A typical river rat.
By David Goudsward
Special to Wavelengths
Dr. Carl Mindlin, a Russian Jewish immigrant, had been growing his medical practice in Currier Square (Washington Street at High) for five years. His fluency in Yiddish and the location, a block west of the predominantly Russian-Jewish congregation of Temple Ahavas Achim, provided a steady stream of patients. So successful was his practice that he had moved his wife and 5-year-old daughter from above the office to a new home on Commonwealth Avenue.
When Mindlin arrived at the office Jan. 2, 1926, he found a patient already waiting. Mindlin often had walk-ins, not unusual with the influx of blue-collar workers in the neighborhoods. Most felt more comfortable seeing a physician who was also an immigrant, but financial concerns and language limitations still drove these patients to wait as long as they could to see the doctor. This minimized lost time at work, but often exacerbated the illness. This early arrival was one such immigrant neighbor, a shoe worker from the Lithuanian community along River Street who passed the office heading to St. George’s Church, less than one-quarter mile from Mindlin’s practice.
Mindlin was deeply concerned as he examined the patient. The symptoms seemed to indicate influenza. The patient complained of chills, severe headaches, violent nausea, a high fever, dizziness and a loss of energy. Massachusetts had been ground-zero in the deadly flu pandemic of 1918-1919, when approximately 45,000 people died from influenza in the Commonwealth alone. If it was the return of the flu, it was a serious matter. The only treatment for influenza in 1926 was isolation. Mindlin ordered him to quarantine himself and he would come to the house in two to three days.
Mindlin wasn’t entirely sure it was the flu—it was too early in the year and there were anomalies. Flu symptoms tended to gradually worsen, but the patient described falling ill with no advanced warning. After three days, the patient was feeling much better, and Mindlin relaxed, relieved that if it was the dreaded flu, it was a mild strain. His relief was short-lived; the patient reported several of his neighbors were now exhibiting the same symptoms.
The patient returned Jan 8. His fever had suddenly returned with a new set of symptoms—debilitating pain and swelling in his wrists and elbows. The next day, Mindlin made a house call to find the swelling and pain had spread to his knees, making walking next to impossible. By the end of the day, the swelling had spread to his shoulders. Mindlin was perplexed, the symptoms were completely alien to him. And worse, the disease was spreading. Mindlin saw several more patients, all from the same section of River Street.
By Jan. 12, Mindlin had treated 15 patients with no clear idea what disease he was treating. He began asking other local doctors along Washington Street if they had encountered cases. Fifteen other local doctor had also seen one to two cases each and were similarly at a loss as to what disease they were seeing. Mindlin’s estimate that there were now between 30 and 45 people suffering from the mystery disease—all from River Street, Washington Street and the cross streets that connected the two. The earliest patients continued to suffer horribly. The arthritis-like joint pain had continued to spread, now into fingers and ankles. Adding to the misery, a rash soon developed on toes and fingertips, spreading up extremities over the course of a week, then turning to bloody sores.
On Jan. 22, Mindlin made a decision. His previous patients were all but immobile from the joint pain. Mindlin had no choice but began admitting patients to the Gale Hospital and notified the city’s Health Agent George Lennon that there was a mystery illness in the city and without knowing how to treat it as it spread, Haverhill could be facing an epidemic.
Lennon immediately contacted Alderman Samuel Lewis, the city’s commissioner of Health and Charities. All that aldermen had to hear was there was a mystery disease that started with flu symptoms. No one was sure if it was new strain of flu, but Massachusetts took flu season very seriously. The 1918 Spanish flu pandemic had been introduced into the U.S. through Boston, and a minimum of 45,000 people died from influenza in the state alone, and Haverhill had been heavily hit. Lewis contacted the state Board of Health immediately, who in turn requested Harvard Medical School professor Edwin H. Place investigate.
