Vaccines and Disease An investigative Report The fatal tendency of mankind to leave off thinking about a thing which is no longer doubtful is the cause of half their errors. � John Stuart Mill I n 1949, the DTP vaccine was licensed to prevent diphtheria, tetanus, and pertussis (whooping cough) issuing forth the modern use of vaccines in the prevention of childhood illnesses. Polio immunization was later introduced to prevent that dread disease. In 1963, the measles vaccine was licensed and was combined with mumps and rubella vaccines to create the MMR vaccine. In more recent times the hepatitis B and chickenpox vaccines have been developed and incorporated into our healthcare system. Now a child can expect to receive up to 33 vaccines during their childhood with more vaccines on the horizon, such as herpes zoster (shingles), West Nile virus, influenza, pneumococcal, HIV, and many more. The belief that vaccines are safe and effective is pervasive in today�s society. The vast majority of the medical, public, and government communities have a well-established belief system in the benefits of vaccines.

Even children�s books show how important it is to �get a shot from the doctor to keep us well.� Our belief system is so ingrained that we look to medical science to create new vaccines to protect us from everything from AIDS to ear infections. Unlike almost any other health-related issue in the free world, governments mandate many vaccines for the theoretical public good. In the United States, all 50 states require a large number of vaccinations before children are allowed to attend public schools or day care centers. Although most states have religious and medical exemptions, with some having a philosophical exemption, public and medical officials exert a great deal of pressure to vaccinate. The pervasive attitude that plagues will return and ravage the western world without everyone giving their child a full set of vaccinations is a powerful force in modern society. One of the chief concepts that vaccine proponents tell us, and that we generally believe in modern society, is that the use of vaccines is responsible for the virtual elimination of many childhood scourges that used to ravage the world.

We are told, and assume, that in the 1800s and early in the 1900s many diseases killed a large number of people, and that vaccines were invented and stopped these diseases from being a threat. But is this in fact the case? An immunization booklet produced by the CDC (Centers for Disease Control) states the following: �Why are baby shots so important? These shots protect your baby from nine diseases: measles, mumps, rubella (German measles), diphtheria, tetanus, pertussis (whooping cough), polio, Haemophilus influenzae type b (Hib disease), and hepatitis B. Are these diseases very serious? Today we might not think of these diseases as being very serious because thanks to vaccines, we don�t see them as often as we used to. � Measles used to kill hundreds � sometimes thousands � of people a year. In the 1920s, over 10,000 people a year died from diphtheria.� �Years ago, diphtheria was a widespread and greatly feared disease.

Through the 1920s, it struck about 150,000 people a year and killed about 15,000 of them. Since then these figures have dipped considerably, thanks to parents who have gotten their children vaccinated against this terrible disease. There were only 918 cases in 1960, 435 in 1970 and 128 in 1976. Today, only a few cases occur each year.� �Before measles vaccine was available, nearly all children had measles by the time they were 15 years old. An average of 530,000 cases a year were reported in the United States during the 10 years before vaccine was available. And during each of these years, over 450 people died because of measles. Now, thanks to the measles vaccine, the number of measles each year is a fraction of what it was then.� [1] These statements are certainly compelling. On the face of it, we cannot help but assume that vaccines have played a key role in improving all of our lives.

But looking carefully at the evidence over a longer period of time reveals a different picture of disease evolution and the role vaccines have played. One Swiss scientist that analyzed data over a longer period of time came to a different conclusion of what occurred in Switzerland: �An analysis has been made of the evolution in Switzerland of mortality due to the main infectious diseases ever since the causes of death began to be registered. Mortality due to tuberculosis, diphtheria, scarlet fever, whooping cough, measles, typhoid, puerperal fever and infant gastro-enteritis started to fall long before the introduction of immunization and/or antibiotics. The decline was probably due to a great extent to various factors linked to the steady rise in the standard of living: qualitative and quantitative improvements in nutrition; better public and personal hygiene; better housing and working conditions and improvements in education.� [2] In that research paper, several graphs of death rates in Switzerland show massive drops in deaths from disease long before vaccinations are introduced. One graph shows diphtheria death rates for children from 0 to 14 years of age peaking at over 200 deaths per 100,000 in the late 1800s.

This is followed by death rates decreasing to less than 10 deaths per 100,000 near the time of the introduction of the vaccine in the mid 1930s. There was an apparent 95 percent decrease in diphtheria death rates before introduction of the vaccine. Another graph within the same study shows scarlet fever decreasing from 200 deaths per 100,000 in the late 1800s to virtually zero by the 1930s before drug treatments were introduced. Yet another graph in the study shows typhoid also decreasing from 50 deaths per 100,000 in 1876 to virtually zero by the 1940s when drug treatments were introduced. A review of �Childhood�s Deadly Scourge� states: �During the last two decades of the 19th century diphtheria was the leading cause of death of toddlers in the industrialized world, in some cities killing more than a thousand in a single year. In contrast, since 1980 fewer than 100 cases have been reported in the entire United States.

Although diphtheria is hardly the only infectious disease to have thus faded, its story is unique because the early period of its decline can be directly linked to advances in bacteriologic knowledge and practice. Between 1880 and 1930 health authorities in New York City were responsible for much of the practical innovation in the control of diphtheria, as well as a good share of scientific progress.� [3] The Vital Statistics of the United States contains compiled statistics for a wide variety of information since early in the 1900s. Among those are death rates from all diseases, including infectious diseases. An introductory statement from the 1937 statistics indicates that death rates from infectious diseases declined greatly in the early part of the century. These declines occurred well before the advent of vaccines to treat these conditions. �The trend in death rates for specific causes, over the past 20 or 30 years, may be characterized by two general statements. In the first place, there has been a great reduction in the death rates for infectious and preventable diseases; in the second place, there has been an increase in the rates for certain diseases characteristic of older ages.

Greatest proportional rate decreases have taken place for such diseases as typhoid and parathyroid fever, which has declined from a rate of 23.5 in 1910 to 2.1 in 1937; and diphtheria, which declined from a rate of 21.4 in 1910 to 2.0 in 1937. � The rate reductions for infectious and preventable diseases can be largely attributed to the development of modern public-health practice.� [4] From these figures, we can see that death rates from typhoid decreased by 91% from 1910 to 1937 and death rates from diphtheria declined by 90.5% during the same time period. The decrease in diphtheria occurred well before the use of vaccination. An even a more recent editorial statement from the Journal of Pediatrics states that proper sanitation was largely responsible for the early large declines in infectious diseases.

