Chapter I: January 2-The People. II. February 6-The Place. III. March 2-The Work (7)

The toilet accommodations, while possibly more adequate than the water supply, are unsatisfactory in consequence of the lack of running water. There is not a single indoor closet in any of these courts. The streets of Homestead all have sewers, and by a borough ordinance, even the outside vaults must be connected with them. These are, however, ordinarily flushed only by the waste water, which flows from the yards directly into them; when conditions become intolerable, the tenants wash them out with a hose attached to the hydrant. As long as they are in the yards, this totally inadequate device is apparently the only one possible. The closets, moreover, which are usually in the center of the courts only a few yards from the kitchen doors, create from the point of view either of sanitation or decency an intolerable condition. While occasionally three or four families must use one compartment, usually only two families need do so. But even this means that often they are not locked and that no one has a special sense of responsibility, in consequence of which they are frequently filthy. It is not perhaps surprising that this state of affairs is tolerated by people who have lived on farms and were used to meager toilet facilities; but the discomfort and danger here are infinitely greater than in the country, and here the conditions are remediable.

The overcrowding within the houses shown by the accompanying chart makes the water and toilet conditions more unendurable. Half the families who do not take lodgers and eighty-five per cent of those who do, average more than two persons to the room,--a number indicative, generally, of conditions which do not permit moral or physical well being.

FAMILIES CLASSIFIED AS TO AVERAGE NUMBER OF
PERSONS PER ROOM.

Number of persons
per room 1 2 3 4 5 5 plus

Families without
lodgers, total,
137. percentage 13.8 35.7 38 9.7 1.4 1.4

With lodgers,
Total 102,
percentage 5.8 8.8 42 30.4 6.8 5.8

Let us consider first the causes of such congestion in so small a town, next its nature and results, and finally the possibility of improvement.

Three factors are involved in producing this state of affairs, the growth of the mill and town, the low wage of the laborer, and his ambition. The mill has developed fast, and in spite of improved machinery has rapidly increased the number of its employes. In 1892, at the time of the strike, 4,000 men were employed; now nearly 7,000, exclusive of the clerical force. Moreover at each addition to the size of the mill, homes are destroyed to give it place. And further, the steep slopes of a hill hinder the growth of the town. Although suburbs are gradually building beyond this hill, car-fare is an item to be considered when a man earns $1.60 a day, and as there have not been, except during the hard times of 1908, a sufficient number of cheap houses for rent, the people accustomed to small quarters have crowded together along these alleys. The lowest paid workingmen are naturally the ones that inhabit them. Of 220 men, eighty-eight per cent were unskilled workers receiving less than two dollars a day. This figure is usual among the Slavs, since of the 3,602 employed in the mill, eighty-five per cent are unskilled.

That the greatest overcrowding is in the families taking lodgers, shows a general tendency to economize in this way rather than by crowding the family into too small a tenement. The three dollars a month which the lodgers pay for their room might seem a small return for the labor and loss of privacy of home life; but in more than three-quarters of the families taking lodgers the income from them covered the rent, while in one-fifth of the families it was twice the rent or even more.

This tendency to economize even at the loss of home life, induced primarily by low wages, has a further cause in the ambition of the Slavs to own a home in a better locality, or to buy a bit of property in the old country to which they may some day return. Again and again in explaining why they took lodgers these excuses were given, "Saving to educate the children", "The father does not earn enough to support the family", "Taking boarders in order to start a bank account". Thrift, it would seem, is not a virtue to be recommended indiscriminately. Figures as to overcrowding are in themselves but a lifeless display; when you see them exemplified in individual homes they become terribly significant. I entered one morning a two-room tenement,--the kitchen, perhaps twelve by fifteen feet, was steaming with vapor from a big washtub on a chair in the middle of the room. Here the mother was trying to wash, and at the same time to keep the elder of her two babies from going into a tub full of boiling water standing on the floor. On one side of the room was a huge, puffy bed, one feather tick to sleep on and another for covering; near the window a sewing machine, in the corner an organ,--all these besides the inevitable cook stove whereon in the place of honor was cooking the evening's soup. Asleep upstairs in the second room were one boarder and the man of the house. The two other boarders were at work.

Can you picture the effect on the mother of such a home, the overwork for her, the brief possibility of rest when the babies come? Yet it is even more disastrous to the children. And, as appears in the accompanying chart, many of the families who take boarders are families with children.

WITH LODGERS WITHOUT LODGERS
No CHILDREN FAMILIES FAMILIES
0 30 XXXXXXXXXXXXXXX 24 XXXXXXXXXXXX
1 30 XXXXXXXXXXXXXXX 46 XXXXXXXXXXXXXXXXXXXXXXX
2 25 XXXXXXXXXXXXX 26 XXXXXXXXXXXXX
3 10 XXXXX 22 XXXXXXXXXXX
4 7 XXXX 15 XXXXXXXX
5 0 7 XXXX

The situation brings serious results both to the health and the character of the children. The overworked mother has neither time nor patience for their care and training. As half of the families use the kitchen for sleeping, there is a close mingling of the lodgers with the family which endangers the children's morals. In only four instances were girls over fourteen found in the families taking lodgers, but even the younger children learn evil quickly from the free spoken men. One man in a position to know the situation intimately, spoke of the appalling familiarity with vice among the children in these families. A priest told me that he preached to the women against this way of saving money, but as long as wages are low and the good ambition to own a home or have a bank account can find no other way of fulfilling itself, it is difficult to persuade them to give it up.