Place arrived in Haverhill the next day with two colleagues, Lee E. Sutton Jr. and Otto Wilner. All three were experienced doctors with extensive experience dealing with epidemics. Dr. Place was the former head of the contagious disease department at Boston City Hospital who successfully battled an outbreak of infantile paralysis (polio) in Boston schools. Sutton worked with Place on several of the Boston epidemics and was preparing to become dean of medicine at Virginia Commonwealth University. Willner, only in Boston until an upheaval in China quieted down, was on staff at the Rockefeller Foundation’s Peking Union Medical College Hospital and designed an early form of a hazmat suit to deal with a typhus epidemic in Siberia.
Sutton and Willner met with the Health Department and Lennon began taking the two to the patients, taking blood cultures, white blood cell counts and fluid from swollen joints. Place proceeded to the Gale to examine the worst of the cases. Then headed up Washington Street to discuss the disease with Mindlin and the various doctors treating the disease.
Mindlin reported to Place that he had seen eight new cases of the mystery ailment that day alone. Other physicians nearby had seen some cases and there were at least another dozen doctors across the city with patients, some as far away as Dr. Paul Nettle on Groveland Street. Most of the earlier patients were recovering slowly, but still suffering from severe joint pain. Mindlin had tried everything in his pharmacopeia with no results. Gold Salt (gold sodium thiomalate) injections, a treatment for arthritis, seemed to help with the joint swelling slightly, but not enough to be useful.
Place, who had arrived assuming he was dealing with a mild influenza outbreak, was already doubting it was a new flu strain. He discovered the number of confirmed cases had doubled overnight from 30 to 66. A decision was made to avoid a panic and continue referring to the disease as a minor form of flu until the disease’s identity could be determined.
With their samples, Place, Sutton, and Willner returned to Boston and began a clinical study to establish a treatment. Dr. Lyman Jones from the state Department of Health arrived to assess the situation. Place and his team would seek to identify the disease to know how to treat it. Jones would seek the cause.
Although Dr. Jones was now director of the state Department of Health’s Division of Food and Drugs, his background made him the ideal field investigator in this epidemic. He was formerly the State Health Inspector for the northeast district, so he was already familiar with the geography and traffic patterns of Haverhill. Additionally, he had extensive experience in battling outbreaks of Tuberculosis.
Jones began with basics, charting where each patient lived on a map. Once they were marked on a city map, Mindlin’s observation was found to be correct. The patients all lived in a concentrated area, forming a rough triangle starting at Railroad Square, traveling west along River Street up to the parallel streets of Ayer, Beach and Varnum that connected through to Washington Street. Up these streets then east on Washington back to Railroad Square.
This map explained why Dr. Mindlin was seeing the most patient traffic—he was closest physician to the Lithuanian neighborhood, clustered from River Street at Ayer and Margin Street where the majority of cases were located.
On the 25th, things began to get complicated. Tony Luchkis a River street resident, who has been confined to his bed with the disease, was driven mad by the constant pain. He began destroying the furnishings in his apartment. It took three policemen to restrain him. He was brought to the not yet city-owned Hale Hospital but refused admittance. If it was indeed influenza, the hospital was not equipment to isolate Luchkis at the risk to the other patients. He was returned home where Mindlin sedated him. He was put back to bed only discover his wife had also contracted the disease and was unable to care for her husband. Now the disease was more common knowledge and about to get a higher profile in the public. The Haverhill Evening Gazette broke the story on the front page after attending a board of health emergency meeting that day. Without knowing what the disease was, the doctors collectively lied and reiterated that yes, the symptoms suggested influenza, but that the number of cases has not reached stage to alarm the public. There were no deaths, although a few cases were considered serious. They noted the number of new cases had declined, neglecting to mention most of the older cases remained incapacitated.
In private, both Place and Jones admitted this was not influenza. It was something neither had seen before. So, while the board of health was technically in control of the investigation, these local doctors were over their heads. When one of the doctors asked to admit one of the mystery ailment sufferers to the Gale Hospital, it too refused to admit the patient, even with pneumonia.
