Red River Fever — typhoid epidemic led to improved water and sewage systems

by Bruce Cherney

On September 16, 2002, a mechanical failure at the North End Water Pollution Control centre caused 427,000 

cubic metres of raw sewage to flow into the Red River. 

Surprisingly, untreated sewage entering Winnipeg’s two major rivers is not an uncommon occurrence. In any given year such spillages will happen at least 18 times during heavy rainfalls which overwhelm the sewage system’s carrying capacity.

The 2002 spill was a warning that a new sewage treatment facility was desperately needed to ensure the health of the Red River and Lake Winnipeg. The plan is to build a new $1.2-billion treatment plant by the fall of 2008, though there is some question whether this target date can be met. 

Water quality and sewage disposal has been a concern in Manitoba for generations. While sewage spillages are no longer associated with typhoid fever, the alarming frequency of outbreaks from the 1870s to the early years of the 20th century forced Winnipeg city council to take drastic steps to ensure the health of local residents. 

Typhoid was so prevalent that it became known as “Red River Fever,” and Winnipeg gained the dubious distinction of having the most cases per capita of any North American or European city.

Although a scourge in the city’s early years, the presence of Red River Fever eventually did provide the impetus needed to complete a massive engineering project to bring clean, potable water to Winnipeg. The construction of the 160-kilometre Shoal Lake aqueduct was a watershed in the community’s history that allowed Winnipeg’s leaders to confidently plan the cty’s future expansion and development. The aqueduct was extemely expensive for the era, but it alleviated a crisis that had the potential to relegate Winnipeg to backwater city status. Since the aqueduct’s completion in 1919, residents and businesses have been enjoying its health benefits for decades.

In 1871, there was a serious outbreak of typhoid fever in Winnipeg. The federal government came to the town’s aid, setting up a makeshift hospital for “the temporary reception of the afflicted who have no friends or relatives to care for them.”

It would be another four years before a building — not far from the present site — was specifically set up as Winnipeg General Hospital.

“There are a great many problems which the people of the city of Winnipeg must solve ... and not the least among them is the one relating to health,” said an editorial in the October 3, 1874 Manitoba Free Press. The editorial writer said he had seen “all kinds of offal thrown in the small ditches” leading to the city’s two major rivers.

A few weeks earlier, the city had commissioned Stewart Mulvey, the health, fire and licence inspector, to investigate the sanitation conditions about the city.

In his August 10, 1874, report — the first on health conditions in Winnipeg — Mulvey said he paid visits to several premises and ordered them to perform a thorough clean up under the provisions of existing bylaws.

Mulvey recommended the establishment of a board of health committee that could advise council on important cases. It was a valid recommendation, but it would be years before such a committee was established.

He also recommended “that orders be given to have the drains on the west side of Main Street open and kept open ... so that the stagnant water in cellars and excavations on this side of said street could be pumped out ...”

He further called for pigs running wild in the streets to be restrained, saying they wallow in the water pumped out of cellars, “thus producing the worst kind of stagnant waters to the danger of the health of the citizens.”

Mulvey said the sickness prevalent (no mention was made of typhoid) in the city could be attributed to overcrowding in the city’s hotels and boarding houses where he found it not uncommon to have five, six or more people crowded into a room.

In keeping with the common belief of the era, Mulvey implied that it was the odours wafting through the air outside and in the crowded rooms that was the root of illness. At the time, the nature of bacterial diseases  was not  greatly understood. In fact, many still felt foul vapour, or “miasma,” to be the primary method of spreading the disease.

The Free Press reported in 1875 that a Paris doctor had shown “free breathing of pure, fresh air” was essential in the treatment of typhoid. In addition, such air provided “absolute immunity from contagion.”

The reality is that allowing foul water to enter the city’s drainage system had more of a detrimental effect on residents’ health that the stench borne on the wind.

Typhoid cases in Winnipeg were frequently reported in Eastern Canadian newspapers — a severe blow to the city’s efforts to attract more people from outside the province’s boundaries.

A reporter from the Winnipeg Daily Sun visited physician Dr. Kerr on October 22, 1882, to uncover the extent of the typhoid problem. The doctor said the reports were greatly exaggerated.

