August 16, 1933: Chicago Amoebic Dysentery Outbreak Begins

Entamoeba histolytica

August 16, 1933: First day of amoebic dysentery outbreak at the Chicago World’s Fair. American Journal of Public Health editorial. “There are many reasons why the outbreak of amebic dysentery in Chicago in 1933 still holds intense interest. Some of these are practical and some scientific. On the practical side it will be recalled that the Exposition for 1934 opened in May. Already some of the daily papers are asking whether precautions have been taken to make the city safe for visitors, and repeating the charge that the news last year was suppressed. On the scientific side it must be pointed out that, as far as we have been able to determine, this is the first epidemic of the sort which has ever been recorded. The health officers had an entirely new problem to deal with, and there is no question that it took them by surprise, as it did everyone else. The paper read before this Association on October 9, 1933, attracted little attention; so little, in fact, that a prominent officer of the Public Health Service who heard it went back to Washington and did not even mention it. Some days later the report of a physician in Indianapolis that there were 5 or 6 cases of the disease in that city, all traceable to Chicago, gave the first intimation of its seriousness. Following this, on November 25, came from Boston what was probably the first information which showed how widespread the infection was, cases in Canada and elsewhere being reported. There was no official publication from the Board of Health of Chicago, as such, until November 18, though on November 14, the radio was used.

The health authorities of Chicago have been blamed severely for suppression of the news and it has been charged that it was done in order not to scare visitors away from the Exposition. A careful and what we believe to be an unbiased investigation fails to substantiate such a motive, though the facts are as just stated.

It must be remembered that very few of these cases occurred in Chicago, two having been reported on August 16, the date which the authorities fixed as the beginning of the outbreak. Owing to the period of incubation, which has been fixed by several observers on epidemiological evidence as from 12 to 30 days for the majority of cases, and even longer for others, visitors had arrived home in Canada and various parts of the United States before being taken sick. Doctors have all been taught that amebic dysentery is a tropical disease, and were not looking for it. Various diagnoses, such as appendicitis, colitis, ulcerative colitis, etc., were made. Operations for appendicitis were entirely too frequent, and the evidence shows that the majority of deaths have occurred among those who were operated on under mistaken diagnoses. Up to January 24, 1934, 721 clinical cases of amebic dysentery in 206 cities have been found and traced to Chicago, in addition to which, 1,049 carriers have been found in Chicago. Ninety-four per cent of the cases detected were guests at either Hotel C or A. Hotel A obtained its water from a tank on the roof of Hotel C. This water had been used for cooling and air conditioning purposes before being pumped to the roof. On January 22, a committee met in Chicago for 6 days and heard reports. Their conclusions have entirely changed the picture if they are accepted. In the meantime engineers have studied the situation, and several men who are specialists in the study of tropical diseases have been called upon.

As early as November 22, the hotels incriminated were directed to improve their plumbing arrangements. The Board of Health has had some 15 engineers or technical assistants making an intensive study of the water and sewage systems of the hotels involved. It must be said that they were in a mess. Like Topsy, the system has just “growed,” without noticeable planning. The house engineers have been in the habit of making repairs and additions without notifying the city. The inspection of hotels is not what it should be. Several city departments have inspectional powers, such as the Building Department, Fire Department, License Department, Department of Gas and Electricity, Smoke Inspection Department, Department for the Inspection of Steam Boilers, Department of Public Works, and Board of Health. It would seem that concentration of responsibility might have led to better results. Since the depression and the bankrupting of the city by the former administration, there is a shortage of inspectors, and even new work is scarcely kept up with, much less watching old work, repairs, alterations, etc. The evidence is that two hotels were responsible for 94 per cent of the cases detected. Careful charts have been made showing the dates of registration of the visitors and the dates when their bills were paid, as well as the appearance of the symptoms and the course of the disease as far as possible. If any considerable number of cases have occurred in the city, they have not been detected.

The hotels involved have been ordered to rearrange entirely their plumbing systems and to install new works throughout. The older part of the chief hotel dates back to the time when steel pipe was considered the best material for such work. The sanitary sewer pipes were found to be badly corroded, so that the writer pushed a five cent kitchen fork through the main pipe. Many leaks existed and, in a number of places, wooden plugs now badly rotted had been used to stop holes. Unfortunately, the sanitary sewer which carried some 62 per cent of the load of the hotel passed directly above the tank in which water was refrigerated for the dining rooms and the floors….”

Commentary: When I was an undergraduate, my textbooks referred to treatment methods to remove Entamoeba histolytica from drinking water. I was always confused about this because I had not heard why this pathogen was such a problem. The editorial from the American Journal of Public Health in 1934 reproduced above (almost in its entirety) gives much of the needed detail about the problem. It appears clear that the outbreak was caused by a cross connection between the sewer system and the drinking water system and that it affected two hotels. I particularly like the visual image of pushing a fork through a corroded sewer pipe. Another report noted that some cases of the disease probably occurred as early as June 1933. A total of 98 deaths were attributed to the outbreak.

