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both have played a part in the gradual reduction of cases occurring in that section.
The spotted-fever zone of the Bitter Root Valley is a narrow strip of generally uncultivated land which lies just outside of the grain and hay fields on the west side of the valley. The spotted-fever problem is to graze this strip in such a manner as to bring about a continual decrease in tick infestation.
Constant effort has been made for several years past to secure the enactment by the State legislature of proper grazing laws for this district and there is good reason to believe that at last this effort will meet with success. A bill of this character was prepared during the past year and its passage was encouraged by the State health officer; it was also given the active support of the State board of entomology. Broadly, the bill provides for the restriction of horse and cattle grazing, the encouragement of sheep grazing, and the exercise of control over both in spotted-fever territory by the State board of entomology. With the passage of this law it will be possible to prevent the breeding of ticks on domestic animals, something that has never been accomplished in the Bitter Root Valley through dipping operations. On the assurance that this bill would be enacted into law, the Public Health Service made preparations to withdraw from the active campaign of spotted fever eradication in Montana, leaving the work entirely to the State authorities.
Pending the passage of a grazing law the dipping of domestic animals was continued in the Bitter Root Valley as heretofore. This measure has always been considered by the service as a temporary expedient only, of doubtful value, to be superseded as soon as possible by an adequate grazing law. During the past season the dipping of domestic animals at the three dipping vats which have been operated in the valley for several years, was conducted under very adverse weather conditions. Because of the cold weather none of the vats was placed in operation before April 15, and following this the dippings were frequently interrupted for the same reason. The following is a list of the live stock, exclusive of sheep, in the three dipping districts, comprising about 60 square miles, which were either dipped, hand picked, or inspected for ticks periodically during the tick season:
Cattle, range 382, milk 78; total, 460. Horses, range 32, work 20; total, 52. Hamilton district:
Cattle, range 187, milk 116; total, 303.
Cattle, range 251, milk 84; total, 335.
Rodent destruction.-Inasmuch as the immature forms of the spotted fever tick are found only on small rodents in the Bitter Root Valley the destruction of these pests has always been considered by th: Public Health Service as a valuable procedure in tick eradication. The methods employed in the destruction of rodents during the past season have been continued as heretofore and were directed primarily against the ground squirrel, Citellus columbianus. The methods advocated are (1) Poisoning with strychnine; (2) shooting; (3) trapping.
One thousand six hundred pounds of hulled oats freshly coated with starch and strychnine paste were distributed in the three districts early in the season and the distribution of poison grain to the west side ranchers was extended the entire length of the valley to the south. Sixty thousand .22 calibre cartridges were expended, approximately half of these by the different poison squads and the remainder by the west-side ranchers, to whom they were given. The ranchers were also urged to use a moderate number of small steel traps judiciously placed around gardens, grain, and hay fields throughout the squirrel season. In addition to these measures a law providing for the destruction of ground squirrels and other rodents was passed by the last State legislature and efforts were made to cooperate with the county commissioners of Ravalli County in enforcing this provision.
Sheep grazing.-Any practical plan of tick eradication as a means of controlling Rocky Mountain spotted fever must take into consideration the fact that the tick-infested territory must and should be used from year to year for agricultural or grazing purposes. Tick eradication in any western community can not be completely accomplished in one or two seasons and then left as a finished undertaking, except where all of the infected territory is put under fence and placed in cultivation. On land which is useful for grazing purposes only, the fight against tick infestation must be carried on persistently from year to year. When this grazing land is in close proximity to the settlements, as it is in the Bitter Root Valley, the problem of tick infestation and Rocky Mountain spotted fever infection becomes most grave. For these reasons no campaign of tick eradication which does not include the employment of sheep grazing in some form can be said to be complete where grazing lands are involved. Sheep lend themselves to the grazing restrictions which are necessary for tick control much better than do cattle or horses; in fact sheep in small bands naturally graze in a manner adapted to tick eradication.
Sheep grazing experiments were continued during the past season along two main lines, as follows: First. The employment of large bands of sheep to be used mechanically in sweeping the ticks away from the settlements toward the mountains. Second. The grazing of sheep in small bands over lightly infected lands close around the ranches.
