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The Work of a Chronic Typhoid Germ Distributor, George A. Soper, Ph.D.
EPIDEMIC AT SANDS POINT IN 1904.
In 1904 a well-known New York family on moving to Sands Point, L. I., to spend the summer experienced an epidemic of typhoid which attracted a considerable among of attention at the time. The household consisted of eleven persons, seven of whom were servants. The household arrived on June 1. On June 8, or about one week later, typhoid began to appear.
The first person to be taken sick was the laundress. She had entered the employ of this family ten days before for the summer season. Following this case in irregular succession three other persons were taken sick. Within three weeks after arrival, there were four persons, in all, all attacked.
None of the family itself was taken sick. No person was attacked who had been long with the family. The new laundress fell ill first, then the gardener who had not come from the city with the family, but worked on the place the year round, then the butlers wife, and finally the butlers wife sister. The latter was not in the family service, but lived with the other servants in a little house separate from the main dwelling.
The cook had been in the family nine months, seemingly without suffering from typhoid fever or producing typhoid.
The Sands Point epidemic was confined to the house where the servants lived. There were no other cases in the vicinity. None preceded this outbreak and on followed at Sands Point. No doubt could be placed on the diagnosis. One of the cases, that of the laundress, was long and severe. There was no death.
The outbreak was studied by several persons. Finally, Dr. R. L. Wilson of the New York City Department of Health was called as expert to investigate it. Dr. Wilson examined the water supply, drainage and other sanitary conditions. He caused an analysis of the water to be made by Dr. Jeffreys of the New York Polyclinic. It is unnecessary to descibe this analysis or the details of Dr. Wilsons careful investigation.
Dr. Wilsons conclusion was that the epidemic must have been caused by the laundress. In his opinion, she had probably been infected before entering this employment. Her case, he thought, gave rise to the others. Dr. Wilson tired to find how the laundress became infected before joining this family, but was unsuccessful.
EPIDEMIC AT DARK HARBOR, MAINE, IN 1902
In 1902 a severe outbreak of typhoid occurred in the family of a prominent New York lawyer who had just taken his household, consisting of four in family and five servants, to Dark Harbor, Maine, to spend this summer. Seven members of this household of nine were soon ill of typhoid. In addition, a trained nurse was attacked, as, it is said, was a woman who was employed to work by the day.
The first case occurred two weeks after the arrival at Dark Harbor, on June 17. The onset of this case was sudden. In just one week another case occurred. Two days later there was a third. The remainder followed rapidly. The only persons who escaped were the cook and the head of the family; he had had an attack of typhoid fever some years before.
All the servants, except the cook, had been employed in this family for one month or more in New York. The cook had been engaged especially for the summer and had joined the family three weeks before it left New York.
The outbreak at Dark Harbor was studied by a number of persons and especially by Dr. E. A. Daniels of Boston and Dr. Louis Starr of Philadelphia. The house was new, never having been occupied before. It has been impossible to rent it since.
Because of its newness, the water supply of the house was not in every way satisfactory. A tank on the top floor of the house had not been cleaned since it was set in place. Until this cleaning was accomplished drinking water was obtained from a spring.
Water was never believed to have been the original cause of the outbreak. Two analyses of the water were made; one at the Massachusetts Institute of Technology in Boston and one in New York. They confirmed the opinion that the water was safe.
It was suspected that the household supply later became contaminated. A pitcher from a room in which the first typhoid case was nursed was supposed to have been filled at an open tank on the same floor, this infecting the household supply. But the epidemic had already broken out when this event was believed to have occurred. Typhoid fever was scarcely known in Dark Harbor at the time of this outbreak and had been exceedingly rare since. No case immediately preceded or succeeded it.
It was believed by some that the original cause of the epidemic was the sickness of a footmanthe first case. The theory was that the footman contracted his illness before going to Dark Harbor, either in New York or on the way. Dr. Daniels was of opinion that the first three cases received their infection in this way at the same time and place.
On making a careful study of the facts, both views seem to me untenable. The period of time which elapsed from the first to the second case was too short to agree with the theory that the first case led to the others. The incubation period required to be covered in the event that the first three cases were infected before reaching Dark Harbor was too long. Beside, for the most part, these three persons had not shared the same food for a long time.
OUTBREAK IN NEW YORK IN 1901.
The history of the cook before going to Dark Harbor is not entirely clear. In 1901-2, she lived about eleven months in one family. Here a laundress was taken ill and removed to Roosevelt Hospital, Dec. 9, 1901, one month after the cooks arrival. This case was seen by Dr. R. J. Carlisle of New York. The diagnosis was positive. The cause of the attack was not, apparently, investigated at the time, and fuller information concerning it has so far been difficult to obtain.
