by David DeKok
The next question we must address is this: If the excrement along Six Mile Creek was first observed in the fall of 1902, and it was indeed virulent, why did it take until the middle of January 1903 for the epidemic to break out?
The most helpful testimony in this regard came much later in reference to a different typhoid outbreak. Olin H. Landreth, a well-known engineer on the faculty of Union College in Schenectady, New York, testified before a New York legislative committee that the absorbent quality of the soil made all the difference in whether rain would wash virulent excrement into lakes, rivers, or streams. “In winter, there is no absorption by the soil of the impure material whatever; that is when the ground is frozen. As a consequence, the accumulation is the same as it is during a drought.”21
Tucker & Vinton did not bring the Italian immigrants and striking anthracite coal miners from Pennsylvania to the dam site until September, which along with October had close to normal rainfall. Assuming the typhoid carrier was on the job from day one, much of his waste would have been dissolved harmlessly into the absorbent soil by the rains of September and October, according to Landreth’s theory. The rains in the first two months of the project were not enough to create a sudden, broad, sweeping action pushing most of the excrement into Six Mile Creek. Even if some survived these normal rainfalls, perhaps it was not virulent or the virulence died with the passage of time.
In November, the weather changed. It was the driest November in Ithaca in a quarter century, with only 0.99 inches of rain recorded by the National Weather Bureau office on the Cornell campus. There was little opportunity for virulent excrement to be dissolved into the soil. Work stopped for the season in late November. While shelf-life issues would have rendered some of the excrement harmless, enough of it could have stayed virulent until an insulating blanket of snow in early December covered, froze, and preserved it. As Rev. William Elliot Griffis, pastor of First Congregational Church in Ithaca, wrote in his journal on December 5, 1902: “Woke up to find the world in white. Shoveled snow.”22
December’s precipitation in Ithaca made up for November. It was the snowiest December in twenty-five years. Some 44.9 inches fell, twice as much as any other December since 1879. The snow piled up across the valley where the reservoir would form once the dam was completed. The Italians had denuded the valley of trees, standard procedure in creating a reservoir but eliminating the brakes on the flow of storm water. A thaw occurred on December 16 but was not accompanied by significant rainfall and the ground stayed frozen. Without enough push from the rain, the contamination stayed out of the water supply. More snow fell.
Matters came to a head on January 2 and 3, 1903, when unseasonably warm temperatures arrived and a heavy rainstorm pelted the Ithaca region. This time the snow on the reservoir site melted and water raced down the frozen, denuded hillsides to Six Mile Creek, sweeping the valley clean. Within two days, the typhoid bacilli entered the Ithaca Water Works intake pipe and the countdown began.
Chapter 9
Denial
Christmas recess ended on Tuesday, January 6, but most students returned during the weekend of the rains, emptying out of trains at the Lehigh Valley Station and making their way in carriages or on foot through the slush to their rooms on East Hill. For those who lived in rooming houses with city water instead of a private well, or who patronized downtown restaurants like Theodor Zinck’s Hotel Brunswick, a slow waltz with death began.1 They drank the typhoid water at its most concentrated and virulent.