The crowding and other ills have also serious physical consequences. The birth rate and the deaths of children under two, show that while among the Slavs in the second ward a child died for every three that were born, among the other population of Homestead one died for every six that were born. Against many of these deaths was the entry "malnutrition due to poor food and overcrowding." Sadder still is the case of those wailing babies who do survive and begin life with an under-vitalized system ready for both the disease and the dissipation that attend weak bodies and wills.

Outside of the crowded tenement rooms where are the many children to play? In investigating the conditions in one narrow court, I opened a door into a low shed where the entrails of a chicken lay on the floor. It was foul and dark and I turned away in disgust, but the bright little boy beside me piped up cheerily, "Oh that's our gypsy cave." A sorry region, surely, for a child's imagination to rove!

EVENING SCENE IN A HOMESTEAD COURT.]

SLAVIC COURT, HOMESTEAD.

Showing typical toilet and water supply; also a few of the boarders in these houses.]

The congestion in Homestead must be considered not only from the standpoint of the family and the child, however, but of the single man. His problem is no small one. In the figures for the mill we find that 30.5 per cent of the total number of Slavs are unmarried. This large group, in the period before they send back for a wife or sweetheart, must find some sort of a home. While some are scattered in families and create the lodging problem we have been considering, others live in groups over which a "boarding boss" presides. In West Homestead, for example, in about twenty houses there were three hundred Bulgarians, among whom at the time of the depression there were only three women. These scattered houses hidden away on the outskirts of the town housed a group of happy, industrious men, all ambitious to hoard their money and return to the old country as men of property. They cared little how they lived so long as they lived cheaply. One of these homes consisted of two rooms one above the other, each perhaps twelve by twenty feet. In the kitchen I saw the wife of the boarding boss getting dinner, some sort of hot apple cake and a stew of the cheapest cuts of meat. Along one side of the room was an oilcloth covered table with a plank bench on each side, and above a long row of handleless white cups in a rack, and a shelf with tin knives and forks on it. Near the up-to-date range, the only real piece of furniture in the room, hung the "buckets" in which all mill men carry their noon or midnight meal. A crowd of men were lounging cheerfully about talking, smoking and enjoying life, making the most of the leisure enforced by the shutdown in the mill. In the room above, double iron bedsteads were set close together and on them comfortables were neatly laid. Here besides the "boarding boss" and his wife and two babies, lived twenty men. The boss, himself, was a stalwart Bulgarian who had come to this country several years ago, and by running this house besides working in the mill, had accumulated a good deal of money. The financial arrangements of such an establishment are simple. The boarding boss runs the house, and the men pay him three dollars a month for a place to sleep, for having their clothes washed, and their food cooked. In addition an account is kept of the food purchased, and the total is divided among the men at each pay day. The housewife purchases and cooks what special food each man chooses to order: beef, pork, lamb, each with a tag of some sort labeling the order, and all frying together. A separate statement is kept of these expenses for each boarder. Such an account for a group of men in a small Slavic household may prove of interest.

The family (which consisted of a man, his wife, his brother, and three children, eleven, eight, one, and four boarders), occupied a house of four rooms, one of them dark, for which they paid a rent of fourteen dollars. The man, though he had been in this country about twelve years, was still earning only $10.80 a week with which to meet the needs of his growing family. One-half the cost of the food was paid by the boarders including the brother, amounting for each man to about $1.06 a week. For the whole family, the expenditure was as follows: flour and bread, $2.03; vegetables, $1.06; fruit, $.56; milk, eggs, etc., $1.98; sugar, $.49; sundries, $.73; meat, $5.78; a total of $12.63. Besides this the boarders ordered "extras," and the following table for a month expresses the men's individual likings:

EXPENSES FOR THE MONTH.

_Pamhay._ _Baker._ _Drobry._ _Pilich._ _Timko._
Beef .87 1.20 .48
Pork 3.71 .92 2.14 3.04 2.30
Veal .90
Eggs .10 .05
Milk .21 1.90
Cheese .10 .19 .09 .05
Fuel .15 .25 .25
----- ----- ----- ----- -----
Total $3.96 $3.34 $3.04 $4.43 $2.88

This made the average total expenditure about $8.02 a month for each man. Adding $3 a month for room and washing, the total expense each is about $11. These men make from $9.90 to $12 a week. It is obvious therefore that a large margin remains for saving or indulgence, after clothes are provided. They are thus able if they will to send for wife and children, to fulfill their duties to aged parents, or to provide for their own future.

While this program is an economical one, it by no means furnishes to this great group of homeless foreigners a normal life. Though some expect to return and others to send for their families when they have made their fortunes, all for the time being are in a strange country with neither the pleasures nor restraints of home life.

To those who have no family at home or no desire to save, the temptation to spend money carelessly is great. Unfortunately the saloons get a large tribute. On pay Saturday, the household usually clubs together to buy a case of beer and drink it at home. These ordinarily jovial gatherings are sometimes interrupted by fights, and the police have to be called in. One officer, who had been on the force for nine years, said that while in general these men were a good-natured, easy-going crowd, and in all his experience he had never arrested a sober "Hunkie," when they were drunk there was trouble. The punishment usually inflicted for their disorderly conduct is of course, a small fine, which has little or no effect. It is indeed currently said that the bigger the fine the better they like it, as they feel that it indicates increased importance.

