The Typhoid Fever Epidemic at Waterford. INVESTIGATION OF AN EPIDEMIC OF TYPHOID FEVER AT WATERFORD, WIS. BY THE SECRETARY. The village of Waterford is a secluded one, pleasantly situated in the extreme northwest corner of Racine county, on the Fox river, and contains, by the census of 1885, a little less than 500 inhabitants. It has no railroad, the nearest station being Rochester, about ten miles distant. Into this quiet hamlet there came during the last summer, an epidemic which speedily attained such threatening proportions as to cause a degree of alarm that amounted to almost a panic among the citizens, both in the village and country surrounding it. In this condition of things, appeal was made to the State Board of Health, to ascertain, if possible, the nature and cause of the disease, and what could be done for its control. The existence of the disease first came to the knowledge of any member of the Board on July 9th, and the following day the place was visited by the President and Secretary, who made a thorough examination of its sanitary conditions, and of the nature and cause of the existing sickness. This examination revealed a condition of things the careful study of which can hardly fail to interest the sanitarian or to convey wholesome sanitary lessons. It is the design of this paper to present the chief facts in the history of this epidemic. One of the points first observed was the intense anxiety of the people concerning the sickness, and the manifest fear The Typhoid Fever Epidemic at Waterford. that existed lest the worst had not yet been reached. The streets were very quiet and we were told that farmers from the country around feared to come into the village lest they should be smitten by the contagion, and that the business interests of the place were therefore suffering severely. A brief examination showed that the sanitary condition of the village was not good; the too common spectacle was presented of neglected privy vaults, accumulations of manure, heaps of ashes and rubbish of various kinds, but although the conditions likely to increase the virulence of disease were not lacking, prior to the present epidemic there had been for a long time but little sickness, and nothing at all akin to that from which many were now suffering. Tracing the history of this outbbreak it was found that the worst manifestations were in the family of Wm. Huening, consisting of the father, mother and eight children, all of whom, with but one exception, were or had been sick, and shortly after our visit this one, a girl of about fifteen years old, also was reported ill, with symptoms similar to those of the other members of the family. On further inquiry concerning the first appearance of the disease, it was learned that Bernard Huening, one of the older children, had been at work for some time in the city of Milwaukee, where in the early part of May last he had been taken sick, being under the professional care of Dr. E. Kramer until about May 17th or 18th, when he was considered convalescent, and shortly afterward, by advice of the physician, went home to recuperate. He was able to give but little account of his sickness in Milwaukee; he thought that he remembered having some Diarrhoea and that he was said to have Jaundice. After his arrival at Waterford he appears to have suffered a relapse, was confined to his bed for a period of about two weeks, and was probably worse than at any time during his stay in Milwaukee. The history The Typhoid Fever Epidemic at Waterford. of this relapse was very obscure. The patient was described as having been very weak, as having no appetite and as having slept most of the time for the first week. He had no physician until a later date and no regular nurse, having been waited upon indiscriminately by other members of the family, often by those who were quite young. By persons outside of the family he was said to have been delirious during this time. About June 12th, probably about two weeks after Bernard's arrival home, the youngest of the family, a girl of eight years of age, became sick, and in quite rapid succession other members of the family came down also, so that at the end of the month nine of the household were sick, being the entire family with the exception above noted. In the mean time sickness similar in character had appeared elsewhere in the village, but with special frequency among the scholars in attendance at a Catholic parochial school situated nearly opposite the Huening residence, the whole of that locality being regarded with suspicion on account of the prevalence of the disease therein. These facts having been ascertained, the next inquiry related to the possible or probable cause of all this sickness. The Huening house, where the disease first appeared, is an old one, much too small for the number of its occupants, the bedrooms measuring only 7 x9 feet on the floor, but it was found to be in reasonably good sanitary condition, and no suspicion could fairly attach to it as a cause of the trouble. The privy, which was in the barn, 65 feet to the southwest of the house, was found in a very offensive condition. The well is very near the northest corner of the house; it is nine feet deep and has been in use for forty-five years; we were told that it had been cleaned often, the last occasion having been in the fall of 1885. The well was surrounded on three sides by a fence, which formed a recess in 7-H. The Typhoid Fever Epidemic at Waterford. the enclosure of a garden which lay beyond it to the north; measurement showed the distance from the fence to the well on the south side to be one foot seven inches, and on The Typhoid Fever Epidemic at Wuterford. the west side, toward which the nozzle of the pump was turned, four feet; a slight ditch on the west led the waste from the pump into the garden. The water in the well was clear and cool; it rose and fell with the rise and fall of the water in the river, which flows through the low and nearly level yard at some distance to the west and rear of the house. The relative positions of the house, privy and well are shown by the preceding diagram, drawn to a scale of twenty-four feet to the inch. With this diagram of the premises in mind, we now turn to the first case of sickness in this house, that of Bernard Huening. As already said he was very weak and slept much of the time, and though but little information could be obtained as to the exact nature of his symptoms during the first two weeks of his illness, it was ascertained that for a part of this time at least he had Diarrhoea, that the vessel containing the bowel discharges was habitually emptied into the privy, in the barn, that the vessel was then taken to the well and rinsed, the rinsings being thrown upon the ground, and that additional water was afterward pumped upon the ground to wash the rinsings away. When the vessel contained urine only, it was usually emptied on the ground, i. e. between the house and the river, but in this case as with the bowel discharges, the vessel was rinsed at the well before being returned to the house. These methods of disposing of the excreta were practised from the first, and down to the date of our investigation, notwithstanding better instructions from the attending physician. By consulting the diagram it will be seen that the rinsings from the vessels must have been thrown upon the ground very close to the well, and certainly within four feet of it, as the fence was only removed by that distance; the probabilities, especially when this service was performed by children, are largely in favor of these rinsings having reached |