[Music]
[Narrator:] A pleasant pastoral scene, a farm not far from you, in a placid river valley,
a friendly place, haven of memories.
Grandpa's farm where dad worked and played as a boy.
A silo, a barn, a shed, a peaceful setting for a visit by the children on a sunny Sunday afternoon.
Or a place to shun like the plague, beware of histoplasmosis.
[Histoplasmosis]
[Church bells ringing]
The University of Kansas presents Highroads to Health, produced in cooperation with the
Kansas Tuberculosis and Health Association and the Communicable Disease Center
of the Public Health Service.
Today's program is entitled the Mississippi Valley Disease, Histoplasmosis.
This young lady with her physician and nurse is Sandra. Sandra lives in Kansas City.
At intervals for the past eight months, her home has been a Kansas City hospital.
Sandra has histoplasmosis.
All that medical science knows about this disease is being used to help Sandra.
The marks made on her body by physicians outline the enlargement of her spleen and liver,
the internal organs most seriously affected by the disease.
The doctors studying the size of these organs can determine the progress of the disease,
but these marks are not Sandra's alone. Histoplasmosis has left its scars on most of us.
This program is about 30 million other residents of the central United States, persons who carry evidence,
like Sandra, of a disease which sometimes kills, often brings severe illness,
baffling physicians and is so little known that even your doctor is just beginning to hear about it.
Yet this disease is so common that if you are an adult living in the Mississippi basin,
chances are four to one that you have scars to prove that you, too, have been marked by histoplasmosis,
a disease which in its severe form should be avoided, as you shall see.
This man, working at his desk, is one of the world's authorities on histoplasmosis.
He is in charge of histoplasmosis research for the Public Health Service
at the University of Kansas Medical Center in Kansas City.
I shall be your voice, this is Michael L. Furcolow, M.D. Good evening doctor!
[Dr. Furcolow:] Good evening.
[Narrator:] Dr. Furcolow, I understand your specialty is fungus diseases of the lungs.
[Dr. Furcolow:] That is correct.
[Narrator:] Would you tell us first what is a fungus and how does it cause disease in human beings?
[Dr. Furcolow:] Well, a fungus as most of you know is a plant, a mold, most of you have seen molds
growing on bread, old bread or in moist places,
This is an enlargement of a group of fungus colonies showing the moldy characteristics.
Actually this is an enlargement of the histoplasma capsulatum fungus which causes histoplasmosis.
And this is a microscopic picture of this same colony showing the spores which cause infection
when they are inhaled in human beings.
[Narrator:] What are some of the diseases beside histo caused by fungi of this type doctor?
[Dr. Furcolow:] Well, there are a number of these and unfortunately all of them have
very complicated names; however, I would like to speak to of four of them very briefly.
The first is coccidioidomycosis. This is a fungus disease which occurs in the southwest,
in the area of California and over to Texas.
This causes lesions in the lungs and in the bones.
Next is blastomycosis, this is a fungus disease that occurs in the southeast and up to Wisconsin.
It causes lesions in the skin and in the bone.
And then cryptococcosis, which causes lesions mainly in the bone,
and causes a fatal disease in some cases.
And finally there is the Mississippi valley disease, histoplasmosis.
[Narrator:] Dr. Furcolow why do you call this Mississippi Valley disease?
[Dr. Furcolow:] Well, this is because it's so common in the Mississippi Valley,
as I will show you from this map.
This is a map, of course, of the United States showing in this area which covers the Mississippi, Ohio,
and Missouri valleys, that more than half of the people in this entire area are infected
with histoplasmosis.
As a matter of fact in this area about 80 percent are infected.
[Narrator:] Dr. Furcolow, I happen to be a native of this area, Kansas to be exact, do you...
[Dr. Furcolow:] That's right and we gave you a skin test several days ago, didn't we?
[Narrator:] Yes, you did.
[Dr. Furcolow:] Let's see your arm.
[Narrator:] All right.
[Dr. Furcolow:] Oh, just as I thought, positive.
[Narrator:] What does that mean?
[Dr. Furcolow:] Histoplasmosis.
[Narrator:] You mean I've got it?
[Dr. Furcolow:] No, no, you've had it.
[Narrator:] I see what you mean.
[Dr. Furcolow:] Well, I'm not sure that you do. You remember from this map that about 80 percent
of the people in this large area of the United States have had the disease.
