Typhoid Fever and the Ironwood Epidemic.
(Continued from last week.)
Railroad surveys show that Pine Lake has an elevation of 170 feel above the station in the center of Ironwood, and this is ample to convey the water of the lake to town by gravity flow. The stream, from the lake to Ironwood, flows rapidly, and, except for local pollution, the quality of the water when it reaches town should be fully as good as when it left the lake. Indeed, if there is anything in the theory of the self-purification of streams, the water ought to be better after its journey. This was proved to be the case. Samples of the water from the lake, and from the river at the point where it is proposed to locate a new intake pipe, were sent to I’rof. Vaughn for analysis, and he reported that the quality of the river water was superior to that of the lake water.
Flowing through a thickly timbered country, entirely unsettled with the exception of the small lumber camp which was previously mentioned, and which will soon be abandoned because all the available timber there is cut, it seems selfevident that very little improvement in the quality of the water can be effected by taking directly from the lake instead of from the river, unless there exists some contamination which the water company cannot remove.
Evidently the contamination causing this epidemic was due to some local cause which had not existed before the season in question; and that cause must be either the lumber camp or the drainage from the city of Ironwood. The lumber camp had been visted earlier, and nothing had been found there which would affect the stream; hence, if the mischief came from the river water, only the city drainage could be held accountable. It was known, but not generally, that the drainage from the southeastern part of the town discharged into the river above the water works, and this fact had been overlooked in the previous examinations. This stream was therefore examined, from its discharge into the river to its source in the town. The result was startling. At the upper end, inside the city limits, but in a part not yet built up, six decomposed carcasses of cattle and horses were found on the banks, or in the stream itself. It was said that these carcasses had been hauled there during the previous winter by one of the aldermen of the city, and, ex-officio, member of the Board of Health, who, by the way, died of typhoid fever about a week before this discovery.
Contamination of the water supply had certainly been discovered and decided contamination too. It is a question, however, whether this was the cause of the outbreak of typhoid fever; some physicians claim that it was not necessarily responsible.
According to the germ theory, which recent investigations appear to confirm, typhoid fever is the result of a specificgerm or bacterium, which grows and propagates itself in the human system, producing the fever. The bacteria are a group of low plants, so small as to be quite invisible to the naked eye and, until within a few years, entirely unknown to man. So small are they, and so simple in their structure and activities, that it was not an easv task for scientific men to decide whether they belonged among animals or plants. It is now definitely settled, however, that they are plants and are closely related to the algae. They vary much in shape, but, in general, are either spherical or ovoidal, like a billiard ball or an egg, rod-shaped, like a lead-pencil, or spiral, like a corkscrew. They appear under the microscope as pale, translucent bodies. Warmth, moisture, oxygen, and a certain amount of organic matter, are the simple conditions required for their activities. When the conditions are favorable, they increase to a degree limited only by their surroundings. So rapid is the process of reproduction that a single germ, by the process of growth and sub-division, may give rise to millions of similar organisms within twenty-four hours.
Many forms possess the power of living and multiplying so long as the proper conditions obtain, but when life, owing to some change in the surroundings, becomes no longer possible, the vital powers collect themselves in a little shining mass at one end of the bacterium, which then protects itself by a dense membrane, and in this form, which is called a spore, the individual can survive adverse conditions which, in the ordinary form, would have destroyed its life. Restore it to the needed conditions and the spore swells into a bacterium again and becomes the ancestor of new generations.
It was formerly believed that such low organisms as the bacteria could spring spontaneously into being whenever in nature, the conditions were favorable; but this notion, which was shown to have depended on insufficient and crude observation, has long been given up. It is now believed that every living thing comes from some pre-existing living thing, be it man, beast, plant or cell, and that this principle holds true as well among bacteria as among more highly organized beings. The typhoid germs are little rodsor bacilli,considerably larger than those which cause tuberculosis. Genuine typhoid fever is caused by this particular germ and no other, and never in any other way. This germ is not known to grow, except in the human body, but it may remain alive outside
the body, in water, or under other conditions; and it has been abundantly proven by careful experiments that it can remain alive for long periods when frozen solidly in a block of ice.
The most common ways in which the bacteria are spread are by the air we breathe, the food we eat and the water we drink. If any of these necessities of life contain in them the living germs of the disease, there is liability of the infection of healthy or predisposed individuals. The probabilities are, however, that in the majority of cases typhoid germs are introduced into the system by drinking water which has been polluted by human waste containing them.
The typhoid germ can act on the system only after it has been taken into the stomach and has passed from it into the intestinal canal. In the intestines, if the conditions are favorable, it multiplies enormously. Some of the germs gain access to certain of the internal organs, but most of them either complete their existence in the intestinal canal or are cast out in the living condition with the diarrhceic discharges which always accompany the disease. Human excrement, therefore, is the necessary agent for the spread of the disease, as it is only by this means that the germs can pass from the body of the patient. It is said that human beings alone are affected by the disease, and they alone can be the source of infection.
The effects which these, as well as other disease-producing bacteria, may produce in the body, vary considerably unde different conditions. Sometimes the general condition of tin body is such that it seems to furnish very favorable soil foi their propagation; or is specially vulnerable to their action, Sometimes the particular germs which gain access to the sys tem seem to be especially virulent, perhaps from their inher ent vigor, or from conditions which we know nothing about In typhoid fever, analogous predisposing factors seem to determine that, when exposed to the same risk of infection, one individual may be attacked by the disease and another not. But in all these forms of bacterial disease the particular species of bacteria, belonging to each, must be present, predisposition. or the disease cannot occur.