The reporter told the doctor that an eastern man had indicated that there were 300 typhoid cases in Winnipeg.

Kerr said the number cited was 

“untruthful.” In fact, the doctor said he doubted if the Red River Fever present in the city was fatal and in many people was possibly just “indigestion” (symptoms of typhoid include stomach pains).

A call to the Winnipeg General Hospital during the interview indicated that only 50 cases of fever had been treated but six had died.

What Kerr did get right was the need to improve the city’s sewage system. 

Winnipeg had just undergone one of its greatest periods of expansion. During 1881-82, thousands of people flooded into the city to take advantage of a speculative land boom. Most of the people seeking to get rich quick found that the only bed available was in a make-shift tent or a boarding house. Under such unsanitary conditions, typhoid bacteria had plenty of opportunity to spread.

However, the land boom ended as quickly as it had begun. By the time the Sun reporter visited the doctor, the boom had gone bust and many were now leaving the city, mostly penniless and disillusioned. 

It was a cruel blow to city boosters who during the heady days of the land boom felt the sky was the limit. Reports of typhoid in the city from the East only added to their grief. After all, the presence of typhoid was bad for business and the people who led the city were the commercial elite.

By the late 1890s and early 1900s, the danger from typhoid could not be so easily dismissed as exaggeration. In 1899, the provincial board of health was frustrated by the number of cases in the city and in outlying communities. 

The board said there was no reason for cases of the fever to persist because the disease was preventable. The board said all that was needed was to clean up the filth found in cesspools, filthy drains, damp and unclean cellars, which afforded the typhoid germ “a fertile soil for reproduction.”

The board possessed a greater understanding of the disease than had previously been the case. It correctly pointed out that typhoid germs could be traced to fecal material and was spread through defective sewers which in turn contaminated drinking water. 

It was also correct in saying typhoid’s spread could just as easily be the result of contaminated food. This was how the disease was spread by “Typhoid Mary” Mallon in New York City. She was a carrier of the typhoid bacilli who never got sick but contaminated the food she handled when preparing meals for the families she was hired to cook for — they became sick and many of them died. Eventually, the city’s health department arrested her and quarantined her on an island for the rest of her life.

Surprisingly, the Manitoba health board still was under the mistaken impression that the bacilli could be inhaled into the body from sewer gases. Still, it did offer some good advice such as never having a “hole-in-the-ground” privy and that healthy people should avoid contacting bodily discharges from infected patients.

“Typhoid fever goes through families because all have been exposed to the disease-producing cause: or the first cases contaminate the water supply, or ‘seed-down’ the privy vault and the house surroundings with disease germs,” the board reported.

Its best recommendation was to boil all water and milk to be used for human consumption.

In 1900, there were a reported 582 typhoid cases among the city’s 42,500 people resulting in 34 deaths. Despite a population increase by 2,500 people, the next year was slightly better with  349 cases reported, although 36 people died. 

But the number of cases began to climb upward over the next two years. In 1902, the city’s population had reached 45,400 and there were 356 cases and 29 deaths. In 1903, 56,700 people lived in Winnipeg and there were 489 cases resulting in 46 deaths.

Yet, this was just the beginning of what would become the worst outbreak in the city’s history. When the population stood at 67,300 in 1904, the number of cases jumped to 1,276 and 133 people died. 

What facilitated the spread of the disease in 1904 was a fire at James Ashdown's Main Street hardware store. To keep water pressure up to fight the fire, untreated Red River water was fed into the domestic water supply which at the time was primarily supplied by artesian wells. The fire was contained but the water supply was contaminated, thus Red River Fever was free to roam the city.

In 1904 and 1905, the typhoid outbreak was primarily felt in the poorer sections of the city, especially the North End where few homes were connected to the city’s sewer system. The rich had less chance to catch the disease because they lived under better sanitary conditions. 

Thousands of working poor lived in the North End. They were mostly immigrants labouring in the massive CPR yards and in other industries such as the Olgilvie Flour Mills and Vulcan Iron and Engineering Works. In this area, profit-minded developers squeezed in as many dwellings as possible. The average lot in the North End was only 25 to 35 feet wide. 

“The filth, squalor, and overcrowding among the foreign elements is beyond our power of description,” wrote three doctors who prepared a 1904 report on conditions in the North End.