August 15, 1915: Akron Water System Begins Operation; 1922: National Coast Anti Pollution League

Akron Water Treatment Plant, 1915

August 15, 1915: Akron Water System Begins Operation. “A century ago, Akron was a very unhealthy community. In 1915, 126 people came down with typhoid fever — with 25 deaths. The deaths and illnesses in Akron and other American cities were caused by contaminated drinking water. Akron’s problem started to disappear in 1915 when the city opened its new reservoir and new water-treatment plant in Portage County — plus lines to bring that water into Akron. The new system went into operation Aug. 15, 1915 — 100 years ago this Saturday. And before long, typhoid cases diminished. In 1920, Akron had eight typhoid deaths. By 1925, the death toll had dropped to two.

Today, Akron’s water system remains one of the city’s biggest assets. The city has invested $3 billion in the water system in the last 100 years, says Jeffrey Bronowski, Akron’s Water Supply Bureau manager. Akron’s efforts to overhaul its water system began in 1910. That’s when Mayor William T. Sawyer and City Council decided to create a whole new water system. On Aug. 28, 1911, an engineering team recommended that Akron buy land and build a reservoir north of Kent on the Cuyahoga River. That would serve as Akron’s main water source, with large pipelines running from the reservoir’s water-treatment plant to Akron. It was a costly $30 million step, but a major typhoid outbreak in 1911 resulted in 40 deaths in Akron that summer.

The recommendation came from two consulting engineers: Frank A. Barbour of Boston and E.G. Bradbury of Columbus, who played a key role in developing Akron’s new system. They were paid $10,000 by the city. They analyzed the city’s options, including the Cuyahoga River, the Portage Lakes, the Tuscarawas River, the Little Cuyahoga River and the Congress Lake area. They told Akron that the best water came from the Cuyahoga River watershed. There were fewer people there and less pollution. The watershed was also bigger and capable of producing more water. What they envisioned was a series of reservoirs away from the city, much like what New York City was planning.

Before the report was released, Akron Mayor William Sawyer and Service Director John Gauthier began buying options on more than 2,000 acres of land in the Cuyahoga River watershed for about $150 an acre. The two consultants were then hired by Akron to oversee building the new water system. Work began in 1913. A dam 280 feet long was built on the Cuyahoga River about three miles north of Kent. The 769-acre reservoir, called Lake Rockwell, was designed to provide Akron with 25 million gallons of drinking water per day. Steam shovels were used to dig the lake, but 18-horse teams with plows were used to cut through the heavy clay.

A parade of 200 vehicles traveling from Akron to Lake Rockwell celebrated the opening of the new $5 million water plant. Ex-Mayor Sawyer and current Mayor Frank W. Rockwell both claimed credit for the safe drinking water. Akron initially installed 70 miles of street mains to distribute the water. The city pumped about 12 million gallons that first year.”

Horses Hauling Cast Iron Pipe for Akron Distribution System

August 15, 1922: “In support of the National Coast Anti-Pollution League, the Philadelphia Ledger writes of a time, 20 years beforehand, when fish were common in the Delaware River: ‘How [can] any sane person deliberately go into such black and vile-looking water? … [Only twenty years ago] the haul of the shad net brings that thrilling moment when the encircled fish break water and the whole surface enclosed in the arc of bobbing corks suddenly bursts into silver flame as a hundred fine big fellows leap and churn in a last desperate effort … There’s a lot more than sentiment in such reminiscences as these… They mean happiness and health in an age when the tendency is to sleep away from the turmoil and the ‘twice breathed air’ of the city… The lack of such things means millions of dollars in good, hard cash, to say nothing of the less material considerations. Philadelphia, of all cities, should support the Anti-Pollution League and should welcome the election of Gifford Pinchot to its presidency.’”

Commentary: Four days prior to the Ledger article, the National Coast Anti Pollution League was formed by state and municipal officials at Atlantic City, New Jersey to stop oil dumping. The rampant industrialization of the late 1800s and early 1900s had terrible consequences for the water resources of the U.S. Philadelphia bore more than its share of contaminated water and vanished fisheries. It would be many decades before these trends were permanently reversed. Based on what I saw in China in May of 2013, they should form a National Coast Anti Pollution League immediately and tackle their severe air and water pollution problems.

