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Excerpt from the Department of Public Health's Annual Report for 1906-1907

Typhoid fever




Living condition

1906 Earthquake & Fire


Early Sanitation Work
 (Deparment of Public Health Report)

Each one is sufficiently familiar with the memorable events of April 18th, so that it requires no review of that period for the purposes of this paper. While chaos reigned throughout the City, and it would appear that each man if he attended to his own interests would be justified, yet to the lasting credit of the Inspectors of the Department of Public Health, as if actuated with one accord, they reported for duty within one hour of the disaster. The City was arbitrarily districted and each district placed in charge of an Inspector, who was directed to secure volunteers, which was done. Squads were detailed to rope off walls and buildings that were in immediate danger of collapse, and ether groups were stationed along the fire line to assist in the work of rescue of injured and dead.

On April 19th temporary quarters for the Department of Public Health were established on Laguna Street, and from this point the work of sanitation began.

The squares, public parks and vacant lots were packed with the stricken multitude, and without sanitary conveniences of any kind. While they were ably protected by the military, without whom it would have been impossible to successfully cope with the situation at this period, still the gravest condition presented itself. Sick and well were confusedly packed together; water supply cut off; sewers broken and no protection from the elements, which were unusually severe for this time of the year. The medical profession of this City realizing the danger, came quickly and voluntarily to headquarters, offering their services, and were immediately added to the regular staff. Details were arranged for the segregation and care of the sick and injured in the various camps, and the isolation of all those suffering with contagious disease. Provision was also made for the re-establishment of the water supply, and the construction of latrines.

Conferences were planned and meetings arranged by President Ward of the Board of Health for a special Health Commission, which consisted of representatives from the United States Army, the Public Health and Marine Hospital Service, the State Board of Health, and the Board of Health of this City and County. These meetings were held two and three times a day, and ways and means were devised for the proper protection of the people and the rehabilitation of sanitary conditions.

Hospitals and dispensaries were organized and established. Damaged hospitals were repaired immediately, and to this end a large force of skilled labor was summoned and material placed at their command to complete the work. The locations of these hospitals and dispensaries were given to the public through the medium of the Press and the Bureaus of General Information.

A call was made for plumbers for the purpose of making a house to house inspection; to shut off the water in houses where the pipes were broken; to make temporary repairs in sewers and pipes; and to assist the Spring Valley Water Company in stopping the leaks, and make it possible to re-establish the water supply. Six hundred and thirty-eight men were thus employed.

Then came the districting of the City into three great sanitary districts, each in charge of a physician, who appointed his corps for the control of the sub-districts, and reports of the work performed daily were forwarded to the Board of Health.

Disinfecting crews, consisting of a team, several laborers, disinfectants and appurtenances for the digging of latrines, and the collection of debris and refuse and placing it where it could be removed by the scavengers, were organized. Householders were notified to place their garbage barrels at the curb and for a period of thirty days, an average of 200 teams and 225 men were engaged in this work. This was free of cost to the citizen.

A serious difficulty confronted the City at this time in that the Sanitary Reduction Works, where all garbage had previously been incinerated, was a total wreck. For a period of ten days the City's garbage was taken to the burned district, and an effort made to incinerate it; this, however, proved unsuccessful, and finally arrangements were completed for 'its disposal at sea by means of barges. An average of seven hundred loads were removed daily. Considering the destruction of the system of the disposal of garbage, the entire population cooking in the streets, these streets filled with debris of all kinds, teams and wagons difficult to hire, a stupendous task was undertaken and accomplished in meeting and successfully coping with the above conditions.

For the first twelve days after the earthquake and fire there were 509 dead animals removed from various parts of the City, including the burned area. These were incinerated. During the succeeding months to date, over seven hundred dead horses have been disposed of in like manner.

