Report of Outbreaks of Communicable

Diseases.

BY A. C. HUNT, M.D., STATE SANITARY INSPECTOR.

The legislative enactment of 1887, creating local boards of health and the State Board of Health, conferred upon the State Board of Health similar powers to those granted to local boards of health, and, in addition thereto, control of infected persons and baggage in transportation upon railroads. The law also placed the State Board of Health in an advisory relation to local boards, and made it the duty of the State Board of Health to investigate the causes of epidemics. The organization of boards of health in the larger cities has been perfected to such a degree that the State Board of Health is seldom called upon to give advice in regard to outbreaks of communicable diseases in those districts. In townships and small municipalities, however, a different state of affairs exists. Local boards of health in townships are composed of the township committee, the assessor and a physician. The persons composing such boards are, generally, in rural districts, farmers and business men whose attention has never been called to sanitary matters, and therefore they are often unfitted to deal with problems of this nature. Our experience has shown, however, that local boards of health in townships are very willing to receive advice and to act upon it, and the results of sanitary administration in townships, in the care of communicable diseases, have been fairly satisfactory. Under the law passed by the State Legislature in 1895, local boards of health are compelled to make weekly returns of all cases of communicable diseases occurring in the various sanitary districts. This law is not observed as rigidly as desired, but there has been a slight improvement from year to year, and we trust that the time is not far distant when full reports will be received from every locality each week. In cases of small-pox, however, the local boards of health usually send a telegraphic communication to the State

Board of Health requesting the presence of an inspector and asking for advice. These appeals are attended to at once, and it is customary to call a meeting of the local board of health and in detail to consider the methods to be used in preventing the spread of the disease. The diagnosis of the first case of small-pox which occurs in any given district is a very important matter, and in rural districts of the State there is often no medical man who has been fitted by experience to definitely determine whether the case is one of small-pox or not. such cases we have been able to assist local boards of health to a marked degree by sending to their aid physicians accustomed to making the diagnosis of small-pox. As showing the necessity of giving this aid, a case can be cited where a hotel was closed on account of the supposed existence of a case of small-pox, and a great deal of alarm had been created by the report. An examination of the case by a physician detailed by the State Board of Health showed that it was not a case of small-pox, and quarantine was immediately raised. In another instance, a case of supposed small-pox occurred in an individual, but examination made by an expert showed that the disease was acne, and not small-pox. It is evident that if we had not been able to assist the local boards of health in these instances unnecessary expense to the locality and privation to the individual would have resulted.

As to vaccination, the local boards in every instance have been urged to take immediate steps to see that not only persons who had been exposed to the disease should be vaccinated, but that systematic vaccination of all of the inhabitants of the city, borough or township should be carried on. It has been our experience that the tendency is to merely vaccinate those persons who have been exposed, and to stop at this point. It requires a great deal of insistence on the part of the State Board of Health to bring local boards of health to a clear perception of the necessities of requiring vaccination of the whole population. Not only is vaccination insisted upon, but care is used to impress the necessity of aseptic methods of performing the operation, as the evidence is increasing day by day that unfavorable results occur more from lack of care in the operative procedure than from the use of impure vaccine.

As regards isolation of patients, the position has been taken by the State Board of Health in every instance that the only proper method of dealing with cases of small-pox is to remove the patient immedi

ately to an isolation hospital. Experience has shown that isolation in private dwellings is, as a rule, unreliable. An instance occurred several years ago in a township in this State where, although guards were placed before the infected houses day and night, several of the quarantined individuals made their escape during the day and visited a crowded picnic ground and remained there an entire afternoon. This case shows the unreliability of the average quarantine of private dwellings. A movement has been started in Essex county having as its object the securing of an isolation hospital for the use of the townships outside of the larger cities. At a recent meeting of the State Board of Health a resolution was passed urging the necessity of providing isolation hospitals in each county of the State, and we trust that the time is not far distant when in every county of the State ample provision will be made for the isolation and care of cases of small-pox.

As regards disinfection, it is the custom of the State Board of Health to not only describe the methods of disinfection, but in a number of townships where cases of communicable diseases have occurred we have been able to send to the aid of local boards of health a person thoroughly competent to disinfect infected buildings. It is safe to say that there are not five persons in the large number of townships and boroughs of the State who are fully competent to disinfect premises after small-pox.

It will be noted, from what has been said, that the relation of the State Board of Health to local boards of health is chiefly advisory, and yet good advice, given at a proper time and cordially received and acted upon, is often more effective than the exhibition of power. The effort has been throughout to increase the efficiency of local boards of health, and it is evident from the experience of the past year that local boards of health are more and more availing themselves of the experience of the State Board of Health in regard to the care of cases of communicable diseases.