OUTBREAK AT MAMARONECK IN 1900.
My earliest record of the cooks employment is in a New York family which has a summer residence at Mamaroneck, N. Y. In this instance, a young man who made a visit to the family was attacked, his illness dating from Sept. 4, 1900. The circumstances in this case were such as to lead to the impression at the time that the infection occurred on Long Island. He had spent two weeks at East Hampton within a few miles of a fever-ridden camp occupied by U. S. soldiers at Montauk Point. It was thought that me might have been infected from water or by drinking from a cup used by some typhoid patient, or in some other way not known.
Inasmuch as the patient lived in the Mamaroneck household for at least ten days before the onset of his illness, and, as his supposed exposure to typhoid on Long Island was by no means reasonably clear, it seems to me probable that he was infected by the cook. The cook left within a few days after the onset of this illness. She had been in the family for three years without, apparently, being connected in any way with typhoid.
OUTBREAK IN TUXEDO, N. Y., IN 1906.
Subsequent to her employment at Oyster Bay, the cook went to live in a family at Tuxedo Park, N. Y. She remained there from Sept. 21 to October 27, 1906. On October 5, fourteen days after her arrival, a laundress was taken sick with typhoid fever and removed to St. Josephs Hospital, Paterson, N. J.
According to Dr. E. C. Rushmore, who saw this case, no other case of typhoid had been known in Tuxedo for several years. Excepting the cook, all the servants had been in the family for two months or more. The cause of the laundress illness was not made clear at the time.
FINAL OUTBREAK IN NEW YORK IN 1907.
When, at last, the cooks final whereabouts were ascertained, it was found that two cases of typhoid fever had broken out in the household where she was employed. These occurred a few weeks after her arrival. One patient, a chambermaid, was taken sick Jan. 23, 1907, and removed on January 29 to the Presbyterian Hospital, New York. The doctor was first called to see the other patient, a daughter of the owner of the house, on February 8. This second case resulted fatally on Feb 23, 1907, the only fatal case in this whole record.
A period of two months elapsed between the beginning of the employment of the cook and the beginning of the first case of illness in this household. The New York City Department of Health officially investigated the first of these two cases at the time it was reported by the attending physician and, in the absence of evidence to the contrary, ascribed it to the public water supply.
The foregoing records by no means all the cases with which this cook may have been associated. As already mentioned, I have been able to trace but fragments of her history through the last ten years.
There is a remarkable resemblance between these seven fragments. In each instance one or more cases of typhoid have occurred in households from ten days to a few weeks after the cook has arrived or among people who have, within that period, come to live near her and eaten the food which she has prepared.
In every instance the families have been of ample means and accustomed to living well. In each household there have been four or five in the family and from five to seven servants. Four of the persons attacked have been laundresses. Two have been gardeners, permanently attached to the country places where the typhoid has broken out. All but two of the outbreaks have occurred in the country.
The cook has escaped sickness in every instance. In only one instance is it known that she has worked in a family where no typhoid has occurred. This family consisted of two people of advanced age and one old servant.
In all there have been twenty-six cases and one death. Twenty-four of these cases have occurred within the last five years.
ACTION OF NEW YORK CITY DEPARTMENT OF HEALTH
Believing that sufficient had been learned concerning her history to show that the cook was a competent cause of typhoid and a menace to the public health, I laid the facts concerning the four principal epidemics here described before Dr. Herman M. Biggs, medical officer of health of the New York City Department of Health on March 11, 1907, with the suggestion that the woman be taken into custody by the department and her excretions made the subject of careful bacteriological examination. I had been unable to obtain her consent to any examination.
The department acted favorably on the suggestion and caused the cook to be removed to the Detention Hospital. She reached there March 19, 1907, after a severe struggle in which she showed remarkable bodily strength and agility. At the hospital the cook was placed in charge of Dr. Robert J. Wilson, superintendent of the department of hospitals, and Dr. William H. Park, chief of the bacteriological laboratories of the Department of Health.
Dr. M. Goodwin did the bacteriological work under Dr. Parks direction. It was expected by me that germs might be found in the urine, but more probably in the stools. None was found in the urine. The stools contained the germs in great numbers. Daily examinations made for over two weeks have failed only twice to reveal the presence of the Bacillus typosus, and on these occasions the sample taken was perhaps too small to reveal them. The blood gave a positive Widal reaction. The cook appeared to be in perfect health.
We have here, in my judgement, a case of a chronic typhoid germ distributor, or, as the Germans say, a "typhusbazillenträgerin."
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