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[NOTE FROM DR. JOHN W. BROWN, PRESIDENT OF THE LOCAL BOARD OF
OCEANA, WYOMING COUNTY, W. VA., December 24, 1883. DEAR DOCTOR REEVES—During our small-pox trouble in this county we had abundance of undoubted proof of the power and utility of vaccination. In every case, I believe, where there had been a successful vaccination (no matter how old the vaccination was) there was only a case of “varioloid.” And in some instances it seemed to extend further than this, for in Mr. Burton's family (where the whole family was attacked) this was noticed, viz., that where the part of the family that had been born to them before the vaccination of the parents all had small-pox in severe form, and the part born after the vaccination of the parents, had the disease in a mild form, thus showing that even the offspring of those success-fully vaccinated are not as liable to small-pox as those who are the issue of unvaccinated parents. Then again, this fact, a lady who was “pregnant” at the time of being vaccinated, and who gave birth to her child during the heighth of the epidemic, the child only suffering after birth from a mild varioloid.
I can say this, I think we had full confirmation of the power of arresting and diminishing the violence of the disease by vaccination, for there were several exposures of persons who had been vaccinated and escaped the disease.
JNO. W. BROWN.1
EPIDEMIC AND CONTAGIOUS DISEASES.
BY GABRIEL M’DONALD, M. D., UNION.
The malignant and fearful character of small-pox is well-known. It is: characterized by a period of incubation-the period between exposure to the contagion and the development of the disease-of about two weeks. The initial symptoms are chilliness, severe pain in the back, fever, headache, sickness of the stomach and, frequently, vomiting, and soon follows another and decisive symptom-namely, the eruption, the character of which foretells the gravity of the disease. At first, the eruption is: papular, then vesicular, next pustular, and then umbilicated.
“In the first stage of the disease, before the contents of the vesicles become turbid, it may be confounded with measles. In measles there is, however, a crescentic arrangement of the eruption which does not obtain in variola, and the marked co-existence of coryza (cold in the head) and other catarrhal symptoms, such as a peculiar, if not a characteristic cough.
“The above symptoms constitute the rule in measles, and the exception in
small-pox. The first indications of the eruption in variola usually show themselves about the forehead and wrists, which fact is said to be peculiar to small-pox. An interval of four days without any characteristic advance in the appearance of the eruption, areola, vesication, umbilication, excludes the idea of small-pox.
"Varicella (chicken-pox) may be mistaken for small-pox, but in this disease the vesicles are much more scattered with less redness around the vesicles. The vesicles appear in successive crops. Moreover the constitutional symptoms are much less grave than in variola. Varioloid is a modified form of small-pox. It occurs in persons who have been vaccinated and who are partially protected. The symptoms are similar to variola, but usually much milder and the disease is ordinarily much less grave in its character. But it is capable of producing true small-pox; that is, each may produce the other; therefore, the sanitary rules in regard to the two diseases must be the same. The supposed epidemic character of smallpox does not rest on any substantial ground, and there is no evidence to prove that it is ever caused except from contagion or previous exposure to the disease or something emanating from it. That for certain reasons not clearly understood, small-pox, and some other contagious diseases, sometimes prevail so extensively as seem to be the result of epidemic influences, but even under these circumstances, that there is always a contagious influence or a previous exposure to such contagion either directly or indirectly may be taken for granted. There is no sufficient evidence that endemic or climatic influences have much to do with the propagation of the disease, but overcrowding, filth and improper ventilation predispose to the spread of the disease, and this fact is proved by statistics.
"That certain nationalities are more prone to the disease than others is probably due to their ignorance and superstition, and especially to their prejudice against vaccination.
"The poison of small-pox may be conveyed by the pus excretions and secretions and anything that becomes impregnated with these substances, such as clothing, either of the body or bed. Public conveyances are probably frequent sources of the disease. The air for a limited distance around becomes impregnated with the poison; for when it is remembered that each individual exhales about 'six hundred thousand cubic inches of air daily,' besides the body emanations, we can readily understand how poisonous and polluted the air must become under these circumstances, and consequently how fearfully contagious it becomes in close proximity to the disease. When it is remembered that the disease not only spreads directly by coming in contact with it, but indirectly, through clothing, or perhaps money, or letters, or many other things that have become saturated with the poison, and moreover, when we remember with what tenacity the poison adheres to clothing, bedding, carpeting, curtains, buildings, etc., it is not strange that it sometimes spreads with such rapidity and with such obscurity as to be regarded as epidemic; but a close and thorough investigation will perhaps nearly always demonstrate a previous exposure to a contagious influence.''
