Epidemic

Epidemic Relapsing Fever Among the Chinese at Oroville.

(Miller, in Medicine and Surgical Journal)
Oroville Weekly Mercury, February 19, 1875 (Friday Morning)

During the months of August, September, and October, bilious relapsing fever was the prevailing disease amongst the Chinese in this locality, and its savages may be inferred from the fact that in the course of four months no more than two hundred of them expired from a complicated form of the disease.  The Chinese population of Oroville and its immediate vicinity numbered eight thousand, five months ago, and may be estimated at present at from three to four thousand souls.  These, with few exceptions, suffered more or less from a type of fever not previously known to this region of the country. In consequence of the superstitious and unskillful treatment of their native doctors, together with bad ventilation and other adverse sanitary conditions, it is assumed such unfavorable symptoms from the onset that death seemed inevitable in almost every case.  So terrified were they at the outbreak of the epidemic that five thousand of them fled to San Francisco and other parts of the State, in the belief that Oroville was visited by Cholera, the devil, or Yellow Fever.  For a brief period there was a lull amongst them, and during this time they commenced devising means for its oppression, such as encircling Chinatown with burning candles, whilst some were intent upon sending to San Francisco for their high-priest—that functionary having, it was believed, the power of scaring away the demon by means of fire-crackers, etc.

At this junction they commenced employing American physicians, and discontinued their bug tea to test the virtues of more scientific remedies. In the latter part of September I was requested to visit fifteen of them by a prominent Chinese merchant, residing in Oroville, who consented to accompany me and to act as my interpreter.  We soon arrived at a dilapidated structure much resembling a pig house, which constituted the dwelling of my celestial friends.  On entering this foul den, I was almost suffocated; there was not a breath of fresh air, the doors were securely closed, and a darkness pervaded the interior that was truly horrible.  The doors being opened at my request, I discovered forty human beings, instead of fifteen, who had requested my attendance.  This, together with the dismal appearance of the honey-combed sleeping apartment, the groans of the dying, and the deadly exhalations arising from them, I shall never forget.

The character of the disease immediately suggested itself as a mild type of typhus fever, described by many authors under the various names of “mild yellow fever,” “bilious relapsing fever,” “five day fever,” etc., and a closer investigation confirmed the correctness of my suspicions.  Epidemics of this form of fever have been recognized to prevail on different occasions since 1739.  In Dublin it prevailed at that time, and several years subsequently, this fever was clinically recognized by Drs. Christison and Welch. In most of the periods of epidemic was characterized by the great preponderance of cases of relapsing fever, and as the epidemic advanced it gave place to a preponderance of typhus cases. I first examined a patient apparently twenty years old.  His skin was dry and hot; pulse rapid and feeble, tongue hard, dry and brown, bowels constipated, and the characteristic mulberry rash covered the trunk and extremities.

Having thus discovered what evidently appeared to be a case of typhus fever, I continued my investigations until twenty-five were made, expecting that each succeeding case would manifest the symptoms of the first.  But in this I was disappointed, since each case varied in mildness and intensity from; the primary symptoms of bilious remittent to the violent delirium of typhus fever. In all these were great debility, and a peculiar bronzed hue of the face more or less like that resulting from chronic malaria toxemia.  In all the severe cases there was a rising and falling of temperature from the fifth to the twelfth day after the initial symptoms of typhus, but in no case did it exceed 104 degrees Fahr.

I treated over three hundred cases during the epidemic, and frequently observed pulmonic complications and secondary cardiac lesions, but these conditions were by no means general.  The question arises whether relapsing fever is generated by malarial influences, and if so, is it of ordinary occurrences where remittent fever is a prevailing disease?  Like other continued fevers, its specific cause is unknown, but it selects its victims from the poor and ill-fed, who live in servable, in crowded, filthy, ill-ventilated apartments, rather than from the wealthy and well-fed, who live in comfortable and well-aired adobes.  Its poison appears to be of a specific kind, and the phenomena of the fever are very different from those of typhus and typhoid fever.  It has been supposed by some to be identical with the malarious form of yellow fever, but there is not sufficient evidence to establish the point.  Yet where remitted fever is rife, and destitution, filth and overcrowding are present, its propagation under these circumstances can not be doubted. The doctrine that a specific poison exists and is formed in cases of relapsing fever, and when so formed that it communicates the disease, rests on evidence similar to that adduced in cases of typhus and the same objection may be made the evidence which aims at establishing the spontaneous generation of the specific poison.  There are cases, circumstances or conditions, which obviously favor the accession of relapsing fever, and no doubt, also, its occurrence in an epidemic form and chief amongst these must be placed destitution and want of food.  The names applied to the disease in different countries, indicated the popular belief as to such pre-disposed causes. Thus it is spoken of as the famine fever of the British Isles, and the hunger pest of Germany.