Gifford Pinchot, Forest Service head, Pennsylvania governor and president of the National Coast Anti-Pollution League

August 14, 1913: Sewerage and Health

Typhoid Fever Death Rate and Sewer Construction in Louisville, KY

August 14, 1913: Municipal Journal article. Effect of Sewerage Upon Health. “Although nearly all intelligent people will to-day agree that there is great value in a comprehensive sewer system, it is not always easy to demonstrate in particular cases all the advantages gained by its installation. A system for the drainage of storm water in a city is not only a convenience but is a valuable asset because, by preventing damage from flooding in storms, it increases the value of property. In a system of sanitary sewers, the beneficial results are convenience in the disposal of household wastes, a saving in the expense of repeated emptying of cesspools, and above all the resulting improvement in the public health. It has not always been possible to establish and define the relation existing between the prevalence of disease and the degree of sewerage in any community, even by those whose confidence has been greatest in the existence of an intimate relation. It is of the greatest importance, however, that the value of all agencies affecting the public health should be well understood, particularly by those in whose hands have been entrusted the responsibility of the government.

For years typhoid fever has been considered a preventable disease, and on this account the degree of its prevalence indicates the efficiency of a community in guarding the welfare of its own inhabitants. It is well known that this disease is caused by the typhoid bacillus which, under the favorable environment within the human body, multiplies rapidly and is cast off in countless numbers from the alimentary canal and kidneys. It is a function of the sewer system to convey the waste products containing these germs from the patient to a point of disposal where they can do no harm. Should they be carried to any stream or body of water without treatment to be drawn into a water supply or to infect shellfish growing therein, an epidemic may result. The infection is too often communicated directly from a sick person to a well one. In the absence of an efficient sewer system, it might find its way, on account of unsanitary conditions, to milk cans or food supplies. If deposited in exposed privies, the infection might be washed over the surface or through underground channels to shallow wells, or it might be conveyed by flies to accessible food.”

Commentary: Many authors tried to show that building sewers saved lives. However, the data was just not there. As I said in my book, The Chlorine Revolution, “It’s the Drinking Water Stupid.” The conquest of typhoid fever and other waterborne illnesses was not complete until the drinking water supply was protected with multiple barriers including filtration and chlorination. The graphic in this article shows that there was a lot of variation in the typhoid fever rate until a filtration plant was installed in 1909. After filtration was installed and operational, the death rate plummeted.

August 13, 1865: Death of Ignaz Philipp Semmelweis

August 13, 1865: Death of Ignaz Philipp Semmelweis. Semmelweis is credited with recognizing the high death toll among women during childbirth caused by physicians using unsanitary procedures. He instituted the disinfection of physicians’ hands with a concentrated chlorine solution and the death rate of new mothers plummeted. His research and practical applications assisted later proponents of the germ theory of disease and also indirectly contributed to the use of chlorine for disinfection of drinking water.

Ignaz Philipp Semmelweis (July 1, 1818 – August 13, 1865) (born Ignác Fülöp Semmelweis) was a Hungarian physician now known as an early pioneer of antiseptic procedures. Described as the “savior of mothers”, Semmelweis discovered that the incidence of puerperal fever could be drastically cut by the use of hand disinfection in obstetrical clinics. Puerperal fever was common in mid-19th-century hospitals and often fatal, with mortality at 10%–35%. Semmelweis postulated the theory of washing with chlorinated lime solutions in 1847 while working in Vienna General Hospital’s First Obstetrical Clinic, where doctors’ wards had three times the mortality of midwives’ wards. He published a book of his findings in Etiology, Concept and Prophylaxis of Childbed Fever.

Despite various publications of results where hand-washing reduced mortality to below 1%, Semmelweis’s observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community. Some doctors were offended at the suggestion that they should wash their hands and Semmelweis could offer no acceptable scientific explanation for his findings. Semmelweis’s practice earned widespread acceptance only years after his death, when Louis Pasteur confirmed the germ theory and Joseph Lister, acting on the French microbiologist’s research, practiced and operated, using hygienic methods, with great success. In 1865, Semmelweis was committed to an asylum, where he died at age 47 after being beaten by the guards, only 14 days after he was committed.”

Reference: Semmelweis, Ignaz. The Etiology, Concept, and Prophylaxis of Childbed Fever. Translated by K. Codell Carter. Madison:University of Wisconsin. 1983.

August 12, 1908: Sewer Outlet for Santa Monica

Santa Monica Pier in 1909 shortly after construction was completed

August 12, 1908: Municipal Journal and Engineer article. Sewer Outlet at Santa Monica. “An unusually extensive piece of work in connection with a sewer outlet is now being carried on by Santa Monica, Cal. The outfall pipe of the sewer system of the city is being carried a distance of 1,600 feet into the Pacific Ocean, and as the shore is abrupt and the water comparatively deep it was decided to support this upon piles, which will also form part of a pier, the entire cost of which is estimated to amount to about $100,000….

