Typhoid Fever and the Ironwood Epidemic.

E. A. RUDIGER
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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.

THE CLINTON HOOK AND LADDER COMPANY, MOUNT VERNON, N. Y.

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.

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Typhoid Fever and the Ironwood Epidemic.

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Typhoid Fever and the Ironwood Epidemic.

THE intimate connection between purity of water-supply and the health of cities and towns is now universally recognized. Many epidemics have been traced directly to the use of polluted water, and, where there is an outbreak of sickness in a community, the water used for drinking should be immediately examined in order to determine whether it has become contaminated.

The determination of the wholesomeness of a sample of water is no easy matter ; taste and color are not infallible tests of its qualities. Chemical tests, although necessary, are not decisive. A microscopical examination is the only one which will show conclusively whether germs of disease actually exist in the water. A chemical examination will, however, show whether the water contains matter which will serve as nourishment for bacteria. Water that contains visible impurities, or that has a disagreeable odor, or taste, or color, may be rejected as’*unfit for use; but it may be comparatively harmless when compared to another that gives to the senses no outward indications of danger, but which is, nevertheless, contaminated by the germs of disease, and is, therefore, extremely dangerous to health. In general, however, a drinking water should be clear to the eye, pleasant to the taste, and free from offensive odor.

No Derfectly pure water exists in nature. The waters of springs and wells, even though quite pure enough for diinking, usually contain mineral matters in solution. The water of shallow wells, obtained from surface gravels or the like, near large towms. is invariably much contaminated with organic matter, ammonia, nitrates and chlorides; the ammonia being obtained by putrefaction, and the nitrates by the oxidition of organic matter. The water which falls on the surface in such districts, percolates through the gravel, carrying soluble matter with it, including organic matter of the worst kind, which is present in large quantities near stables, privies, etc. Such water is totally unfit for domestic use, but is often in favor for drinking; for, when fresh from the well, it may be cool, sparkling, and pleasant to the taste, owing to the decomposition and oxidation of the filth it contains. The excess of carbonic acid makes it sparkling, and the nitrates render it cool to the palate. These evil effects of surface drainage are often greatly aggravated by the slovenly habits and the ignorance of the inhabitants, as shown in the disposal of refuse matters. Putrescible refuse from the house, excrement of man and beast, garbage of all kinds, and slopwaters, are allowed to lie exposed, decomposing in the open air, poisoning it and everything it contains; or are put into receptacles Lorn which they are allowed to escape by seepage into the surrounding soil, and ultimately to reach the stratum of water from which the well is supplied.

Extreme care must be taken, where necessary, to prevent the surface drainage from reaching the wells, for contamination can occur without visibly affecting the quality of the water, and nothing may be suspected until sicki.ess actually occurs. In an outbreak in one city, water from forty different wells was tested, and it was found that surface drainage had affected the water in every one. On an average, nearly 17 grains of injurious salts were found in the gallon of water. In another town, where only well water was used, sixty wells were examined, and every well was found to be contaminated. One well, used by 400 school children, was only 22 feet distant from the cesspool, and free ammonia and nitrous acid were found in excess in the water, which was used freely and pronounced excellent.

Streams, no less than well waters, are susceptible of contamination from excreta, and it has been satisfactorily demonstrated that these impurities cause outbreaks of typhoid fever, dysentery, and kindred diseases. In running streams such impurities appear to be eliminated from the water by the process of oxidation of the organic matter, and by settlement.

In May, 1893, the city of Ironwood, Mich., a mining town in the Gogebic mining region, was visited by an outbreak of typhoid fever, which continued to increase in virulence until the end of June, at which time there were over 300 patients sick with the fever, and about 40 deaths from the disease had occurred. The city had suffered every year from fever, since the place was settled (eight years before), but not noticeably before the end of August or the beginning of September. Many of the wells in the town are notoriously subject to contamination from surface drainage, and all of them are shallow wells, sunk in the quicksand overlying the rock formation of the country. In all previous outbreaks, the disease was charged to the use of water from such wells. The unusual outbreak, so early in the season—practically on the breaking up of the winter, and occurring simultaneously throughout the city—led the city authorities to ascribe the cause of the epidemic to a common source, the water-supply of the Ironwood Water Works Company, whose works were built three years before. These works furnish water to the city of Ironwood. Mich., of 12,000 inhabitants, and to the village of Iluiley, Wis., of 3,500 inhabitants. The two towns are separated from each other by the Montreal River, a small mountain stream, flowing almost due north at this point, whose source was in a series of small lakes, about fourteen miles south of Ironwood, The supply of the Water Company is taken from this stream, and the pumping station is located on its banks, where it enters the southern limits of the city. 1 he water, like that of all streams in the lumber regions of Michigan and Wisconsin, is discolored by passing through cedar and tamarack swamps. It comes from lakes and springs; is soft and flows rapidly in a rocky bed. and, with the exception of its color, has every requisite of a desirable and wholesome water supply. The country through which it flows is entirely unsettled, with the exception of a small lumber camp of about half a dozen families, about eight miles above Ironwood, so that with this exception no typhoid contamination of the stream is oossible. unless it come from the city of Ironwood itself. Chemical analysis of the water had always shown that it was eminently suited to supply the city, and heretofore its quality had never been questioned. After the outbreak, another chemical analysis was made by Mr. E. P. Jennings, chemist of the Norrie mine, and this showed that the quality of the w ater had not deteriorated. The analysis gave the following result :

Free ammonia,.0.01 parts per million.