Typhoid fever is often called a filth disease, and its occurrence has often been attributed to bad food, foul air, sewer gas and overcrowding. This is in a sense true, since these adverse conditions are apt to induce a state of the body which reduces its power of resistance; but no imaginable conditions could ever induce typhoid fever without the presence of the particular germ which causes it. The disease cannot spring up among any class or condition of people without the introduction of the germ from outside.
According to the germ theory, the carcasses found along the banks of the small stream certainly contaminated the watersupply and rendered it dangerous for domestic purposes, yet it would not necessarily follow that they produced typhoid epidemic. However, shortly after they w-ere removed and buried, it began to be noticed that the fever was subsiding, and that the cases were growing less malignant, and within four weeks thereafter the number of cases had decreased to one-third of what they had been. Very few new cases were occurring, and most of them were directly traceable to the use of water from contaminated wells. It does not follow, however, that the decrease of the epidemic resulted from the removal of the carcasses, for other causes were also at work. Long before the fever had become so prevalent, many of the physicians of Ironwood had been very active in warning the people against the use of water from the water works, and, on account of its color, only a limited number of persons had ever used it for drinking, but instead had bought spring water brought in carts, or had used well water. Since the beginning of the epidemic the health officers had also been very active in closing polluted wells and in cleaning yards, alleys and streets; and as a result of their efforts Ironwood was cleaner than ever before in its history.
The discovery of the pollution of the small stream shows positively the mistake on the part of the city in allowing the water supply to be taken anywhere below the discharge of the drainage from any part of the city. The difficulty will now be remedied by extending a new intake pipe up the river about half a mile, to a point above where the small stream discharges.
The health of the city will not by any means be insured by this change in the water supply. It will still be necessary for the city to thoroughly drain the ground on which it stands, and to carry off in sewers all the water which is discharged from the mines and which now forms many swampy places in town, detrimental to the general health. All wells containing only surface water must be condemned and filled in. Finally, the practice of throwing slops and refuse into the yards and alleys during the long winter months, must be rigidly forbidden. If these changes are effected, the health of the place will become normal, and its present reputation for unhealthfulness may in time become only a memory.
It may appear strange that although the causes of the epidemic have existed since last winter, it did not appear until May. Isolated cases had occurred before—it is said, indeed, that the place is never free from the disease—but the number was insignificant until May. It must be remembered that the winter in this latitude is very long and very severe. During the winter of 1892-93, there was sleighing at Iron wood from November 7th until April 7th. Snow was deep in the woods until May 15th, and patches of snow were found even on Decoration Day. The melting snow carries the germs into the drinking water, and about two weeks after they enter the human system the fever appears.
A seemingly curious fact was observed in this epidemic. Certain nationalities seemed to be almost proof against attack and others were peculiarly susceptible to the disease. Poles, Italians and Hungarians are probably as filthy in their habits as any people in existence, and yet hardly one of them had the fever. Many cases existed among the Finnsand Cornishmen, but the Swedes seemed the most susceptible to the disease, and most of the fatal cases occurred among persons of that nationality.
As a result of the investigations made, it appeared that the outbreak of fever was not due to the contamination of the river water, but rather to that of the wells throughout the city, when the snow melted in April and May, and washed into them the filth which had accumulated during the long and tedious winter. There is, however, a constant danger that the river supply will become polluted, and this danger will exist until the location of the intake pipe is made such that the water is taken from a point above where any city drainage discharges into it. Plans were made by the company for this change, but negotiations were then completed for the sale of the works to the city, and owing to the delay in the transfer of the works, winter came on before the work was done. As soon as the city takes possession, it will undoubtedly complete the arrangements made, and insure an uncontaminated supply for the inhabitants.
Thepresent company is formed by the consolidation of two companies, organized under franchises given by the city of Ironwood, Mich., and by the village of Hurley, Wis.; each system having been originally constructed independently of the other. Consequently, there are two pumping stations and two standpipes thirty feet in diameter and fifty feet high, one respectively in each place. The pipe system, for two towns, consists of about fourteen miles of mains, with 156 fire hydrants and the necessary stop valves. Since the consolidation of the two companies the pumping station at Ironwood has supplied the water for the two towns, and since the city of Ironwood discharges its drainage into the rixer, it would be impossible for the Hurley pumps to supply uncontaminated water. For pumping into the same mains the Ironwood station has two Deane compound, non-condensing pumping engines, each of one and one-quarter million gallons capacity per twenty-four hours. Besides, there is a three-quarter million gallon high pressure pump which draws the water from the river and discharges it into a Jewell gravity filter, from which it flows into a receiving well, thirty feet diameter, from which it is pumped to town by the compound pumps. Pumping operations are continuous, and the daily consumption is about 700,000 gallons, of which a large percentage is undoubtedly wasted, as the number of taps is only about 600. Alum is used in the filter as a coagulant, but not enough is used to remove the color from the water, for this would require so much alum as to make the water hard. Possibly some other process of filtering and purifying the water might remove the color without affecting its softness. While the discoloration indicates no injurious quality in the water, it creates prejudice, and, if it could be removed, many would use the water who will not do so now.