The advantage of having a trained medical health officer on the job constantly for the purpose of preventing trouble as well as to meet sanitary and health emergencies has been demonstrated in Elgin, where there is now being experienced an extensive outbreak of typhoid fever among employes of the Elgin National Watch Company. Twenty cases were reported to the State Board of Health by the local health authorities on August 16, 17, 18 and 19. The explosive outbreak did not appear until August 16, but the danger signals which would have been significant to a medical health officer were in evidence as early as the first of July. Six cases of typhoid fever were reported in the last nine days of June, and four of these victims were employes of the watch factory.
Inasmuch as these reports were received by a lay health officer, it is not to be wondered at that the source of trouble was not suspected.
During the month of July there were eight times as many cases among employes of the watch factory as among other residents of Elgin, but this fact continued to be unobserved. It was not until August 17th when an epidemic was impending that the assistance of the city physician, Dr. A. L. Mann, was sought by the health officer and within two or three days Dr. Mann determined the source of trouble to be in the drinking water supplied to the employes of the watch factory.
When a representative of the State Board of Health visited Elgin in response to the reports of the health officer the source of infection had been determined and the watch company was doing everything in its power to abate the prevalence of the disease, including free anti-typhoid vaccine for all its employes.
In entering upon his investigation, about the 17th of August, the health officer carried out bacteriologic water examinations proving that the drinking water furnished at the watch factory was entirely safe, but that the water supply for fire protection was highly polluted. When this was brought to the attention of the officers of the watch company a close search was made to find the intercommunication of the two water systems. It was ascertained that there were four or five points where the drinking water pipes and fire protection pipes came together, the two water supplies being separated by valves. A leaking valve was determined to be the source of trouble.
Upon learning these facts the two water services were permanently discontinued and all pipes thoroughly flushed.
The sequence of events leading to this epidemic may be summarized as follows:
1. A leaky valve admiting the highly polluted water of the Fox river into the drinking water mains.
2. While the river was relatively high the dilution of the sewage was such that, with a comparatively small leak, the water was only moderately contaminated.
3. This resulted in numerous cases of diarrhea and a few cases of typhoid fever among more susceptible individuals, whose sewage added further to the amount of typhoid infection in the river above the water intake at the factory.
4. A low water stage of the river concentrated the infection and increased the amount of infection from earlier cases. -
The attitude of the watch company has been characteristic of the increasing sense of responsibility common to manufacturing and industrial organizations of the higher type. The control of secondary cases has been much simplified by the offer made by the company to pay the hospital, nursing and doctor bills of all sick employes, insuring adequate protection against contact infections.
A control of the collective merits of sensitized and ordinary typhoid vaccines, in preventing typhoid in persons who have already received their infection, is being carried out at Elgin and the results will be watched with interest by the State Board of Health. Whether or not a trained medical health officer would, in this case, have seen this impending epidemic when its first evidence appeared in June and July, it is impossible to say, but it is certain that a clear interpretation of the threatened calamity would have prevented the later epidemic, and this interpretation can only be fairly expected from the health officer of medical training.