This means there are many mild cases.
[Narrator:] Well doctor, why is it so common in this area?
[Dr. Furcolow:] We are not sure of this, but it appears that certain elements of humidity and temperature
in this area favor the growth of the fungus whereas in other areas of the country this,
these conditions do not exist.
[Narrator:] If histoplasmosis is so common then two questions, first is it serious and second,
why have we heard so little about it?
[Dr. Furcolow:] For the answer to these questions, we'll show you a film, and from happens
to a family that has histoplasmosis, you can get an idea whether it's serious or not,
and you can begin to see why you've heard so little about it.
[Video playing]
[Narrator:] This pleasant pasture land in central Missouri provides excellent grazing for dairy cows.
Good hay and silage produce rich milk.
This silo on Frank William's rented farm hadn't been used for years.
The roof had come apart with weather and wind, and vagrant pigeons had moved in.
An active colony of pigeons, nesting, feeding, defecating, living with the blackbirds, starlings,
and sparrows.
This year, Frank with a neighbor and son David decided to clean the old silo for use once again;
decided to remove its accumulated feathers, droppings, straw and assorted rubbish.
It was hard, dirty work inside the silo, digging up and throwing out the debris.
And most unpleasant breathing from the dust.
Even on the outside, the air was filled with the silo dust. Neither David nor his father Frank
enjoyed the work.
It was nine days after the silo clean-up that David abruptly became ill.
He was hot and then he felt a sharp chill.
It was a bad night, first hot and then cold, sweat and then chills; the onset of a severe illness,
frustrating, frightening.
His temperature was taken by David's mother.
When she saw his condition, she was worried, but the temperature reading frightened her.
It was over 105 degrees, a severe fever.
Time for the doctor and penicillin quickly.
The doctor thought it might be pneumonia or TB.
Father Frank on that same morning was far below par.
He was weak, dispirited.
His muscles were achy, stretchy, sore.
But he was able to get up and go to work, just barely able.
David, on the other hand, went speedily to hospital isolation, suspected of having galloping TB.
David's general practitioner, puzzled about the accurate diagnosis, had asked an internist
for consultation.
The consultant was concerned with an unexplained enlarged spleen.
A continuing high fever with its prostration and lung findings was certainly suggestive of galloping tuberculosis.
But in a husky youth, in early fall, without a history of tuberculosis contact?
The doctors continued to doubt their diagnosis.
The consultants showed the curious x-rays to a research worker in chest diseases for his advice.
David's skin test for histo was positive, evidence of the disease.
While the skin test for TB was negative, no evidence.
Diagnosis: histoplasmosis.
The masks could be removed; no danger to others.
And a relief to David to know it was not contagious even if dangerous to himself.
Frank's chest x-ray also showed similar lung inflammation, despite his mild symptoms.
The skin test was positive.
The blood was positive.
He, too, had histo mildly.
The investigator tracing the little epidemic visited the barn's silo.
The straw, rich in pigeon guano and possibly rich in histo spores, was collected.
These samples would later be tested in the laboratory.
Outside, more of the same rubbish with its bird droppings and possibly containing dangerous histo spores,
was collected in a separate container for study.
Back in the laboratory, a mouse was injected with a suspension of the suspected dust from the silo.
Histo was found.
Blood tests were run on everyone in the family, including the neighbor,
who helped during the clean-up.
Lab cultures were done on sputum from Frank and David.
Yes, colonies of histo with their fuzzy mold growth.
Histoplasmosis, from the dust of the leaky old silo with its bird colony.
[Dr. Furcolow:] Well what do you think, was it serious?
[Narrator:] It certainly was for David, the boy, but why did the father have a milder case?
[Dr. Furcolow:] Well, you remember that he was outside the silo,
and he got less of that dust with the spores entering into his lungs.
[Narrator:] Doctor, you still haven't answered fully why we have heard so little about the disease.
[Dr. Furcolow:] Well, there are several reasons for this.
You remember that David was supposed to have had tuberculosis.
[Narrator:] Yes, I wondered about that.
[Dr. Furcolow:] Well, this tuberculosis and histoplasmosis are often confused,
as I'll show you on this chest x-ray.
This is an x-ray of the chest as is this showing the ribs and the heart.
In this x-ray the inflammation in the lungs is seen with cavitation, this is due to tuberculosis.
