Wednesday, Jul. 16, 2008

In sickness and in health: Belleville pulls through cholera, smallpox, Spanish Flu

The miraculous cure of a 14-year-old girl's tetanus.

The difficult extraction of a piece of metal from a boy's throat using the latest in imaging technology.

A touch-and-go operation on a man's broken neck that drew surgeons from both sides of the river to watch.

Recent breakthroughs at a St. Louis medical school? No, all three were cases handled in Belleville and made Page-One headlines in the early 1900s.

Surprised? You shouldn't be. As early as 1840, city doctors had helped form the first Medical Society of St. Clair County "to contribute to the perfection of the Medical profession," as Dr. Albert Trapp wrote the next spring in the Belleville Weekly Advocate.

They have been striving for that perfection here ever since. From the days when a handful of doctors made their rounds on horseback to "bleed" patients, residents have watched health care blossom into the city's largest industry as physicians have worked to make state-of-the-art care available close to home.

In 1875, for example, five German nuns came to Belleville to offer emergency services in a few rooms at the St. Peter's Parish school. These Sisters of St. Francis had so little room and resources, they had to offer other health care in patients' homes. Such was the start of St. Elizabeth's Hospital.

Contrast those humble beginnings with the two massive complexes that exist today -- St. Elizabeth's and Memorial hospitals -- enabling doctors in countless specialties to provide services undreamed of just a generation or two ago. Intricate heart surgeries, cancer care centers, virtual colonoscopies ... the list is long and filled with an ever-growing number of cutting-edge diagnostics and treatments.

But with the advances also has come wave upon wave of deadly epidemics that kept city leaders and health officials scrambling to contain over the years.

Local newspapers are filled with reports of burning public fires on every street corner to control cholera in the 1850s, hastily erecting large tents for an outdoor smallpox isolation hospital in 1903, and banning all church services and public funerals during the Spanish influenza pandemic in 1918.

Diphtheria, measles, scarlet fever, typhoid, yellow fever -- all took heavy tolls here over the past 150 years, often fueled by the public's own negligence to be vaccinated, a subject that continues to makes headlines.

Then, just as those scourges were becoming a thing of the past, a mystery illness that would come to be known as AIDS arose, bringing with it a new set of medical and public policy challenges that persist today.

Belleville was not immune

City fathers probably did not expect so much bad news when, in 1814, George Blair donated an acre of land for what would become Belleville's Public Square, wrote Dr. Isaac D. Rawlings in Volume Two of "The Rise and Fall of Disease in Illinois."

Instead of building on the mosquito-infested marshes and bogs of what is now Cahokia and East St. Louis, Belleville grew up high and dry on Compton Hill.

Far from both the unpredictable Mississippi and Kaskaskia rivers, residents likely hoped most medical problems would be more like the first known surgery here in 1805, when a Dr. Tuttle cut a hazel stub from the foot of Turkey Hill farmer Samuel Shook. But even in its infancy, townspeople learned how hard it would be to keep disease from their midst -- and how deadly the consequences would be.

In 1833 a man stricken with cholera was attacked while camping near town. Refused accommodations at a number of local inns, he took refuge in the courthouse, where he was treated by a Dr. William Mitchell. The man soon died, but the plague he had started raged several months, eventually killing even former Gov. Ninian Edwards.

Considering the primitive state of medicine back then, some may wonder how patients survived a doctor's care.

One of the favorite treatments of the day was "bleeding," which was thought to cure disease by removing "bad" blood. And, just how much blood should be let? Perhaps this anecdote from a 1882 lecture by Dr. O.T. Moore, of Smithton, shows again why medicine is often called the inexact science:

During one winter in the 1820s, a Dr. Green, one of the first Belleville doctors, was called to treat some of Lt. Gov. William Kinney's slaves, who had contracted pleurisy, a common winter malady.

With his caseload piling up, Green bled those who were ill, but told one of Kinney's workers to bleed any new cases himself, showing him where to stick the lance.

"'But how much blood shall I take?'" the worker asked worriedly.

"Oh, bleed him until he falls over; then you have enough," the doctor reportedly replied.

Nevertheless, those early physicians already had developed a strict schedule of fees for their service, according to Alvin Nebelsick in his "History of Belleville." Among them: Visit in town -- $1; visit in country -- $1 for the first mile and 50 cents for each additional mile; extraction of a tooth -- $1; amputation -- $20-$50. Double those prices for night calls and anything that involved contagious disease.

