In Diagram XI the typhoid death rates of Columbus, Ohio, and New Orleans
are shown to exemplify conditions that have not been improved by
chlorination. The endemic condition of typhoid in Columbus was brought
to an abrupt conclusion by the installation and operation of the
softening and filter plant in September, 1908, and no further reduction
followed the introduction of chlorination in December, 1909.
In New Orleans the typhoid rate decreased on the inception of the new
water works system in 1909 and again after the installation of the
Carrollton filters in 1912. The product of the filtration plants has
always been above suspicion but aftergrowths occasionally developed and
the bacterial count then exceeded the United States Treasury standard.
To overcome this difficulty, hypochlorite was used in 1915, but, as was
anticipated, it had no effect on the typhoid rate. The high rate in New
Orleans is largely due to outside cases received for hospital treatment
and to other circumstances beyond the control of the water and sewerage
department.
In all the examples previously cited, the evidence as to the effect of
chlorination on typhoid mortality rates is circumstantial but, taken as
a whole, it is fairly conclusive. In the examples to be considered next
the evidence is more direct.
[Illustration: DIAGRAM XI
TYPHOID IN COLUMBUS AND NEW ORLEANS]
One of the most conclusive experiments as to the beneficial effect of
chlorination is that reported by Young[8] of Chicago. The water supply
of Chicago was obtained from Lake Michigan by means of intake pipes and
pumped to various parts of the city. The distribution system was divided
into four districts and, although there was a certain amount of mixing
along the borders, the water supplied to each district was substantially
separate. The rapid and progressive decline in the typhoid rate of
Chicago (from 19 in 1900 to 10.8 in 1911) subsequent to the diversion
of the city sewage from the lake, led to the assumption that water-borne
typhoid had ceased to be of any moment. Early in 1912, however,
permission was secured to chlorinate the supply of one district (No. 1)
and the treatment was continued until December when the solutions
commenced to freeze. Diagram XII shows the effect of the treatment on
the autumnal increase in District No. 1 as compared with the other three
districts. The autumnal increase was calculated from the excess of
typhoid incidence for July to November inclusive, over that for February
to June inclusive.
[Illustration: DIAGRAM XII
AUTUMNAL INCREASE IN TYPHOID, CHICAGO (Young)]
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