Not everyone who did became ill, and we will never know with certainty what determined the outcome of this lottery. It may have been as simple as natural defenses. Stomach acid is the enemy of typhoid bacilli. Large numbers must invade the stomach for a few to have a chance to climb over the walls into the intestine and begin to wreak havoc. Drinking a lot of water, on the other hand, can dilute stomach acid, and milk or ice cream can neutralize it. There are so many variables that one can never be sure. As in any epidemic, ill fortune was important in determining who lived or died.2
Here and there around town, people fell ill, but not in numbers to arouse suspicion. Some parts of Ithaca received water only from Six Mile Creek, and some received it only from Buttermilk Creek. Cornell University, including Sage College and some fraternity houses, received water from Fall Creek, and some 1,500 private wells served the outlying areas of the city but were not unknown elsewhere. Only Six Mile Creek carried the typhoid bacilli. The student boardinghouse district of East Hill, which received only water from Six Mile Creek, became the epicenter. Dr. Edwin O. Jordan, the Chicago bacteriologist who investigated the Ithaca epidemic and wrote a four-part series on his findings for the Journal of the American Medical Association, was shaken when he realized what had happened: that the typhoid water had flowed first to where it could do the most damage. “It is well known that the greatest susceptibility to this disease is between the ages of 15 and 25, and that consequently a population of college students presents a mass of material of peculiarly inflammable nature.”3
Typhoid’s incubation period is ten to fourteen days. Some physicians might go short on one end or long on the other, but a week and a half to two weeks is about in the middle of medical thinking on the subject.4 George A. Soper, who was a renowned sanitary engineer but not a medical doctor, and about whom we will hear much more in later chapters, believed that Patient Zero made his way to a physician’s office or to City Hospital on January 11. We know little about these first few patients. Two new cases were reported on January 12, one on the following day, four on January 14, five on January 15, and three on January 16. Dr. Jordan believed that the epidemic began “about” January 15.5 The appearance of the first patients corresponds to an incubation period of about ten days and provides more evidence that the heavy rains of January 2 and 3 triggered the catastrophe. Soper found the typhoid in Ithaca to be “extremely malignant.”
Typhoid, as Dr. Jordan noted, is mainly a disease of youth and middle age, with the majority of cases grouped around age twenty-one. There were patients outside that group, but they were rarely under age two or over age fifty. Why the very young weren’t affected was a mystery, but the older a person was, the more likely it was that he or she had been exposed to typhoid earlier in life. Data gathered during the 1900 federal census showed that more than a third of typhoid deaths occurred among people aged fifteen to thirty years. Only 10 percent occurred in children under age five.6
The symptoms of typhoid were sometimes mistaken for the grippe, meaning influenza, but usually not for long. For many physicians, the first clues were a swollen spleen and the characteristic rash of flat, pink spots associated with typhoid.7 Other symptoms followed in quick succession. Dr. Julius Dreschfield wrote a description of the onset of typhoid for A System of Medicine, a multi-volume medical encyclopedia first published in London and Philadelphia in 1897. He wrote that typhoid patients initially complained “of pain in the limbs, of excessive fatigue, of cold and chilly sensations, of headache often very severe, of loss of appetite, and sleeplessness.” Nosebleeds erupted by the second or third day. As the symptoms became more severe, Dreschfield wrote, the patient rarely got out of bed. Body temperature rose steadily, and by about the fourth day reached 103 or 104 degrees Fahrenheit and the patient became thirsty and sleepless. Diarrhea might or might not be present from the start. The patient’s skin turned dry, but there could be sudden attacks of profuse perspiration.8 Such was the first week of typhoid.
One thing Ithaca did not lack was physicians. According to The Standard Medical Directory of North America for 1902, Ithaca had forty physicians, which in a town of 13,136 people gave it the highest ratio of physicians-to-population in New York State, higher even than New York City.9 Of these physicians, eight were homeopaths and one was listed as “eclectic.” The allopaths, or what we consider today to be “regular” physicians, had not yet won their war against homeopathy. Although often derided as quackery, homeopat
hy began with the best of intentions. It sprang from the disgust of its founder, Samuel Hahnemann of Germany, with the brutality of traditional medicine in the eighteenth century. Bloodletting and severe bowel purges appalled him. Hahnemann and his latter-day disciples used natural remedies, including very dilute poisons, to stimulate the body to heal itself. Homeopaths in Ithaca actually had more in the way of medicine to give their typhoid patients than did the allopaths, and as we shall see, claimed some success in curing them.
Most typhoid patients in Ithaca were treated by traditional physicians such as Dr. Alice M. Potter, a member of a large and amazingly accomplished Ithaca family. Unlike five of her ten siblings, Alice Potter had not gone to Cornell University but instead migrated directly from Ithaca High School to the University of Buffalo Medical School, graduating in 1897. She went into practice at 116 W. Seneca St. in Ithaca. (Her sisters, Bina and Jaennette, were also physicians, though not in Ithaca, and her brother, Charles, a veterinarian in Chicago. Two other brothers were lawyers.) Women physicians were still a novelty in 1903, but their numbers were growing: Cornell Medical College in New York City graduated nine of them (plus forty-four men) in June 1902.
