Medicine: Valley Fever

One of the most stubborn of California’s public health problems is the high incidence of coccidioidomycosis (“valley fever,” “desert fever”) among farmhands, sheepherders and oil workers of the San Joaquin Valley. Although coccidioidomycosis was first recognized in 1893, it was not until last June that a complete picture of the course of the disease was presented to physicians. Last week, at the San Francisco meeting of the Society of American Bacteriologists, Dr. Ernest Charles Dickson of Stanford Medical School, pioneer worker in valley fever, gave the first public, comprehensive account of the disease he had studied for 20 years.

Cause of the disease is the reproductive spores of the coccidioides fungus. which are found in grape, hay and cotton dust—primarily in the San Joaquin Valley. When the spores are inhaled they settle in the lungs, cause symptoms similar to those of flu, common cold or bronchopneumonia. In a few days the “cold” clears up, but a week or two later, painful red swellings appear on the shins, thighs, arms, scalp. Known to valley workers as “the bumps,” this erythemanodosum lasts anywhere from a few days to several weeks. When it finally fades, leaving only brown spots, the first stage of the disease is complete. There is no specific treatment for the erythema, but even without a physician’s care practically all the victims recover.

More rare and more deadly is the second stage, known to physicians as coccidioidal granuloma. Any time after an attack of “valley fever,” about one patient in 500 develops symptoms of tuberculosis: enlargement of lymph nodes, lesions of the bones. Large ulcers develop all over the body and after extended suffering, 50% of the patients die. Medicine can offer them no help, for doctors know little of the course of the disease.

Only procedure is to treat coccidioidal granuloma like tuberculosis. By 1936, said short, bright-eyed Dr. Dickson, 450 cases of the secondary disease had been reported in San Joaquin Valley, most of them in Tulare, Kern, Kings and Fresno counties. The disease is not contagious and attacks animals as well as men. Why San Joaquin Valley is the centre of coccidioidomycosis, Dr. Dickson could not say. Perhaps the hot dry summers, he suggested, favor the growth and reproduction of the fungus. Certain it is that the disease is not spreading beyond the valley.