Northwestern Public Health Review

By Bronwyn Rae, MD

On January 22, 1892, William T. Sedgwick, Professor of Biology at the Massachusetts Institute of Technology, and his protégé, Allen Hazen, the chemist in charge of the Experimental Station of the State Board of Health in Lawrence, Massachusetts presented a paper at the American Statistical Association meeting in Boston [1]. Sedgwick was famous for his work at the Lawrence Experimental Station where he had demonstrated the importance of preventing sewage contamination of domestic water supplies and had halted an outbreak of typhoid fever in the Merrimack River Valley [2]. Hazen, only 23 years old and at the start of a brilliant career was back from several visits to Chicago where he had investigated reports of an increase in deaths from typhoid fever [3]. Their message was grim. Chicago, which had won the right to mount the hugely anticipated Columbian Exposition the following year, was in the grip of a “typhoid epidemic of alarming proportions.”

Chicago’s typhoid problem

The speakers opened by saying that their attention had been drawn to a fact not generally recognized: that typhoid fever had “become unusually prevalent in Chicago and that during the last year an alarming epidemic had prevailed.” The authors then compared the current condition of typhoid in Chicago with similar conditions in Philadelphia prior to the city’s hosting the Centennial Exhibition in 1876. It was known that there had been a large increase in typhoid deaths traceable to infection received in Philadelphia after that exhibition. Given the number of national and international visitors expected in Chicago, the prevalence of typhoid there was of “more than local concern and it should excite grave apprehension.”

The paper went on to cite data from the official reports of the Chicago Department of Health to show the excess mortality in Chicago from typhoid as compared to other large cities in the US and abroad, which was even more striking given that the death rate from other causes in Chicago was generally lower than most other places. Typhoid had been “abundant” in 1872, after the Great Fire, but had then declined rapidly as the city recovered from that disaster, only to rise steadily through the previous decade, culminating in a “rise to extraordinary proportions” in 1890 and 1891 and still increasing in January of 1892. As the incidence rate of the disease was about 10 times the death rate, the authors concluded that in 1891, more than 1.5% of the population of Chicago was affected by typhoid. The typhoid bacillus had been identified and named in 1880 and bacteriological examination of water supplies, rather than the older chemical estimates of human waste, was starting to be the new standard of quality though it was not yet being used in Chicago [4].  As such, typhoid was now classified as “preventable.”

Though Sedgwick and Hazen emphasized that an inquiry into the causes of the typhoid mortality demanded “patient and thorough investigation on the spot” (which they implied the Chicago authorities should have done and hadn’t) they did point out that the usual cause of a “constant excess” of this disease was sewage-polluted drinking water. The paper then traced the history of the Chicago Water Supply and using reports from the Chicago Department of Health and the Illinois State Department of Health, they showed “year after year the unsanitary condition of the Chicago River and the intermittent pollution of the public water supply with sewage,” especially in time of flooding and during the intermittent outages of the pumps at Bridgeport which drew water from Lake Michigan to flush the Chicago River westward. In addition the sewage pollution had worsened in the last few years. The population had grown and the sewage from 200,000 people flowed directly into the lake. Also as the Bridgeport pumps had been operating only at half capacity in the last few years the Chicago River was continuously polluted. They concluded that “any remedy should be applied without delay” and recommended that the Bridgeport pumps be upgraded.

Sedgwick and Hazen’s paper ranks with John Snow’s cholera map as a beautiful example of the new epidemiological paradigm of public health. It was truly, “a masterly array of facts and conclusions, by means of tables, diagrams and text forceful comparison was made of typhoid cases and deaths in Chicago, New York, Philadelphia, Boston and various foreign cities” leading inexorably to the damning conclusion: Chicago, about to host the Columbian Exposition, was in the grip of a typhoid epidemic and if nothing was done about it, there was a danger of a huge increase in cases, not just in Chicago itself, but throughout the US and Europe [5].