MANAGEMENT OF CASES..
"The management of contagious diseases necessitates co-operation between physicians at large and the sanitary authorities. The Sanitary Bureau should consist of a superintendent or head and a sufficient number of inspectors; besides these there should be a corp of vaccinators and one for inspection, as well as an ambulance corps. The proper care of small-pox also requires a comfortable hospital, at a safe distance from inhabited districts.” The method adopted in the city of New York is as follows: The physician in charge of the case is required to report the name and residence of the patient, and a diagnosis of the disease. When such notice is given, the inspector of the district is expected to visit the case at once and report by telegraph his instructions. Should the patient be found in a house where isolation is infpossible, and it is possible to remove him without compromising life, the inspector's telegram directs that the case be removed to the hospital at once, and the premises be disinfected and fumigated. If the friends object to the removal, another inspector is called in, and if he concur in the previous report the police are called in and the case removed to the hospital. The corps of disinfectors next visit the house and carry out the prescribed plan, while the vaccinating corps vaccinate all persons in the house and vicinity whom they can persuade to submit to the operation. In this way the disease is ordinarily promptly arrested. “Isolation of the case is only possible when the patient has been taken sick in a private house or on the top floor of a tenement house. In such cases it is imperative that all communication with other persons be stopped, the nurse and the physician being the only persons who should be admitted to the sick-room. All members of the family should be sent away, provided the nature of the disease is discovered before the end of the third day, but in any case they should be immediately vaccinated. Children of the family should be kept from school, and the teacher informed of the circumstances. This isolation should be kept up certainly for three weeks, or until the separation of the scales take place, and until the apartment and clothing have been carefully fumigated and disinfected."
DISINFECTION AND FUMIGATION.
"In small-pox cases, as well as in other eruptive contagious disease, it is well to anoint the body surface with some fatty or oily substance to prevent the detachment of expatiated substances, which might be carried to a distance and become the source of contagion. The excreta of the patient, as well as the soiled linen, carpeting and bed clothing, should be subjected to careful disinfection. A tub filled with warm water, to which has been added sulphate of zinc, six oz. to the gallon, and carbolic acid, one oz. to the gallon, and all underclothing, rags or cloths used about the patient should be soaked in this solution or burnt; and besides cloths should be dipped in this solution and hung about the room." After convalescence it is well to burn all useless clothing and bedding, or if valuable they must be thoroughly disinfected and fumigated.
"After convalescence the room should be subjected to fumigation. One or two pounds of roll sulphur should be broken up and placed in some old iron or tin vessel and floated in a tub of water. After the room is vacated, and all living creatures removed, some alcohol must be poured over the sulphur and ignited The windows and doors should then be closed and kept so for half a day. The room, after being thoroughly aired and ventilated for some hours, or better still for some days, may be re-occupied. As additional precaution, saucers filled with a solution of pennanganate of potash, an ounce to a pint, may be placed about the room out of the reach of children and others, and the room may be still further ventilated by leaving the windows and doors open for some days."
Of all hygienic and sanitary measures, there is nothing in the history of medicine comparable to vaccination as a means of preventing small-pox. It strikes at the root of the matter by destroying the pabulum upon which the disease feeds and thus prevents its direful effects. Before the immortal Jenner discovered vaccination, small-pox was doubtless the greatest scourge of the world. While war and famine slew their thousands, this pestilence swept off its tens and hundreds of thousands every year. The death rate from small-pox in London during the last century was one hundred and ninety-nine thousand six hundred and eighty-five annually. As an evidence of the salutary effects of vaccination during the year ending December 31, 1875, there were admitted to the Riverside Hospital, New York, 2,427 cases of small-pox, and of these 674 died. Out of the total num- , ber 1,866 had been vaccinated; among these there were 375 deaths; 405 had never been vaccinated and among them there were 200 deaths. Among the vaccinated the mortality was 20.09 per cent., and among the unvaccinated 49.38 per cent.".