Albuminoid ammonia.0.360 parts per million.

Chlorine.3**° Kr»»n per gallon.

Nitrates.light trace.

In his report, Mr. Jennings says; T he amount of free ammonia and chlorine is small, and does not indicate any contamination from decaying animal matter. 1 he albuminoid ammonia is from the vegetable matter held in solution, and is common in all river and pond water of the Lake Superior country. The analysis is almost identical with those made a year ago.

While Ironwood was suffering so badly, the village of Hurley was almost entirely free from fever, and many were sincerely in doubt as to the responsibility of the Water Company for the epidemic.

One of the requirements of the company’s franchise is, that filtered water shall be furnished for domestic consumption. During the previous winter the filter had been allowed to freeze and the pipes to burst, and, inconsequence, the former superintendent was for some time unable to furnish filtere water. On the outbreak of the epidemic an investigation of the works was made by a committee of the citizens of Ironwood. The two stand-pipes belonging to the company were opened, and in each there was found a deposit, one or two n/.tioc rlifdiif’nvinff animal and vpcrtahle matter, which (like that seen in the beds of stream?) had Iren precipifalrd from the water pumped into them. The writer was afterwards engaged to take charge of the works and to make all improvements and repairs necessary to insure an uncontaminated water supply.

The sanitary conditions affecting the health of the city and the nature of the waterupply used by the company were studied, and investigations were made to determine whether there could he found another and better supply sufficient for the present and future requirements of the city.

From a sanitary standpoint, the location of the city of Ironwood is a most unfortunate one. and the growth of the city has been so rapid that it has been » ntirely impossible to make proper provisions for protecting‘he health of the people. The site of the town, although a ridge, was a swampy forest eight years ago. before the discovery of the immense deposits of iron ore which were found there: and it is divided into three different watersheds, all of which drain into the Montreal River. The southeastern part of the town, including the Fast Norrie. Aurora and Vaughn mines, is drained by a small stream, which discharges into the river about a quarter of a mile above the intake pipe of the Water Company. This part of the city is of recent growth, and. when the works were built, it was not foreseen that this little stream would become a menace to the company’s supply. The southwestern p;«rt of the tOA’n. including the Norrie and Ashland mines, is drained by a small water-course w hich discharges into the river about 300 feet below’ the intake pipe, and the entire northern half of the town is drained by streams discharging into the river north of and beyond the city limits.

Owing to the swampy nature of its site, Ironwood has always been unhealthy, and the trouble has been greatly aggravated by the extensive domestic use of water from shallow wells. The population is largely foreign, consisting of Swedes. Norwegians, Finns. Englishmen, Cornishmen, Irishmen, Frenchmen, Germans, Poles, Hungarians and Italians, and their habits increased the trouble. During the winter they dispose of all slops from the house by simply throwing them out of the back door on the snow, often only within a few’ feet of the well from which they draw tl eirw e r supply. Consequently, in May. when the snow melts, these accumulations of kitchen and chamber slops and excreta are carried into their wells and into those of their neighbors. Many of these wells have such notoriously bad surroundings that thev have been repeatedly closed by the health officer, but he does not seem to be clothed with sufficient authority to keep them closed and they are soon in use again. In some localities sickness in as many as a dozen families has been traced to one well from which they drew their water. The filthv habits of these foreigners would naturally result in the pollution of all wells in their neighborhood w hen the snow melted, and w ntld produce the contamination necessary for the outbreak of fever. These facts were ignored in accounting for the’epidemic, ai d it was claimed that the condition Of river water must be the cause; for it was argued that it was impossible otherwise to account for the simultaneous outbreak of the fever throughout the city. The city officials investigated the banks of the river for some distance above the pumping station, but discovered no source of contamination.

An an dysis of the water taken at the intake showed that the quality of the water was good. Several analyses were made at different times, and in no instance were typhoid germs found. In one analysis, where the water was drawn from a faucet after passing through a Bullring filter which had not been cleaned for six months, and which therefore was very foul. Prof. Victor Vaughn, of Ann Arbor University, found germs, with which he inoculated white rats, and which caused their death within twenty-four hours: but he stated that the germs were not those of typhoid fever.

Owing to the discoloration of the river water, a very strong movement was iniugurated to compel the water company to secure its supply fro n some other source. Springs immediately north of town; springs about eight miles north of the town, in Wisconsin; I/ike Superior, distant about twelve miles north, in an air line; and, finally. Pine Lake, the source of the Montreal River, about twelve miles south, were all su’reued. An e. mi nation, however, showed that neither of the supplies fro n springs was adequite. even if the quality of tfie w iter and the other conditions had been satisfactory,

A supply from Lake Superior was out of thequestion, because the elevation of Ironwood is over 1,000 feet above that of the lake, and the cost of pumping would have been entirely prohibitory. An examination of Pine Lake showed it to be a small deep lake, covering several hundred acres, but its waters have the same discoloration as the river water.

(Continued next week.)

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