In this x-ray, which as you can see looks very similar, this same inflammation is seen
with the cavities and this is due to histoplasmosis.
[Narrator:] Well, the x-rays look almost identical doctor.
[Dr. Furcolow:] Indeed they are identical and this has been one of our difficulties.
[Narrator:] Well, how can you be sure then, that a disease is histoplasmosis?
[Dr. Furcolow:] Well, we have learned by various methods to differentiate this disease,
such as for instance, skin tests which you saw on the narrator a short time ago,
and then we have blood tests which reveal whether the disease is positive or active or not.
[Narrator:] Well, doctor, as you said, my skin showed positive,
but I don't ever remember having the disease.
[Dr. Furcolow:] This has been one of the troubles. The disease often is so mild,
and actually up until 1945, there were very few cases of the disease reported, and they were all fatal.
And then in 1945, the Public Health Service established a laboratory at the University of Kansas Medical Center,
and in this laboratory we have done many studies of histoplasmosis.
Studies here and elsewhere have shown that a large proportion of the people
in the Mississippi Valley are infected; in fact 80 percent of residents of the Mississippi Valley are infected.
And we have found that the disease mimics other diseases such as influenza for instance.
[Narrator:] Influenza then is another disease mimicked by histoplasmosis,
like David's father in the film.
[Dr. Furcolow:] That is correct and others, typhoid, leukemia and many other diseases are mimicked
by histoplasmosis, and the patient and his physician are often very happy to find that
the disease is histoplasmosis because in most cases patients with histoplasmosis recover.
[Narrator:] Well, you've told us quite a bit about histo already...that it is often mistaken for other diseases,
you can identify it by skin tests. What else have you discovered about this interesting disease
since the beginning of your studies in 1945, doctor?
[Dr. Furcolow:] Well, we have discovered many things, for one thing where the organisms grow.
How it enters the body, that the body builds immunity and that the disease is not communicable
from person to person or from animals to persons.
[Narrator:] You said you know where the organism grows, where does it grow doctor?
[Dr. Lehan:] Most commonly in this area it grows in chicken coops as seen here, or in silos,
especially those frequented by pigeons.
Also it's been found in caves in the ground, or in stumps, in tree stumps or in old rotting logs
and also in storm cellars such as this.
And actually, there was a large epidemic in a storm cellar in an Army camp in Louisiana when a
number of men burned logs which they had collected and which
were found to have the spores upon them.
[Narrator:] It occurs to me doctor, that all of these examples refer to the country.
What about city dwellers and this disease?
[Dr. Furcolow:] Well, we have found in studies in Kansas City that city dwellers, most of them,
seem to get their disease by going to the country, and actually they probably go out to grandma's farm
and they enter the chicken coop or similar place and that's where they acquire their disease.
[Narrator:] What about products from the farm purchased by city dwellers, products like chickens
or eggs for example.
[Dr. Furcolow:] These are perfectly safe to use, there have been no infections from chickens or eggs.
[Narrator:] Do I understand that the organism actually enters the body through breathing of the spores, is that correct?
[Dr. Furcolow:] That is correct, the spores are inhaled with the breath into the lungs,
and the lungs set up an inflammation around each little spore so that when the disease heals,
it looks something like this.
And this is a picture again of an x-ray showing all these little dots which represent healed,
calcified organisms in the lung, and incidentally this type of x-ray is the type which made us at one time doubt
the validity of the tuberculin test.
This was because we found negative tuberculin tests in people whose x-rays looked like this.
However, we now know since histoplasmosis causes this type of x-ray, that the tuberculin test,
you know the test given in the skin of the arm with a syringe such as this, we now know that this
tuberculin skin test is valid and that it is a good tool for finding tuberculosis.
[Narrator:] Would you say doctor that your studies have shown that the body builds
an immunity to this disease?
[Dr. Furcolow:] That is correct.
The immunity to histoplasmosis is such that we have never found the case in a patient
who had a positive skin test to relapse again and recur.
[Narrator:] Well, doctor we've learned a great deal from you about the disease, certainly none of us
wants to get it, especially in its severe form.
So we have two more questions for you, first is it easy to get and second, how can we avoid it?
[Dr. Furcolow:] For the answers to these question I would like to introduce to you exhibit X.
This is Dr. Patrick Lehan, my associate in the Public Health Service.
Meet Dr. Lehan.
[Narrator:] Glad to know you doctor.