_Photograph by Lewis W. Hine._

CLOSE QUARTERS. ONE ROOM AND THREE IN THE FAMILY.]

It is not surprising that excesses exist in a town which offers so little opportunity for wholesome recreation, and whose leaders have failed to realize any obligation toward the newcomers. The Carnegie Library represents the only considerable effort to reach them. The clubs are open to the Slavs. Aside from a class in English, however, they are not adapted to non-English speaking people. Even the Slavic books which the library bought for their benefit are seldom used. I found that a number of the influential Slavs in Homestead did not know that these books were in the library; therefore I judge that one reason why they are not used is a lack of proper advertising. That the building is on the hill away from their homes, that it has an imposing entrance which makes the working man hesitate to enter, and that certain forms must be gone through before books can be secured, or the club joined,--these things have doubtless acted as deterrent influences. However desirous the management of the library may be to reach them, the Slav's ignorance of our language and customs will keep many from ever getting inside. If a library is really to reach the foreign population, it must not wait for them to come to it; it must go to them. A simple reading room opening right into the courts where the people live, where they could drop in after the day's work, find newspapers and books in their own tongue, and where the Americanized Slav could reach his newly-come brethren, teaching them both English and citizenship, would become an important center of influence.

For though these people are in many respects aliens, they are not unwilling to accept American standards. The quickness, for example, with which the women adopt our dress, reveals an adaptability which might find expression in more important ways. That they are glad when they can afford it, to have really attractive homes, is shown by these pictures. They are the homes of two families from the same place in the old country, one a newcomer, the other one of the "oldest inhabitants" of the Slavic community.

_Photograph by Lewis W. Hine._

INTERIOR OF HOUSE OF WELL-TO-DO SLAVIC FAMILY.]

In the first instance, as the man earns but $9.90 a week, rent must be kept low if other bills are to be paid and a little provision made for the future. It is hard enough in a one-room tenement, though the furniture includes only absolute necessities, to keep all one's crowded belongings in order. On wash day morning, when this picture was taken, there are extra complications. On the whole, therefore, the home will be seen to be as neat as circumstances permit. The bright pictures on the wall manifest a desire to make it attractive.

The other picture, a "front room" with its leather covered furniture, is in a five-roomed house which the family owns. The vivid-colored sacred pictures relieve the severity of the room; and they reveal a dominant note of Slavic life, for if happiness is to stay with the family, the priest must come yearly to "bless the home." The family who came many years ago, has by slow thrift accumulated the means to obtain this house. And though the mother, who is now a widow, still takes boarders, the family has in general the standards of Americans.

This instance I introduce because it is well to recognize that low standards are not necessarily permanent. When Slavs do buy their homes, the size and attractiveness of them indicates that the unsanitary surroundings and crowded quarters of early days were simply tolerated until the ambition could be attained. With a house on the outskirts of the town, a garden about it, and a glimpse of the larger out-of-doors, they begin to feel that the dreams of their emigration have come true.

Only the few however have fulfilled the dreams and it is back in the squalid courts that we find the typical problems of every industrial center that has felt the tide of immigration. The Homestead community has so far shown a general indifference to the problems which its industry creates. The mill demands strong, cheap labor, but concerns itself little whether that labor is provided with living conditions that will maintain its efficiency or secure the efficiency of the next generation. The housing situation is in the hands of men actuated only by a greed of profit. The community, on the other hand though realizing the situation, does not take its responsibility for the aliens in its midst with sufficient seriousness to attempt to limit the power of these landlords.

The Slavs themselves, moreover, are people used to the limitations of country life, and are ignorant of the evil effects of transferring the small rooms, the overcrowding, the insufficient sanitary provisions which are possible with all outdoors about them, to these crowded courts under the shadow of the mill. And, as we said, their ambition to save and buy property, here or in the old country, is a further incentive to overcrowding.

Summing up the results of the indifference of the community and the ignorance and ambition of the Slavs, we find a high infant death rate, an acquaintance with vice among little children, intolerable sanitary conditions, a low standard of living, a failure of the community to assimilate the new race.

As we waited in one of the little railroad stations of Homestead, a Slovak came in and sat down beside a woman with a two year old child. He made shy advances to the baby, coaxing her in a voice of heartbreaking loneliness. She would not come to him, and finally her mother took her away. As they went, the Slovak turned sadly to the rest of the company, taking us all into his confidence, and said simply, "Me wife, me babe, Hungar." But were his family in America, it would mean death for one baby in three; it would mean hard work in a little, dirty, unsanitary house for the mother; it would mean sickness and evil. With them in Hungary, it means for him isolation, and loneliness, and the abnormal life of the crowded lodging house.

BUCH ALLEY.

Showing conditions in the unpaved alleys.]