Medicine was just 25 cents a dose, but considering what you were getting, even that price may have been too high. Still decades before the first rudimentary antibiotics, healers relied on everything from quinine to morphine. Snakeoil remedies were rampant as newspapers touted ads for Prickly Ash Bitters and Simmons Liver Regulators, which could cure a host of ills from bad breath and "biliousness" to dyspepsia and malaria. In most cases, Nebelsick notes, the most a sick person could hope for was a placebo effect.

People in the 1800s avoided surgery at all costs. For one thing, just as you see in those old Westerns, anesthesia consisted of a strong shot of whiskey, hypnotism, extreme cold -- or extreme pressure. That ruled out operations in anything short of a dire emergency.

"Special strong men were hired to hold the patient down," Nebelsick wrote. "At that time the common operations were the extraction of gun shot and the amputation of limbs, although a few doctors were quite successful with the removal of harmless tumors."

At the same time, the city's public health services were next to nonexistent, Rawlings noted in his 1927 book. While there is some evidence of a board of health here early on, it was mostly a paper tiger. Today, for example, an infant morality rate of 10 or 15 per 1,000 births is considered alarming; as recently as 1922, that rate was 91.8 here -- down from 554.4 in 1879.

Cholera outbreak

Put those ingredients together -- along with a primitive sewer system that drained the town's wastes into Richland Creek -- and you have the makings for a perfect storm every time a new disease made its way here.

Typical was the cholera epidemic that swept through Belleville in 1849. In February, the Belleville Weekly Advocate was urging city leaders to help prevent yet another outbreak of the highly contagious intestinal disease that can cause fatal bouts of diarrhea.

"We have frequently urged upon our town authorities the propriety of passing stringent ordinances for the purpose of keeping our streets and alleys in a more healthy and wholesome condition than they are at present," the paper opined.

But by July 4, efforts to avoid the disease had replaced any thoughts of any Independence Day celebrations. Despite the best preparations of the day, dozens of new cases were being reported each week.

"The town has been thoroughly cleaned, lime has been abundantly spread upon private premises and the public streets," the Advocate reported. "But more than this ... large fires of bituminous coal, tar and sulpher have been kept constantly burning, at almost ever corner of the street."

Doctors "were like a mariner at sea without chart, compass, or quadrant," the paper noted. The epidemic became so rampant that a "pesthouse" -- or isolation hospital -- was opened in the southwest part of the city to care for the ill.

"We therefore earnestly recommend to our citizens to use chloride of lime, boiling vinegar, tar and burning coffee in their dwellings," the Advocate wrote. "The last is said to be a powerful disinfectant and, judging from the pungent aroma which it diffuses, we confidently recommend its use."

By the time the epidemic had run its course in August, upwards of 250 people had died, wiping out nearly 10 percent of the population. But four years later, the paper reported, "Richland Creek polluted with offal of the distilleries was a source of disease when the cholera was here, and now it is still worse."

Waves of disease

For the next century, diseases that sound strange to the ear today made their periodic deadly rounds through the metro-east.

On Christmas 1891, for example, the Advocate reported that Turkey Hill farmer John Miller had lost his fifth child in five weeks to typhoid fever.

In 1905, Belleville was designated an inspection station to prevent any cases of yellow fever from entering St. Louis by passengers riding the Louisville & Nashville & Southern Railroad. In 1914, the city ordered that any family with a case of scarlet fever should burn library books rather than return them.

As late as 1922, more than 1,300 cases of malaria were being reported annually in St. Clair County. A measles epidemic in February 1931 closed schools and contributed to at least four deaths.

No wonder doctors today are concerned about a growing reluctance among parents to have their children vaccinated. They've never lived through a diphtheria epidemic like the one that killed four children of Gustave Goerlitz in 10 days in 1887. Or yet another outbreak in 1915 that resulted in a seven-week quarantine, the death of a doctor's son and an order that all funeral flowers be buried along with the deceased.

Still, all of these later epidemics were minor compared to the two biggest health battles Belleville ever waged: the smallpox epidemic of 1904 and the invasion of the Spanish influenza in 1918.

Smallpox epidemic

When it came to smallpox, Belleville should have learned its lesson early.

After escaping a major outbreak for its first 90 years, the city found itself fighting its first epidemic in the fall of 1903. By November, all city schools had been fumigated, and residents were being fined hundreds of dollars for breaking strict quarantine rules. Six people died.