[Dr. Furcolow:] Dr. Lehan the question is, is histoplasmosis easy to get
and how can one avoid it?
[Dr. Lehan:] Well, Dr. Furcolow has identified me as exhibit X.
The reason for this happened some months ago.
Actually the story took place in central United States where I was sent to investigate an outbreak
of unusual illness occurring in a family named Barley.
[Narrator:] The Barley family were newcomers to the farm but they were taking hold like natives.
Dad liked to putter in the garden, was taking pride in the shrubs on the front lawn.
Mother was not fond of everything about the farm, pumping water for example, but there was always
grandmother to help, especially in the care of the baby.
And the baby loved the farm, most of all the pump.
Another thing mother didn't like was the water, fine for washing but for drinking, bitter.
She hoped it was safe.
No one else in the family complained about it and they were all so much healthier since they moved
from the city, she knew the farm must be better for the children.
How they liked to play. The middle-sized boy was Billy.
In yard games he was often the victim of his big brother Henry, but Henry was gentle with his little brother
and Billy enjoyed the fun even if he was the victim.
Mary, the only girl, was always the heroine.
Mother had never done her washing on the front porch before moving to the farm,
but this was the practice in the hills and she, too, had discovered its advantages.
It was a pleasant place to work.
Grandmother was always easygoing, she seemed to fit in wherever she was.
The best features of the farm to mother were the air, the view, and plenty of elbow room.
Dad could see that the farm needed improving.
First of all he wanted to get some livestock, and he figured he knew where he could put them,
in the empty building in the side yard, yes that was the place for pigs, the old chicken house.
Soon the pigs were in their pen, dad and the three other children were on hand to see that the
new farm residents were properly welcomed and comfortably housed.
It was a memorable day that first week in September. Now the Barleys were farmers.
It was several days before mother had time to welcome the new arrivals.
She wasn't especially fond of pigs anyway, but she thought the baby would enjoy seeing them.
Then something hit the three oldest children.
Little Billy was taken to the county hospital for examination and treatment along with his big sister Mary,
both of them with high fever, chills, headaches, coughing and vomiting.
And big brother Henry who seemed to have the most severe illness of all the children.
The doctor was quite concerned. Mother thought she knew what was wrong
She told the doctor about the water, the bitter water.
The doctor revealed his suspicions, typhoid.
Now every one was concerned about Henry.
Back on the farm, dad was trying to take care of things but he wasn't feeling so well.
Not bad enough to go to bed, but not good enough to work very hard.
A slight case of flu he thought, an occasional coughing spell.
A little stomach upset and very little ambition.
Grandmother on the other hand stayed healthy and took care of the baby.
Though suddenly several days later the baby became ill and was hospitalized.
At the same time mother became sick and she was admitted for x-rays and observation.
Her symptoms, too, were chills, fever, headache, coughing.
It was time to call for a specialist from the Public Health Service.
Lung x-rays showed tell-tale spots.
All members of the Barley family were given the skin test which would show the presence
of absence of an old enemy.
Histoplasma was injected in the forearm of each patient. Forty-eight hours later the suspicions
of the specialist would be verified when red blotches would indicate a positive reaction,
evidence of histoplasmosis.
Next step for the researcher, a visit to the Barley home. Where was histo's lair on the farm?
This was a question for which the Public Health Service wanted an answer in its continuing quest
for more knowledge about the causes of the diseases.
Grandma, still well and helpful, was there to greet the researcher.
This assignment called for no super detective work, all he needed to know was the location
of the old chicken house.
Armed with that information and the simple tools required in his own kind of research,
a satchel containing boxes in which to collect soil samples, and the curiosity of the animal kingdom,
including pigs and human beings.
He was soon at his work inside the structure scraping that suspicious-looking soil into the
cardboard containers, soil which he would examine more carefully in his laboratory.
Certainly this was the kind of place where one might expect the fungus to fly, a shed formerly
used by chickens, later unoccupied, left vacant long enough for the fungus to grow undisturbed.
Now disturbed again, releasing spores into the air, soon he would know whether this was also
the home of histoplasma capsulatum.
[Music]
The researcher returned to his laboratory to inject mice with the suspected soil from the chicken house,
and to work at his routines.
But there was a quicker way to run a test, Dr. Lehan himself suddenly became acutely ill
with an abrupt onset at 4:30 a.m., five days after his return from the Barley farm.