Through the cooperation of the Forest Service officials 45,000 sheep were introduced this season into the Bitter Root Valley. These sheep were all placed on the west side of the valley and it was intended that they should be grazed away from the settlements up through the passes of the Bitter Root Mountains, taking a large percentage of the valley tick infestation along with them. The introduction of these sheep was a result of several seasons' effort, and if sheep grazing upon this scale can be placed on a business basis in the valley, so that the movement will be continued from year to year, it is expected that it will go far toward clearing up the spotted-fever situation.
A band of 500 sheep was secured for experimental use and grazed first in a near-by tick-free irrigated pasture, then for 10 days over adjacent tick-infested territory, and finally back to the pasture for
observation. The purpose of this experiment was to show that by watching the tick infestation closely on a small band, the sheep might be grazed over territory showing a high degree of infestation, provided they are shifted as often as every 10 days to nearly tick-free pasture. In addition to these experiments the west-side ranchers were encouraged to secure small bands of sheep, which they have done in so far as their means will permit.
The entire spotted fever situation, so far as the Bitter Root Valley is concerned, appears to be much more satisfactory than ever before. The adoption of proper grazing methods, the realization of the inadequacy of dipping domestic animals, the continuation of small animal destruction, and the contemplated enactment of suitable legislation, have all served to place the work of tick eradication and the elimination of spotted fever on a more scientific basis. There is reason to believe that if these procedures can be continued as outlined the ultimate control of spotted fever infection in this district will be effected.
MEASURES FOR THE PREVENTION OF THE INTERSTATE SPREAD OF TYPHUS FEVER.
OPERATIONS AT EL PASO, TEX.
As an additional precautionary measure to prevent the spread of typhus fever and other diseases from border points to places within the United States, and to discourage in large measure the interstate travel of Mexicans who had entered the country clandestinely, an order was issued January 20, 1917, to all transportation companies operating trains out of the city of El Paso, directing that no Mexicans of the laboring class or their families were to be furnished transportation unless they were provided with a service certificate showing that they had been deloused, bathed, and vaccinated, and that their clothing and baggage had been disinfected.
All railroad companies have given valuable cooperation in the enforcement of this order. Through the operation of this measure the interstate spread of typhus has been largely controlled and the requirement has also been of material assistance in enforcing quarantine regulations at the port of entry, undoubtedly tending to diminish clandestine crossing and causing immigrants to present themselves at the proper station for treatment.
After January 2, 1917, all Mexicans requiring quarantine treatment were disinfected at the El Paso plant before leaving for interstate points, and since this date no cases of typhus have been reported elsewhere in the United States that could be traced to El Paso or Mexico through entry at El Paso. January, February, and March are months especially favorable for the spread of typhus, so it would appear that the measures adopted were quite effective in preventing the dissemination of the disease. This is borne out by the fact that prior to the establishment of the disinfecting plant and before any control was exercised over interstate travel a number of cases were reported in California and Colorado which had their source of infection traced to El Paso.
During the latter part of the last fiscal year it was suggested to the El Paso authorities that they make an effort to eradicate local typhus
infection, this suggestion being advanced in response to a request for a nonintercourse quarantine with Mexico. At that time service assistance toward the accomplishment of this end was offered. Later, in January, 1917, the city health officer of El Paso died of typhus fever contracted while performing the duties of his office. Immediately after this death the mayor and the city council requested that Asst. Surg. J. W. Tappan be granted permission to accept the position of health officers of the city. In compliance with this request this officer was granted leave without pay and took over the sanitary work for El Paso on January 15.
Under the administration of this officer a general plan to eliminate louse infestation was commenced and carried out with considerable success. The city health department secured a motor-driven omnibus, and an inspector of the department of health made frequent trips each day with this vehicle to crowded Mexican tenements, conveying louse-infested persons and their personal effects to the service disinfecting plant, where they were deloused. This measure resulted in a very marked improvement, not only from the actual number of persons treated at the plant, but in stimulating all other Mexicans to bathe and boil their clothing so as to avoid being carried away for official delousing.
