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.