It was finally decided that the Gale would admit patients (Mindlin had admitted his first case days before the concern had grown). Gale would isolate them on the third floor, and with cases becoming fewer, that should be sufficient. If the disease suddenly became wildly contagious and the number of cases jumped, they would open the old TB hospital.
Dr. Jones, going door to door in the neighborhood, made a stunning discovery—there had been cases of the mystery illness months before Dr. Mindlin saw his first case, with cases dating back to late November, 1925. In total, Jones investigated 89 cases, 11 of which turned out to be other illnesses. Jones began building a profile of the afflicted. Jones’s resulting profile gave him a number of leads he could pursue.
He found the 78 cases were spread among only 37 families. Sixteen families had one case each in the household and several families had 2, 3 or even four members with the illness, and one family had 10 cases in the household. 76 of the cases lived in the epidemic area, but two lived elsewhere but had visited the area.
The age of the patients ranged from eight months to 54 years, and 41 percent were male. Combining the patients with the uninfected family members, 231 people had had the potential to become infected but only 36 percent did. To Dr. Jones, this suggested the disease was not contagious through contact as a flu would be. Instead, this suggested to Jones that the source was environmental. If this was the case, all Jones had to do is find the common denominator.
Finding this common denominator proved more difficult than expected. Although most of the patients were Lithuanian, there were also Polish and Italian immigrants affected; this eliminated foods in common or a specific place where all 78 congregated, such as a church. Home conditions ranged from good to poor, with minor health issues, such as leaks, mold and mice, but none that were consistently present at all the homes. Water and sewerage were provided by the municipal system and could be eliminated because no one outside the triangle had come down with the symptoms. When the households listed everything they had eaten since the beginning of the month, the only thing everyone had in common was milk consumption.
Focus Moves to Milk Source
Complicating the issue, some of the affected families had milk delivered, and some purchased it in neighborhood stores, and a number of the families used several sources and couldn’t say which they had used when. State law did not mandate milk be pasteurized in 1926. In fact some of the local dairies considered pasteurization to be a fad, and used it in advertising as a marketing tool. Pasteurization would eliminate any disease carrying pathogens in milk, and Dr. Jones had been running the state’s food and drug division long enough to know unpasteurized milk merited a further look. Dr. Jones and his team quickly discovered that 17 families, with 46 of the cases, regularly used the same milkman. Another 16 families, accounting for another 28 cases, used this same milk man occasionally. Another four families declared they never used that milk man. But with 90 percent of the cases using the same source, Jones went to the milkman and got his customer list. The milk man had delivered 20 quarts of milk to 13 afflicted families during the outbreak and 60 quarts to the four convenience stores in the area, where another 25 families bought most of their milk. Factoring the store, Jones could suddenly place 74 patients in probable contact with this milk from one source.
Dr. Jones went to this dairy supplier with veterinarian Charlemagne Bricault. Dr. Bricault was a member of the Haverhill Board of Health and was also the city’s animal inspector. Dr. Bricault examined the cows of both the farm and two small neighboring farms that sent their milk to him for distribution. Dr. Jones examined the families involved. Neither the families nor the cows showed signs of illness. The two did confirm the milk was not being pasteurized. On Jan. 27, the farmer was “encouraged” to begin pasteurizing his milk. Although Jones knew the milk was the cause, there was no way to confirm it medically. Two days later, the last case of the disease was reported.
On Feb. 2, Dr. Place triumphantly announced the source of the outbreak was one dairy farm, and although no specific disease or contamination could be found, they were convinced the epidemic was nipped in the bud. At no point did Place mention Dr. Jones by name, or even infer there was another physician who should be sharing the credit. The next day, Place had reviewed the initial pathology reports and announced that whatever the mystery disease was, it was not contagious.
The outbreak was over. The unknown disease was being referred to informally as “Haverhill fever.”
