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TABLE 3. THE COST OF TYPHOID FEVER IN OHIO – DEATHS,

SICKNESS, MONEY.

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Age.

Male.

Female.

Total.

32 25 13

45-49 50-54 55-59 60-64 65-6.9 70-74

26 17 9 5 4 1

58 42 22 11 10 2

6 1

TABLE 4. SEX AND AGE DISTRIBUTION IN 2,000 REPORTED CASES

OF TYPHOID FEVER, TABULATED IN 1917.

Age.

Male.

Female.

Total.

Under 5 years. .

5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44

60 165 160 115 162 130 72 55 40

61 180 157 127 135

121
345
317
272
297
213
120
102
681

48
47
28 1

All ages

1,072

928 | 2.000

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.

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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 3! 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 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 warning which should at once start typhoid fever in Ohio for the past action, individually and collectively, nine years, figures $51,885,645,-an for control and prevention. The annual loss of $5,765,072, speak- responsibility for reporting cases ing merely from a mercenary stand- rests too lightly on the shoulders point.

of many physicians and health

officers. It is unfortunate that at Complete Case Reports

least the financial loss from unreThe purpose of these diagrams ported cases cannot be levied upon and tables is so evident that a plea the physician or other person who for reports of all cases of typhoid fails to report or upon the health fever should be unnecessary. One officer who neglects to take necescannot fail to recognize that prompt sary action upon the receipt of case reports will give to health

report. authorities and community that

S. K.

Water Purification As a Factor in

in the Elimination of Urban Typhoid fever

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occur

and

T is a well established fact of the water supply cannot be rel

that the use of contaminated ative, but must be absolute, to

water is the most important accomplish elimination of watersingle cause of urban typhoid borne typhoid fever. Moreover, fever. Serious outbreaks of the such an improvement must be acdisease frequently

companied by the universal use of abnormally high typhoid fever the public water supply throughout death rates obtain in cities and the community and by the complete villages which maintain impure elimination of all other sources, public water supplies secured from including private wells which are streams and other surface sources contaminated, or the safety of and furnished to the consumers which is questionable. If this is without treatment. The use by accomplished, all typhoid resulting individuals of water from con- from the use of drinking water taminated private wells is also a will be eliminated and the residual serious factor, and in those com

typhoid will be that due to other munities where such wells

causes. generally used typhoid fever is

It has been stated that in the prevalent with more or less regular

northern part of the United States ity.

Obviously, the first essential in the purification of the public water elimination of water-borne typhoid supply of a city will result in the fever is the provision of a pure

reduction of the annual typhoid public water supply. It is per- death rate to a figure usually under tinent to observe that the purity 20 per 100,000.

Another writer * A. W. Freeman, M. D.. The Present Status of Our Knowledge Regarding the Transmission of Typhoid Fezer.

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ASH TABULA

CINCINNATI
Population 1910 18266

Population 1910 363.591
Source of water supply Lake Erie Source of water supply. Ohio River
Water filtration plant procedin operation Water filtration plant placed in oper-

ation in 1907

140 in 1910

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Typhoid Mortality Rote per 100000

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Rote per 100.000

120

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Typhoid Mortality

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240

30

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states” that if all of the urban population of the United States were supplied with filtered water,

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 FILTRI

TION OF IMPURE WATER SUPPLIES OF OHIO CITIES.

Typhoid Fever

Death Rates
Per 100,004).

Population 1910.

Date of Installation of

Filtration Plant.

Average for Five

Years Prior to

Filtration.
Average for Five

Years Subsequent to Filtration.

12 18

1909 1907 1.10 1897 1909 1910 1905

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35 32

60

21

City.

Source of Water

Supply

Ashtabula
Cincinnati
Columbus
Lorain
Sandusky
Toledo
Youngstown

18.266 Lake Erie
303,591 | Ohio River
181,311 Scioto River
28.883 'Lake Erie
19.989 Sandusky Bay
168.497 Maumee River
79,066 Mahoning River

Weighted averages

* George A. Johnson, "The Typhoid Toll". Journal American Il’ater Works Association. June, 1916. * For four years

- 1893 to 1896, inclusive.

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