In the prosperous south end of the city, over 78 per cent of the homes were connected to the city’s sewer and water system. In this rabbit’s warren of houses and tenements in  the “Foreign Quarter,”  only 42 per cent of the dwellings were connected.

One person who recognized the need to improve sanitary conditions was Mayor Thomas Sharpe (1904-06). His subsequent actions can be attributed to growing concern that typhoid had reached epidemic proportions. There were 1,276 typhoid cases and 133 deaths from the disease in 1904. In 1905, there would be another 1,606 cases and 138 deaths. 

It was suspected that a number of cases had not been reported to officials. In addition, there was conflicting information on the number of typhoid deaths in Winnipeg during the epidemic years. In 1901, for example, the city’s health board said there were 8.04 deaths per 10,000 people, while the provincial agriculture department reported 11.83 deaths per 10,000 people. 

Sharpe recommended the establishment of a single authority to register and post the death toll.

“We have been going along without knowing ‘where we were at,’ to use a slang phrase, and with a system of that kind there is every liklihood of being misled,” said Sharpe.

In 1905, Sharpe visited 11 Eastern cities in Canada and the United States to investigate what had been done to improve sanitation. 

He also commissioned Edwin O. 

Jordon, a professor of bacteriology at the University of Chicago and an expert on typhoid fever, to prepare a report on the city’s epidemic. Another report was prepared for the city by Allen Hazan, an expert sanitary engineer from New York.

“One of the great troubles in Winnipeg is that the city has grown from a village to the status of a town ... so rapidly that the municipal measures dealing with many of the problems ... have not had the necessary consideration to make them adequate to the needs of the case,” said Sharpe. 

“For instance the man who was supposed to look after the plumbing inspection had a whole category of other duties to perform with the result that he could not devote sufficient time to any of them. As a consequence there is now before the municipal management of Winnipeg several heavy problems which would not have come so prominently to the front had they been dealt with when the city was smaller ... The health of the community is a serious matter and it is my opinion that ... there should be a well organized board, which should have jurisdiction continually.”

City council supported Sharpe’s proposals and established a health department “composed of ... good medical men,” and experts in sanitation to be inspectors and work with the city’s medical officer to administer Winnipeg’s health regulations. In addition, health board funding was increased to provide better assistance to chief medical officer Dr. J.A. Douglas. Greater funding allowed the board  to hire more public nurses.

Among Hazan’s recommendation was to immediately do away with the city’s pumping station on the Assiniboine River. In times of peak need, water had been pumped into the domestic water system from the Assiniboine which  proved to be heavily contaminated with typhoid bacilli.

Hazan also informed the city that the old wives’ tale that foul air caused the spread of the disease was unfounded.

“The belief is now firmly held infectious diseases are not carried by the air of sewers of sewers ... The odors have nothing to do with the typhoid epidemic.”

Instead, Hazan said the entire fault lies with the disposal of fecal material and its contamination of the city’s water system.

He said a good and ample water supply would do much to improve sanitary conditions and protect the city from typhoid in the future.

Jordon attributed the typhoid epidemic to contact infection between people, the use of box closets, the lack of sewer connections, infections from the milk supply and the use of Assiniboine water.

Jordon reported that many cases of typhoid occurred in clusters. He visited an area where 12 houses in a group had more than two cases each, three had as many as five cases and one had six. He said household precautions against the spread of the infection had not been as “rigorous as desired.”

“In some instances, food has been prepared for the members of the family by the individual who was at the time performing some of the duties of nurse to a typhoid patient,” he added. “Members of a patient’s family and even outside visitors have in some instances associated more or less freely with a patient ... and in more than one household disinfection  of the excreta and of the bedding and other articles used by the patient has not been carried out with the rigor necessary to stamp out all trace of the infection.”

A later report on typhoid in Winnipeg General Hospital by Dr. S.J.S. Peirce revealed that contact with typhoid patients was even dangerous under the sanitary conditions of the hospital. Between 1901 and 1905, 26 nurses, male help, maids and physicians contracted the disease from patients. Nurses, with the most contact with patients, suffered 21 cases. 