During the latter part of January, the mayor and city council made an official request for assistance in eradicating typhus-fever infection. It was estimated by the officer in charge that the necessary work would require an expenditure of approximately $10,000. It was impossible to grant this request on account of insufficient funds, but Asst. Surg. T. C. Galloway was detailed to assist in sanitating El Paso.
Upon the arrival of Dr. Galloway from Colorado, where he had been on typhus epidemic duty, a sanitary survey of El Paso was inaugurated under the supervision of the officer in charge, and with the cooperation of the city health officer and his employees. The results of this survey disclosed housing conditions that were highly conducive to the spread of typhus fever, and clearly brought forth the necessity for public baths and laundries in El Paso where the peon class of Mexicans might bathe and wash their clothing. With a view to correcting the crowded conditions in tenement and cheap lodging houses, ordinances were prepared and recommended to the municipal council for enactment. These ordinances were passed on April 5, 1917, and are being enforced at the present time, so that the conditions under which the peon class live have been markedly improved.
Plans for a suitable municipal free bathhouse and laundry were submitted to the city council, with an estimate of the cost of operation, and the probable number of persons that would avail themselves of these facilities. Considerable local support for the project was obtained and a site for the building selected. Both the site and the building could have been secured without expense to the city, through public-spirited citizens, but it was found that the unsatisfactory state of the city finances would not permit the appropriation for maintenance and operation at that time. With the support of a local paper, a sanitary educational propaganda was carried on which will not only make the building of such a plant almost certain, as soon as the tax levy will permit the expenditure, but which also accomplished much
good in advising the public in regard to the deplorable conditions which existed and to create a desire for their improvement.
In addition to the sanitary work in connection with typhus eradication, Asst. Surg. Tappan while city health officer secured amendments to the old milk ordinances, which have greatly improved the milk situation in El Paso and have had some effect in reducing infant morbidity. Upon completion of his duty as city health officer the work accomplished was made the subject of a commendatory letter from the mayor of the city.
OPERATIONS IN COLORADO.
During the latter part of November and in December, 1916, several cases of typhus fever, which had evidently been imported from Mexico, occurred in the vicinity of La Junta, Colo. The State board of health requested the cooperation of the service in limiting the further spread of the disease, and Asst. Surg. T. C. Galloway, jr., was detached from the Laredo station and ordered to Colorado for that purpose. The epidemiology of the cases which had occurred was investigated and the measures suggested and enforced apparently controled the disease, although the operation of the service plant at El Paso made it more difficult for vermin-infested Mexicans to reach Colorado points.
Nine cases of frank typhus and two other suspicious cases were found to have occurred-all in Mexicans, except one known case and and one suspicious case in Americans. Five of these cases arrived from Mexico via El Paso during the incubation stage of their illness: the others were secondary, due to nonrecognition or failure to isolate the primary cases.
Conferences were held with State and county health officials, medical representatives of the various railroads in Colorado, and the beetsugar companies. The history and diagnosis of typhus were discussed and the method of its control outlined, measures being suggested for local application. All were interested and concerned and gave their willing, active cooperation, making it unnecessary to propose any further quarantine restrictions. A circular letter of information and suggestions was also prepared, with the cooperation and assistance of the secretary of the State board of health, and this was placed in the hands of those interested.
OPERATIONS AT FORT MADISON, IOWA.
Owing to an outbreak of typhus fever occurring among Mexican railroad laborers at Fort Madison, Iowa, requests were received from the State health officer of Iowa and the chief surgeon of the Chicago, Rock Island & Pacific Railway relative to the detail of an officer of the service for the purpose of confirming the diagnosis of the disease and offering recommendations as to the measures necessary for the prevention of its further extension. Accordingly Surg. M. J. White was directed December 28, 1916, to confer with the medical authorities in question and to make such inspection of the railway camps in various States as was required. It was ascertained that the outbreak of typhus originated among Mexicans who had recently arrived from across the border, and that their habits of life and lack of cleanliness favored the further dissemination of the disease.