It should have sent residents running to their doctors for a simple vaccination. It didn't. By late September 1904, the disease had returned with a vengeance. This time, dozens were facing death.

"Had more people overcome their narrow-minded prejudice against vaccination three or four weeks ago ... the disease would not have spread to the extent it has," the Belleville Advocate chastised its readers in its Sept. 28 edition. "There are always some people who place their opinion against that of the savants of the world and persist in sticking to it, despite the fact that results prove them to be in the wrong."

The situation had become so grim that the very next day, city officials, led by Mayor (and News-Democrat owner-publisher) Fred J. Kern, decided to erect an isolation hospital immediately at what today would be West G and North 17th streets. (They later appropriated $6,000 for its operation.)

Just three days later, construction began -- not the laying of bricks and mortar, but the erection of large tents, one each for male and female patients and another for a commissary, with smaller tents for the nurses and doctors who would staff the emergency institution.

"Each tent will have a solid pine floor and be erected in a substantial manner," an Oct. 1 Advocate story reported. "Over each tent, an arc light will be installed. A telephone will be installed at the hospital, and patients will have an opportunity to communicate with any relative or friend at any hour of the day. The best of food will be provided. ..."

On Oct. 7, an 18-month-old infant became the first of several dozen patients to be admitted to the hastily constructed facility.

"As has all along been stated in these columns, the Isolation Tented Grove is one of the best places imaginable for the home of persons afflicted with smallpox," the Advocate reported. "As usual, Belleville was doing things in her usual thorough manner."

Thorough, maybe; comfortable, not so much. With winter not far away, tents obviously weren't going to work for long, even though they did have heat.

Just three months later, the city paid $14,000 to buy the Theopholis Harrison mansion, one mile south of town on Illinois 159, to use as an isolation hospital. The alternative, a committee told the City Council, would be to return smallpox patients to their homes and post the "much-dreaded" yellow quarantine signs that had dotted the city before.

"That plan has been tried, and it has been found to be a serious menace to the public health and entirely inadequate and ineffectual in stamping out pestilence," the committee reported. "(It is) fatal to the good name of the city, and to be costly to the degree of barbarous extravagance, both in the expenditure of wealth and the sacrifice of human life."

On Dec. 14, what few patients remained were moved to the new hospital, and the tents on 17th Street were folded away for good. In all, 46 people had died, and perhaps residents had finally learned their lesson: According to Rawlings, the one smallpox death in 1905 was the last the city suffered.

Even so, smallpox outbreaks did not end. In 1918, the Millstadt Enterprise was stopped from distributing an issue because of a case in editor Arthur Mollmann's family. As late as 1933, Belleville Township High School was closed for three weeks when a student contracted the disease in late March.

Still, that City Isolation Hospital, although later prepared as a tuberculosis sanitarium, was never used again and was razed in 1940 after falling into disrepair. And, thanks largely to an intensive United Nations vaccination campaign, the world was declared smallpox-free in 1980.

Spanish influenza

The fall of 1918 was supposed to be a joyous time for Belleville.

With Germany finally teetering on the brink of collapse after a four-year world conflict, city residents -- and the rest of the country -- were looking forward to their boys coming home for a very merry Christmas.

But just as one war was ending, an even deadlier one was beginning -- an epic fight against the Spanish influenza, which would kill 20 million to 100 million people worldwide, depending on which estimate you believe.

For months, the city could feel it creeping ever closer. In the spring of 1918, papers had been filled with reports of American soldiers dying of the dreaded disease in Europe. In August, the illness gripped Boston and quickly began spreading south and west.

Belleville officials were optimistic that they could keep the monster at bay. On Oct. 9, the Board of Health ordered schools and theaters closed along with a ban on all dances, club meetings and other public gatherings. Saloons were asked to remove all chairs and tables so customers would not linger. Judges were ordered to avoid large trials. The local railroad was ordered to fumigate its cars regularly.

"There seems to be no danger of an epidemic of the disease in Belleville at present," the News-Democrat reported on Oct. 10.

That changed almost overnight. Dozens of cases were popping up at Scott Air Force Base, and hundreds were becoming ill in small towns around the metro-east. Over the next month, churches were closed and all funerals were ordered held in the deceaseds' homes.

Every day, the News-Democrat ran a story on "Spanish Influenza -- What It Is and How it Should Be Treated," which, if you read to the end, turned out to be an unmarked ad for Vick's VapoRub.