Beginning almost immediately with the establishment of camps, and the dealing of rations, was a vigilant inspection of all food supplies. To the first of August, 109,021 pounds of beef, veal, mutton, lamb, pork, fish, poultry, and many sacks of vegetables and boxes of fruit were condemned and destroyed as unfit for food. Coincident with the closing of saloons an unusually large number of refreshment stands opened for business in all sections of the City. These stands offered for sale principally soda waters and a product called cider. As these liquids were manufactured, the Department was interested in the purity of the ingredients. Samples from each manufacturer were submitted of the Chemical and Bacteriological Laboratories. The findings of the Chemist revealed the fact that the soda waters were colored and flavored with coal tar extracts and dyes and sweetened with saccharine. The cider was a concoction of tartaric acid, citric acid and coal tar dyes. The quantity of tartaric acid in some instances ran as high as forty-eight grains to the five ounces, which is the usual amount served in a five-cent glass. The report of the Bacteriologist showed these products to run exceptionally high in bacteria; in many cases fermenting gas, and growing upon Parietti and Ellsner's media, which warranted the conclusion that the water which formed the base of these drinks was contaminated, or that gross carelessness prevailed in the cleaning of the containers used by the manufacturers. The Board of Health realizing the seriousness of this situation, ordered the suspension of the manufacture of the products and the withdrawal from sale of all that was upon the market at that time. This led to the condemnation, in a single day, of ninety barrels of cider and several hundred boxes of mixed soft drinks. Subsequently, soda waters were permitted to be sold if manufactured from distilled waters, and providing, further, that saccharine and coal tar colors be omitted.

Special vigilance was maintained over the milk supply. In addition to the quantity produced in this City and County, 80,000 gallons was about the daily average shipped from outside counties to San Francisco, and owing to the fact that the lines of communication were disorganized or engaged in giving their sole attention to transportation of refugees and relief stores., a milk famine seemed imminent. This condition was aggravated By the problem of obtaining milk cans, thousands of which .have been destroyed and many of those left Were seized by the homeless for cooking purposes. Los Angeles and other neighborhood cities contributed in this behalf until a supply was obtained from the Eastern markets. An average of 250 local dairies and dairy depots are carefully inspected each month, and close -watch kept over them to see that the cans and bottles are properly scalded and washed. A sample of the water supply of each depot and dairy in the county is submitted monthly to the laboratory for examination, and where such water shows a suspicion of contamination the source of supply is sealed and the use of the water is prohibited. In addition, a careful inquiry is instituted regarding the existence of any contagious disease occurring. among the employees of the dairy or members of their families, and a special report of each visited is filed by the Inspector daily.

Three thousand one hundred and twelve new structures were passed upon by the Plumbing Inspectors of the Board of Health, and 183,610 linear feet of soil and sewer pipe were tested during the months of May, June and July. One thousand one hundred and thirty-two complaints of defective plumbing were investigated and abated. The Department having but four men in the field for this work, the magnitude of these figures can be appreciated only by those familiar with such work.

The Board of Health also maintains a Supervision over the baths and laundries, and two trained Inspectors devote their entire time to the disinfection and fumigation of places where contagious diseases have existed.

Uppermost in the mind of the Board was the question of the water supply. Within three days after the fire, notices to boil all drinking water were posted in the camps and other conspicuous places. At first these notices were made on a piece of board of shingle with a marking pot and brush; later printed circulars, cards and hand-bills were distributed. The Department was in a dilemma. Our means for the examination of water, milk and food stuffs were totally destroyed, and a like condition existed in nearly every other available public or private laboratory, and analytical work seemed out of the question. The emergency, however, was met by erecting a tent in Golden Gate Park as a temporary bacteriological laboratory, and the equipment necessary to perform the work was supplied through the courtesy of the Hahnemann Hospital. The College of Agriculture of the University of California very generously placed their laboratory at the disposal of the Board of Health, thus making it possible for chemical examination of water, milk, etc.

During the past three months 145 chemical and 225 bacteriological examinations of water alone were made.

The first weeks following the disaster found Spring Valley water high in albumenoid of ammonia, nitrates, nitrates and chlorine; high in bacteria and fermenting considerable gas, proving that by reason of the disturbance there had been some contamination in the water mains. Careful investigation was then made of the waters stored in the Lakes Pilarcitas, San Andreas and Crystal Springs, also from the pumping station at Niles. The waters from these sources of supply were found potable. The repair work on the mains by the Spring Valley people was rapidly progressing, and owing to the immense number of leaks in the various sections of the City, the water system received a very thorough flushing, and subsequent examinations of the water showed a decided improvement.

