« ForrigeFortsæt »
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 $i 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 ist 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 to 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 assumption that it was less than this time. In fact, I am sure, the period of incubation was at least two weeks, and in some cases longer, as I had a number of cases suffering from the prodromes of the fever for this length of time, and who took to their beds on dates between the 18th and 25th of the month. Among them was a druggist's wife and my own wife. They suffered from symptoms almost identical-severe pain in the head and back, with marked lassitude, etc. They came down simultaneously on the 25th of November. Again, patient Weir was sick for twenty-one days. Should the discharges from his bowels and bladder be deposited in said ditch, from day to day, up to the end of his sickness, and most likely they were, as we have no information that they were not, new cases should continue to come down in Fort Collins for a period of at least thirteen days. The facts, however, are, they ceased to come down after seven days, save in a few scattering cases.
It is, therefore, very conclusive to my mind that this particular case was not the cause of the epidemic. Such being so, who will say that it was caused by the water supply, when a second epidemic of more or less severity was not produced by the direct contagion of the river, by the discharges from said patient Weir, and which should have occurred on the 27th. What, then, was the cause of the infection?
If it were caused through the water supply, it would seem that the hotels, where unboiled water was drunk ad libitum, would furnish at least some percentage of the cases. This they failed to do. As previously stated, the inhabitants living in the northern and eastern portions of the city, where the sanitary conditions are the poorest and the means of the people most limited, were practically exempt. Those more able to afford the luxuries of life were the ones principally afflicted. Might not this suggest that the food supply was the source of the infection? Calay has collected a number of instances in which typhoid fever occurred from poisoned meat. This, of course, would not necessarily exempt the water supply, as the meat might, without question, be contaminated by it.
Numerous epidemics have occurred in which no outside source could be found for their origin. An instance of this kind is reported from the Military Academy of Chelsea, Pennsylvania, in which fourteen cases developed among 132 students After a thorough investigation by Dr. Billings, no source could be found for the infection.
Murchison and other writers of note have contended that cases may develop independently of pre-existing cases of typhoid fever, and it has been suggested that the bacillus occurs in nature, possibly in an imperfect state of development, and under certain conditions takes a pathogenic power, which enables it to produce the disease in susceptible individuals.
In this instance might it not, through contact with the results of some unknown decomposing organic matter, have acquired this power, and might not the long continued dry season (little rain having fallen from July to December) have so reduced the resisting power of individuals as to make them susceptible to the disease? And I might suggest further, with Baumgarten, that the dust of this unusually dry season may have disseminated the germs, and the bacillus entered the system with the inspired air. We do not need to go outside of Colorado to find physicians who seem to entertain the idea that typhoid fever is an eminently infectious disease. Among these is Dr. T. A. Hughes, head examining physician Pacific Jurisdiction Woodmen of the World. In his April, 1901, report to the head officers of that Order he says:
"Typhoid fever and pneumonia have each claimed an equal number of victims. Both diseases have been extremely prevalent in our jurisdiction during the last six months; the community at large, as well as our Order, have recorded many deaths from these causes. I might almost say that a wave of typhoid fever and pneumonia, following la grippe, have swept over our country from the Atlantic to the Pacific, no state or community having escaped, as shown by the death reports of our cities."
In speculating on the source of the infection, I have no desire to minimize the dangers to the public from the pollution of streams that supply towns and cities with water, but I do believe that water supplies are not the sole source of infections which Produce typhoid epidemics. We have abundance of statistics to show that a rapid reduction in the number of cases of typhoid fever has been effected annually by good filter systems, but we also know that such reduction will be apparent without the assistance of filters. Nine years ago we had in Fort Collins a large number of typhoid fever cases; my own cases numbered sixtysix in that year alone. Since then there has been a gradual annual decrease in the number, until the occurrence of the present epidemic. The filters at the waterworks, according to Dr. Mitchell's report, could not influence this result, and to my own knowledge they are incapable of filtering out bacteria from water. At any rate, they were put in but five years ago, and the reduction in the number of cases had been going on annually for four years previously. Twenty years ago we had a similar outbreak, and a decreased annual number of cases for the following two years. Does not this suggest that immunity, either acquired or hereditary, plays a great part in the occurrence of epidemics of typhoid fever? It is not necessary that an individual should have an actual run of typhoid fever, or any other contagious disease, to acquire immunity. It may be conferred on some persons by the reception into the system of a limited amount of poison, but not enough to produce actual disease. Twenty years ago all, or a large percentage of the community, was rendered immune by actual disease or by semi-intoxication. This immunity would seem to have lasted for the following ten or eleven years, when another epidemic, though mild in character, occurred. Immunity was again conferred, and this lasted until the recent epidemic.
The discovery of the bacillus coli communis in the water supply of Fort Collins by Dr. Mitchell is very suggestive. The presence of intestinal bacteria in drinking water is satisfactory evidence of pollution by fecal matter of man or animal, and srtongly points to the possibility of contamination by typhoid germs, and whether the epidemic was caused through the water supply or not no time should be lost in securing a supply that will be free from such untoward contamination.
In describing the clinical manifestations of the epidemic, I have already said that I believe the period of incubation was from two to three weeks. The time at which the fever began, however, was well marked and decisive in most cases. In children the premonitory symptoms were headache, usually occipital. loss of appetite, coated tongue with red edges, colicky pains in bowels and general indisposition. Often a hacking cough accompanied these symptoms. The fever did not run high, except in the cases of those who were managed badly or had imposed on them improper food. In some the temperature was highest at the outset of the disease, until the end of the second week, when it declined by rapid lysis. In the majority the rise was gradual, attaining its maximum at the end of the first week and declining gradually the third week of the disease. Still others had practically no fever, the diagnosis resting on their apathy, loss of appetite, coated tongue and presence of mucus in the fecal discharges. Out of the total number of children I treated,