Sedgwick and Hazen’s talk was reported the next day in an article in the Chicago Daily Tribune, which quoted Dr. John D. Ware, the Chicago Commissioner for Health at length. Ware declared Chicago was “the healthiest city of its size in the world” and denied Sedgwick’s statement that there had been nearly 2,000 deaths from typhoid in Chicago in 1891, although the Tribune documented that the Department’s own records showed the total to be 1,997, a two fold increase over the previous year. Ware blamed the figures on the ignorance and carelessness of physicians in listing typhoid as a cause of death on the death certificates when the death had really been caused by something else. He added “Advantage has been taken of this by Eastern physicians, who are unfriendly to Chicago for various reasons, to give out the impression that our city is unhealthy and suffering from an epidemic of typhoid fever. If there was such an epidemic here we would know it long before the news of it had reached Boston, and the best medical skill of the city, or, for that matter, of the Nation, would be at once called in to combat and avert it” [3]. When a Chicago Tribune reporter interviewed Sedgwick in Boston after his talk, he insisted he had no dislike of Chicago. He had reported the facts as he saw them in the hope there was still time to rectify the state of the city water supply before the Fair and that perhaps the Federal Government would step in to aid the city to finish the projects it had already undertaken such as improving the Bridgewater pumps, opening a longer four-mile Lake Michigan water intake tunnel, and hasten the building of the new canal which would link the Chicago River with the Mississippi [6].

High stakes for the City of Chicago

The report of the typhoid epidemic put Chicago in a terrible position. The city had been awarded the right to hold the World Columbian Exposition by Congress in 1890, beating out other contenders such as New York City. However, initially there was little faith that Chicago would be equal to the task [7]. National newspapers sneered calling it “the proposed Cook County Fair” and foreign newspapers ignored it altogether. Support was needed, not just to encourage visitors but also to persuade governments to appropriate money for the exhibits. The Exposition’s Commissioners became so alarmed at the “ignorance [which] prevailed and the skepticism at home” that they formed a special Department of Publicity and Promotion, headed by Moses P. Handy, in December, 1890. It was the world’s first modern publicity campaign. Thousands of letters were written to State officials, boards of trade, national and State industrial organizations, members of Congress, State legislatures and anyone else who might be able to stimulate Federal and State governments to appropriate money for Fair exhibits. Speakers and pamphlets were sent to every important commercial, industrial, agricultural and trade association meeting. The Department sent publicity releases to national and foreign newspapers, already translated into the appropriate language. The Rolodex fattened and in August, 1891 the Department sent out 161,000 separate pieces of printed matter in nine different languages. Progress was monitored by word counts of both national and foreign newspaper articles. The numbers were increasing, yet funding was always a problem. The city could not afford a setback.

Ware had no choice initially but to deny there was an epidemic. He had been appointed in 1891 as the Chicago Commissioner for Health by the incoming mayor Hempstead Washburne and as a political appointee his job was dependent on the Mayor who in turn was answerable to the historically powerful city council [8]. Ware was not incompetent. Despite his department’s chronic understaffing he had moved quickly and successfully to forestall a recent smallpox epidemic and he was dealing with a possible influenza epidemic [9]. Now he had to spend the rest of his time as Commissioner steadily averring that the water was safe to drink.

A month after the initial reports however, the Council and the Health Commissioner could no longer deny there was a typhoid epidemic in the city, though Ware continued to issue statements that he believed the water was safe to drink. Sedgwick and Hazen’s talk was published as a paper on April 21, 1892 in Engineering News and Railway Journal. Sedgwick contributed a postscript to the published paper saying that news of his report had appeared in the Chicago Tribune and “after some demur” was accepted as a fair statement of the facts. Perhaps to placate those who accused him of an animus against Chicago he added that though the Tribune alleged not much was being done about the situation, the four-mile tunnel was proceeding rapidly and typhoid deaths in Chicago had started to decline.