Restless, feverish, burning hot, but also chilling, shivering.
His alarmed nurse wife took his temperature. It had leaped to 105 and a half degrees.
Small wonder the acute discomfort, the sweating, billowing; comfortless, sleepless unease of an
acute histopneumonia.
Off to the hospital where x-rays showed the shadows of histo in the lungs.
Histo inflammation of the large vein to the leg on pressure produced excruciating pain,
produced also swelling which prevented walking.
The hospital chart recorded the spikes of a high and continuous fever, this was not the kind of a
disease you would walk into if you could avoid it.
Blood drawn for serological tests, was positive for histo.
Fluid in the lung cavity was drawn off by syringe and was squirted onto Petri dishes for culture
in the laboratory.
In the laboratory it received further handling before incubation. Days later under the microscope,
the answer was clear, clear beyond question were the characteristic round colonies of the
fungus histoplasma capsulatum,
from the old chicken coop on the picturesque farm in central Missouri.
[Dr. Furcolow:] Now you know why I called Dr. Lehan exhibit X.
[Dr. Lehan:] And that histoplasmosis is easy to get.
All one has to do is breathe in some dust that contains spores.
[Narrator:] How are you getting along, Dr. Lehan?
[Dr. Lehan:] Just fine, thank you.
[Narrator:] Good and what about the two families shown in the film?
[Dr. Lehan:] Oh, they're all better now.
[Narrator:] Very fine, there's still one question which remains unanswered.
How do you avoid the disease?
[Dr. Lehan:] Well obviously I'm no expert at this and uh, I think we can point out however,
the common sources, the places where this fungus grows, the old chicken coop, the silo, the cave, decaying logs
and the storm cellar. These places should be avoided.
[Narrator:] But farmers must clean chicken houses, mustn't they?
[Dr. Furcolow:] Yes, that's true, but the best thing to do in avoiding the disease
would be to keep children out of chicken houses since they have such serious effects from the disease.
And also, it would be well to wet down the material so that the spores wouldn't become airborne
when one is cleaning by wetting it down with some water or disinfectant.
[Narrator:] Dr. Furcolow, how did grandmother avoid the disease?
She went out to the chicken coop but she didn't seem to get it.
[Dr. Furcolow:] Well, you remember that grandmother was a native of this area
and therefore she probably had had an infection some years previously and was immune.
[Narrator:] One final word then, two days ago you gave the histoplasma skin test to a number of us here.
What did you want to demonstrate by this, doctor?
[Dr. Furcolow:] Well, if this test works the way it should, we will show that persons who don't live
in this area, were not natives of this area such as Dr. Lehan, who came here from Long Island
in New York, that these people are not infected.
And in natives of the area, as we have shown, most of them are infected.
If Dr. Lehan will give me a hand and read the skin tests, I will record them on the board
and we will see where the positives fall on this map of the United States.
Now we have Dr. Lehan who was infected here and our narrator who was positive over here
and how about some more readings.
[Dr. Lehan:] Gentleman come in please, where you from sir?
[Man 1:] New York, doctor.
[Dr. Lehan:] Negative, New York.
How about the floor man? Step right in, where you from, sir?
[Man 2:] Missouri.
[Dr. Lehan:] Positive.
Cameraman?
Where you from, sir?
[Camera man:] Missouri.
[Dr. Lehan:] Positive.
Would some of the audience and others come in please?
Where you from, sir?
[Man 3:] Texas. [Dr. Lehan:] Negative.
[Man 4:] Kentucky. [Dr. Lehan:] Positive.
[Narrator:] So Dr. Furcolow what does our map look like now.
[Dr. Lehan:] Positive. Negative
[Dr. Furcolow:] If you look here, you will see that the positives fall in the area of the Mississippi Valley.
[Narrator:] So we see that histoplasmosis has left its mark on most of us who are adults living in this area,
and we know that here is where the fungus grows best, developing spores which are
dangerous to children, to newcomers to the area, and to 20 percent of the rest of us who are not immune.
Let this circle of infection be our warning. Beware of the Mississippi Valley disease, histoplasmosis.
[Music]
[Narrator:] This program, one of a series entitled Highroads to Health, has been produced
in cooperation with the Kansas Tuberculosis and Health Association and the Communicable Disease Center
of the Public Health Service.
[Music]
[Church bells ringing.]
This has been a University of Kansas television production.
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