
How much of the Pittsburgh typhoid has been due to direct contagion from such conditions as these, can only be inferred at the present writing. In line with the general question of contagion, and secondary cause, however, our data afford some clews. They show that in forty of the families studied, the first case was followed in from ten days to one or two months by other cases, seventy-six cases in all, in addition to the original forty. It shows further that in at least eighteen of these families, one or more of the following conditions existed: Family crowded into one or two rooms; home dirty and poorly kept; the person who cared for the patient also doing the family cooking; well and sick members of the family sleeping in the same room and often in the same bed; privy vaults in exceedingly bad condition, and often stopped up and overflowing with filth. In one family, consisting of man, wife, four children and three lodgers, crowded into two dirty rooms, a three year old boy was taken sick in October. The mother did the family cooking and cared for the patient. The cesspool in the yard which was in bad condition was used by two families. Another member of the family became ill November 3, and the mother came down on December 19. There were seven cases in this one courtyard within the year.
In another instance a man, wife, and nine children were living in three rooms. The sixteen year old son was taken sick on June 20 and was sent to the hospital. Then in July came the thirteen year old daughter for whom her mother cared at home. The mother also did the family cooking. The father, mother and eleven year old son all slept in the same room with the patient. All three of them followed within a month, and another son twelve years old, was taken sick in August.