�� the largest historical decrease in morbidity and mortality caused by infectious disease was experienced not with the modern antibiotic and vaccine era, but after the introduction of clean water and effective sewer systems.� [5] Again, in a 2001 paper in the Journal of Infection Control: �The conquest of infectious disease and the health revolution it initiated is arguably one of the greatest achievements of Western civilization. Yet the phenomenon is largely unknown and rarely taught, even in history courses. Conventional wisdom usually assumes that conquest of infectious disease can be credited to well-known lifesaving innovations in medicine such as vaccines, antibiotics, and surgical asepsis. These icons are truly essential ingredients of modern medicine, and their contribution to human life and health in this century can never be minimized. However, except for the smallpox vaccination, which was introduced in 1798 and made compulsory in England in 1853, the overall contribution of medical innovations to the health revolution of the 1800s is difficult to validate.

Diphtheria, tetanus, and pertussis vaccine arrived on the scene only after disease mortality rates already had been reduced significantly; measles, rubella, and polio vaccines did not become available until the middle of the 20th century, when most infant deaths were the result of other causes. The same holds true for sulfa drugs and antibiotics. Their contribution is unequivocal, but they did not affect mortality rates until the 1940s.� [6] Another paper published in the premier medical journal The Lancet in 1977 by the Department of Community Medicine in the United Kingdom also indicates that vaccines were not responsible for the decline in disease rates in that country. �There was a continuous decline [whooping cough deaths], equal in each sex, from 1937 onward. Vaccination, beginning on small scale in some places around 1948 and on a national scale in 1957, did not affect the rate of decline if it be assumed that one attack usually confers immunity, as in most major communicable diseases of childhood.

� The steady decline of whooping cough between 1930 and 1957 is predictive of a linear exponential decay characteristic of a general and progressive lessening in the volume and spread of infection among the susceptible population. With this pattern well established before 1957, there is no evidence that vaccination played a major role in the decline in incidence and mortality in the trend of events.� [7] The author�s conclusion that �there is no evidence that vaccination played a major role in the decline in incidence and mortality� is quite monumental and far different than the general public perception. Thomas McKeown who was Professor of Social Medicine in the University of Birmingham Medical School between 1950 and 1978, is still regarded as a major social philosopher of medicine, and known for his important works on epidemiology and the practice and purpose of medicine. His conclusion was also that diseases were declining well before medical interventions such as vaccinations came into standard use.

�The distinguished epidemiologist Thomas McKeown (1912-1988) maintained that reductions in deaths associated with infectious diseases (air-, water-, and food-borne diseases) cannot have been brought about by medical advances, since such diseases were declining long before effective means were available to combat them.� [8] Another author shows that disease and mortality was falling before the advent of vaccines or drug therapies: �� in 1869 there were 716 deaths from typhus in London; by 1885 this had been reduced to 28; and at the beginning of the twentieth century there was none. Similar declines could be given for other infectious diseases. Tuberculosis began a remarkable disappearing act. Killing perhaps 500 out of every 100,000 Europeans in 1845, consumption slowly but continuously sank to 50 per 100,000 by 1950. Curative medicine played little part in that transition. The disappearance began before Koch discovered the tubercle bacillus. By the time antibiotics entered the picture, TB in cities such as New York had fallen to eleventh place in the death lists.

And the mortality graphs for most of Europe�s fatal crowd diseases all dived before antibiotics had been marketed. Whooping cough killed 1400 children out of every million in 1850, but one hundred years later whooping deaths were less than 10 per million. Scarlet fever behaved in the same way. Measles, typhus, pneumonia, dysentery and polio all share similar histories. Their retreat had a dramatic impact on the European population. By 1900 civilization had lost its biological population check: infectious disease. After centuries of hostile encounters, humans and microbes found a new adjustment with little interference from drugs or vaccines. In some cases the microbe became less virulent (measles and diphtheria) or the human host more resistant (tuberculosis).� [9] In the view of this, how can the statements made by the CDC on how �thanks to vaccines� diseases are a thing of the past be correct?

Back in 1924 Mark Twain was quoted as saying, �There are three kinds of lies � lies, damned lies, and statistics.� When Mark Twain made this statement, his point was that numbers could be manipulated by the unscrupulous to misrepresent facts, to justify a particular bias, or fulfill a particular agenda. It is an unhappy fact of modern life that anyone with an idea can support that idea with statistics. The less the public knows about the source of the statistics, the more possible it is to have misinformation posing as scientific results. Simple statements, such as �in the 1920s, over 10,000 people a year died from diphtheria�, although accurate are very misleading. Providing a piece of historical fact without any real context and mixing it with statements on how vaccines helped cure these diseases leads the reader to erroneously conclude that vaccines were instrumental in the massive declines of deaths from these diseases. The CDC�s statements on vaccines only provide a few facts and then draw a conclusion on this limited information. To understand the role of vaccines, we must use the raw information and analyze it over a long period of time.

The Vital Statistics of the United States provides the most accurate information of death rates from various causes starting early in the 1900s. [10] Figure 1 is a graph of the death rates from measles, typhoid, scarlet fever, whooping cough (pertussis), and diphtheria. Both the pertussis and diphtheria vaccines were made widely available in 1949 and the measles vaccine was introduced in 1963. Figure 1. Death rates from infectious diseases This graph shows that large drops in disease death rates occurred long before vaccines were introduced. From 1900 to 1963, when the measles vaccine was introduced, death rates from measles had declined from 13.3 per 100,000 to 0.2 per 100,000 � a 98% decrease. From 1900 to 1949, death rates from whooping cough declined from 12.2 per 100,000 to 0.5 per 100,000 � a 96% decrease.

From 1900 to 1949, death rates from diphtheria declined from 40.3 per 100,000 to 0.4 per 100,000 � a 99% decrease. These are clear and major changes in the severity of diseases well before any vaccines were introduced. Close up views (figures 2-4) of the diphtheria, pertussis, and measles death rates show this dramatic drop well before vaccination programs began. Figure 2. Death rates from Diphtheria Figure 3. Death rates from Pertussis Figure 4. Death rates from Measles Similarly, in England and Wales we find the same decline in disease mortality. The data for the disease mortality was recorded 50 years earlier than in the United States, beginning in 1850.

[11] From 1850 to 1968, when the measles vaccine was introduced, death rates from measles had declined from a range of 52.11 to 26.6 per 100,000 to 0.11 per 100,000 � a range of 99.8% to 99.6% decrease. From 1860 to 1955, death rates from whooping cough declined from a range of 43.73 to 60.86 per 100,000 to 0.2 per 100,000 � a 99.5% to 99.7% decrease. From 1859 to 1940, death rates from diphtheria declined from a range of 49.2 to 22.7 per 100,000 to 6.77 to 1.83 per 100,000 � a 96.2% to 70.2% decrease.