Europe voices its concern

Typhoid rates in Europe, especially in Germany and England were falling rapidly, due to the installation of new methods of sewage treatment and the introduction of filtration plants for city water supplies. The Old World did not want an invasion of New World disease to undo its good work. The BMJ in an editorial on March 12, 1892 warned that “on the eve of the great World Fair of 1893, any danger threatening the public health of Chicago has a direct personal interest to many thousands upon this side of the Atlantic” [10].  Another prominent English medical journal, The Lancet, decided to do its own investigation and sent a special sanitary commission to examine the Chicago water supply and the arrangements at the Columbian Exposition [11].

No visitor ever left Chicago praising the sanitary arrangements but the Lancet’s chemical analysis report, published in April, 1893, was particularly caustic. The Lancet was horrified to find people cooling their drinks with ice made from unfiltered water, a custom they discovered “was common, even to the point of being almost universal throughout the United States…. and capable at the present moment of breeding mischief on an appalling scale.” They could not warn against this practice strongly enough, impressing upon their own people to never drink water cooled with ice and appealing to Chicago to “provide a supply of water free from this reproach”. The Lancet report did concede that if the water were filtered and boiled, it would be potable. They also conceded “there was not sufficient information for considering accurately the effects upon health” but cautioned that “the high death rate of the city from typhoid fever” (at this time 12 times that of London) “needed inquiry.” The article included a letter from Dr. Ware in its appendix, which gave results of the chemical analysis of the water on two different days and stated again that he believed the drinking water to be safe.

Engineering News continued to pursue the question of Chicago’s water supply and the typhoid risk at the Exposition reporting, among other things, that the Chicago Commissioner of Health was unaware of the high typhoid death rate in 1892 or was at least reported on good authority as having indignantly denied that there were nearly 2,000 deaths from the disease in Chicago [12].

Ware was defensive in his 1892 annual report of the Chicago Health Department (published in 1893) saying of course there was typhoid in Chicago and he had never attempted to deny it [9]. Indeed how could there not be typhoid in a city with 40,000 privies and people who wouldn’t connect to the sewer even when threatened with legal action? Yet again, he repeated his belief that anyone visiting Chicago need have no apprehension as to the quality of the water. Ware spoke truly when he said that quite a lot was being done about the typhoid problem. The four-mile tunnel came on line in December, 1892. Typhoid deaths had begun to fall in 1893, partly due to the cleaner water from the tunnel but probably also due to the new public awareness about boiling or filtering the water. Work on the huge Ship and Sanitary canal project, which was to famously turn the Chicago River around and send its waters and Chicago’s sewage down to St. Louis instead of into Lake Michigan, had begun in September 1892 although the canal would not be opened until 1901. In the meantime Ware did not see what else he could do, but typhoid was a preventable disease and if it was preventable then it was clear that with the world’s eyes upon it, Chicago had better prevent it.

Planning a new city—the Exposition

Before the public outcry and international attention to the typhoid problem and despite the City’s bluster, the Officials of the Columbian Exposition had taken the concerns about the spread of infectious disease through the Fair seriously. Under the leadership of Director of Works, the architect, Daniel Burnham, the Exposition Affairs Committee was tasked with building what was in effect a “city within a city”, which though it might be artificial could expect real problems, not just from disease, but also from crime, accidents and fire [13] [14]. The prevention of contagious disease was not only a concern for the millions of visitors expected but also for the 30,000 or so construction workers, many of whom came to the city seeking work and were to be housed on site. Even while the water supply and sanitation facilities for the Fair were being built, those building it would have their own water and sanitation needs. The Exposition authorities considered it essential “that we take extraordinary  precautions to prevent disease of a zymotic character among those employed upon the ground” [15].