In connection with the sewerage system a novel method of treating the sewage has been installed and a sixty-day test run of it has been begun. The sewage flows into two wooden tanks, each two feet deep and 30 feet long. Each tank is equipped with ten sets of electrodes and an equal number of electro-magnets which are supplied with energy from a generator of low voltage and high amperage. The electrodes and the ends of the magnets are so placed as to be submerged three inches under the surface of the sewage. The theory is that the organic matter in the sewage will be oxidized by the nascent oxygen released and that in some way the inorganic matter also will be removed. On being started it was found that the effluent had no odor and was almost as clear as spring water. The combined capacity of the tanks is said to be one million gallons per day and the inventor estimates that the electric energy will not cost more than so cents per day.”

Commentary: Once again, nascent oxygen rears its ugly head. I have also included in this blog another article about Santa Monica’s miraculous treatment of sewage with electricity (April 28). Obviously, the City management had fallen into the hands of con artists. The one outstanding thing to come out of this incident was the Santa Monica Pier, which today is a major attraction and a beautiful addition to the city waterfront.

Santa Monica Pier Today

August 11, 1909: Queen Lane Reservoir Water Treated Chemically

Queen Lane Pump House Boilers

August 11, 1909: Municipal Journal and Engineer article. Queen Lane Reservoir Water Treated Chemically. “Philadelphia, Pa.-Though residents of that section of the city lying south of Allegheny avenue and between Sedgley avenue, Twenty-seventh street and the Schuylkill River have for more than two months supposedly been drinking absolutely raw, unfiltered water from the Queen Lane reservoirs, it became known recently that they have been using water that has been chemically purified by the city. Without letting the public into the secret, Chief Dunlap of the Water Bureau has had the bacteriologists of the Water Department improvise a station at the Queen Lane Reservoir for the oxidization of water by a chemical process which has proved highly effective. A shed has been erected at the intake of the reservoir, and all the water that is pumped from the river to the reservoir is ozonated or oxidized by chemical process as it passes through the shed. By oxidization all the animal or vegetable life is destroyed in the water, and it goes into the reservoir free from harmful impurities. Of course Chief Dunlap says this process does not clarify the water, but this is accomplished to a very large extent by precipitation or sedimentation [in Queen Lane Reservoir].”

Commentary: It is highly unlikely that ozone was being used to disinfect the water supply in Philadelphia in 1909 (in a shed by the river). More likely, the use of the term ozone referred to the chlorination of water, which supposedly released “nascent oxygen” which was responsible for killing bacteria. The same argument (some might say subterfuge) was used in the second Jersey City trial, which was going on during the time that this article was published. No water utility wanted to admit that it was using chlorine during this period. After the New Jersey Supreme Court approved the use of chlorine for drinking water disinfection in 1910, the linguistic jujitsu exemplified in this article was not as widely used.

August 10, 1916: Sterilizing Water and Flushing Mains

August 10, 1916: Municipal Journal article. Sterilizing Water and Cleaning Mains. “In connection with the information concerning their water works furnished by more than six hundred officials and published in our June 1st issue, these officials also answered the questions: “Is the capacity of your mains diminished by corrosion?” “Do you clean them?” “If so, how and how often?” “Do you sterilize the water?” “If so, by what process?” Their answers are given in the table on the following pages.

These answers are given as furnished, and no attempt made to change them with a view to uniformity. For instance, some report sterilizing by “liquid chlorine,” others by “chlorine gas,” and some by “chlorine”; but we suppose that all refer to the same treatment. Also “hypochlorite,” “chloride of lime” and “bleach,” all probably refer to the same material.

In the answers concerning cleaning mains, quite a number report doing this by flushing or blowing out. This is generally believed to remove only sediment deposited in the mains, mostly that brought into them by the water, and to have no effect upon tuberculation or corrosion. A few, however, report “cleaning,” which refers in probably all cases to the actual removal by some application of force of tuberculation or other incrustation on the pipes.

It is interesting to note that, of the cities reporting, 96 employ some sterilizing agent, 53 of these using liquid chlorine, which is the latest form of applying chlorine for sterilizing purposes but from these figures appears to have become undoubtedly the most popular. The use of liquid chlorine or hypochlorite is reported from 33 states scattered over the entire country; and it is known that several cities use one or the other which failed to report it, some probably because of local popular prejudice against putting “chemicals” in the water supply.”

Commentary: Disinfection information in this article is fascinating on several levels. First, we see details of which cities were actually disinfecting their water supplies (and those that were not). We also read that there was STILL a fear of chemicals in drinking water even after the overwhelming evidence that typhoid fever and diarrheal diseases could be stopped by such a practice. Finally, this survey documents the conversion from chloride of lime to the use of liquid chlorine that was occurring during this period of water treatment history. Chloride of lime was first used on the Jersey City water supply, which started the disinfection craze (see my book, The Chlorine Revolution). However, the availability of liquid chlorine in pressurized cylinders and the ease of its application ultimately converted everyone to this newer technology.