The exact decrease in mortality is difficult to obtain because the mortality from these diseases fluctuated from year to year, and the exact introduction of a vaccination and number of people vaccinated each year is difficult, if not impossible, to obtain. However, it is clear that death rates in England did to a large extent decline before vaccinations were widespread. Figure 5 is a graph that shows the mortality rate declines in England and Wales. The gap from 1891 to 1900 is because data was not acquired for those specific dates. Figure 5. Death rates from infectious diseases in England and Wales The modern era of vaccines actually began with the advent of the vaccine against smallpox. Edward Jenner was aware of the belief that people who contracted cowpox never contracted smallpox. He hypothesized that inoculating people with cowpox would immunize them against smallpox. On May 14, 1796, he inoculated an eight-year-old boy, named James Phipps, with matter taken from a cowpox pustule. Phipps developed coxpox and quickly recovered. Several weeks later, Phipps was inoculated with smallpox and did not contract the disease.

In 1798, Jenner reported his work in the book, �An Inquiry into the Causes and Effects of the Variolae Vaccine.� This book prompted the medical professionals of the time to adopt the practice of vaccination. The vaccine was introduced in England in 1798. It was later made compulsory in 1853 through the Compulsory Vaccination Act, and then in 1867, an even more stringent law was passed to enforce vaccination. Looking at the raw data from England during that era [12] , as shown in Figure 6, we see that despite enforced vaccinations against smallpox there was no significant decrease in deaths from smallpox. In fact, three major epidemics during 1857-1859, 1863-1865, and 1871-1872 occurred, even though there was a high vaccination rate.

The last major epidemic in 1871-1872 had death rates of 101.2 and 82.1 per 100,000 people respectively, occurring just four years after a newer and more strict vaccination law was enacted in 1867. Figure 6. Death rates from smallpox and scarlet fever in England. Another interesting point is that the smallpox disease cycle of decreased deaths and epidemics appears closely tied to the scarlet fever disease cycle. Just as there was a large decrease in scarlet fever deaths after 1885, there was simultaneously a decrease in smallpox deaths. It is important to remember that death from scarlet fever, which was the worst of infectious diseases in that era, was eliminated without any vaccination program. Figure 7 shows that vaccination coverage had no apparent affect on smallpox deaths. As coverage fell to from a high of 86% in 1879 to 61% in 1898 there was no resurgence of smallpox deaths.

There was a small increase in smallpox deaths to 7.5 per 100,000 people as vaccine coverage rates again increased to 71.8% in 1902, but there after, as vaccine rates fell to below 40%, there was no increase in smallpox deaths. In fact, after 1905, deaths from smallpox almost completely vanished. Figure 7. Smallpox deaths and vaccination percent of births. We must also remember that deaths were directly attributable to the smallpox vaccine. Figure 8 shows the deaths per 100,000 that were caused by the smallpox vaccine. Although the number of people that died from the vaccine is small compared to the number of people that were killed directly by smallpox, after 1888 there were years that the deaths from the vaccine was close to or exceeded that from the disease itself (e.g.

1889 � smallpox: 23, vaccine: 58; 1890 � smallpox: 16, vaccine: 43; 1891 � smallpox: 49, vaccine: 43). After 1905, as can be seen in Figure 9, the number of deaths from smallpox and vaccination were very close to one another. In point of fact, after 1905, a person was almost as likely to die from the vaccine for smallpox as from the disease itself. Figure 8. Deaths per 100,000 from cowpox and other effects of vaccination . Figure 9. Actual smallpox and smallpox vaccination deaths. Another interesting point of note is that certain diseases that also once killed many people declined and vanished without any assistance from mass vaccination programs. Typhoid death rates of 10s per 100,000 each year was not uncommon. Scarlet fever once killed large numbers of people at a death rate of 100 or more per 100,000 each year.

While quite deadly during their prime, these two �killers� were in effect eradicated due in large part to advances in hygiene and a better understanding of germ activity. The Canadian Medical Journal contains the following statements in an advisory statement: �Typhoid fever is caused by Salmonella typhi, which affects only humans, often causing serious systemic illness. The organism is generally transmitted by the feces or urine of the people with the disease or those who are the S. typhi carriers. The death rate is approximately 16% for untreated cases and 1% for those given appropriate antibiotic therapy. � The incidence of typhoid fever is very low in all of the industrialized countries. Approximately 70 cases are reported in Canada and 190 in the United States annually. The low incidence of typhoid fever in these countries is attributable to improved living conditions, better drinking-water quality and the treatment of sewage. The vaccine does not seem to play an important role in maintaining this lower incidence. Most infections occurring in the industrialized countries are acquired elsewhere. � It is certain that vaccination does not afford adequate protection when heavily contaminated foods are ingested.

� There cannot be too much emphasis placed on hygiene and food precautions; these measures appear to be the most effective protection against the disease.� [13] If the forces of improved living conditions, better drinking water quality and the treatment of sewage virtually eliminated illnesses such as typhoid and scarlet fever, then isn�t it reasonable to consider that other diseases, such as measles and pertussis, would have had similar fates? An analysis of the death rates for all these diseases does support this idea. The Conquest of Disease by Thurman B. Rice, MD from 1932 states: �The benefit of pure water is expressed not only by the lowering of the typhoid rate but also in a considerable lowering of other death rates, and even of the general death rate. � Why has the death rate [for Scarlet fever] markedly fallen in the days before the cause of the disease was understood? It must be remembered that a given germ is only part of the cause of a disease; there are often many other very important contributing, predisposing, or determining factors.

As housing conditions were improved, as the general laws of sanitation, ventilation, and personal hygiene came to be better understood; as we came to insist on individual drinking cups; fresh air in bedrooms, and frequent bathing; as doctors became more proficient in treating the infection so as to prevent its serious complications and sequelae; as boards of health became more efficient in the enforcement of public health laws; as methods of isolation and disinfection were better understood the death rate declined accordingly.� [14] Again, the major decline in mortality rates can be attributed to improvements in proper hygiene, not only at a societal structural level, but also due to major changes in attitude in personal hygiene. �In addition to the seminal and recognized role of environmental hygiene, a substantial but overlooked component of the health revolution was the transformation in personal hygiene practices and cleanliness. The transformation probably started in the early 1800s, became extremely popular from 1890 to 1915, and has since become an essential feature of �civilized� behavior in the United States and Europe.