The Fair’s organizers had an advantage, however, over the City of Chicago. Even though they had to estimate its population, they were building a planned city from scratch, rather than scrambling to keep up with an explosive and chaotic growth. As leaders of an Independent Corporation that did not depend on the city for financing they did not have to cater to council politics. The unimproved 700 acre site chosen for the Exhibition Grounds at the south of the city was linked to neither the city water nor its sewers so they could build a new system based on the latest advances in sanitation engineering and bacteriology. Burnham appointed Chief Engineer of Water, Supply, Sewage and Fire Protection, W.S. MacHarg in November 1890, even before the typhoid epidemic was underway. MacHarg’s final report of works shows that he was well aware of the Chicago’s typhoid problem and the international interest it had attracted, citing “a very serious death rate from typhoid fever” in the years prior to the Fair and noting the efforts that had already been made by the city to improve the water supply [15].

MacHarg’s plan divided the water needs according to purpose–a supply of good drinking water for domestic purposes and a second supply for mechanical uses such as the fountains and fire protection “which need not be of the same character” [15]. A priority was not to pollute the lakefront nor many scenic lagoons to be built on the site because that would be both the source of the water supply and the location of the Grand Promenade which would hardly be improved by the stench of sewerage. MacHarg reckoned that the sanitation facilities would need to accommodate at least 30,000 permanent workers and 200,000 visitors per day, with up to 600,000 on occasional days. To plan the treatment works he had to estimate the volume of liquid they would need to be able to handle and came up with a fairly accurate estimate of about 10 gallons/ person/ day.

Sanitation during construction

The initial water supply for the site was to be obtained from an intake one mile out in the lake at Hyde Park next to the fairgrounds using pumps erected by the Exposition Company that would later be turned over to the city at cost. However, water drawn from so close to shore was not considered immediately fit for domestic use. It was therefore boiled by being fed under pressure into a coil where it was super heated to greater than 212^o F. The condensate was then cooled and aerated by being passed through a cascading series of eight 2,000-gallon tanks made of cypress wood. The water from the last tank was drawn into barrels which were distributed through the building site by a system of water carts. This water was “used freely by all the men employed in the works and during this summer all were especially free from bowel troubles” though the medical director, Dr. John F. Owens, grumbled that it was difficult to prevent the men using hydrants and surface water and notices had to be posted prohibiting the use of water from the hydrants and lagoons [16]. The Exposition employed the indefatigable Allen, to perform daily bacteria counts on the water which they correlated with what they were seeing clinically. On the few days that the water could not be boiled due to problems with the temporary power plant and the barrels were fed directly from the water supply, an uptick in diarrheal diseases was noticed by the medical staff who immediately sent a report to the engineers.

The city sewerage system served the Midway Plaisance but did not extend to Jackson Park so while the sewers were being constructed wooden privies with concrete floors were used. Each privy had 13 seats, galvanized iron pails for solids and troughs for liquids with galvanized iron urinals. The pails were kept odor free by an attendant throwing a quantity of dry earth pulverized nearby for that purpose and copperas, a ferrous sulphate solution also known as green vitriol was applied to the troughs. The catch basins were pumped each night. The liquids were dumped in the nearest city sewer and the solid taken to the southern portion of the grounds and dug into black earth, which mostly worked well except when it didn’t such as during the wet weather in the Spring of 1892.

Sanitation at the Exposition

The water supply for the actual Exposition was a careful exercise in public relations. MacHarg recognized that “visitors would be pretty certain to use city water at their places of residence while attending the Fair.” That was beyond his control but he contrived “to make every effort to furnish innocuous water” to those attending the Exposition [15]. Given the adverse publicity about the Chicago water, it was decided to reassure the public that it was safe to visit the Fair by supplying drinking water from an outside source. The Waukesha Hygeia company, already well known in the city where its bottled water was prescribed as a health drink, won the concession to supply water to the Exposition site. The water was pumped to a reservoir on a hill near Waukesha 416 feet above the level of Lake Michigan and then gravity fed through one hundred miles of pipe to the Exposition [4]. The water was cooled on arrival at the Fair grounds to a pleasant 38^oF, but heeding the Lancet’s dire warnings, not by the direct addition of ice. Instead it was piped through Lind Ice Machines. Once cold, the water was distributed throughout the fairgrounds via 50 miles of insulated pipes to automatic slot machines which weighed out a glass full once a penny was dropped into the slot or sold to booths and exhibitors at 5 cents a gallon.