In the latter part of the month of May grave suspicion again rested upon the water, which led to the belief that the reservoirs were filled with water from North and South Merced Lakes and from Lake Honda, which waters have shown in the many examinations made to be be [sic] high in albumenoid of ammonia, chlorine, and sometimes high in nitrites and nitrates, due probably to the unsanitary condition of the surrounding watershed and contamination from surface sewers.

The waters from these sources have been declared unfit for human consumption, and condemned by the Board of Trade. The Spring Valley notified that exception would be made in the event of a great emergency which would render its use necessary for fire purposes.

Weekly, from six or seven sections of the City and County, bi-monthly from the different reservoirs, the water has been examined, and in no instance, except in relation to Lakes Merced and Honda, was it found to be not potable. The prevention of disease is the first thought in the mind of the medical man and certainly the reason for the existence of the Board of Health, hence, wherever large bodies of people are congregated, whether as the result of a calamity, or some arranged plan of centralization, the prime factor for consideration is the elimination of contagious disease. That this is - more difficult where such aggregations are the outcome of a disaster is obvious, for the problem concerns not only the unfortunates, but the environs of the unaffected.

On April 18th there were sixty-five cases of variola [smallpox] in the Isolation Hospital, and seven or eight patients quarantined in private houses. The number of cases of diphtheria, scarlet fever and measles was comparatively small. The typhoid fever cases numbered seven, apparently a very low record and due to the fact that reports of this disease are seldom received from the profession. As already stated, a rigid inspection was inaugurated at the outset to locate and place under control the developed cases, and every effort exhausted to track and keep under observation the contacts. With people quartered in every available park, lot or street, and hundreds crowded in basements, stables and like places, the task was tremendous. Personal responsibility and thought of self were submerged, no doubt due to the terrors they had faced or the losses sustained. Another source of menace was a class of misguided people who have no faith in the doctrine of Aesculapius, but treat their sick after the manner of dogma. Illustrative of this is the case of a refugee living on Page Street, who was by chance found in the street suffering with variola [smallpox], and in the advanced stage of desquamation. At this time he was engaged in peddling doughnuts in the various camps. He was quarantined in his residence, but too late, for not only did every one of the fifteen inmates, all of the same cult, fall victims to this disease, but forty other cases are directly traceable to him. To-day we have but ten cases of variola [smallpox] in the hospital.

Typhoid fever [CDC on typhoid fever] was at all times the disease that received the major share of attention from the standpoint of prophylaxis, being the sequence logically expected in so complete a revolution of the mode of living of the population of an entire City, and is to-day the disease principally considered by the Board of Health.

An attempt to eliminate the danger of infection by water, which is naturally suspicioned, was the first work.

A careful and thorough inspection of food stuffs followed.

The latrines, which numbered hundreds in every conceivable part of the City, were systematically disinfected, with a view of limiting the menace of flies.

During the month of May we recorded sixty cases of typhoid, fifteen of which had their origin in Tennessee Camp, in the Presidio Reservation. Anticipating the probability of an epidemic, the Joint Health Commission erected in Golden Gate Park a contagious pavilion, which was intended to be used wholly for typhoid patients. This, however, has never been opened, for the reason that, beginning with the first week in June, a perceptible decline in cases was noticeable. At the end of June the total for the month numbered thirty-five. This marked reduction and the reports from the laboratories on water and milk was certainly reassuring. About this time the disinfecting squads were diverted from the latrine work for the purpose of moving and concentrating small camps of refugees. This work was continued until about the middle of July, when the situation again became alarming on account of the multiplication of typhoids reported. In order that there should be no error of diagnosis of cases reported, a Widal test and diazo reaction were requested in every instance, and if possible a Leucocyte count, before the report was accepted as typhoid. The chemical and bacteriological findings on the water again submitted proved negative, and yet the number of cases daily increased. A review of the ground revealed that some other factor was responsible for the continued spread of the disease. Inspection showed that the large public relief kitchens located in the camps were unscreened and open to the dirt, dust and invasion from flies; myriads of the latter were found in every portion of and. upon everything in these kitchens. In many instances latrines were not far distant, and these were likewise uncovered, and unscreened. Investigation and inquiry proved that many refugees were careless in the disposal of excreta, throwing it on adjacent surface soil. This became an added menace, as quite a number of the cases were of the ambulatory type. From one such patient, whose tent was in Garfield Square, were traced twelve cases.