"Go to bed and stay quiet," the "story" advised. "Take a laxative, eat plenty of nourishing food, keep up your strength. Nature is the cure."

By late October, the caseload had so overwhelmed medical authorities that the Rev. Joseph Schlarman at St. Peter's Cathedral offered the use of Cathedral Hall and the Brothers Home for additional hospital space. It was quickly accepted because the city's own isolation hospital, bought during the 1904 smallpox epidemic, already had fallen into disrepair.

For nearly three months, stories of influenza deaths filled the front page. Nobody was immune. An Oct. 15 story told of how 47-year-old Albert Baker, head of the Baker Stove Works on Freeburg Avenue, had succumbed in just a week. On Nov. 11, when the city should have been celebrating the Armistice, a 6 p.m. business curfew (except drug stores) was imposed.

The epidemic did have its lighter moments. On Oct. 22, a story told of how an increasing number of people, even with Prohibition fast approaching, were making friends with John Barleycorn as a flu preventive. Sure enough, a week later when James Wells was hauled into court for disturbing the peace, he gave Justice Ben Lautz this explanation:

"I'm not a drinking man at all and have never been arrested. But I heard so, so much talk that drinking would prevent influenza, that I guess I did drink a little too much over Sunday and while in that state the trouble must have happened."

Finally, in mid-November, a supply of flu vaccine developed by Dr. E.C. Rosenow at the Mayo Clinic arrived, and life slowly returned to normal.

Schools, which had been shuttered for six weeks, reopened, although many would close again in early December. Church services started again, dances and movies returned, and businesses were enjoying their normal hours for the holiday shopping season. On Christmas, residents even were invited to the Public Square for a community celebration.

After watching the epidemic make its grim rounds for three months, they had a lot to be thankful for. Of all cities in the state, Belleville had been hit fourth hardest with 188 deaths or a mortality rate of 895 per 100,000 population. Although the disease would rage elsewhere until June 1920, Belleville would suffer only a dozen flu deaths the next year.

Medical miracles

Meanwhile, city residents were beginning to benefit from the evolution of modern medicine. With the growth of St. Elizabeth's Hospital and, later, St. Vincent's just up the block, city physicians began trying bold, new treatments that, on occasion, even turned the heads of their big-city colleagues.

Take the case of Loretta Monken, for instance. In early August 1910, the 14-year-old had been brought to Belleville with a "well-developed" case of lockjaw, or tetanus. Her body was already "terribly bent" and her jaws were locked tight.

With her prognosis poor, local doctors tried something radical. Instead of injecting her with 300 units of an anti-tetanus serum, they gave her 10 times that amount every day for nearly two weeks. She was expected to make a full recovery, according to a Belleville Daily Advocate story on Aug. 27.

Remember the old surgeries done under whiskey? They were a thing of the past by the time Dr. C.H. Starkel attempted a daring operation on George Korte on Jan. 5, 1917.

Two weeks before, Korte, after falling off a wagon, began suffering what he thought was a stiff neck. An X-ray revealed that he had dislocated his second vertebra -- in simple terms, he had broken his neck.

Not only that, but because the vertebra had been forced back, Korte's head was shoved forward, nearly blocking his windpipe and gullet. Without surgical intervention, the bone could slip farther out of place, snapping Korte's spine.

The perilous operation drew an audience of more than a dozen doctors, including two from St. Louis. Several physicians had to stretch Korte's neck muscles so Starkel could slip the bone back into place. The slightest slip could have meant instant death.

But when the procedure was over, a follow-up X-ray showed the bone "was just where it should be." Chances for a full recovery were good, Starkel said the next day.

A similarly tricky operation at St. Vincent's restored the speech of Edwin Walker in 1922.

On Nov. 1, a storm blew down a large brick smokestack at Belleville Stove & Range Co. Walker, 21, was buried underneath the sudden cascade of 10,000 bricks, fracturing his skull and leaving Walker unable to talk.

A few days later, surgeons removed a small piece of bone that was pressing on his speech center along with a heavy blood clot on his brain. On Nov. 16, Walker wrote "never speak again" on a piece of paper, which he gave his wife. Thirty minutes later, his speech came back, and, in a Nov. 23 story, Drs. E.P. Stiehl and Leroy Reuss expected a full recovery.

Then, there was the story of Dr. G.C. Otrich. On March 14, 1924, Otrich pleaded guilty to striking a 9-year-old patient.

