Throwback Thursday: The Casper Project shows world how to fight rheumatic fever, March 17, 1957
By Kristy Bleizeffer Mar 4, 2021
In the 1950s, rheumatic fever, and its associated heart disease, killed 22,000 people a year. This was before the widespread use of antibiotics to combat strep throat, the disease's precursor. Casper showed the world how to stop rheumatic fever in its tracks.
In 1954, Dr. Brendan Phibbs and eight other doctors on our medical staff launched The Casper Project, according to “Wyoming Medical Center: A Centennial History,” written by historian Rebecca A. Hunt, Ph.D.
The effort trained nurses and teachers to swab and culture school children’s throats each morning for the quick detection of strep throat, which can lead to rheumatic fever when left untreated. Kids found to be infected were not allowed back in school until they started treatment or tested negative. Mothers and other volunteers also stepped up to help the program.
The mandatory program was so effective at preventing rheumatic fever that its results were published in the Journal of the American Medical Society in 1958: "On the basis of experience in the past, 18 and 27 new cases of rheumatic fever would have been expected for the school years 1955-1956 and 1956-1957 respectively; instead, only 3 and 2 cases were found." The nine doctors who published the article were Brendan Phibbs, Donald Becker, Charles R. Lowe, Roy Holmes, Robert Fowler, Oliver K. Scott, Kenneth Roberts, Walter Watson and Ralph Malott.
Cities around the world modeled similar programs after project, and if you remember standing in line to get your throat swabbed while in elementary school, you have the Casper Project to thank for it.
On March 17, 1957, the Denver Post published a 1,168-word feature article on The Casper Project featuring several photos of teachers and students: "Casper, with a population of 30,000 in the heart of a great inland oil empire, is teaching the world how to fight rheumatic fever in a city-wide cooperative plan involving doctors, volunteer lay workers, and almost 10,000 school children," wrote the Post's Bernard Kelly.
Today, with good medical care and antibiotics, rheumatic fever is rare in the United States. But our fight against this disease is a good reminder of what we can accomplish when we pull together - particularly when you have the help of an industrious mother from Poison Spider School. (Read the article to see what we mean. It's transcribed below.)
CASPER FIGHTS RHEUMATIC FEVER: DAILY CHECKS FOR STREP THROAT IN EVERY SCHOOL THE AREA KEEP DOWN THE NUMBER OF CASES OF THE DREAD DISEASE
By BERNARD KELLY
A line of children forms in the gymnasium of St. Anthony's School, Casper, Wyo. At the head is a pretty 8-year-old girl.
"Say 'Ah,'" a young matron directs, and trains the beam from a flashlight down the little girl's throat.
"Ah-h-h!" says the child.
"Red," say the woman to another. She reaches for a swab, gently moves it over the inflammation in the child's throat and places it in a test tube. One more child is coming under the protection of modern medicine. There may be one less case of rheumatic fever in Casper.
Casper, with a population of 30,000 in the heart of a great inland oil empire, is teaching the world how to fight rheumatic fever in a city-wide cooperative plan involving doctors, volunteer lay workers and almost 10,000 school children. And because it has been deliberately simplified and trimmed of every excess step, the cost of the program in the Casper area last year was only 8-cents per child.
Under the program, children with streptococcal throat infections are banned from schools in and near Casper. Rheumatic fever can kill or cripple by damaging heart valves. It hits adults, too, but affects more children than adults. It develops after an infection of the throat or chest with a certain type of streptococci germs. By using penicillin or one of the other powerful antibiotics against the earlier infection, or "strep throat," the number of resulting attacks of rheumatic fever can be greatly reduced.
The Rocky Mountain region has more strep throat per capita than any other region in the United States. That's the problem that Casper has attacked with massed forces.
Dr. Brendan Phibbs, Chairman of the Natrona County Medical Society's rheumatic heart disease control committee, said the program started in 1955 on a pilot basis with children from one school examined daily for strep throat. In the school year 1955-56, the program was extended to include all the public and parochial schools in the Casper area and the work in continuing this year. It is too early to talk of dramatic results. But the doctors are hopeful.
