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A Small Typhoid Epidemic by Captain Louis C. Duncan

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A SMALL TYPHOID EPIDEMIC

By CAPTAIN LOUIS C. DUNCAN

ASSISTANT SURGEON IN THE UNITED STATES ARMY.

The County of Missoula (Montana) is situated in the north-western portion of the state. The whole area is mountainous, the narrow valleys and canyons alone being inhabited.

This part of the state is noted, or notorious, as the home of that peculiar and mysterious disease commonly known as Rocky Mountain Spotted Fever; though the main spotted fever area is a little farther south in the valley of the Bitter-root river. Typhoid is epidemic in the county, not a year passing without scattering cases, and some years are marked by real epidemics.

In 1897 and again in 1900 there were serious outbreaks in the town of Missoula, with as many as ten cases per thousand inhabitants; at least so I am informed. The local physicians look on typhoid as an annual disease, always to be reckoned with in the late summer and autumn.

During the summer of 1907, the Pacific Coast Extension of the C. M. & St. P. R. R. was under construction across the county, and across the entire state. Grading camps were established at many points along the line, especially in Hellgate Canyon, where there was much tunneling and other heavy work. The N. P. R. R. was doubling its track at the same time in this canyon, and for seventy-five miles there was a close succession of camps along one stream in a very narrow canyon.

In these camps were gathered laborers of the lowest class from all parts of the country, living in tents and temporary houses, with no sanitary arrangements or control. The large contractors employed physicians to treat the sick and injured, but no sanitary officers to prevent sickness. Here was to be seen the working of the idea prevalent in the army until recently, that medical men were employed to cure sickness, not to prevent it.

These camps were inhabited at the beginning of spring; with no supervision, all sanitary rules were of course violated. Water from the small, and always apparently pure, mountain streams, was used for all purposes; there was no protection from flies, personal cleanliness among such a class of ignorant men was nowhere to be seen. The disposal of excreta was not considered as worthy of attention. In fact these camps differed little from the camp of an army in the middle ages.

There were all the necessary factors for an epidemic of typhoid and it came.

Yet no case occurred until August 12th, or rather the first case was reported on that day. It will be remembered that typhoid appeared at Camp Alger early in June, and was so widespread in July as to cause the abandonment of a part of the camp.

Missoula lies near the 47th parallel, some five hundred miles further north. The summers are cool and the summer of 1907 was cooler than usual. September appeared to be as warm as July. This difference in the seasons seemed to influence the time of appearance of the disease.

After the first case others appeared in rapid succession. Thirty-four cases were reported from Missoula county in August. From the grading camps the disease rapidly spread to the adjoining sawmill and lumber crews. The first case occurred in a grading camp at Bonner; it was probably imported. From this camp it spread to the sawmill and then to a point ten miles up the Big Blackfoot river. It is worthy of note that the first case at this latter place was a teamster who hauled meat to the sawmill below.

In September there were seventy-four cases reported in the county, nearly all from camps and sawmills. A remarkable epidemic in miniature occurred at a small sawmill on Grant creek. Eleven men worked in this mill; they used the water of the stream for all purposes; every man of the eleven contracted the disease. Evidently here was a virulent culture let loose. And the first man attacked was a teamster who hauled lumber to the railroad.

On the advice of the company physician, a well was dug and when a new crew was installed no more cases occurred.

In October fifty-three cases occurred. The disease was disappearing; partly from more hygienic measures and partly on account of winter, which comes early here.

During this time, although practically all these cases were brought into a Missoula hospital for treatment, there were but seven cases in the town itself and they were nearly all or all imported. Missoula has an excellent water supply which was under supervision.

A few years ago the town itself had an epidemic, due to a part of the population using water from an open ditch. Fort Missoula, four miles distant, has had no case of typhoid during recent years.

Flies do not appear to be an important element in the infection; flies are comparatively scarce in Montana. The great majority of these cases were treated in one hospital which was very much crowded.

Few prophylactic measures were in use. Nurses and attendants handled the patients freely without using antiseptics. I saw a ward of over thirty typhoid cases where the odor that the old doctors talk about was very apparent. As no case of the disease was contracted by the hospital personnel, I should say that personal contact was not an important factor. Dust does not enter the problem here. There is practically no wind and little dust. It appears that the infection was chiefly in the drinking water.

Montana is peculiarly susceptible to epidemics of typhoid on account of irrigation ditches. These ditches are found in all the inhabited sections, always carrying clear, cold, sparkling water. The traveler or working man always has at hand water that almost invites him to drink.

But these streams, while fed by snow in the mountains, pursue their courses for miles, passing through fields, pastures, barnyards, hog-lots and other sources of filth and infection. Local physicians look upon the water as the chief carrier of infection and I believe they are correct.

There were in all (to February 1st, 1908) two hundred cases and thirty-six deaths. The actual population of the camps from which these cases were drawn could hardly have exceeded 2,000. If that be true, about one person in ten suffered with the disease.

The “Reed Board” found that about one in five in the camps of 1898 [was] attacked by typhoid.

Local physicians thought the disease not of a severe type. As a matter of fact it was most virulent, the mortality being eighteen per cent, as compared with 7.61 per cent in 1898, and a general average of about 8.5 per cent.

I do not believe that widespread epidemics are ever of a mild type. It is the few scattering cases that may be mild. The very fact that an infection secures a foothold and spreads, proves its virulence.

While the water supply, personal contact, flies, and dust have to do with the spread of typhoid, back of all there is the one primary cause, human excreta. The Reed Board gave out no more important finding than this: “The amount of typhoid in the different regiments varies with the disposal of excreta. When excreta was well disposed of there was little typhoid, when scattered promiscuously and neglected there was much.”

This dictum has been abundantly proved by our experience in the maneuver camps of recent years.

In these railroad camps, especially the smaller ones, there was no care of excreta; the small streams were polluted and the epidemic followed.

TABLE OF CASES COMPRISING THE TYPHOID EPIDEMIC

Cases - Deaths

August 34 - 3

September 74 - 9

October 52 - 8

November 28 - 7

December 6 - 7

January 1908 6 - 2

____ ____

200 - 36

Mortality 18 per cent.

This small epidemic was but a repetition of a thousand previous epidemics. It offers nothing new but serves as an excellent illustration of the work of typhoid in camps and temporary settlements, with little or no observance of sanitary laws.

These 200 cases and thirty-six deaths could all, or nearly all have been prevented. Considered only from a financial standpoint, they cost the construction and other companies not less than $50,000. It would have paid these firms richly to have employed sanitary officers instead of physicians. Five thousand so expended would have saved the balance; but no doubt the contractors would have considered that a needless expenditure.

The City Health Officer of Missoula, F. D. Pease, M.D., a former U. S. volunteer surgeon, appreciated the conditions and foretold the epidemic, but he could only recommend, he had no authority.

If these camps be compared with the recent maneuver camps, the control of typhoid in the army will be better appreciated.

The above article is taken from – The Military Surgeon – Journal of The Association of Military Surgeons of the United States – 1907-1908.

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Last Updated on Tuesday, 19 May 2015 19:24