It is proposed that this mass behavioral changes in washing, bathing, laundering, and domestic hygiene practices contributed significantly to the continuing reduction of illness and death rates at the beginning of the 20th century.� [15] It would appear that, at best, vaccines could be credited with only a tiny fraction of the overall decline of disease deaths in the 1800s and 1900s. Because death rates were declining, it is impossible to say whether vaccines had a real effect or if that the same forces that caused the majority of the decline would have continued to have a positive impact. Those forces were primarily that of improved sanitation, proper personal hygiene, improved diet, and the natural cycles of disease. Based on our knowledge that proper sanitation, improved living conditions, and improved nutrition were the key factors that caused declines in these diseases, we can ask the question: are the present deaths and complications from these diseases in people of poor socioeconomic or compromised nutritional status? Is it possible that the focus on mass vaccination programs diverted attention from continued improvements in sanitation and nutrition that could have further reduced or eliminated disease deaths and complications?

It would seem that the people who recognized the underlying cause of diseases and instituted better living conditions, proper water and better sanitation should be recognized for their remarkable achievements, not the inventors and promoters of vaccines. This analysis, which is based on historical and scientific studies, is a far different picture than the one alluded to by the CDC in their vaccine literature. Because the focus has predominantly been on medical intervention, the history of what really caused the decline in disease mortality is �largely unknown� and �rarely taught�. The information that disease death declined before vaccination is important in the present day because we need to pay attention to these underlying causes of infectious disease. We must be ever vigilant to avoid returning to those disease-causing conditions and to examine these conditions when disease outbreaks occur. It is an important lesson in how we should approach disease prevention in third world countries. We should not forget the words of George Santayana: "Those who cannot remember the past are condemned to repeat it." [1] Parent�s Guide to Childhood Immunization. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Immunization Program, Atlanta Georgia 30333, 1993, pp.

1, 7, 21 [2] Gub�ran, E., �Tendances de la mortalit� en Suisse�, Schweiz. Med Wschr. 110, 1980, pp. 574-583 [3] Morman, E.T., �Childhood�s Deadly Scourge: The Campaign to Control Diphtheria in New York City, 1880-1930�, The Journal of the American Medical Association, April 12, 2000 Vol. 283, p. 1889 [4] Vital Statistics of the United States 1937 Part I, U.S. Department of the Census, 1939, p. 11 [5] �Zinc, diarrhea, and pneumonia (editorial)�, The Journal of Pediatrics, December 1999, Vol. 135, No. 6, p.

663 [6] Greene, Velvl W., PhD, MPH, �Personal hygiene and life expectancy improvements since 1850: Historic and epidemiologic associations�, American Journal of Infection Control (AJIC), August 2001, Vol. 29, No. 4, pp. 203-206 [7] Steward, Gordon T., �Vaccination Against Whooping-Cough Efficacy Versus Risks�, The Lancet, January 29, 1977, pp. 234-237 [8] Porter, Roy, �The Greatest Benefit to Mankind�, Harper Collins Publishers, 1997, p. 426 [9] Porter, Roy, �The Greatest Benefit to Mankind�, Harper Collins Publishers, 1997, p. 427 [10] Vital Statistics of the United States 1937 Part I, U.S. Bureau of the Census, 1939, pp. 11-12; Vital Statistics of the United States 1938 Part I, U.S.

Bureau of the Census, 1940, p. 12; Vital Statistics of the United States 1943 Part I, U.S. Bureau of the Census, 1945; Vital Statistics of the United States 1944 Part I, U.S. Bureau of the Census, 1946, p XXII-XXIII; Vital Statistics of the United States 1949 Part I, U.S. Public Health Service, 1951, p. XLIV; Vital Statistics of the United States 1960 Volume II � Mortality Part A, U.S. Department of Health, Education, and Welfare, 1963, p. 1-25; Vital Statistics of the United States 1967 Volume II � Mortality Part A, U.S. Department of Health, Education, and Welfare, 1969, p. 1-7; Vital Statistics of the United States 1976 Volume II � Mortality Part A, U.S. Department of Health and Human Services, 1980, p.

1-7; Vital Statistics of the United States 1987 Volume II � Mortality Part A, U.S. Department of Health and Human Services, 1990, p. 11; Vital Statistics of the United States 1992 Volume II � Mortality Part A, U.S. Department of Health and Human Services, 1996, p. 12; Historical Statistics of the United States � Colonial Times to 1970 Part 1, Bureau of the Census, p. 58 [11] Mortality in England and Wales for 95 years as provided by the Office of National Statistics - Published 1997; [12] Written answer by Lord E. Percy to Parliamentary question addressed by Mr. March, M.P., to the Minister to Health on July 16th, 1923 [13] �Statement on overseas travelers and typhoid fever�, Canadian Medical Association Journal, 1994, 151, pp.

989-990 [14] Rice, Thurman, A.M., MD The Conquest of Disease, The Macmillan Company, 1932, pp. 68, 121-122 [15] Greene, American Journal of Infection Control (AJIC), August 2001, Vol. 29, No. 4, pp. 203-206 How Four Once Common Diseases Were Eliminated From The American South How Four Once Common Diseases Were Eliminated From The American South History of Medicine at Duke University in Durham, North Carolina Margaret Humphreys (meh{at}duke.edu) Next Section Abstract Four major diseases stigmatized the American South in the nineteenth and twentieth centuries: yellow fever, malaria, hookworm, and pellagra. Each disease contributed to the inhibition of economic growth in the South, and the latter three severely affected children’s development and adult workers’ productivity. However, all four had largely disappeared from the region by 1950. This paper analyzes the reasons for this disappearance. It describes the direct effects of public health interventions and the indirect effects of prosperity and other facets of economic development.

It also offers insights into the invaluable benefits that could be gained if today’s neglected diseases were also eliminated. Lessons learned during the twentieth century can inform modern disease-control activities today. In 1916 a new textbook appeared on the “endemic diseases of the southern states.” With chapters on malaria, pellagra, and intestinal worms, the book’s authors identified the region as particularly, and peculiarly, diseased. 1 Absent was the dominant southern disease of the nineteenth century: yellow fever. Although yellow fever had traveled hand in hand with the import trade of southern cities, the twentieth-century triad of pellagra, malaria, and hookworm was inextricably linked with the rural poverty engendered by cotton culture and the tenant labor system that evolved to replace slavery after the Civil War. The rural farm worker had little money or access to health care, ate a poor diet, and lived in a subtropical landscape that was host to parasitic worms and mosquitoes. In 1916 the South’s endemic diseases appeared to be thoroughly entrenched. Later, in the depths of the Great Depression, these diseases continued to plague southerners. Yet by 1950 southerners were almost free of them all.

