Wednesday, January 27, 2010

Wash that typhoid right outta my hair

While searching through the bound issues of volume 14 of the Medical Sentinel, published monthly in 1906, for a particular item, one notices a recurring thread. Well, several recurring threads, really, including rancorous medical partisanship and the uncovering of quackery. But the thread under discussion here is typhoid fever.

The March issue has an editorial note on "Typhoid Fever Conditions at Eugene" (as well as the bluntly titled "The Willamette a Sewer"); the July issue carries an in-depth article on "The Character of the Recent Typhoid Epidemic at Eugene" by W.L. Cheshire; the August issue contains a note on "The Typhoid Fever Question"; the September issue reports an outbreak of typhoid fever in North Yakima, WA, and has a note on the "impure water" of the Columbia and Willamette river systems; the October issue reports on "Typhoid Fever in Oregon"; the November issue warns of "Typhoid Fever at Klamath Falls"; and the December issue culminates in not one but two feature articles on typhoid fever epidemics. The October report indicates that there had been 61 deaths and 600 cases of the disease in Oregon in the period January 1 to September 1.

The first of the December features, by Marius B. Marcellus, MD, is entitled "Typhoid Fever, with Especial Reference to Diagnosis and Treatment." The paper was first given at a meeting of the Portland City and County Medical Society on October 17 of that year, and aims to give readers the benefit of Marcellus' wisdom, gleaned during his "rare privilege of serving as Interne in St. Timothy's Hospital, Roxborough, Pa., during an epidemic of typhoid fever" (and we can only agree that it must have been a rare privilege, indeed).

After an introduction on the particular circumstances of the Roxborough outbreak, Marcellus declares that "It is not the intention to dwell long on upon the pathology nor the symptomatology of the disease, for one could enumerate symptoms and pathological changes indefinitely which are not of especial interest to the busy practitioner who is anxious to make a positive diagnosis and institute the proper treatment" ("You say you have fever, white-coated tongue, headache, nausea? Let's let the blood test be the judge of that")

Marcellus goes on to recommend use of the Widal reaction in all cases (though admittedly only present in 95.5 to 97 percent of all cases), averring that "The Diazo reaction first described by Ehrlich in 1882, the writer believes to be practically useless."

The article continues in this tone to its end, which comes with a list of "books consulted", "journals and articles", and "references." It contrasts sharply (no doubt intentionally) with the next paper, "Some notes on the Chicago Epidemic of Typhoid Fever of 1902" by Noble Wiley Jones, M.D., who had just arrived on the Portland medical scene fresh from European training. Jones' approach is both more quantitative and more speculative than Marcellus; we get detailed numbers on types of patients, autopsy findings, symptoms, complications, and outcomes, while he muses on the causes behind unusual findings and outlines case reports on a few individual patients.

After analyzing 980 cases, Jones states: "Our work, therefore, to sum up briefly, led us to rely upon the following factors, which as shown by Kuehn and others, are given in their order of importance: The leucopaenia, the early enlarged spleen, the Diazo-reaction, the roseala, and, lastly, the general clinical picture" (this would be that pesky list of symptoms). At "Diazo-reaction" we get a footnote that Marcellus' refutation of the efficacy of the test in the preceding article is "of great importance. To my knowledge it is the first time that pathologic significance has been denied this reaction."

Coming from a man who had just finished a course in advanced pathology training at the Allgemeines Krankenhaus in Vienna, I do believe this amounts to a smack-down.

For a modern reader, the details of treatments provide a great deal of the entertainment value of Jones' piece. We hear about the colonic flushings with saline water administered every other morning, the dosings with brandy and whiskey, rectal temperatures "taken frequently", and the nearly continuous baths. With 980 patients, the creative staff of Cook County Hospital "converted a large rubber sheet with the corners tied to the bed posts into a tub." Positively spa!

Today, typhoid fever is nearly absent from the U.S., and occurs primarily in travelers.


MikeOnBike said...

Marius Breckenridge Marcellus might also have noted his recent experience as part of the Oregon Doctor Train mission to San Francisco after the 1906 earthquake.

And since we're considering Marcellus: he was 26 in 1906 and married sometime that year. He later served as an Asst. Lab Demonstrator of Pathology at UOMS (1909-1910). In 1915 he helped secure municipal legislation to authorize school health inspection in Portland.

Thanks for posting all-things-typhoid!

Kimberly Jensen said...

The Medical Sentinal vol 14 number 6 for June 1906, published during the epidemic, indicates that Dr. Emil Pohl presented a paper at the Oregon State Medical Association, May 15, 1906 on cerebro-spinal meningitis.
At this same meeting, Esther Pohl "moved to grant ten minutes to Dr. Anna Howard Shaw," chair of the National American Woman Suffrage Association in Portland for the 1906 Oregon woman suffrage campaign. Shaw "advocated that the doctors assist in the equalization of the franchise (the vote) as aid to the doctor, drawing some amusing and instructional lessons . . ." Medical Sentinel 14:6 June 1906, 284-84.

Sara Piasecki said...

An excellent defense of young Marcellus, Michael--thank you! Noble would have been 29 that year. It would be another four years before he started one of the city's first multispecialty clinics and (simultaneously) joined the faculty of the Dept. of Medicine at UOMS. He was active in the medical community until his death in 1975. His name lives on at OHSU through the Noble Wiley Jones Lectureship, but Marcellus hasn't been as lucky.

1906 was certainly an eventful year in Portland medicine, and it's interesting to see the efforts to turn attention to suffrage. One wonders if another piece, published in the October issue on "The Over Supply of Doctors" was directed at a perceived influx of uppity women physicians!

Kimberly Jensen said...

That's certainly a possibility. In 1912 Lovejoy said that Shaw told the audience at the 1906 meeting that if women had the vote they could help to create healthy communities through public health laws and avoid typhoid outbreaks.