Another Ithaca physician, and one who had a prominent role during the epidemic, was Dr. Luzerne Coville. He graduated from Cornell in 1887 and from the College of Physicians and Surgeons at Columbia University in 1889, after which he set up practice in Brooklyn. In 1896, he moved his practice to Ithaca, and in 1898, after the founding of the Ithaca branch of Cornell’s College of Medicine, Coville joined the faculty as a lecturer in anatomy. He switched to surgery in 1900. His Work Book in Surgery, privately published in 1902, was a primer for his students. Coville was a determined truth teller, cautioning his students to be “candid and direct, yet kind. . . . Make the diagnosis what it is, even at the expense of the patient’s wishes or preclusions or his presumptions.” He would follow his own advice during the epidemic to his ultimate sorrow.10
But whether Ithaca physicians were men or women, allopaths or homeopaths, the first problem they faced, as Dr. Robert Koch in Germany knew so well, was making a correct diagnosis. They often looked first for that enlargement of the spleen and characteristic rash of flat, pink spots, but laboratory options also existed. Typhoid bacilli were difficult to distinguish under the microscopes of the day, even when stained bright red with carbol-fuchsin dye. Physicians could try growing colonies of typhoid, feeding them agar, a nutrient extracted from Japanese seaweed. Such colonies resembled clusters of tiny rods with rounded ends and whiplike appendages called flagella that propelled them through fluids.11 The trick was also to distinguish them from other bacilli that were of a similar appearance.12 There was really no good way to do that with a microscope in 1903, or at least do it quickly.
A better method was using the Widal Reaction. Georges Fernand Isidor Widal, a French medical researcher, discovered in 1896 that specific agglutins in the blood of typhoid patients could be employed in the laboratory to cause the typhoid bacilli, and no others, to stop moving and clump together. The test required drawing blood from the patient, which in 1903 was accomplished either with a sterilized hypodermic syringe, invented in 1853, or a cupping glass, which used heat or suction to create a vacuum that pulled blood out of several small incisions in the skin. The blood sample was placed in a test tube for a period of time to allow the red cells to settle out. Then the serum was mixed with about the same volume of typhoid bouillon not more than ten to eighteen hours old. Results came almost immediately. “The bacilli will be seen—immediately after the admixture—to become immobile and to collect in clumps of varying size,” Dr. Heinrich Curschman wrote in 1901. Through his microscope, he observed the bacilli continue to swarm in a control sample to which no serum had been added.13
The problem with the Widal Reaction, as noted earlier, was that it sometimes gave false results. A typhoid patient did not begin producing the agglutinate factor until he had been ill for seven to ten days. So if the physician gave the test too early, it produced a false negative. Or if the patient had been exposed to typhoid earlier in life, it might give a false positive. But in areas like Ithaca, mostly new to typhoid, the Widal Reaction was a valuable tool for diagnosing typhoid. Coville, for example, wrote afterward that he administered Widal tests to about half of the three hundred patients, mainly Cornell students, that he saw during the epidemic.14
There was also the Diazo urine test to diagnose typhoid. This actually predated the Widal Reaction, having been discovered by the noted German immunologist Paul Ehrlich in 1883. Physicians could use the Diazo test to diagnose typhoid between the fifth and fourteenth day of the disease. Urine from a suspected typhoid victim was mixed with an equal amount of Diazo solution. Then a few drops of ammonia were added and the mixture was shaken. If the patient had typhoid, the froth at the top of the shaken mixture would be a shade of red. The problem with the Diazo test was that several other diseases, including tuberculosis, could trigger a positive reaction, and so physicians preferred to use it in tandem with the Widal Reaction to be doubly certain of a typhoid diagnosis.15
The first signs that something was wrong in Ithaca appeared during the third week in January. The Ithaca Daily Journal reported on January 21 that ninety-six cases of grippe, or flu, were being treated in the city. Rumor had it, though, that these citizens did not have flu, but rather typhoid.