2 , 3 The southern liberation from disease paralleled the end of sharecropping and the rise of prosperity in the South. It also occurred in decades that saw a vast migration of rural southerners from the countryside to the city and from South to North. The South’s farm population declined by 20 percent in the 1940s alone, when more than three million people left the region. The number of black farmers fell by 60 percent from 1920 to 1950, when 58 percent of African Americans lived in cities and towns. World War II brought jobs and the opportunity of military enlistment, boosting the economy. 4 Mechanization replaced farm jobs, making the depopulation irreversible. By the 1920s and 1930s the city already offered very different disease ecology than the countryside. This paper examines the interrelationship between disease and development, focusing on the four southern diseases that most stigmatized the region: yellow fever, malaria, pellagra, and hookworm.

It describes the ways in which deliberate public health interventions changed the prevalence of each disease, the impact of that disease reduction on economic health, and the role of growing prosperity in promoting disease eradication. This qualitative overview reveals a complex story. Although it is at times speculative, it highlights a fertile field for future research. The story of these four diseases fits somewhat uneasily into a series of papers on modern neglected tropical diseases. Yellow fever was anything but neglected in the nineteenth-century United States. On the contrary, it aroused national passion, spurring the formation of the first federal public health agencies. Malaria is not a “neglected” disease today, given the attention it has received from major funding agencies. But malaria, hookworm, and pellagra were diseases that emerged from neglect in the American South of the early twentieth century. Malaria had been known, but it was viewed as an inevitable part of life—a disease of place that could not be deliberately fought by public health action until the mosquito’s role was recognized in 1898. The other two diseases were completely neglected. Their bodily manifestations, instead of being simply signs of disease, were seen as stigmatizing individuals as belonging to lower social classes.

Pellagra was not a “tropical” disease in the modern sense—it was not tied to a hot, humid climate in any direct way. But it was indirectly linked to the poverty and social heritage that the southern environment encompassed. The region as a whole suffered from the indigenous poverty that marks many developing areas around the world today, and its relationship with disease offers interesting lessons for modern development. Previous Section Next Section Yellow Fever Yellow fever is caused by a virus carried by mosquitoes of a particular genus, Aedes. These mosquitoes travel easily on ships and thrive in urban landscapes that offer freshwater breeding sites. Yellow fever caused major epidemics in the Northeast in the Colonial era and early years of the Republic. But by the second decade of the nineteenth century it had become an exclusively southern disease. Wilmington, Charleston, Mobile, Galveston, and other southern cities suffered from the disease, but New Orleans was a particular target. It was free of the disease for only one year in the two decades before the Civil War. After the war’s end, a devastating epidemic spread out of New Orleans in 1878, traveling up the river and rail lines as far north as Ohio.

One estimate put the damage at 10,000 lives and 100,000 cases, with millions of dollars lost in trade. 5 National impact. The 1878 epidemic spurred a national reaction. Congress enacted the first federal health agency, the National Board of Health, although it survived only until 1884. Although northerners pitied the carnage and collected money for the yellow fever victims, others lambasted the South for its filthy, careless ways. 6 Health authorities progressively tightened quarantines, and epidemics after 1880 seem to have been introduced by smugglers who avoided the official trade routes. When yellow fever broke out in Jacksonville in 1888, the Marine Hospital Service took over the task of limiting the epidemic. This agency evolved into the U.S. Public Health Service after the turn of the century. In 1905 the last yellow fever epidemic struck New Orleans, and the Public Health Service was able to bring it to heel using mosquito control techniques based on the work of U.S. Army surgeon Walter Reed and his colleagues in Havana in 1900. 5 Eradication.

The threat of yellow fever affected the financial growth of ports in the South, as shippers were loath to send their goods to a port that might be precipitously closed by quarantines. Yellow fever retreated from northern cities by 1830, perhaps as a result of changes in the sugar trade. 7 After 1878 most shipping in the South that came from a port where yellow fever prevailed went through a quarantine that isolated infected people and pumped ships’ holds full of acidic gas. Meant to kill the supposed yellow fever germ, the gas effectively destroyed mosquitoes as well. Key to the eradication of yellow fever in the United States was control at its source in Havana by 1910. 8 Previous Section Next Section Malaria Malaria once ranged widely on the North American continent, extending as far north and west as New England, Ontario, Minnesota, and California. It particularly plagued the upper Mississippi Valley in the Antebellum era and affected settlement patterns throughout the southern colonies. One type of malaria, falciparum, brought to the continent by African slaves, was limited to the warmer environments south of the Ohio River.

Another type, vivax, traveled with European settlers and spread with them throughout the temperate zones of North America. Both organisms are carried in the United States by the Anopheles mosquito species, which breeds in still water, such as ponds, swamps, and bayous. By the twentieth century malaria was largely a southern disease. Even before the mosquito was identified as a vector in 1898, mosquito habitats had been destroyed by settlement throughout much of the country. The disease had been diminished by access to cheap quinine. Only in the South did frontier conditions persist and the disease thrive. 9 , 10 Both falciparum and vivax malarial organisms rupture red blood cells, causing anemia. Falciparum is deadlier; when enough parasites clog the capillaries of kidneys or brain, death can result. Malaria parasites can likewise clog the placenta in pregnant women, killing or damaging the fetus. A child with malaria, if not killed outright, suffers stunted growth, lethargy, and decreased cognitive development. An adult with chronic malarial infection is often listless and weak. Malaria is, in short, an enervating disease that robs a community of vigor and productivity.

10 Scientific breakthroughs. Deliberate antimalarial work began in the early 1900s after William C. Gorgas, a U.S. Army physician who later served as the Army’s surgeon general, had demonstrated the possibilities of malarial control in the Panama Canal Zone. During World War I the army attempted to control mosquitoes around military bases and wartime industries by oiling breeding places, screening barracks, and spraying insecticides. After the war the Rockefeller Foundation set up demonstration projects in the Mississippi Delta to discover which means of malaria control were most cost-effective and realistic. They tested preventive use of quinine, screening, and larval control. All worked well in the first couple of years of the studies; all showed some regression when local authorities had to assume responsibility. During the 1920s the use of medication as a public health measure receded, and most campaigns during that era focused on mosquito control. 10 Eradication. Malaria became a disease of the rural countryside by the end of the 1920s. Cities and towns drained wetlands in the process of development and took active steps to control mosquitoes. Easy access to cheap medication in town likely also played a role.

