6484 JUN 23 1902 LIBRARY. DENVER MEDICAL TIMES VOLUME XXI. JULY, 1901. NUMBER 1. ORIGINAL COMMUNICATIONS. THE LATE EPIDEMIC OF TYPHOID FEVER IN By P. J. McHUGH, M.D., Fort Collins, Colorado. In writing up the epidemic of typhoid fever which occurred in Fort Collins last fall, it is needless to say that absolute accuracy, in considering the various symptoms, complications, etc., can hardly be expected. It is only in well regulated hospitals, where careful records are kept, that this can be. In a general way, therefore, I shall have to depend on my memory for most of the data referred to in this paper, except in cases where trained nurses were employed. During the latter part of October, 1900, and up to the 18th day of November following, quite a few cases of typhoid fever occurred in Fort Collins and vicinity. The outbreak, which I refer to as an epidemic, however, did not occur until the 18th day of the latter month. On this day cases of typhoid fever began to come down with appalling rapidity. This continued until the 25th, when my business was increasing to "no rest" proportions. All the physicians in the city were working by this time day and night. I should judge that 95 per cent of the total number of cases fell sick between the 18th and 25th of November. Those who came down afterwards, with but few exceptions, were nurses or members of families who contracted the disease from their patients or sick relatives. It is impossible to be accurate as to the total number sick, but the general consensus of opinion among the townspeople and physicians place it at 300. Of these the larger proportion were between the ages of 7 and 25 years. The extremes of life were, as a rule, spared. *Read before the Colorado State Medical Society, Denver, Colo., June, 1901 Few cases occurred below 7 or above 50 years of age. Between these ages males and females were sick in about equal proportions. From the age of 25 years and upward a gradual decrease in the number sick was manifest. A noticeable fact, however, was the better-to-do classes seemed to have the disease in its severest form. It was general all over the city, except in the northern and eastern portions, which lie along the river, both of of which might be regarded as the least healthy, on account of the lowness of the land. Few cases occurred in the hotels, but in private boarding houses a large number of college students fell victims to the infection. With few exceptions the disease was confined to the city; in previous years the country furnished the greater number of cases, in proportion to the population. As victim after victim was stricken down and the disease in many prominent homes began to take on a malignant form, the inhabitants became almost panic stricken; they recalled the fact that nothing like it, in severity, ever occurred in our city before. Typhoid fever for a number of years previous to this outbreak had dealt mildly with the inhabitants of the Poudre valley. True, it was, a few deaths occurred from it from year to year; but the percentage of cases compared with the population had been small, and the percentage of deaths unusually low. Every means possible was taken by the inhabitants to evade the disease. after the first day's sick list was recorded. The water and milk were sterilized by boiling; the butter was made into an unpalatable mass by the same process. Patent nostrums, compounded and sold by enterprising druggists at a profitable price, were freely partaken of by a goodly number, and many hungry bacteria were mercilessly swept through the alimentary canal by those who believed in "physic" as a preventive. Celery underwent a rigid process of cleaning before it was allowed to enter. the stomach of many individuals. I am told that one physician used a sterile tooth-brush for this purpose. Armed with a nonpoisonous antiseptic solution, and aided by a powerful magnifying lens, the tooth-brush was made to go over the celery from root to foliage and lay waste and dead (?) any typhoid bacillus that might, perchance, have nestled upon this palatable vegetable. The charges of municipal neglect were numerous. The Mayor of the city received his full share of criticism for the prominent part he was supposed to have played in the ill-management of the water supply. The chairman of the board of waterworks was charged with incompetency and as being es sentially derelict in the discharge of his duties by prominent citizens, men, who, after the epidemic has passed by and the cemetery had absorbed the flower of our young sons and daughters, fought a proposition of extending our water system to a point on the river, that was thought by many, would practically guarantee against subsequent epidemics of a like kind. Business for a period of at least three weeks was practically suspended. In the home of almost every business man one to three persons were sick, and the farming community was so fearful of contracting the disease that few of them came to town. The wildest and most exaggerated reports were conveyed from one family among them to another, and thus the panic was extended to the widest limits among those who did their marketing at Fort Collins. In the stores and shops the disease was discussed from every conceivable standpoint. Each individual knew exactly how serious was his neighbor and the plan of treatment adopted by the attending physician. This and that physician's treatment was criticised without hesitation or limitation. The cold bath treatment received its full share of disapprobation; and woe to the physician who dared to use ice on a fever-stricken individual! The placing of an ice cap on the head for any purpose, or on the abdomen to control a hemorrhage, was by these would-be connoisseurs of the medical art, construed as packing the individual in ice and so reported. It is only fair to say, however, that in the homes the physician's word was held in the highest respect. For my own part, and