Experts estimate that 3 percent of the children who contract strep throat will come down with rheumatic fever. If we accept that figure, out of 1,277 positive cultures developed in Casper so far during the city-wide program, the number of cases of rheumatic fever should have been about 38. Actually, five cases have been discovered since the city-wide program was instituted.
"We do know that every time we treat a child with penicillin, he is not going to get rheumatic fever," said Dr. Donald Becker, pathologist at the Natrona County Memorial Hospital and a key figure in the plan.
Here's how the program works: Every school morning, teachers ask their children if any do not feel well. Those reporting symptoms are sent to a central point in the school to have their throats checked. This is done by mothers or members of service groups who have been especially trained by Casper's doctors. The children line up. It's fun for them, and they get out of the classroom for a little while and there is almost no chance any will "cover up" symptoms.
As they come forward, one of the workers examines the throat of each child. She is looking for one of these four symptoms: Enlarged lymph glands along the side of the neck, beefy-red or lipstick-red throat, post nasal drip or fever, all easy to spot. If any is present, the worker takes a culture by swabbing the throat of the child with a sterile swab. This is placed in a test tube and labeled with the name of the child and his school.
After the session, one of the workers takes all the tubes to the laboratory at the hospital. The children go back to class. At the lab, Mrs. Lois Wheeler, nurse, plates each of the swabs on a circular plate marked off in sections like a tiny pied. Each is identified by a number and school. These plates go in the incubator overnight. Then Dr. Becker, the pathologist, reads the growing cultures for streptococci and transplants all of these to a second plate. Again they are incubated overnight.
The second morning, the cultures are again examined and this time, the type A Streptococcus -- the dangerous one -- is differentiated from the type D, which is not dangerous. Now the cultures which are twice positive are identified as to child and school. Dr. Becker's secretary, Mrs. Maxine Cochran, reports these names by phone to the school principals. The principals send each of the infected children home immediately with a form letter explaining to the parents that the child has a streptococci infection, and asking that the child be taken to the family doctor for a shot of long-acting penicillin. The form must be initialed by the doctor before the child can be readmitted to school.
The child treated with Penicillin usually is free of symptoms within 24 hours. Recheck cultures are performed within 10 days on many of the infected children. But when the child repeatedly shows up with positive symptoms, the workers arrange to examine other members of the family.
In 60 families in which one positive culture was taken, 35 percent showed infection present in one or more of the other members. All were asked to obtain proper treatment from their physicians.
During the school year 1955-56, a total of 8,120 cultures were taken with the total positive for beta hemolytic streptococcus (of) 587, or 7.2 percent. From Sept. 1, 1956, to Jan. 1, 1957, a total of 6,590 cultures were taken with 511 positive, 8.53 percent. From the first of the year to the time this article was written, another 179 positive cultures were found.
What does the program cost? In Casper, it costs much less than it might elsewhere, thanks to enthusiastic help given by doctors, teachers, mothers and hospital personnel. To meet actual needs, the Casper United Fund this year gave $500 and the Wyoming Heart Association gave $1,000.
"We have deliberately simplified the program so that it can take in all school children," Dr. Becker said. This is done by culturing only the children with strep throat symptoms.
Similar programs have been started, on a two- or three-school basis, in Miami, Fla., Cleveland, Ohio, Philadelphia, Pa., and London, England. Sheridan, Cheyenne, Riverton and Midwest, Wyo., are undertaking test systems.
Nothing could be done, Dr. Phibbs said, without the unfailing service of the mothers. At Poison Spider School, 20 miles west of Casper, 101 pupils are brought to classes by school bus. One of the mothers drives 15 miles from her home to Poison Spider School, then drives 20 miles to Casper with the tubes containing swabs, drives 20 miles back to the school with replacement supplies, and then 15 miles home - a total of 70 miles.
For Poison Spider had the highest percentage of positive cultures of all Casper area schools at the start of the program. Now it has the lowest.
Throwback Thursday looks back on Wyoming Medical Center’s long, rich history in Natrona County. Special thanks to the Casper College Western History Center, which archives our vast collection of newspaper articles, photographs and other memorabilia; and to "Wyoming Medical Center: A Centennial History," by Rebecca A. Hunt, Ph.D.