But malaria persisted on the farm, and it surged in the 1930s as many southerners returned to the land. Although New Deal programs included drainage projects to combat malaria, these were poorly planned and likely had little impact. More important were agricultural programs that paid landowners to take land out of production and other measures that resulted in the depopulation of the southern countryside. By World War II, malaria had become rare in the South. After the war the newly formed Communicable Disease Center sprayed the insecticide DDT within a million southern homes. In 1949 the center announced that malaria had been eradicated in the United States. 10 Impact in the South. It is difficult to quantify the impact of malaria on southern development. One historian, who assumed that malaria was largely controlled in the 1920s, found that malaria eradication raised income in the “malaria-free” generation born in the next decade by 15 percent. 11 , 12 There was a significant drop in malaria mortality in the 1920s, but mortality is a weak measure of prevalence for a disease such as malaria.

Many of its victims were too poor to see a physician or be accurately diagnosed, and most cases of malaria do not end in death. And it can be difficult to apply recent evaluations of malaria and development that focus on falciparum malaria in tropical countries to the biracial, subtropical South with its mixed infections of falciparum and vivax. Still, it seems highly likely that this disease was greatly debilitating to the vulnerable populations it affected, and its eradication had a positive impact on the health and productivity of both children and adults in the American South. Previous Section Next Section Pellagra As noted above, pellagra is a disease caused by a deficiency of niacin (or the amino acid tryptophan, which the body converts to niacin) in the diet. Severe cases are marked by dermatitis, diarrhea, dementia, and coma leading to death. 13 Nearly 100,000 deaths in the United States were attributed to pellagra in the first four decades of the twentieth century, making it the most severe nutritional deficiency disease in U.S. history. Most of those deaths occurred in the South, and blacks and women bore the brunt of the disease.

14 There were many cases for each death, as death represents only the extreme end of the spectrum of disease. Pellagra was seasonal, striking in the spring when stored food was exhausted and the new crop and the money it brought were still months away. 15 It is not obvious when pellagra first emerged as a significant health problem in the South. It is likely that pellagra afflicted at least some slaves in the Antebellum era. 16 But the cases among African Americans were largely invisible even after physicians became aware of the disease in the early twentieth century. What is clear is that the disease burst into medical consciousness in the first decade of the twentieth century. In 1906 and 1907 physicians began to report epidemics of pellagra in southern orphanages and asylums. Mill owners in North and South Carolina found their workers enfeebled by the new plague, which left them too weak to work. By 1914 one estimate counted 50,000 cases of pellagra in the South. Causes. The assumption at the time was that pellagra was caused by some as yet unidentified infectious agent, perhaps spread by a fly.

Others noted the association of diets rich in corn with the presence of the disease, and they posited that moldy cornmeal was the causative agent. 17 In retrospect, a change in the way that cornmeal was processed for market most likely explains the sudden appearance of pellagra. Midwestern corn was increasingly processed in large mills, packaged in bulk, and shipped by railroad throughout the country. In the first decade of the twentieth century these mills installed new machines, which removed much of the corn germ to increase the meal’s shelf life. It also reduced the small amount of available niacin in cornmeal by as much as 40 percent. Institutions bought their cornmeal in bulk from these Midwestern mills, and the loss of niacin tipped vulnerable, otherwise malnourished populations over the edge into pellagra. 18 But in 1914 the cause of pellagra was still a mystery, and the U.S. Public Health Service sent one of its physicians, Joseph Goldberger, to investigate it. After ruling out an infectious agent, Goldberger targeted the inadequate diets of institutionalized people as the likely cause.

Through experiments on orphans, on prisoners, and later on dogs, he sought the “pellagra preventive factor” that would cure the disease. Other diseases such as beriberi and scurvy had previously been tied to specific vitamins. Goldberger was sure that pellagra would prove to be similar, and he showed that certain foods, such as brewer’s yeast, eggs, milk, and meat, were rich in the preventive factor. In 1937 Conrad Elvehjem at the University of Wisconsin identified niacin as the substance deficient in people with pellagra. 19 Peak and decline. In the meantime, pellagra continued to claim lives. Its incidence peaked after a 1927 flood forced thousands of poor farmers in the Mississippi Delta into refugee camps, and again in the early 1930s as the Great Depression took hold. But then it began a slow decline, and the decline accelerated in the 1940s. The Red Cross and other public health agencies distributed brewer’s yeast after the flood. Physicians became increasingly aware of the disease and how to treat it.

Although the early 1930s brought great poverty, many people moved during that period from the jobless towns back to the land, where they could grow some subsistence foods. Home extension agents offered information about garden plots and canning, contributing to improved nutrition. Grocery store chains such as Piggly Wiggly, A&P, and Kroger spread to the small towns of the South, bringing cheaper groceries to an increasingly mobile population. 20 The final phase of advances against pellagra came during World War II. A recovering economy meant better nutrition and access to health care. Although growing prosperity decreased the rate of pellagra, specific programs to enrich the nutrition content of foods were most important in these final stages. With niacin, thiamine, and riboflavin now identified as important nutrients, bakers began in 1938 to voluntarily fortify flour with high-vitamin yeast and later with specific vitamins. By the end of the 1940s, twenty-six states had enrichment laws, and most wheat flour, cornmeal, and grits were enriched with niacin.

After such a law was enacted in Mississippi, the pellagra rate dropped from 101 per 100,000 in 1946 to fewer than 1 per 100,000 in 1947. 21 Previous Section Next Section Hookworm Hookworm disease was once associated so much with the South that when a baseball commentator referred to southern players as coming from the “Hookworm Belt” in 1947, the phrase needed no explanation. 22 The hookworm is a tiny parasite that latches onto the wall of the small intestine, secretes an anticoagulant to promote bleeding, and feeds on the host’s blood. About 110 worms can consume a teaspoon of blood a day. A well-fed host with adequate iron intake can usually replace the lost iron and plasma proteins of a mild infection, but a malnourished person harboring sizable numbers of parasites will become anemic and protein deficient. In children the disease stunted physical and cognitive development. It made them weak, apathetic, and perpetually tired. 23 The hookworm’s presence in the South was tied to its ecology and history.