MacHarg recognized that not everyone could or would pay for their water so free but uncooled water was also provided at 100 free distribution centers, each with 4 faucets and communal cups, which were evidently not feared as a source of contagious disease. The free water came from the Hyde Park intake but was filtered. To “give confidence to those using the water” MacHarg chose filters from the Pasteur Chamberland Filter Company of Dayton, Ohio which being already in common use in hotels and homes were well known. The free water proved very popular despite the strategic product placement of the Waukesha water in the most visible sites [4]. The water sterilizers, which had been dismantled once the site construction was finished, were reinstalled to supply the demand for water when water drawn directly from the mains was linked with an increase in diarrheal disease. In a nice piece of social engineering the exhibitors were not allowed to have their own taps so as to prevent them distributing untreated water.

When planning the sewerage system, MacHarg wanted to avoid the mistakes made in Philadelphia when sewerage discharge from the fair had almost certainly polluted the water supply. He decided that no sewage would be discharged directly into the lake. Unlike the city where domestic, surface and rain water all fed into a common sewer, MacHarg was able to treat different waste sources differently. Roof water was fed back into the lagoons and the surface water fed back into the lake so that only domestic waste needed to be treated. An estimated 6 million gallons of sewage a day would need to be disposed of and MacHarg looked for a system that would give “fair results as to the effluent water with as small a cost as possible.” To transport sewage from the lavatory blocks to the treatment plant he chose the Shone-Hydropneumatic system which used compressed air to force the sewage into large receiving tanks. There the sewage was flocculated using a chemical process that MacHarg had found in use in Dortmund, Germany. The sludge from the tanks was compressed into cakes and taken to the garbage crematory where it was burned along with the Fairground garbage using two furnaces supplied by the Engle Sanitary and Cremation Company. The advantage of the Engle was it burned very clean so that only fifty feet from the chimneys no odor was detectable. The ash left over from the incineration was used as fill in the grounds and roads.

There were nearly 3,000 toilet rooms, closets and lavatories scattered throughout the grounds [17]. The fancier lavatory blocks charged 5 cents admission and had towel and soap service and you could also get your boots blacked while you waited. Women, as always, were doomed to queue; only the men got free urinals. MacHarg was pleased with the operation of his system though he commented that many of the Fair visitors “wholly unfamiliar with the use of sewers have thrown every character of stuff into the same. Underwear of various kinds was constantly taken from the branch connections” [15].

Success

The public health and engineering community watched the events in Chicago with keen interest. Alongside the physical exhibits of the Exposition were the “mental exhibitions”, meetings, or “Congresses” which would bring together the great minds of the day to discuss the latest scientific and social advances [17]. Among the many Congresses was the World’s Public Health Congress.  Many of the attendees took the opportunity to tour the sanitary arrangements at the Fair, which then as now, was a public health geek’s idea of a good time. W.F. Morse presented a paper on the disposal of garbage and waste at the World Columbian Exposition in which he said “It is doubtful in the history of this or any other country whether there has ever been a sanitary problem of equal magnitude which must be solved in the short time allowed, or which demanded a more safe and scientific solution than was the one here presented. To make a failure was to imperil the fortunes of the great enterprise, while a success meant not only absolutely protection for health, but the comfort, well-being and convenience of a great multitude of people” [18].

The new Chicago Health Commissioner Arthur Reynolds’ report for the Chicago Department of Health for the year 1893 was late [19]. He pleaded “unusual demands of work”, one of which might have been the setting up of a bacteriology lab for his department, but there was no mistaking the satisfaction he felt at a job well done. Despite the “predictions of disaster and warnings of inevitable sickness and increased mortality” which had been “freely indulged in by envious rivals and prophets of evil,” the 1893 mortality rate of 16.8 per thousand had been the lowest in Chicago’s history, and the lowest of any large city in the world, except Berlin at 16.3 per thousand. There was not a single case of typhoid traceable to the Columbian Exposition.

