My father’s older sister, Nellie Roe, was according to my father, who was several years younger, pretty, kind, smart and probably the best of the seven kids. When Nellie was fourteen she was stricken with typhoid fever and died.
Who knows what Nellie might have accomplished? Given that her grandparents were immigrants, the family lived on a farm in Oklahoma, and that she was a girl born about 1903 probably nothing more than most of us do, but we’ll never know.
Looking at a different girl, born decades earlier we get some idea of the degree of loss.
Mary Abigail Powers Fillmore was born in Buffalo, New York in 1832. Her father was President Millard Fillmore. Given every opportunity available to girls at that time, Mary, known as “Abbie”, by the time her father became president spoke French fluently, was conversant in three other languages, and was accomplished on the piano and harp.
Abbie’s mother, Abigail, was sickly so Abbie took over the role of hostess at the white house, greeting guests, serving refreshments, and playing piano or harp as guests carried on business.
Weeks after her husbandr left the White House Abigail died. Abbie took over management of the home and accompanied her father on the first Grand Excursion. The Grand Excursion was a combination steamboat and rail trip from the East to the Mississippi River basin celebrating the opening of a new rail line from Chicago to Rock Island, Illinois and then upriver to St. Paul, Minnesota Territory. A few weeks later Abbie died of cholera at age 22. Abbie wasn’t in Bangladesh or some other third world country at the time. Water borne infections were common in the U.S. then.
My rotation through Pediatrics as a medical student gave me the opportunity to see several children with Shigella infections (Shigellosis) or Salmonella infections. Typhoid fever is the result of infection with Salmonella typhosa, but there are a number of related species of Salmonella that cause diarrhea which can cause death in infants.
As a student we took interminably long histories on every patient. The questions weren’t just about the present illness, but also about everything else in what was known as the “system review”. One of those questions was, “Is your outhouse uphill or downhill from your well?” If you can’t relate to that question, there were still a lot of people in Arkansas in the mid-20th century that had dug wells (subject to contamination from run-off in some cases) and outhouses. The question seemed pointless; who in that day and age would have their outhouse uphill from the well.
Questioning the mother of one of the kids with diarrhea and dehydration the answer was “uphill”. The infant’s formula had been made using well water.
In November of 2017 I contracted a nasty little parasite, Cryptosporidium. I have no idea how. We had been traveling and I believe I got it in Florida along the gulf coast somewhere, but there is no way to know. Crypto is usually contracted in the U.S. from “recreational water”, however, I had not been kayaking or hiking. People with "Crypto" are sick, typically for one to two weeks. I was in bed for about five days and the symptoms lasted about a week. Crypto causes about 5% of diarrheal diseases in the U.S. but in developing countries it may account for 25%. Why is it not more common in the U.S.?
The history of water safety and sanitation in America is one of piecemeal legislation culminating in the Safe Drinking Water Act of 1974.
Water safety has always been something we understood. Our not-so-distant ancestors watched animals to see which sources of water were safe.
Our first understanding that microorganisms like bacteria and parasites could be the cause of disease did not come until the nineteenth century with the discoveries of Louis Pasteur, and the observations by Dr. John Snow concerning a London Cholera epidemic in which he related the cholera outbreak to a single water source in London. (I have a retired Emory University medical school professor friend who has little regard for physicians. He likes to point out that Dr. Snow was not a scientist, but an epidemiologist. He did not establish cause, merely relationship.) This was a classic epidemiological study.
In 1893 Congress passed the Interstate Quarantine Act. The intent of this act was to protect water sources on trains and boats. The law, for instance, prohibited the use of common drinking cups unless they were washed between each use. Perhaps the most important provision of this act is that it gave the Public Health Service oversight authority to insure that public drinking water on trains and ships was “of satisfactory sanitary quality and safety”.
Note that this Act by Congress occurred decades after Abbie Fillmore died of cholera, possibly contracted on the Grand Excursion. Everything came together too late for her.
Congress revised and expanded the Interstate Quarantine act in 1914, 1925, 1946 and 1962.
In 1899 the Rivers and Harbors Act was passed to keep debris out of navigable waters, but Section 13 provided prohibitions “for the discharge of refuse matter into or affecting navigable waters”. The term “refuse matter” was used later as a tool to improve drinking water quality.
The Federal Water Pollution Control Act of 1948 was the first anti-pollution act in the U.S. It authorized the Public Health Service to work toward safe surface and underground water. It suffered for lack of enforcement powers.
The law was amended numerous times culminating in the Clean Water Act of 1972.
The Water Quality Act of 1965 preceded the Clean Water act and this statement by President Lyndon B. Johnson is classic LBJ,
“There is no excuse for a river flowing red with blood from slaughterhouses. There is no excuse for papermills pouring tons of sulphuric acid into the lakes and the streams of the people of this country. There is no excuse–and we should call a spade a spade-for chemical companies and oil refineries using our major rivers as pipelines for toxic wastes. There is no excuse for communities to use other people’s rivers as a dump for their raw sewage.”
Remember that our streams were once so polluted with industrial waste that the Cuyahoga River, which runs through Cleveland, Ohio, caught on fire “in June 1969 near the Republic Steel mill, causing about $100,000 worth of damage to two railroad bridges”. That fire came four years after he act Johnson passed.
The Safe Drinking Water Act was passed in 1974 and is enforced by the EPA.
The SDWA ensures the safety of public water sources that serve greater than 25 people. It does not inspect private wells, transient public water supplies (the cooler at the church picnic, for example). It oversees both the sanitation and safety of drinking water from introduced or naturally occurring toxins.
I can see a photograph in my mind of my Aunt Nellie and my father as a seven year old boy that I’m afraid no longer exists. One of my cousins looks like our aunt.
I probably would not have liked Abbie Fillmore. She was, after all, Millard Fillmore’s daughter, and President Fillmore was anti-almost everything that was not white and protestant. However, a note concerning Abigail, Fillmore’s wife, said that she didn’t have much use for pretentious people, a trait I share. Whatever the case a life was cut short.
Water borne illnesses like cholera kill through dehydration and shock. Typhoid fever may kill in that way, but it may also kill by perforation of the bowel and peritonitis as it did with my aunt. In some cases individuals recover and become carriers, as in the infamous instance of Typhoid Mary, an Irish immigrant cook who moved from place to place of work infecting others with Salmonella. She was ultimately exiled to an island in order to prevent her from infecting others.
About 13% of people who get Crypto become carriers.
The only reference I found about the short life of Abbie Fillmore was on Wikipedia.
Mary Abigail Powers Fillmore on the Grand Excursion
The EPA and the Safe Drinking Water Act of 1974
History of water safety regulation prior to 1974