Margaret Scott, a nurse who founded the Margaret Scott Nursing Mission in 1904, during her rounds visiting patients in the poorer wards contracted typhoid fever but recovered. Her mission received funding from the city and private citizens during the epidemic.

From city reports, Jordon determined there were 12,000 buildings in Winnipeg. Of this number, 5,600 were connected to the sewer system with the remainder using privies (officially there were 6,153 box-closet outhouses — waste was contained in a wooden box — in 1905).

“Under the conditions that prevail in more than one section of the city the transfer of infectious material 

(discharged from infected patients) from these outhouses to the dwellings and persons of the neighbours is not only possible but in greater or less 

degree certain to occur,” commented Jordon.

Jordon visited areas of the city where excreta and urine flowed onto the alleys from outhouses. He saw that children played in the presence of this foul concoction and soiled their shoes, clothing and fingers with the infectious agent.

“Dogs and other animals may convey infection into homes in ways that need not be specified,” he added.

In addition, he mentioned flies that visited outhouses and later contaminating food in houses.

“The large number of outside privies in Winnipeg is undoubtedly favourable to the maintenance of typhoid fever ...,” Jordon said.

In his report, Jordon said that in the summer of 1904, wards 4 and 5 in the North End of the city “contributed by far the larger number of cases of typhoid fever appearing in the city” due to open privies being plentiful in the area.

Jordon pointed out that, while cases could be high in one portion of the city, “... the welfare of one section of the city is inseparably connected with that of another. The interests of the community, so far as public health are concerned, are not restricted by geographical or social boundaries. The presence of a large amount of infectious material from typhoid fever patients in the open privies of Wards 3 (central core) and 4 (North End) is a distinct menace to the health of the whole city, and as recent events have shown, is likely sooner or later to involve even distant districts.”

Milk was quoted as another source of infection. Jordon prepared a table where he demonstrated that one milkman supplying 160 customers had 34 people develop typhoid fever along his route. 

Through his investigations, Jordon connected certain milk routes and specific milkmen with the spread of disease. For example, Milkman A supplied just 29 houses and there were 14 homes with typhoid cases. In four of the 15 homes along one route, no infection had occurred because the residents took the wise precaution of boiling their milk before drinking it.

“It must not be forgotten that in every locality where typhoid fever is prevalent and where the opportunities for infection are so numerous as they have been ... infection of some or more of the milk supply is not only probable, but almost certain to occur.”

Jordon showed that typhoid cases increased whenever Assiniboine water was pumped into the domestic water supply. In fact, when river water was used there would be a spike in the  number of cases. Fecal material had been found “in considerable numbers” when the river water was collected at its intake by city bacteriologist Dr. J.H. Leeming.

“Even the occasional use of the raw Assiniboine water is an unwholesome and dangerous practice,” Jordon added.

Jordon’s recommendations included:

1. That the health office be given ample power and financial resources for securing isolation and providing disinfection.

2. That all houses should have sewer connections and until this is accomplished thorough disinfection of box closets be practiced.

3. That milk should be carefully inspected and that measuring devices or general receptacles should be brought to or taken away from houses where typhoid fever was present.

4. That private wells should be done away with and Assiniboine water should be used as little as possible.

5. That an expert be put in charge until the proper conditions are brought about.

“I am satisfied with the report,” commented Mayor Sharpe. “Action is recommended and the council is certainly going to act. Box closests will be done away with.” 

While the mayor and council readily accepted the report, it would still take time for the recommendations to be implemented. A 1910 report indicated there were still 1,352 outdoor privies in the city with Elmwood having 538. On February 3, 1944, public health officer Dr. M.S. Lougheed reported to city council that there were still 284 outhouses in the city.

Typhoid was only contained with the completion of the Shoal Lake aqueduct in 1919, which brought clean, potable water to Winnipeg, as well as expansion and improvements to the city’s sewer system.

After the 1904-05 typhoid epidemic,  city council also toyed with the idea of establishing a municipal milk service to help curtail the spread of disease, but it was rejected in a 1919 plebiscite. Instead, the city enacted bylaws regulating milk quality and cleanliness in dairies and promoted the use of milk that was pasteurized to kill bacteria.

In the end, it was preventative measures that ended the typhoid threat to Winnipeg.