The year ending December 31st, 1901, has been marked by an outbreak of small-pox in the State of New Jersey, and 1,139 cases have been reported in that period. At the termination of the year 1900 there were a number of localities in the State in which the disease existed, but from January 1st, 1901, to the end of February the indications were that the disease was under control. At this time, how

ever, cases were reported in Newark, and the source of infection was traced to tramps coming from New York. The existence of the disease in New York City is probably the origin of the outbreak in the city of Newark. In the body of this report a statement is made as to cases which have occurred in Newark during the year. From Newark the disease extended to a number of adjacent localities. In the southern part of the State, more especially in Gloucester county, over forty cases were reported, and to this outbreak a number of cases occurring in surrounding districts were traced. Following is the history of the cases of communicable diseases occurring in various localities of the State in which the State Board of Health was called upon to give advice and assistance:

SMALL-POX.

Acquackanonk Township.-One case of small-pox was reported in this township during the year ending December 31st, 1901. The disease is supposed to have been contracted in a tenement house in New York City. But one house was infected. The house in which the patient lived was immediately quarantined, and the quarantine was maintained for fifty days. The house was then fumigated and the patient liberated.

Asbury Park.-On November 7th, 1901, a case of small-pox was reported on the premises No. 506 Grand avenue. Inquiry showed the following facts: The patient was a colored coachman who came to Asbury Park from Newark, New Jersey, on October 23d, 1901. On November 3d he complained to his employer of feeling ill. On November 4th he ate his breakfast in a restaurant on the corner of Main street and Monroe avenue and subsequently consulted a physician, after which he returned to his room in the stable building on the premises above referred to. A porter, employed on the adjoining premises, waited upon the patient from November 4th to November 7th, when the case was reported to the board of health. The porter was sought out, cleaned up, vaccinated and kept under observation for fourteen days. The family in which the coachman was employed, acting under the advice of the health inspector, were also vaccinated. A temporary hospital building, which was authorized to be constructed at a special meeting of the board on November 7th, was erected, a nurse employed on November 8th, and the patient and nurse were taken to the hospital on November 9th. The temporary building erected for the care of this case was 24 ft. by 24 ft., with roof and sides covered with three-ply tarred paper. The hospital was opened on November 9th and closed on December 26th. The cost to the city for the care of this case amounted to $310.76. The cost of erecting the building was $212.56. No new cases appeared.

Atlantic City.-During the year ending December 31st, 1901, nine cases of small-pox occurred in Atlantic City. May 8th a case was reported at 132 North New York avenue, in a colored lodging house. The disease was contracted in Acamac county, Virginia. Four other persons living in the house contracted the disease. November 8th a case was reported, and the origin of the disease was traced to exposure in Philadelphia. Two other cases were reported, and the disease was

traced to infection in Philadelphia. The last case reported during the year was on December 20th. All of the patients suffering from the disease were removed to the hospital, and the houses were quarantined and premises were disinfected.

Bayonne. Following is the list of cases of small-pox occurring in Bayonne during the year ending December 31st, 1901: June, 1; November, 4; December, 33 -Total, 38.

Boonton-Following is a report by Dr. A. E. Carpenter of a case of small-pox which occurred in Boonton: There has been but one case demonstrated. The origin has not been satisfactorily ascertained. Diagnosis was not promptly made, owing to the fact that the patient had had small-pox before. Eruption came out irregularly, first appearing on body, and then in two days appearing on neck, face and extremities. A few persons, consequently, were exposed to contagion before character of the disease was determined. The first measure employed to prevent spread of the disease was to isolate patient with a professional nurse, vaccinate all who had been exposed, and then everybody in the immediate neighborhood of the house. The house was a good one and located in the best part of town. Then we instituted general vaccination and opened a headquarters where those unable to go to the expense might have it done free of cost. Case terminated by death, July 16th, and was buried five hours after death. House was thoroughly fumigated with formaldehyde by a skilled fumigator from Paterson. The room where the patient died was kept sealed for thirty-six hours, when bedding, all clothing and carpet, and, in fact, everything of a fabric material were taken out of town and cremated. After this was done the house was again fumigated. The house was unoccupied for fourteen days after burial of the patient. Those who came in contact at burial and the cremation of the clothing were vaccinated, properly cared for afterward and inspected daily. The cost to the public for vaccination, fumigation and other incidentals will probably be less than one hundred dollars.

Buena Vista Township.-Three cases of small-pox were reported in Buena Vista township during the year ending December 31st, 1901. The first case originated in New York City. In the two other cases which occurred there had been exposure to the original case. The houses in which the disease appeared were promptly quarantined and no other cases were reported.

Burlington Township, Burlington County.-A case of small-pox was reported in December, 1901, in this township, on Rancocas road, near the city of Burlington.

Camden.--No cases of small-pox were reported in Camden until October, 1901. In this month 13 cases occurred, in November 8 cases were reported, and in December 63 cases, making the total number of cases for the year 86. Six deaths resulted from the disease.

Carlstadt. During the year ending December 31st, 1901, two cases of smallpox occurred in the borough of Carlstadt. One of the cases was imported from New York City and the other from Hoboken. One death resulted from the disease. Quarantine was established in each instance, and after the recovery of the patients the premises were thoroughly disinfected. No further cases were reported.

Chatham Township.-At the request of the members of the Chatham township board of health a conference was had October 3d with the president of the board of health and Dr. Scarborough, the physician acting for the board. Within a few days two cases of small-pox had been discovered in the township. One of