]

THIRTY-FIVE YEARS OF TYPHOID

THE FEVER'S ECONOMIC COST TO PITTSBURGH AND THE LONG FIGHT FOR PURE WATER

FRANK E. WING

ASSOCIATE DIRECTOR PITTSBURGH SURVEY; SUPERINTENDENT CHICAGO
TUBERCULOSIS INSTITUTE

One convincing and startling feature of the Pittsburgh Civic Exhibit in November was a frieze of small silhouettes three inches apart stretching in line around both ends and one side of the large hall in Carnegie Institute in which the exhibit of the Pittsburgh Survey was installed. The frieze was over 250 feet in length, and the figures were distributed in correct proportion by age and sex. They represented six hundred and twenty-two persons in all, the death-toll from typhoid fever in Pittsburgh during the year 1907. Accompanying this frieze, placed prominently over the doors where everyone could read them, were duplicates of the following sign in large display letters:

* * * * *

IF THE DEATH RATE HAD BEEN 25 PER 100,000, still considerably
greater than that in Albany, Ann Arbor, Ansonia, Atlantic
City, Binghamton, Boston, Bridgeport, Brockton, Cambridge,
Canton, Detroit, Fall River, Hartford, Jersey City, Lawrence,
Lowell, Milwaukee, New York, Rochester, St. Paul, Springfield,
Syracuse, Worcester, and a score of other cities having a
fairly pure water supply, but _114_ of these persons would have
died and the line would _be only 2/9 as long_.

_Who is Responsible for this Sacrifice?_

* * * * *

And next to this placard was another sign, showing in comparative columns the amount of typhoid fever in Pittsburgh during the four months that had elapsed since the opening of a great municipal filtration plant, compared with the amount for the same months of the previous year; for example ninety-six cases in October, 1908, as against 593 in October, 1907.

The typhoid problem in Pittsburgh in its larger cause has always been a water problem; in its consequences it has become one of the city's biggest social and economic problems; in its solution, it has been tied up with all the politics of a boss-ridden city. The story of filtration is the story of the navigation of an unwieldy craft through a tempestuous channel. Buffeted by cross winds of public opinion, its sails battered and torn by squalls of commercial opposition and abuse, guided now to the right and now to the left by frequently changing pilots, a plaything for the waves of councils, its booty coveted by buccaneers of each political faction, filtration and its freightage of health (or contracts) has been a prize over which the elements in the municipal life of Pittsburgh have battled hard and long. The docking of this craft in safety and security is one of Pittsburgh's greatest civic achievements; its protracted passage is her most enduring disgrace.

In handling the question of typhoid in Pittsburgh, we must then, deal with three distinct themes: water, economics, and politics.

I.--WATER. THE MENACE.

The publicly supplied drink of Pittsburgh has been river water and whatever that river water contained. Prior to the opening of the new filtration plant last summer, that part of the city known as "old Pittsburgh," comprising the first twenty-three[9] wards, received its water supply from cribs in the bed of the Allegheny River at Brilliant Station, about seven miles above the city. Water taken from these cribs (and since 1905 from an artificial channel of sheet piling along the shore) was pumped into reservoirs on Herron Hill and Highland Park, and then turned unfiltered into the water mains for distribution to the shops and residences throughout the city.

[9] Ward numbers in this article refer to the existing or old notations. A new ward system has just been adopted.

With the exception of two or three wards, which receive a company supply of filtered water, that part of the city known as the South Side, comprising wards twenty-four to thirty-six, and ward forty-three, formerly the Borough of Sheraden, receives its water from the Monongahela direct, and from the Ohio direct, just below the junction of the Monongahela and the Allegheny. The former city of Allegheny, the present North Side, was supplied directly from the Allegheny River from two sources; first from the Allegheny at a point near Montrose, about eleven miles up the river, and second from another point on the Allegheny near Sixteenth street. This latter source of supply was discontinued on March 5, 1908.

The Allegheny and the Monongahela Rivers are turbid at all times, and after a rain or in the spring, so muddy that a platinum wire cannot be seen more than a quarter of an inch from the surface. In addition to this, investigations have shown that the rivers commonly carry in solution the soluble chemical products of the mills along their shores,--organic and inorganic, acid and alkali; oils, fats, and other carbon compounds; dead animals,--rats, cats and dogs; flesh-disintegrated and putrescent; as well as the offscourings of iron and steel mills, tanneries and slaughter houses, and similar industries. But this is not all. Seventy-five up-river towns,--with an estimated population of 350,000 inhabitants,--in the Allegheny or tributary valleys; and in the Monongahela a long string of towns, Swissvale, Homestead, Braddock, Rankin and McKeesport, all furnish their supply of common sewage as a further contamination of the already dirty water with its long list of disease-breeding bacteria.

These conditions have existed since Pittsburgh came into prominence as an industrial center. Typhoid has been endemic. The duration of this "plague" in Pittsburgh, unbelievable though its sufferance may appear in view of the facts already given, is a matter of history and record. For thirty-five years, up to the beginning of 1908, the city was in the grip of a scourge which has been in the words of the most recent treatise on typhoid[10], "one of the black records in the sanitary history of our country." Here and there clamorous, indignant voices were raised against it; but public sentiment had become so callous that it only spasmodically and halfheartedly demanded the carrying into operation of a tardy system of filtration. In the meantime, those who could not afford to buy distilled or spring water, continued to drink this filth.

[10] Whipple, Typhoid Fever, p. 158.