"I am not guilty of the charge, but I am entering a plea of guilty to dispose of the matter as I am too busy to waste time in a justice court," said Otrich, who was fined $5 and costs. "I was working on the girl's nose with an instrument when she started to interfere with her hand, and I pushed the hand down."

Three months later, Otrich was on the front page again -- this time for performing a potentially life-saving procedure on a 4-year-old East St. Louis boy.

Sylvan Robert Summers had been riding on the back of a friend's tricycle with a chewing tobacco tag in his mouth. His friend hit a bump, causing Sylvan to swallow the small piece of metal, which became lodged in his esophagus.

Placing the boy under a Fluoroscope -- or X-ray machine -- Otrich carefully extracted the tag, yet more evidence, he probably figured, of why he had no time to waste on a malpractice suit.

Now, nearly a century later, sewing new vessels onto hearts and sticking drug-coated stents into once-clogged arteries have become routine procedures here.

If you can hold your breath, radiologists can take fabulously detailed views of your inner workings with the newest CT scanners. Local cancer centers offer everything from chemotherapy to massages for the care and comfort of its patients.

The Yellow Pages are now filled doctors in dozens of specialties from sleep disorders to the ever-growing field of geriatrics. And, that's not even counting the page upon page of chiropractors, dentists, physical therapists, podiatrist and mental health professionals along with the St. Clair County Health Department on Public Square.

St. Vincent's, built in 1903 and run by the Adorers of the Blood of Christ, combined forces with St. Elizabeth's in 1926 to eventually take over three square blocks of West Lincoln Street. In 1958, Memorial opened its doors on the west end of town and now, 50 years later, boasts 2,200 staffers and more than 300 doctors in 97 departments.

"Belleville has a long history of having a very solid medical community to provide high quality care to local residents as well as those coming from outlying rural areas," said Dr. Lynne Nowak, president-elect of the current St. Clair County Medical Society, which dates back to 1865.

"Both Belleville hospitals have physicians on staff in nearly every medical subspecialty, and we are fortunate to have state-of-the-art technology so patients rarely need to go elsewhere for their medical needs."

Coming to grips with AIDS

Yet no matter how powerful the drug or how proficient a doctor's diagnostic talent, the next disease is lurking to put medicine behind the eight ball again.

Physicians found that out again in 1981 when homosexual men in Los Angeles began developing a rare fungal-based pneumonia. Soon, the deaths began to pile up and by 1982 researchers were desperately seeking an answer for a new plague that had been christened Acquired Immunity Deficiency Syndrome -- AIDS.

At first, many people ignored the disease, thinking it was limited to Haitians, homosexuals and drug users. But when the disease began spreading through the blood supply, heterosexual sex and even an infected mother's milk, the world took notice.

In Belleville, Keith Croffoot became the local face of AIDS. A hemophiliac, he had contracted the disease through tainted blood products when he was just 5 years old.

Fighting a disease with no treatment, much less a cure, he soon found himself battling the same prejudices that patients across the country faced. His mother, Deanna, for example had to sue Belleville School District 118 to allow him to attend Jefferson School. Despite assurances from medical authorities that AIDS was not easily communicable, other parents protested at the school with signs that read "Don't Let AIDS Kill Our Kids."

Others with the disease along with those trying to help them knew what the family was going through. When two nuns decided to open Bethany Place, they had to sue the city to do it. And, even after they won, there was little they could do at first but comfort the sick and dying.

"Four years ago, they gave me 48 hours to live," Croffoot said back in 1996 at age 15. "One time they said I wouldn't get through kindergarten."

By then, however, drug companies had developed powerful new drug "cocktails." AIDS no longer was an automatic death sentence, and patients could plan for a future rather than a funeral. Croffoot lived until last summer, when he died of unspecified causes at age 26. Bethany Place is now the largest HIV/AIDS nonprofit organization in Southern Illinois, offering everything from prevention education programs to transitional housing.

Nowak, who also serves as the medical director of the Hospice of Southern Illinois, is confident that the Belleville medical community will be able to help meet future crises while providing up-to-date care.

"The medical community in this area took a pretty bad hit over the past 10 years when many physicians were leaving due to threats of malpractice litigation," she said.

"However since tort reform legislation was passed, we have been able to recruit new, young, energetic doctors to ensure the rich tradition of excellent medical care in this community will continued. I see great things ahead for medical care in Belleville -- that's why I came home to practice here!"