1909 1910 1911 1912 1913 1914 1915 1916 1917 TABLE 3. THE COST OF TYPHOID FEVER IN OHIO - DEATHS, SICKNESS, MONEY. Average in 1917. In noting the village and township rates, account should be taken of the excess in the cities of persons at the age periods at which the disease is most common and fatal. Table 2 shows twenty-four counties with average rates in 1916-17 of 10 or less per 100,000, fortythree with rates between 10 and 20, 18 between 20 and 30; one, Scioto County, with a rate of 37.2; one, 80,443 $37,403,790 | $66,367,500 8,938 $4,155,977 $7,374,167 TABLE 4. SEX AND AGE DISTRIBUTION IN 2,000 REPORTED CASES OF TYPHOID FEVER, TABULATED IN 1917. TABLE 5. TYPHOID FEVER, 1917, OHIO CITIES WITH POPULATION EXCEEDING 30,000, 1910 CENSUS: DEATHS AND REPORTED CASES, WITH RATES PER 100,000 POPULATION AND FATALITY RATE PER 100 REPORTED CASES. deaths and 31 percent of the reported cases in the state in 1917, giving an average death rate for these cities of 11.2. Seven of the cities had a rate below 10 per 100,000, the rate at least which a pure water supply and a sewer system should afford. Three of the cities - Akron, Youngstown and Zanesville had rates greatly exceeding 20 per 100,000, indicating in general unsatisfactory water and sewerage. For the five largest cities Cleveland, Cincinnati, Columbus, Toledo and Dayton - the average rate was 7.5, the same as Cleveland's rate for the year, Cincinnati's low rate particularly making up for the higher rates of Columbus, Toledo and Dayton. In these five largest cities, embracing 31 percent of the state's population, there occurred only 18 per cent, or 123, of the 682 deaths caused by typhoid in the state in 1917. In Table 3, two estimates of the financial losses from typhoid fever are given. The conservative estimate, exceeding $37,000,000 for the nine years, is based on an average illness of four weeks, a case fatality of eleven percent, low cost of medical attendance, low wages and the valuation of wages and lives lost on the actual number in specified age groups dying each year. The probable cost of $66,000,000 is based on Johnson's estimated sum total vital capital loss from one typhoid fever death of $7,500. Johnson's figure has been reached conservatively enough to indicate that the lower estimates in Table 3 are gross under-statements. Taking however, an aver age of the two estimates the cost of typhoid fever in Ohio for the past nine years, figures $51,885,645,-an annual loss of $5,765,072, speaking merely from a mercenary standpoint. Complete Case Reports The purpose of these diagrams and tables is so evident that a plea for reports of all cases of typhoid fever should be unnecessary. One cannot fail to recognize that prompt case reports will give to health authorities and community that warning which should at once start action, individually and collectively, for control and prevention. The responsibility for reporting cases rests too lightly on the shoulders of many physicians and health officers. It is unfortunate that at least the financial loss from unreported cases cannot be levied upon the physician or other person who fails to report or upon the health officer who neglects to take necessary action upon the receipt of report. S. K. Water Purification I T is a well established fact that the use of contaminated water is the most important single cause of urban typhoid fever. Serious outbreaks of the disease frequently occur and abnormally high typhoid fever death rates obtain in cities and villages which maintain impure public water supplies secured from streams and other surface sources and furnished to the consumers without treatment. The use by individuals of water from contaminated private wells is also a serious factor, and in those communities where such wells are generally used typhoid fever is prevalent with more or less regularity. Obviously, the first essential in elimination of water-borne typhoid fever is the provision of a pure public water supply. It is pertinent to observe that the purity 1 of the water supply cannot be relative, but must be absolute, to accomplish elimination of waterborne typhoid fever. Moreover, such an improvement must be accompanied by the universal use of the public water supply throughout the community and by the complete elimination of all other sources, including private wells which are contaminated, or the safety of which is questionable. If this is accomplished, all typhoid resulting from the use of drinking water will be eliminated and the residual typhoid will be that due to other causes. It has been stated that in the northern part of the United States the purification of the public water supply of a city will result in the reduction of the annual typhoid death rate to a figure usually under 20 per 100,000. Another writer 1 A. W. Freeman, M. D., The Present Status of Our Knowledge Regarding the Transmission of Typhoid Fever. states that if all of the urban population of the United States were supplied with filtered water, or water of equal purity, the average urban typhoid fever death rate would be 14 per 100,000. Whatever the residual figure may be, it is evident that it represents the typhoid fever due to causes other than infected water supplies if complete use of a perfectly pure water is secured. In a table compiled by Mr. George A. Johnson, showing the reduction in typhoid fever death rates following the filtration of public water supplies, data for twenty American cities are used. It is shown that the weighted average typhoid fever death rate for all of the cities for a period of five years prior to filtration of their public water supplies was 60 per 100,000, and that the weighted average rate for a similar period following filtration was 21, showing a reduction of 65 percent. These figures appear to indicate that an average residual rate of 20 per 100,000 is about what may be expected with the general use of purified public water supplies. In Ohio the experience resulting from the purification of public water supplies has been much the same as has been recorded in other places. In the accompanying table (No. 1), a comparison of typhoid fever death rates is presented before and after filtration of the water supplies of seven Ohio cities. These cities have been selected for TABLE 1. EFFECT ON TYPHOID DEATH RATE CAUSED BY FILTRATION OF IMPURE WATER SUPPLIES OF OHIO CITIES. George A. Johnson, "The Typhoid Toll", Journal American Water Works Association, June, 1916. |