With what result? For the last twenty-five years, an average death rate of 102.3 per 100,000 population; since 1889 never below 107; for the last nine years an average of 130; and last year, the year of the completion of Pittsburgh's filtration plant, 131.5 deaths and 1,115 cases for every 100,000 inhabitants. A black record this, in the face of uncontrovertible evidence from other cities, both in this country and abroad, that the purification of the water supply should blot out at least seven-ninths of the typhoid fever. In contrast with Pittsburgh's high mortality, the average for other large American and European cities since 1898 may be seen from the following list:

Pittsburgh 130.0
Allegheny 104.4
Washington 59.0
Philadelphia 54.7
Baltimore 35.3
San Francisco 30.5
St. Louis 30.3
Chicago 27.3
Boston 24.5
New York 18.2
Paris 17.4
London 11.7
Vienna 5.2
Berlin 4.2

The very even distribution of typhoid in Pittsburgh,--another indication pointing to infected water as the chief cause,--is seen in the map on page 927, on which each dot represents a case of typhoid within the year,--July 1, 1907, to June 30, 1908, the period covered by the main part of this study.

The second map shows the relative mortality, by wards, for the same period.

The following chart shows the relative rise and fall from year to year in cases and deaths during the past twenty-five years, and is based on estimates of population provided by the United States Census Bureau. The morbidity figures are taken from the United States census prior to 1901, and from the Pittsburgh Bureau of Health records following that year.

Previous to 1883 very little attempt was made to compel physicians to report typhoid cases to the Pittsburgh Bureau of Health; hence no reliable morbidity records are available up to that time. But in the year 1882 an ordinance was passed requiring such reports to be made. It is very certain that several years elapsed before a majority of the cases was actually reported, and even at the present time, in spite of prosecutions and a more enlightened sentiment, many cases never reach the bureau. Yet the number of cases actually reported in Pittsburgh proper, since 1883, reaches the astounding total of 54,857. In other words, within the past twenty-five years, one person to every six of the total population has had an attack of typhoid fever.

But even more telling in its significance is the fact that out of these 54,857 reported cases, 8,149, or 14.8 per cent died as a result of their illness. Over eight thousand men, women and children were sacrificed here in Pittsburgh in the last twenty-five years to a disease known by modern science to depend for its very existence upon lax methods of handling food, drink and waste. Over eight thousand graves have been dug, half of them (4,069) since February 6, 1899, more than nine years ago, when the report of Pittsburgh's Filtration Commission, advising the necessity of a pure water supply, was placed in the hands of the Pittsburgh councils. In life, these eight thousand people, standing single file, four feet apart, would form a line six and one-sixth miles long, extending from the court house in a straight line to the Filtration Plant; or from the Point Bridge down the Ohio as far as the Borough of Emsworth.

II.--THE COST.

In order to establish a sure ground for estimate as to the economic drain of this disease upon this community, a concrete study of the cost of typhoid in six selected wards of Greater Pittsburgh was undertaken by the Pittsburgh Survey. The sections of the city chosen are fairly representative of living conditions among the wage-earning population. Wards 8 and 11, in what is commonly known as the Hill District, represent a congested quarter made up largely of Russian Jews, Austrians and Italians, with a considerable number of Americans and American Negroes. The residents of these two wards are chiefly employes of the small trades and the sweating and stogie industries, clerks, factory hands, common laborers, etc., who are rather below the average scale of earning capacity. They number about 22,000 for the two wards and among them there were forty-four per cent of the cases studied.

Wards 25, 26 and 27 are on the South Side. Their total population is about 33,000; mill hands, mostly of Slavic origin, occupy those parts of these wards bordering the Monongahela River, and a better-off class of Americans occupy the hilltops overlooking the river. The wards would, therefore, represent a rather uneven population, as based on nationality or wage scale, but were not a large factor in this study, as only eight per cent of the cases covered were found in these wards.

DISTRIBUTION BY WARDS OF TYPHOID FEVER CASES

JULY 1, 1906 TO JUNE 30, 1907

SAME PERIOD AS THAT OF STUDY OF ECONOMIC COST IN WARDS 8, 11, 21, 25, 26 AND 27]

TYPHOID FEVER DEATH RATE PER 100,000 BY WARDS

FROM JULY 1ST, 1906 TO JUNE 30TH, 1907

~NOTE:~ WARDS 42, 43 & 44 WERE NOT INCORPORATED AT TIME OF STUDY.]

Ward 21, the other section selected, is in area one of the largest in the city, lying to the east in what is known as the Homewood District. The population of this ward is about 26,000, living mostly in good homes, with occasional poorer dwellings along the railroad and in some of the "runs." In the main, they represent a high wage or small salaried class. From this section, the other half of the cases studied, about forty-eight per cent was taken.

The period covered by the investigation was one year, beginning July 1, 1906, and ending June 30, 1907. The field work was done by Miss Anna B. Heldman, visiting nurse of the Columbian School Settlement, whose personal acquaintance with many of the families of the Hill District, and whose six or eight years' experience in caring for typhoid patients in this same neighborhood, enabled her to secure in detail many facts that might have escaped a person less familiar with the district or the families concerned.

An analysis of the cases thus studied, shows that there were either reported to the Pittsburgh Bureau of Health, or known to the investigator, but not reported, 433 cases of typhoid fever in wards 8 and 11, 94 in wards 25, 26, and 27, and 502 in ward 21--a total of 1,029 in these six wards within the one year studied. These cases occurred in 844 families. Miss Heldman, five months after the close of this year period, was able to locate but 338 of these families, the remainder having either moved out of the state, or been lost track of by people living in the neighborhood.