The worm probably arrived in the bodies of enslaved Africans. Hookworm eggs in human feces thrive in warm, sandy soils, where they hatch into larvae. The coastal plains of the South provided a particularly suitable environment for the worm. The frequent absence of sanitary facilities meant that the eggs remained in the surface environment. The hatched larvae waited for bare feet to come by, burrowed between toes, and from there traveled in the bloodstream to the lungs, where they broke through the alveolar wall. Coughed up by the host, the larvae made the final part of the journey down the esophagus to the intestines. 24 Rockefeller campaign. Hookworm no doubt caused anemia and lassitude in the centuries before 1900, but no one in the American South identified the parasite, even though the disease was known in Europe. In 1902, however, Charles Stiles, a medical zoologist, recognized in southerners the same symptoms he had seen among European hookworm victims. Once he started looking, he found a startling prevalence of the disease.

He convinced representatives of the Rockefeller Foundation to take up the cause of hookworm eradication, and in 1909 the philanthropy launched an all-out assault on the disease. Their initial surveys found 43 percent of those surveyed to be infected with hookworm; in some areas the percentage rose into the 90s. 25 The Rockefeller campaign stressed education, treatment, and the assumption by local and state boards of health of the responsibility to carry on what the foundation had begun. With a million dollars in their coffers, the Rockefeller men spread across the South, offering lantern shows about the hookworm, testing and treating individuals, and pushing the construction of sanitary privies. Surveys of rural schools and churches found that 80 percent lacked any sort of privy; private homes were even less likely to have sanitary facilities. Children of all classes went barefoot in the summer, often not wearing shoes until they were teenagers. By 1914, when Rockefeller ended its U.S. campaign, the prevalence of infection had been cut to 39 percent, but the message of hookworm and its implications was now well known throughout the South.

The campaign also energized southern public health, leaving a legacy of empowered institutions on the state and local levels. 25 The campaign did not eradicate hookworm from the South, and it is difficult to know the detailed slope of the disease’s decline. Hookworm was not a disease that health departments were required to report, and it rarely caused death. Only stool surveys could identify it with precision—a method of research that required much personnel and dedication. Rockefeller declared victory in the late 1920s, but others wrote of widespread hookworm in the South during the Great Depression. One physician 26 noted in 1924 that in rural Georgia, the prevalence of clinical hookworm did decline significantly after the campaign but that it was worse again, as would be expected if permanent sanitary improvements did not follow medical therapy. In Covington County, Alabama, 99 percent of rural schoolchildren were infected in the early 1920s. 26 Observers in the 1930s and 1940s acknowledged that hookworm was less widespread and less severe than it had been before, but it was still a problem. 27 , 28 Persistence of the disease.

Surveys in the 1950s found that hookworm persisted in the poor, sandy coastal plains of the South. In southern Alabama, where 37 percent of schoolchildren were positive in 1937, 17 percent had hookworm eggs in their stools in 1954. 29 Likewise, in east Texas, 33.4 percent of specimens sent to the state laboratory were positive for the disease. 30 Even in the 1960s there was persistent infection in coastal South Carolina (3 percent) 31 and eastern Kentucky (14 percent). 32 One source reported that hookworm prevalence in southern Georgia went from 60 percent in 1910 to 13 percent in 1964 and to 6 percent in 1970. 33 It is likely that hookworm persists to some degree in the contemporary South. One 1987 survey of migrant farm workers in North Carolina found that more than half of the Central American workers carried hookworms, and 6 percent of the Mexican workers did. These immigrants frequently worked barefoot or wore sandals, and bathroom facilities were not always available near the fields where they worked.

34 Hookworm disease has a profound effect on the developing child, and it weakens the working adult. Although early-twentieth-century newspapers parodied the disease as the “germ of laziness,” it could equally have been dubbed the “germ of stupidity.” 35 Modern researchers have correlated cognitive delay with hookworm disease, and the zoologist Stiles noted that children with hookworm were likely to be behind their appropriate grade in school or tracked into the lowest-performing strata of their grades. 36 Impact of eradication. Historians have attempted to correlate the eradication of hookworm with economic productivity. One attributed the rise in agricultural production during the 1910s to the hookworm campaign and subsequent increases in workers’ energy. 37 Another scholar found that increases in school enrollment, attendance, and literacy followed the Rockefeller intervention and that the children of the treated cohort had substantial gains in long-term incomes.

38 These scholars may overestimate the impact of the Rockefeller campaign (the disease was not neatly eradicated between 1909 and 1914), but it is likely that the growing awareness of the disease among teachers, physicians, and children may well have had its major impact in the 1910s, even if the disease was not gone by the end of that decade. Hookworm’s decline can be attributed to a number of causes. Foremost were Stiles’ pivotal recognition of the disease and the clarion call amplified by the Rockefeller campaign that this disease was common, easy to treat, and easy to prevent. Concerns about typhoid, which was frequently fatal, drove the cities to put in sewers and running water, and fears that the privies of the poor would infect the affluent meant that even the poorer sections of towns had sanitary waste disposal throughout much of South in the 1920s. 39 Slowly the expectation grew that the sanitary privy was essential for adequate housing. In North Carolina in the 1940s, the state board of health required them by law. Children increasingly wore shoes, at least to school.

More children were in school, and for more years, decreasing their chances of acquiring larvae even if the larvae were prevalent around their homes. (In south Georgia only a third of houses had sanitary facilities in 1948). 40 Schoolchildren learned about hookworm in their classes, and physicians were likewise more conscious of the disease. The severe case of hookworm became rare; one World War II physician reported that 18 percent of men from southern coastal states had hookworm when surveyed, but all had been well enough to pass the initial physical and serve in the Pacific theatre. 41 All told, the disappearance of severe hookworm disease probably made southern workers more intelligent and energetic, increasing their productivity. Previous Section Next Section Conclusion All four of these debilitating diseases could and did affect the same population, creating an additive and perhaps synergistic effect. The child with malaria and hookworm had pale red cells deficient in iron and oxygen transport capacity and had fewer such cells because malaria had destroyed so many. Malnutrition would have weakened the child’s body even further. In a region with weak mortality reporting and largely absent morbidity data, it is difficult to pin down exactly when these various diseases disappeared.

One can question historians who assume that hookworm and malaria were so reduced by 1930 that conclusions about child development and worker productivity can be drawn accurately. None of this happened in the blink of an eye, except perhaps the disappearance of pellagra with enrichment programs. But it did happen. By the end of World War II, the major debilitating diseases of the South had ceased to burden the region. An important determinant of this change was the development of cities and towns, and the movement of southerners from the rural landscape. In town, wage labor made the purchase of nourishing food within reach, at least sometimes. Town governments controlled mosquitoes. Doctors who would not make house calls to rural areas, or charged fees per mile traveled, were much cheaper in town, and drugs were available from the nearby pharmacy. Urban dwellings had sanitary privies or flush toilets. Driven by the fear of contagion, the affluent funded such amenities even for the poor. Children in urban schools were expected to wear shoes, and chain stores brought the prices of such shoes within the reach of many. Of course, town life had its price. Infectious diseases such as tuberculosis, measles, and influenza now threatened.