It is not intended to claim that the camps or camp kitchens are the only source of infection, although 151 cases are directly traceable to camps; thirty cases to sources outside of the City and County, and nearly forty are case to case infection and rated as contacts. A part of the remaining number are no doubt due to the use of infected spring and well waters, which were used in spite of all warnings. The balance of the cases it was impossible to trace the source; some, however, give a history of having eaten in relief kitchens, but owing to indefinite and inaccurate data they cannot be included in camp cases.

To verify our conclusions that the infection was fly-borne in the majority of the cases, an. elaborate set of experiments was made. An agar plate was exposed at a distance of ten feet on the windward side of the tent of the case mentioned as living in Garfield Square, and after allowing several flies to touch the plate the dish was sealed and taken to the laboratory. After twenty-four hours of incubation it showed staphyloccocci, streptococci, bacilli resembling coli communic, and putrifaction rods. Further segregation showed the culture to ferment a large amount of gas and to grow on Parietti and Ellsner's media. Second and third test cultures were taken from the relief kitchen, distant about 250 feet, and showed the identical results obtained in the first plate. This led to the securing of similar cultures from every established camp and relief kitchen in the City, as well as from numerous open restaurants and street vendors' stands.

Appended herewith are some of the results obtained:

Camp, Nineteenth and Potrero Avenue (Kitchen) - Bacilli resembling coli ; strepto bacilli ; streptococci ; staphyloccocci : large amount of gas; grows by Parietti and Ellsner's media.

Camp, Nineteenth and Potrero Avenue-Plate No. 2- Spore bearing bacteria; ferments much gas and grows by Parietti and Ellsner's media.

Camp, Nineteenth and Potrero Avenue-Plate No. 3- Results same as Plate No. 2.

Kitchen, Duboce Park- Spore bearing bacteria ; numerous small cocci ; bacilli resembling coli ; ferments; large amount of gas; grows by Parietti and Ellsner's media.

Kitchen, Duboce Park-Plate So. 2- Bacilli resembling coli; putrifactive rods: large amount of gas; grows by Parietti and Ellsner's media.

Kitchen at Camp Lake- Bacilli resembling coli; spore bearing bacteria; large amount of gas; grows by Parietti and Ellsner's media.

Nieto Kitchen, Precita Square (taken from meat block)- Bacilli resembling coli ; spore bearing bacteria ; large amount of gas ; grows by Perietta and Ellsner's media.

Nietro Kitchen, on Bernal Heights (Cortland and Andover)- Bacilli resembling coli ; spore bearing bacteria ; ferments large amount of gas; grows by Parietti and Ellsner's media.

Kitchen at Lobos Square. Camp No. 9- Bacilli resembling coli ; staphyloccocci ; streptococci ; general turbidity ; large amount of gas; grows by Parietti and Ellsner's media.

Kitchen at Lobos Square. Camp No. 9-Plate No. 2- Bacilli resembling coli ; putrifactive rods ; staphyloccocci ; general turbidity ; large amount of gas; grows by Parietti and Ellsner's media.

Kitchen, Harbor View Camp- Bacilli resembling coli ; spore bearing bacteria ; general turbidity ; large amount of gas; grows by Parietti and Ellsner's media.

Camp Kitchen, Washington Square- Spore bearing bacteria ; slight turbidity ; bacilli resembling coli; no gas; grows by Parietti and Ellsner's media.

Canton Restaurant (Chinese), 7 Brennan Place- Cocci bacilli ; staphyloccocci ; bacilli resembling coli ; large amount of gas ; general turbidity; grows by Parietti and Ellsner's media.

Golden Gate Cafe, 634 Golden Gate Avenue- Spore bearing Meteria in chains ; staphyloccocci ; bacilli resembling coli ; large amount of gas; general turbidity; grows by Parietti and Ellsner's media.