There were 2,045 individuals in these 338 families, or an average of 6.4 persons per family. Of this number, 448 individuals, or 22 per cent had typhoid fever within the year. Out of these 448 cases, there were 26 deaths and 422 recoveries, an exceptionally low percentage of deaths to cases.

Of the 448 patients, 187 were wage earners, contributing all or part of their earnings to the family income. As a result of their illness, these 187 wage earners lost 1,901 weeks' work, or 36.6 years. This averaged over ten weeks per patient, and represented an actual loss in wages of $23,573.15. In addition, other wage earners lost 322 weeks' work while caring for patients, thereby losing $3,326.50 in wages, and bringing the total of wages lost to $26,899.65.

The other large item of cost is that of expense for care and treatment of patients. Ninety cases were treated in hospitals for all or part of the time, as pay patients, half-charity, or full-charity cases. To meet these hospital expenses, $2,332.00 was paid to hospitals by full-pay patients themselves, and $1,834.50 was paid the hospitals by either individuals or charitable organizations for the care of half-pay patients, making the total cost of caring for 90 hospital patients $4,166.50. This is an understatement, because it omits the contribution of the hospitals themselves to the care of half-charity and full-charity patients. If figures were available, there should be added the amount represented by the difference in the money paid to hospitals and the actual cost of maintenance, presumably another $1,800.[11]

[11] Out of the 448 cases studied, twenty-four of the ninety cases treated in hospitals were as full charity patients and sixteen were taken as half charity cases; of the 358 cases treated at home, fifty received outside aid and ninety-six were compelled to incur a debt for all of their expenses, with no immediate prospects of being able to repay it. Moreover, many received sick benefits and others were a direct drain on the business interests of the city from the fact that their employers kept them on their pay-rolls during sickness, at half pay.

The expenses of the remaining 358 patients cared for in their homes amounted to $12,889.90 for doctors' bills, $1,965.50 for nurses, $2,640.60 for medicines and drugs; $1,810.10 for milk, $629.20 for ice, $861.50 for servants made necessary by the illness of those naturally caring for the home, and $1,204.45 for other expenses, of which the largest single item was the cost of a trip to Colorado and return at the doctor's orders, for a patient threatened with tuberculosis. The total of these expenses was $22,000.35.

The funeral expenses of the 26 patients who died, amounted to $3,186.00. It may be argued that sooner or later funeral expenses must inevitably be met, and that they should not, therefore, be charged against this account. Under the circumstances, however, these expenses were premature, and were directly chargeable to typhoid fever. Consequently, it has seemed fair from the point of view of this study, to include them. The grand total loss in wages and in expenses thus outlined was $56,252.50.

Further analysis shows that the average loss in wages per patient among the 187 wage earners was $126; that the average cost per patient in loss of wages and expenses for the 446 patients was $128; and that the average cost in loss of wages and expenses for each typhoid death among the 448 cases was $2,164.

Consider the losses in these wards in their bearing upon the city as a whole.

There were 5,421 cases of typhoid fever in Greater Pittsburgh in 1907. If the cost to each patient was $128, typhoid fever cost the city that year $693,888 in expenses and loss of wages alone. There were 622 deaths from typhoid fever in Greater Pittsburgh during the same period. If we put the value of these lives lost at so low a figure as $4,000, an additional loss of $2,448,000 was sustained. Or in round numbers $3,142,000 was the minimum economic loss to the community of Greater Pittsburgh, due to typhoid fever alone in the year 1907. This is a conservative estimate, in view of recent values placed on deaths from tuberculosis.[12] The two and a half million dollar death item might be doubled without overstating the case.

[12] Prof. Irving Fisher, of Yale, in a paper read at the International Congress on Tuberculosis in Washington last October, held that "the money cost of tuberculosis, including capitalized earning power lost by death, exceeds $8,000 per death." The average "expectation of life" lost through death from typhoid fever is not greatly different from that of tuberculosis.

When it is considered that typhoid fever has been almost constantly prevalent within the city limits, with practically no abatement, for the past thirty-five years, it requires only a little applied mathematics to calculate the probable enormity of the money loss to the community, through the ravages of this disease alone, year after year. Was it not time for it to stop? In the face of over a $3,000,000 loss last year, $5,450,000 was not more than the city could afford to pay for the filtration plant that is purifying the drinking water. Nor was it extravagance for the mayor and city councils to grant the superintendent of the Bureau of Health an increased staff of tenement house and milk inspectors, to make it possible to clean up other sources of infection, and hasten the time when typhoid fever in Pittsburgh shall constitute a no greater menace than in any other well-kept American city.