The fact has been shown by Mr. Farr's tables, that over 50 per cent. of the patients who die, are under five years of age. It is believed by this author that such mortality is due to imperfect or neglected vaccination at an early age.
"The decided influence of vaccination in the modification of the disease, is well shown in the statistics of the London Small-pox Hospital during the same epidemic of 1838. Of those un protected by vaccination, 295 cases of confluent small-pox were admitted, of whom 149 died ; while of those who had been vaccinated, there were only presented 56 cases of confluent smallpox, and of this number 21 died. Of all forms of variolous disease among unvaccinated people, there were 396 cases, of whom 157 died ; while of 298 cases among persons who had been vaccinated, there were only 31 deaths. In the city of New York, during the year 1870, when systematic and general vaccination was practiced, the mortality from small-pox was 293, and the total number of cases 1,580, the population being 942,229. In 1878 the population was 1,100,000, and the number of cases but 14, thanks to judicious and general vaccination. In addition to the above facts, when we take into consideration the fact that the great majority of persons who are properly vaccinated are so protected as not to be liable to small-pox, we may have some conception of the great boon conferred on the world by the discovery of vaccination.
Vaccination should be universal, and ample provision should be made by law for this purpose. As to whether it should be compulsory or should be left to moral suasion, by an appeal to the common sense and self interest of the people, is a matter for serious, sober consideration. It is true that in
exceptional cases, where there has been carelessness in the collection of the virus, or in the operation, that syphilis has been propagated. It is said that such a result is only possible when the blood is taken up with the lymph from a syphilitic subject, or that an operator, after operating on a syphilitic subject, fails to properly cleanse and purify his lancet. As both of these sources of the disease are avoidable, there cannot be serious objection to vaccination. It is said by competent authority that humanized virus is most reliable. The virus should be collected from the healthy chil-. dren of healthy families, free from any constitutional disease. From a primary vaccination, or the virus fresh from the calf may be used as may be preferred, and thus all danger of transmitting disease from one person. to another be avoided, provided a clean lancet only is used. "Among 24,395 primary vaccinations made by the New York Bureau, but 147 com-plaints were made, and of these the majority were found to be of a trivial nature, and but two cleaths resulted." The English law compels the parent or guardian of a child to take it to the vaccinator of the district before it is three months old, unless he is excused by the health of the child, or consti-tutional or cutaneous disease, of which fact he must furnish the certificate of a physician (or a certificate of vaccination). For failure to comply with these regulations a fine not to exceed twenty shillings is imposed when • a child under fourteen years is found who has not been vaccinated. “The
operation of vaccination is successful in preventing or abating the disease, if performed before the third day after exposure to it. The most efficacious method of vaccinating is by the ordinary thumb lancet, which should be perfectly clean, and well cleansed after each operation. A number of crossed scratches should be made just deep enough to expose the superficial vessels, for if there be much bleeding the virus may be washed away; the quill, well charged (not previously moistened), is to be rubbed on until the bleeding is stopped and the virus rubbed off.”
SCARLET FEVER, MEASLES AND WHOOPING COUGH.
These diseases are characterized by an eruptive fever and are contagious. Scarlatina or scarlet fever is usually characterized by a fever ; and on the second day by a scarlet eruption, which shows itself on the "fauces. and pharynx, face, neck, lower part of the abdomen, flexures of the thighs, very much in the order mentioned, eventually spreading over the entire body, and disappearing by disquamation or peeling off of the cuticle from the fifth to the seventh day." Scarlet fever is usually attended by more or less sore throat. “There are several varieties, such as scarlatina simple, in which we have the fever and rash with but little sore throat. Scarlatina anginosa, in which in addition to the fever and rash, the throat, affection is the most prominent symptom. Scarlatina maligna, a name which is applied to certain cases of extreme violence, in which the system. is overwhelmed by the violence of the disease. There is a fourth variety called scarlatina latens, in which the symptoms are latent or obscure, and none of the external symptoms may appear." Measles is characterized by an eruptive fever and certain catarrhal symptoms. Whooping cough, by a. preliminary catarrh followed by a characteristic spasmodic cough; the symptoms may last six weeks or more. The sanitary arrangement of the