Yellow Wagon, 868 Market Street- Bacilli resembling coli ; bacilli resembling diphtheria ; no, gas ; no growth by Parietti and Ellsner's media.

Globe Cafe, 618 Franklin Street-(Dr.'Furey)- Staphyloccocci ; spore bearing bacteria ; putrifactive rods : large amount of gas: general turbidity: grows by Parietti and Ellsner's media.

Ediliveis Rest and Grill, Fourth Street, near Market- Staphyloccocci ; bacilli resembling coli : no gas ; general turbidity on glucose boullion: no growth by Parietti and Ellsner's media.

Golden Leaf, 2412 Market Street- Spore bearing bacteria; bacilli resembling coli; no gas; moderate amount of turbidity: grows by Parietti and Eilsner's media.

Pioneer Restaurant, Fourth and Jessie Streets- Putrifactive rods ; bacilli resembling coli ; staphyloccocci ; streptococci ; no gas; no turbidity; grows by Parietti and Ellsner's media.

Charter Oak Dairy, 816 Naples Street (from milk room)- Putrifactive rods; no gas: slight turbidity on glucose bouillon; no growth by Parietti and Ellsner's media.

California Diary, 700 Amazon Street (from milk room)- Staphyloccocci ; putrifactive rods : much gas : general turbidity on glucose boullion: no growth by Parietti and Ellsner's media.

John Escloses, Henrietta and Hanover Streets (from milk cooler>- Staphyloccocci: putrifactive rods; no gas; slight turbidity on glucose boullion; no growth by Parietti and Ellsner's media.

Colma Dairy, 615 Morse Street (from entrance to milk room)-(V. Miller)- Bacilli ; sport bearing bacteria : bacilli in chains ; much gas ; general turbidity; no growth by Parietti and. Ellsner's media.

The total number of cases reported in July was 158, making a grand total from April to August 1st. of 289. For the past fourteen days there have been fifty-seven cases reported; this is a marked decrease over what was expected, for in the last two days of July thirty cases have been verified. We believe this decrease due to the strenuous work of the Department for the last three weeks. In this time every latrine in the City has been roofed and darkened and thoroughly disinfected. Many have been abolished. Contacts have been closely followed, and vigorous sanitary measures adopted on all premises where cases were found.

To cope with the situation the Department of Health has recommended to the Relief Committee the following:

1st. Establish automatic flush Reed troughs in all sections where the main sewers in the streets are intact; doors and ventilating spaces of latrines screened. This to meet the wants of workmen employed throughout the burned district, as well as the needs of scattered refugee camps.

2nd. Wherever earth latrines must be maintained, change the design and size, and keep them properly disinfected.

3d. Maintain a sufficient number of latrines to prohibit the depositing of night soil i n any other place.

4th. In the creation of a complete organization, we suggest that the City be subdivided into sixteen districts, each of which to be in charge of a Medical Inspector, who will be furnished with a team and two laborers and necessary apparatus for scavenger work. The wagon will be further equipped with a barrel or tank, with force pump and 100 feet of small hose attached. The barrel to contain a 5 per cent solution of carbolic acid, which 1s to be sprayed upon the surface soil throughout the camps and other areas where flies accumulate, or infection be present.

5th. The use of small sulphur candles in all tents of the permanent camps, under the direction of the camp commander and surgeon, for the purpose of' killing the flies.

To this end the Board of Health has asked the Relief Committee for a certain sum of money.

The Board has felt chagrined at its inability to remunerate the many workers who gave their time and thought after the fire, and have labored besides in many directions in a greater or less degree since that date. There was no provision for this financial relief, and the best that could be done was a letter of thanks sent to as many as the Board could obtain the names and addresses of. and perhaps many who should have received even this small recognition did not, but the intention was to uphold the respect of the profession in this small but kindly appreciation of their efforts.

In conclusion, the policy of the Board of Health has been one of urging closer relationship with the general profession. The Board welcomes criticism that is leveled for a high standard of better organization in its endeavor to work out sanitary problems.

The recent efforts of the Board of Health to meet and consult with the members of this Society was an earnest of the high-mindedness, of its po1icy for the betterment of our citizens.

Chief Sanitary Inspector of the Department of Public Health of San Francisco, California.
August 11. 1906