Dr. Edward Hitchcock Jr., the city health officer who had refused to do anything when Holmes Hollister told him about the excrement along Six Mile Creek the previous fall, was quoted in the Daily Journal on January 22 ridiculing the idea that a typhoid epidemic had taken hold in the city. Rather, he asserted, what ailed people was “a certain low fever, almost exactly similar to that fever of last year which was termed, ‘Ithaca fever.’” Hitchcock, who could have been a character out of the Albert Camus novel The Plague, insisted that this supposed low-grade fever was not contagious and that no one had ever died from it.16
Ithaca’s city government was in a state of uncertainty at the beginning of 1903. The mayoral election of November 1902 had ended in an official tie between Republican Mayor William R. Gunderman and his Democratic challenger, George W. Miller, each with 1,682 votes. The Progressive Party candidate, Edward Spriggs, received 95 votes. Under state law, a tie meant that the incumbent, Gunderman, would stay on until the next general election in 1903. Miller, however, filed a court challenge claiming that in one Ithaca voting district, the Second District of the Third Ward, he had actually received seven more votes than reported. Witnesses said they heard the chairman of the Board of Inspectors call out “140” votes, even though the poll clerks wrote down “133.” Tompkins County Supreme Court ordered the voting machine to be opened, and investigators found that Miller had indeed received 140 votes. The court ruled on January 27, 1903, that Miller was the real winner but issued a stay to allow Gunderman an opportunity to appeal. The Republican, however, said he considered the matter settled by the court’s ruling and resigned on January 31, as did the city clerk. Miller did not take office as mayor until February 12. Despite Gunderman’s resignation, the Republicans did file an appeal that was not resolved until July, when it was dropped. Miller was acting mayor during that five-month period.17
At Cornell, final exams for the fall semester began on January 22, the start of a seven-day slogfest of all-nighters that left students tired and drained. The big medical news was of James B. Hopkins, a graduate student in French and Greek who had returned from Christmas break on January 7 and two weeks later went back home to Bath, New York, supposedly ill with smallpox. Hitchcock was all over this one, telling the Ithaca Daily News he had “kept a sharp watch for smallpox during the present year, and so far none has appeared in Ithaca.” The initial symptoms of smallpox are similar to those of typhoid, and it seems far more likely that Hopkins was one of the early patients in the epidemic.18
The first student brought to the Cornell Infirmary with typhoid symptoms was
admitted on January 23 and was probably Oliver G. Shumard. The infirmary was housed in a three-story brownstone Victorian mansion at 512 E. State St. that had once been the home of lumber baron Henry W. Sage, a former chairman of the Cornell University Board of Trustees. Sage died in 1897, and his sons donated the house to Cornell for use as a student infirmary, along with a $100,000 endowment to outfit and operate it. It had beds for twenty students and was attended by three homeopathic nurses, one of them a student nurse. Patients were billed $1 a day for room and board, a stiff sum when an average workingman’s salary in America was about $543 a year.19
One mystery of the Cornell Infirmary was that no physician sat on the three-member committee that ran the facility. Instead, the administrative committee comprised President Schurman; Emmons L. Williams, secretary-treasurer of the Board of Trustees and its Executive Committee; and Roger B. Williams, president of Ithaca Savings Bank and a member of the Board of Trustees and its Executive Committee. None of them were physicians. Local physicians were welcome to have privileges at the infirmary but were not involved in running it. The committee and the nurse matron made those decisions. But why? In their letter to the Executive Committee announcing their gift of their father’s mansion and the $100,000 endowment, Sage’s sons said only that the infirmary was to be “kept and maintained by the university, under such rules and regulations as may be adopted by its Board of Trustees.” The board created the administrative committee about a week later.20