I believe it was general with the profession, I shall always remember with pride the confidence that was imposed in me by families in whose employ I was, and in passing, let me say that this confidence is the highest stimulus for us to be true, loyal and efficient physicians. In estimating the cost of this epidemic, I quote from a very valuable paper, read before the Science Club of the State Agricultural College, by Prof. Carpenter, in which he says: "Let us examine the cost due to the fever of the past few months. There have been, we will say, 350 cases of fever. Each case has caused an extra expense for nurses, doctor bills, drugs, washing; even extra coal and extra light has been no inconsiderable item. For those who have recovered it is safe to say the sickness has cost in cash on the average at least $200, and those who have not recovered at least $350. "This makes 310 cases at $200, $62,000; 35 deaths at $350, $12,000; or say a cash outlay of $70,000. Now, in addi tion, there has been a loss of time. Some extensive hospital records show forty-three days as the period of convalescence. This is the discharge from the hospital, and does not include the time when the convalescent has not regained his full strength, which many know from experience may extend over a number of months or even years. What shall we consider this? Most of those attacked are in the prime of life. We may count their average earning capacity as $1 per day; the loss on 360 cases is then about $16,000. These items, the cash and loss of time, mean a direct cash loss to the community of $86,000. "But this does not include all. We are considering only dollars and cents, not attempting to weigh the sorrow and anxiety of those whose households have been stricken. “A human life may be considered an asset of a community. The French count every soldier worth $1,200. The courts often consider it as worth $4,000 to $5,000. We may take an intermediate value of say $2,500. This means, then, for thirty-five lives sacrificed thirty-five times $2,500 equals $87.000, loss to the community. "Now, beyond all this, there are indirect losses to a community, the draft on the time and strength of others of the household has not been considered, for this has not been a cash outlay. In many cases it has been a draft sufficient to lower the vitality and perhaps shorten the life of the anxious relatives. "Every piece of property is less in demand. Business transactions are lessened, causing a loss none the less real, though indirect and difficult to estimate. At the lowest possible estimate, this means, all told, a loss to the individuals and the community of over $200,000 for this one epidemic. And who shall estimate the anxiety and sleepless nights of the husbands and wives, the fathers and mothers, whose households have been stricken, or place the money value on the tears of those who mourn?" In seeking the cause of the epidemic, I shall make reference to the very able report of Dr. W. C. Mitchell's investigation. It is needless to say, before this society, that typhoid fever depends on the presence of Eberth's baccillus. About the 1st day of December, 1900, Dr. W. C. Mitchell was employed by the Board of Health of the City of Fort Collins to make an investigation into the cause of the epidemic. After a very creditable and searching investigation into the sanitary conditions of the city and the Poudre river, and a bacteriological analysis of samples of water taken from different points along the river, and from water taps in town, he arrived at the following conclusions, as per his summary: "Both the sanitary inspection and the bacteriological analysis show that the water supply of Fort Collins is subject at the present time to a continuous contamination by the fecal evacuations of both man and animals, and that, moreover, there is no adequate barrier to remove this contamination from the water before it reaches the consumer. "The present epidemic can, in the opinion of your expert, be traced directly to the cases of typhoid fever which existed in Bellvue, and the evacuations of one of which has been clearly shown to have been emptied into the Poudre river at this town. "It was also reported to me that there were three cases of typhoid fever on the North fork of the Poudre, but this is only hearsay. But it can readily be seen that there may at all times be other sources of infection. I am informed by Dr. Killgore that there is hardly a month goes by but that there is one or two cases of typhoid fever present. "In reference to the present epidemic, there is another feature which points to the water as being the carrier of the germs, and that is both the suddenness and the extent of the cases of fever. Then, also, the time could not correspond more accurately—the emptying of the discharges into the water the first or second week in November and the disease two weeks later in Fort Collins." The case referred to in this summary was one Weir of Bellvue, who took sick with typhoid fever on the 3rd of November, 1900, and continued sick until the 24th of November, according tc. Dr. Mitchell. Bellvue is a town on the Poudre, about seven miles above Fort Collins. The discharges from the bowels of the above patient, instead of being disinfected according to the attending physician's orders, were thrown into a ditch which empties its contents into the Poudre river. Allowing eight days (Hiss) as the time at which the bacilli would first be discharged from the bowels of this patient, two days for their conveyance to Fort Collins and fourteen days as the period of incubation, the epidemic should not have occurred until the 27th of November. It did, however, occur on the 18th, or nine days before it was likely to occur, if the infection was from this source. The virulency of the poison might account. for a shorter period of incubation than fourteen days, but the clinical history of many of these cases does not justify the as |