On Feb. 18, Dr. Place issued his preliminary report in the Boston Medical and Surgical Journal. He declared the outbreak was caused by a previously undiscovered bacterium, and took the liberty of naming the disease Erythema Arthriticum Epidemicum. Needless to say, Haverhill Fever proved to be a more popular name.
Haverhill Fever was quickly overshadowed by a bigger threat. Influenza cases were starting to appear even as Place headed back to Boston. By March, flu was ripping through the city at rates that over shadowed the Spanish flu pandemic. By March 22, more than 1,000 residents had the flu in Haverhill, crippling the factories and overflowing the hospital. Haverhill Fever was essentially forgotten in its namesake town.
In September, Drs. Parker and Hudson, the pathologists who did the actual testing of the samples taken by Dr. Place and his team, published their own results in the American Journal of Pathology. They agreed with Place—it was a new bacterium, and they named it Haverhillia muliformis. They offered an interesting observation that Haverhill Fever bacteria did not grow well in room milk temperature or at normal body temperature, but grew very well in blood at normal body temperature.
This inference that milk may not have been the source of the epidemic bothered Dr. Jones and is reflected in the tone of his article “Investigation of Cases of Unidentified Illness in Haverhill, Massachusetts.” Jones carefully explains the demographics, the symptoms and the process of identifying unpasteurized milk as the culprit. This article ran in Boston Medical and Surgical Journal in July, 1927.
All of this was academic. The 1926 flu had disrupted Haverhill’s economy for months, and 1927 brought polio into the city. The only ones who remembered Haverhill Fever were those who had contracted it. However, Haverhill was reporting 85 percent of the milk produced in the city was pasteurized, up from 30 percent at the start of the outbreak. It will still take several decades before pasteurization became mandatory, and ironically, by the time it did become the law, a new medicine had been discovered that cured Haverhill Fever quickly and painlessly—penicillin.
Route of Disease Transmission Distinguishes ‘Haverhill Fever’
Today, Haverhill Fever remains the name of the disease. Subsequent research has determined the bacteria was not a new form, but Streptobacillus moniliformis. S. moniliformis is an anaerobic bacterium that lives in the upper respiratory tract of rats. If you are bitten by a rat, the disease you contract is Rat Bite Fever, with symptoms identical to that of Haverhill Fever. The difference is Haverhill Fever is contracted by ingesting food or liquid contaminated by rat fecal matter.
The disease was in the medical texts in 1926, but the manner of contracting it was unknown. If someone in Boston had been bitten by a rat and have those symptoms, diagnosis would have determined the cause. But over 70 cases plus no evidence of rat bites would have prevented Rat Bite Fever from even being considered. It also explains why Drs. Jones and Bricault could find no trace of the disease in the dairy’s cows. The source was not the livestock, but the processing equipment.
Although there have been sporadic single cases of Haverhill Fever over the years, there have been only three major outbreaks. The first was in May, 1925, in Chester, Penn., where 400 cases of an unknown disease, suspected to be somehow related to milk contamination, were reported by the state epidemiologist. Haverhill was second epidemic, and in 1983, 130 children contracted Haverhill Fever at a boarding school in England when rats gained access to the filtration system for the school’s water supply.
Haverhill Fever was not the first outbreak, and in fact was the smallest of the three. But thanks to a handful of press-savvy physicians, Haverhill finds itself with the dubious immortality of having its very own disease.
David Goudsward, raised on the summit of Scotland Hill, brings his New England sensibilities and respect for historical perspective his work. Although living in Florida, his bibliography consists primarily of New England topics. He recently compiled and edited, “Snowbound with Zombies,” a collection of supernatural stories inspired by Poet John Greenleaf Whittier. (See Members Shop.) His latest book, “Horror Guide to Florida,” co-written with his brother Scott, is available via Amazon. He is WHAV’s Open Mike Show’s historian.