However, these would be controlled through medication and vaccines by the 1960s, in a subsequent triumph of science and public health. 42 It is hard to underestimate the devastation that pellagra, hookworm, and malaria brought to generations of southern minds and bodies. Many southerners were, as their stereotypes indicated, made stupid and lazy by these diseases. But once rid of this burden, they were in a position to take advantage of the educational and economic opportunities that characterized the postwar United States. This physical change should not be forgotten by historians attempting to understand the massive transformations that characterized this region from the end of World War II to the present. The complexity of this story illustrates the lesson that prosperity alone will not contain disease; each disease has its own etiology, and interventions must be tailored to their specific life histories. The lesson is surely applicable to today’s neglected diseases—as is the notion that the benefits to human beings will be incalculable. Previous Section Next Section Footnotes Margaret Humphreys (meh{at}duke.edu) is the Josiah Charles Trent Professor in the History of Medicine at Duke University in Durham, North Carolina.

The author thanks the American Association of University Women, Harvard University, Duke University, the Josiah Charles Trent Foundation, and the Burroughs-Wellcome Medical History Fund for their support of her research. Harry Marks read an earlier draft of this paper, and the author appreciates his input. Springhill Water Blog | Springs, Boreholes and Water Pumps Springs, Boreholes and Water Pumps This gallery contains 1 photo . Autumn is the time of year when we should be looking at our Private Water Supplies and carrying out a bit of preventative maintenance. Are the pipes properly insulated? Are there leaks that need attention? Do my filters need changing? … Continue reading → Posted on February 3, 2016 by fuXozyLi36 However peer reviewed research tells us that children under 12 must not drink untreated ‘spring’ or stream water as they are 6 times more likely to suffer diahorea or vomiting than those drinking town water. If in doubt, fit a UV and pre-filter. Posted on January 13, 2016 by fuXozyLi36 Here is a picture recently taken at Fountains Abbey.

The right side of the wall is made of Limestone and right hand side is made of Sandstone. The relevance is, if water passes over the Limestone it will pick up calcium and magnesium, making the water hard. Water passing over the Sandstone is probably going to be soft, acidic and may turn water brown / black. Not a lot of people know that 🙂 Posted on January 13, 2016 by fuXozyLi36 We are often asked about water testing. I have enclosed a typical response in the hope that some people will find it helpful. “With regard to your spring, if it is a true spring then it may not require filtration. However, true springs are very rare and most springs can best be described as surface derived sources. Even if the water comes from deep underground (which is unlikely) it may be mixed with surface water. Bacteria can live in water for up to 3 months. So, the question is, can your ‘spring’ water get into your drinking tap within 3 months. Assuming the answer is yes, then from a risk assessment point of view you can assume that the water will fail to meet the standards for microbiological contamination.

With regard to testing, research tells us that the quality of a surface derived source is determined by the prevailing weather conditions. This in effect means you could test in the morning and get a microbiological pass and test in the evening and get a fail. However, one contaminant in water tends to remain the same throughout the year and that is pH. Anything below 7 means that your water is likely to cause corrosion of your copper pipes and hot water cylinder and lead to green / blue staining of fixtures and fittings. Both microbiological contamination and pH are easily treated. We would however recommend a free of charge site survey before we provide a quotation as the type of equipment will vary according to water usage, space available and the overall quality of the water.” Posted on December 24, 2015 by fuXozyLi36 A big thank you to all of our customers and suppliers. Set up in 2003 we are proud of our continual growth and positive feedback. Please visit our web site and view the media page for more information relating to what we do. Your feedback is always welcome. Pictured above, Cryptosporidium. “Water makes up over two-thirds of the healthy human body.

It lubricates the joints and eyes, aids digestion, flushes out waste and toxins and keeps skin healthy.” UK National Health Service guidelines. 1 Filtering your spring or borehole water will encourage you and your family to drink more water. Filtered water is nicer to drink than unfiltered water, why else would people buy so much bottled water or spend so much on jug filters. Most people who drink water from a spring or borehole supply comment on how beautiful it tastes. However, some waters derived from these private water supplies can have an unpleasant taste or odour. This may be due to iron, hydrogen sulphide, peat or several other contaminants. Passing water through appropriate filters can greatly improve the taste of your water, encouraging you and your family to drink more water. 2. Filtered water is safer. Water from a private water supply is totally natural. That is, it contains whatever pathogens that might be lurking in the environment that surrounds the source of the supply. In years gone-by that might have been cholera, typhoid or dysentery.

Today it’s more likely to be Cryptosporidium, Giardia, Campylobacter or E.coli – pathogens that might not be as life threatening as the “the bloody flux”, but still, not very pleasant Treating your water with a properly sized and maintained UV purifier will make your water safe to drink. 3. Filtered water is cleaner. There are very few private water supplies (springs, boreholes, wells or streams) that do not contain particulates. This becomes clear when filters are installed as they start block up, sometimes very quickly, dependent on the prevailing weather conditions As a general guideline, if your water changes colour after heavy rain, then it is highly probable that surface water is getting into the supply. These contaminants may not always be harmful to health but they are likely to make your water discoloured – and who wants to take a bath in water that looks like tea? Passing water through appropriate filters will clean your water and make it look wholesome and clean. 4. Filtering your water puts you in control. Filtering water as it enters your house offers a fine level of control over the quality of your drinking, cooking and bathing water.

If you have any doubts about the quality of your water, it’s much better to be safe than sorry. Properly sized and maintained filters will greatly improve the quality of your drinking water ensuring that it is consistently wholesome. 5. Filtered water is more convenient than bottled water. If your water is filtered and you change the filters according to the manufacturers instructions, its one less thing to worry about when you go shopping. “Do I need to buy bottled water? No—I have beautiful filtered water at home, on tap.” 6. Filtered water is cheaper than bottled or jug filtered water. In the long run, it’s probably cheaper to filter drinking water than buy bottled water and it’s kinder to the environment. If you’re looking to save money in 2013, quitting the bottled water habit and choosing to filter your drinking water is a step in the right direction – every little bit helps, so they say. Final note. If you decide water filtration is not for you, I suggest that you do not drink untreated spring, borehole, well or stream water unless you boil it first.

Question: Which disease caused the death of 43 people in Croydon in 1937?
Answer: TYPHOID