* * * * *

I have used the term "economic cost" of typhoid fever with reference to Pittsburgh families. The mere phrase carries with it no knowledge of all those family readjustments and inconveniences, the distress of mind and unalloyed misery that must be considered before we can form any adequate idea of what such sickness holds for a wage earning population. Were it necessary to measure the result of typhoid fever only in cold cash, it would be a relatively easy task. In the first place there are the thousand and one makeshifts and re-establishments that must be reckoned with in order to get a clear idea of what typhoid means to those poorer families, where, without the invasion of sickness, the business of getting bread is a constant struggle. In a family consisting of a man, wife and three children, the sixteen year old daughter, who had not been very strong, contracted typhoid. At the end of sixteen weeks in bed and thirty-two weeks out of work, she had developed a marked case of tuberculosis. Not being strong enough to go back to her former employment, she secured work in a bakery where she was subsequently seen coughing as she wrapped up bread for customers. The father of this girl, during her sickness, was keeping six cows on the premises and selling milk to customers living in the neighborhood.

The twenty-year-old wife of a Hungarian laborer had a six weeks' old baby when she came down with a slow case of the fever. She remained at home for a week with no one but herself to do the work and care for the baby. The husband, who did not realize the cause of her weakness, gave her a beating each day when he came home, because he thought her lazy. He made her carry up coal for the fires until she became so delirious that he could not keep her in the house. She was then sent to a hospital and the baby given to friends. The woman died in a week and the baby two weeks later.

A family of five, consisting of father, mother and three little children, cooked, ate and slept in one uncurtained room. The mother and four year old girl were taken sick at the same time. The girl occupied an Arbuckle coffee box, with a pillow and pillow-case for a mattress, and the man's overcoat was her only covering. The mother slept in the only bed, furnished with a mattress and one small comforter, and shared it at night with the father, the baby and their six year old girl, who lay across the foot of the bed. The girl was in danger of contracting pneumonia from exposure. A family of seven occupied a store and kitchen on the first floor and two rooms upstairs. A small bedroom was the only one which had a fireplace; and the entire family slept there; the mother (who had typhoid), in the only bed, and the father and five children in a row on the floor.

In another family, the six year old boy had the fever, and was found lying on an improvised bed, his little dog tied beside him. The mother had rested the ends of two boards in a china closet at one end of the kitchen, and on a chair at the other, so that she might care for the patient, do the cooking and attend to the baby at the same time. By this make-shift, the father was able to keep at his work.

One family, consisting of father, mother and five children, managed ordinarily with a bed for the parents, a child's bed for the eight year old girl, a two-third size bed for the eighteen and sixteen year old daughters, and a cot for the fourteen year and ten year old sons, one sleeping at each end. First the mother and one of the boys were taken sick, and during the early part of their illness, no one was disturbed. But within a month, and before the first two patients got well, the four other children came down with typhoid, making six in the family sick together. Then the father slept on the floor and the sick mother got out of her bed to give place to two of the children, she, herself, sleeping at the foot of the bed until one of the children became delirious. After that she moved to the foot of the two-thirds bed. In the day time she had no place to lie down, and sat all day in a chair until she became so weak that she could hardly walk. Occasionally she helped her husband who did the cooking and cared for the patients, by paring potatoes and doing other small work about the kitchen. No one had time to keep the kitchen sink clean, and the accumulation of vegetable matter became so filthy that it had to be reported to the Bureau of Health. With family income cut off, and with nothing saved, the family would have been penniless had it not been that the doctor made his bill moderate; the family was trusted for groceries, milk and ice; friends gave about twenty dollars in cash, and Columbian Settlement furnished bedding and the services of a visiting nurse. The mother did not fully recover for about six months. The father, who suffered a good deal from loss of sleep and exposure while caring for the patients, contracted a cold. This developed into a serious case of asthma from which he died.

To these and many similar families there were more serious results than the debts incurred. A school girl's unrecovered health, a stogie roller's reduced speed, a blacksmith's and a tailor's loss of strength, a case of tuberculosis developed, a boy become a truant, a family broken up and deserted, a baby's death,--all are of tremendous concern as items in the annual wear and tear of the city's potential resources. They are items of "economic cost" that cannot be handled by the statistical method. They are, after all, the real human finger marks that typhoid leaves when its clutches are loosened.

* * * * *

Such a showing, then, of actual economic and personal loss as this study of six Pittsburgh wards brought out, is offered as a final leverage to those who in other American cities may be endeavoring to dislodge inertia and clear their water supplies. This investigation of typhoid fever, however, as it was found in the households of the wage earners of Pittsburgh, had its immediate practical bearings. The sanitary facts it brought out showed unequivocally the necessity for ridding the city of other sources of infection at the same time that the water supply was cleared.

There was evidence that many of the after cases in the families studied, were due to conditions existing entirely apart from the water. Reports on housing conditions in Pittsburgh show that a favorable laboratory for the growth and dispersal of germs exists in the city's unsanitary dwellings. Insufficient water supply renders cleanliness almost impossible. Overcrowding means increased possibilities of infection through contact with food and drink in the combined family kitchen, pantry, dining-room, and bedroom. Pittsburgh's thousands of open privy vaults afford ideal conditions for the spread of disease by flies and other insects, and by personal contact. Such plague spots as Saw Mill Run, with its string of double-and triple-decker rear privy vaults discharging on the banks of a stream which are flushed off only when the water rises after a rain, afford further examples, deplorable and disgusting.