We have no conception of the amount of filth and destitution common to a Chinese hovel; but, when we observe their hovels crowded together, the occupants lying on ground nearly a marsh without a circulation of air—with broken walls of rough timber—forty or fifty half starved human beings in one apartment, generally on bare mats, sometimes on the earthen floor, which is raised a foot or two above a ditch with stagnant and foul water, it is not to be wondered at a certain epidemic as the one referred to should break out .  Indeed, the China towns of Oroville and Chico are the most offensive, pestilential, nay, abominable hot-beds of disease in the State.  Each of these towns, more especially in the most densely populated parts, is intersected by streets which can scarcely be traveled by two men abreast, and the gutters are merely irregular furrows in the soil, without any brick work, and are continually left in a filthy and unclean state, emitting the most poisonous effluvia.

The primary symptoms of the epidemic were rigors, frontal headache, and muscular pains of the back and limbs.  Soon after, febrile reaction set in, expressed by heat of skin, intolerance of light and sound, remarkable anxiety of countenance, a white creamy tongue, and a frequently uncontrollable vomiting of bile.  As the disease advanced the bowels became confined, the urine scanty and high colored, and when night came on, there was sleeplessness and often delirium.  From the fourth to the sixth day the symptoms became more and more intense, the pulse rose to 130; there were jactitations, often muttering delirium.  About the sixth day, when death seemed inevitable, there was a complete amelioration of symptoms; a profuse perspiration broke out, the fever disappeared, and the patients seemed altogether well.  On the fourteenth day from the commencement of the disease, they were again attacked with a repetition of all the symptoms; a profuse perspiration broke out, and a mulberry rash occasionally appeared at this period.  At this crisis death frequently took place from collapse following the critical perspiration; sometimes from coma, and occasionally from prostration super induced by a low type of typhus fever.

When the disease terminated favorably, its duration was generally from three to four weeks.  In some cases which I observed, its duration was much longer although the regular paroxysms were not present but extreme debility produced by its exhausting effects was invariably a consequence.  Convalescence was often retarded by obstinate sequence, such as jaundice, rheumatism of the limbs and joints, or enlargement of the spleen.

My success in the treatment of bilious relapsing fever of the Chinese was, so far as medicine concerned, unsatisfactory if not positive nugatory, in the majority of cases, agreeing in substance with the experience of many authors regarding the non-specific effects of antiperiodics and the absolute worthlessness of the disease, when rigors and pains in the back and knees heralded the violent paroxysms of febrile reaction unless purgatives are contra-indicated I resorted to a mild saline evacuate of Rochelle Salts, which produced one or two clayey stools—a fact I would have attributed to the action of calomel had that drug been administered. My experience of past years convinced me of the bad results of mercurials in fevers, and my later experience amongst the Chinese proved to my satisfaction their pernicious effects I hastening dissolution to lower the vital forces.  I therefore resort to sulphite of soda, considering it a more reliable remedy; first, since it is retained when every other remedy is rejected; second, because I have found it a safe and rapid correction; third, because it retains the abnormal secretion of the stomach, a condition generally present in the commencement of bilious remittent fever; and fourth, while it acts with certainty as a detergent and alternative, it arrests fermentation by destroying the minute organisms that determine zygotic disease, as also the condition upon which malarial influences depend.  It is certainly the only preparation of which I can speak favorably except Quinia.  It is the monarch of all specifics if such there be.  I have given it largely and with benefit when the disease could be traced to malaria origin but like other medicines it fails to produce the desired results when destitution, bad ventilation and overcrowding are the exciting causes.  A generous diet consists of beef, tea, raw eggs and brandy, together with abundant ventilation, were the indications throughout the whole course of the disease.

Author: Peter Bruce McDougall Miller, born 1 January or maybe 15 January 1835 in Rosshire, Scotland.  Graduated from the Royal College of Surgery, Edinburgh, Scotland 18 March 1858.  He proceeded to practice medicine in France, in British India, Australia and New Zealand and in the United States in Pennsylvania, New York and later in his life in Washington State.  He came to Oroville in 1873, became Superintendant and 

Physician at the Butte County Infirmary (1875-76), was a member of the State Medical Society and the Northern District Medical Society before leaving for Washington in 1882.  He died in Seattle in December of 1904.