By the time the gates closed on the 31st of October 1893, the Columbian Exposition had sold 27 million entrance tickets at a time when the population of the entire USA was 65 million. The Fair changed urban planning forever – it had shown what the city of the future might look like and what the amenities of the future would be. Those amenities would include sewerage systems, sewerage treatment works, and water that was safe to drink.

References

1. Sedgwick, W.T. and A. Hazen, Typhoid fever in Chicago. Engineering News and American Railway Journal 1892.
2. Benson, K.R., Welch, Sedgwick, and the Hopkins Model of Hygiene. Yale Journal of Biology and Medicine, 1999. 72: p. 313-320.
3. Typhoid in Chicago:  What the Health Records Show Concerning It., in Chicago Daily Tribune (1872-1922) Jan 23, 1892: Chicago.
4. McCarthy, M.P., Should We Drink the Water?  Typhoid Fever Worries at the Colombian Exposition. Illinois Historical Journal, 1993. 86(Spring): p. 2-14.
5. Editorial, Vanishing Typhoid, With a Bit of Editorial Retrospection. Engineeering News, 1917. 77(13): p. 526-527.
6. We Did it for Chicago’s Good:  Reasons Impelling Prof Sedgwick to make the Charges He Did., in Chicago Daily Tribune (1872-1922) Jan 23, 1892: Chicago.
7. Johnson, R., A History of the World’s Columbian Exposition Held in Chicago in 1893. Vol. II. 1897, New York: D. Appleton and Company.
8. Randoll, S.E., The Politics of Public Health in Chicago  1850-1930, 2010, Saint Louis University.
9. Ware, J.D., Report of the Department of Health of the City of Chicago for the Year 1892., 1893: Chicago.
10. Editorial, The World’s Fair and the Water Supply of Chicago. BMJ, 1892. v.1(1628): p. 563.
11. Special Commission on the Water Supply of Chicago, Report of the Lancet Special Sanitary Commission of Inquiry concerning the Water Supply of Chicago, USA. The Lancet, 1893. 141(April 8 ).
12. Editorial, Editorial. Engineering News and American Railway Journal, 1892. 28(Nov 3, 1892).
13. Brown, J.K., Health and Medicine on Display:  International Expositions in the United States, 1876-1904.  2009, Cambridge, Massachusetts: The MIT Press. 326.
14. Neufeld, M., The White City:  The Beginnings of a Planned Civiliztion in America. Journal of the Illinois State Historical Society, 1934. 47(1): p. 71-93.
15. MacHarg, W.S., Report of the Director of Works, Engineer, Water Supply, Sewage and Fire Protection, in The Final Official Report of the Director of Works of the World’s Columbian Exposition, D.H. Burnham, J.E. Draper, and T.S. Hines, Editors. 1893: New York. p. Vol. II, p65.
16. Owens, J.F., Report of the Medical Director, in The Final Official Report of the Director of Works of the World’s Columbian Exposition, D.H. Burnham, J.E. Draper, and T.S. Hines, Editors. 1893: New York.
17. White, T. and W. Igleheart, The World’s Columbian Exposition, Chicago, 1893 1893, Chicago: International Publishing Co.
18. Morse, W.E., The Disposal of the Garbage and Waste of the World’s Columbian Exposition:  A Paper Read at the International Congress of Public Health Chicago, October 11, 1893. The Sanitarian, 1893. 31.
19. Reynolds, A.R., Annual Report of the Department of Health of the City of Chicago for the Year ended December 31, 1893, 1894: Chicago.

About the Author

Bronwyn Rae, MD, is a pediatric anesthesiologist who earned her MPH at NWU. She recently returned from Tanzania where she worked with Seed Global Health teaching anesthesia in Mwanza and Dar-es-Salaam. Her interests include improving the delivery of anesthesia services and teaching in resource challenged environments, the history of public health and water and sanitation and public health. She is an adjunct lecturer in the Department of Preventive Medicine.