How much of the Pittsburgh typhoid has been due to direct contagion from such conditions as these, can only be inferred at the present writing. In line with the general question of contagion, and secondary cause, however, our data afford some clews. They show that in forty of the families studied, the first case was followed in from ten days to one or two months by other cases, seventy-six cases in all, in addition to the original forty. It shows further that in at least eighteen of these families, one or more of the following conditions existed: Family crowded into one or two rooms; home dirty and poorly kept; the person who cared for the patient also doing the family cooking; well and sick members of the family sleeping in the same room and often in the same bed; privy vaults in exceedingly bad condition, and often stopped up and overflowing with filth. In one family, consisting of man, wife, four children and three lodgers, crowded into two dirty rooms, a three year old boy was taken sick in October. The mother did the family cooking and cared for the patient. The cesspool in the yard which was in bad condition was used by two families. Another member of the family became ill November 3, and the mother came down on December 19. There were seven cases in this one courtyard within the year.

In another instance a man, wife, and nine children were living in three rooms. The sixteen year old son was taken sick on June 20 and was sent to the hospital. Then in July came the thirteen year old daughter for whom her mother cared at home. The mother also did the family cooking. The father, mother and eleven year old son all slept in the same room with the patient. All three of them followed within a month, and another son twelve years old, was taken sick in August.

In another family of eight, the sink in the kitchen and the toilet in the yard were in a very filthy condition. The mother and one son were taken sick in August. The sick and the well slept together in the crowded bedrooms. In November four more members of the family came down with the disease, on the sixth, ninth, eleventh and fifteenth, respectively.

Let the reader judge for himself whether or not, in the face of these facts, it can be expected that filtered water alone will solve the problem.

The Pittsburgh Typhoid Fever Commission is a recognition of these facts, and a recognition also from a national and scientific point of view, that probably never again in the history of any large American city will there be such a favorable laboratory in which to study the epidemiological facts of typhoid fever both before and after filtration. The commission was appointed in April, 1908, by Mayor Guthrie; is made possible by a grant from the Russell Sage Foundation, and by the co-operation of the bureaus of health and water, which offered the free use of their laboratories for analytical and administrative purposes. Dr. James F. Edwards is chairman, and the membership includes Dr. Dixon of the State Board of Health, Prof. Wm. T. Sedgwick of the Massachusetts Institute of Technology, and Dr. E. S. Rosenau, of the Public Health and Marine Hospital Service, who has been directing the elaborate governmental investigations into typhoid in the District of Columbia. The following report is made (January 1) by Dr. E. G. Matson, of the Pittsburgh Bureau of Health, executive officer of the committee.

The work of the commission to date has consisted of a minute
investigation of all cases of typhoid which have appeared
since May 1, 1908, including the sanitary condition of their
living and working places. Investigations have also been made
into neighborhoods where there appeared to be fewer cases
than the average of the city, the milk supply, and the water
supply, both public and private. It is remarkable that not even
the smallest outbreak has been traced to milk. A particular
feature of the study of water supply is that in connection
with the acidity of the Monongahela and the eastern affluents
of the Allegheny and its effect upon the sewage discharged
by an enormous town population into them. So far typhoid has
declined greatly in Pittsburgh since January, 1908, as compared
with the average or even the minimum of previous years. This
decline has naturally been a subject of great interest though
it is too soon to give the results of investigations. We have
ascertained that this decline has been shared by the towns on
the lower Allegheny, which have hitherto been supposed to be
the most important source of our epidemics. During November
and December, which would represent the first months of the
filtered water period, typhoid has been reported from the
filtered water area at the rate of the most favorable American
cities, and in Allegheny, which receives nearly the same water
unfiltered, at about twice this rate.

III.--THE STORY OF THE LONG FIGHT FOR PURE WATER.

And now we come to the story of the long fight for pure water in Pittsburgh. The irony of the situation is, that there should ever have been a long fight in a city which has since 1863 publicly recognized the danger of impure water, the significance of which has almost continually been brought before the people by press and platform alike, for the past fifteen years. The story of the whole filtration movement cannot be separated from the story of the struggle for supremacy of contending factions in the dominant political party. And the result,--excess typhoid with its terrible cost,--becomes part of the penalty the city has had to pay for such corruption as the present graft proceedings in councils are bringing to light.

The situation at the beginning of the filtration movement in 1895-96 was this: One of the strongest political machines in the history of municipal government was in absolute control in Pittsburgh. It mattered not who was elected mayor; he had no responsible power. Heads of departments were appointed by outgoing councils. This meant that department heads held over, and used their power to re-elect as in-coming councilmen the outgoing councilmen who had elected them. Moreover, councils were controlled by the ring.[13] In this way the political machine was self-perpetuating. The directors of public works drew specifications for public improvements; councils awarded contracts; and it is a matter of notorious record that the well-known firm of which one of the ring leaders was a member usually secured the contracts.

[13] For an analysis of Pittsburgh politics during this period under the leadership of Magee and Flinn, see Lincoln Steffens's The Shame of the Cities.

The municipal election in February, 1896, was hard and bitterly fought. George W. Guthrie headed the reform party as candidate for mayor. According to one authority the majority of ballots cast were for Guthrie, but when the count came in officially a few days after election, the ring had won. With the mayor, both branches of councils, and the director of public works all of the dominant party, the carrying out of their ante-election pledges so far as filtration was concerned would seem a matter of course.

True to these pledges, a resolution for the appointment of a Filtration Commission, to include the mayor, the president of each council, and eight citizens,--making eleven in all,--passed City Councils on June 8, 1896, and was approved by the mayor on June 10.