ÆäÀÌÁö À̹ÌÁö
PDF
ePub

Destroy

and body clothing that can be washed should be soaked in a bichloride solution 1/2000 and then boiled and washed. what cannot be disinfected.

We suggest that all physicians who receive this circular read the article on small-pox in the latest medical book they may have, and then remember that in many cases of the prevailing mild type, the common symptoms, such as headache, vomiting, backache, etc., if present at all, are in a very modified form.

Not all the county health officers have been as active as they should have been in the control of small-pox. I had reliable information that the disease was spreading in one of the central counties of the state and that the county health officer was not active in the adoption of measures for its suppression. On August 8th, 1913, a letter was sent to this official informing him as to his reported negligence, with specific instructions as to what should be done and a request for full information as to the existing situation. No answer to that communication was received until November 6th, and this was after the board had declined to confirm the reappointment of this official because of his apparent inefficiency. It became necessary later for a member of the state board of health to visit that county in the interest of the public health.

As this report is being prepared (Nov. 1914), we still hear of smallpox prevailing quite extensively in several parts of the state, and some physicians are still calling it chicken-pox, notwithstanding hundreds of the cases have been in the adult. So long as there are physicians who refuse to learn either from their own experience or that of others, and so long as an ignorant prejudice exists to the extent that it does in this state against vaccination, we can scarcely hope that small-pox will disappear from our borders until the supply of susceptible material is exhausted.

While we have made diligent effort to secure a full report as to the number of small-pox patients in the state during the last 18 months, we have not been able to do so. The figures here presented however, are as nearly accurate as we have been able to secure. Never, we believe, in the history of the state, have so many cases of this vile disease occurred. And yet this is the one disease that has no right to exist. It is the one disease that can absolutely be prevented by vaccination and revaccination. The statistics sent to us from some sections of the state demonstrate that almost every case of small-pox that has occurred was in an unvaccinated person, and that the very few cases in which vaccination had been previously done, it was performed many years ago. It would be impossible to calculate the enormous expense entailed upon the people of the state by the necessary expenses connected with the medical treatment of the cases, the loss of time of the patients, the guarding and feeding of quarantined families, the cleansing and disinfecting of infected houses and property, and the destruction of such property as could not be disinfected. All of this would have been saved had vaccination been universally adopted.

tine and guarding of families infected with this disease should cease. Minnesota, Florida and one or two other states have adopted this policy and find it decidedly beneficial. Small-pox in recent years has assumed such an extremely mild form that a death from it is rarely heard of. There is not, therefore, the same reason, as in former years, for the rigid guarding of these cases. I have it from the Secretary of the Minnesota board that since the guarding of small-pox has been discontinued, and the people have been given to understand that they must either secure vaccination or run their chances of contracting the disease, the unreasonable prejudice against vaccination, based almost entirely upon erroneous reports as to its alleged evil results, has very greatly diminished, and after their more modern and greatly economical method of controlling small-pox, now tried for five years, there is no disposition to return to the former very expensive method. We hope that the West Virginia State Board of Health may soon adopt the new plan which we heartily endorse.

SUMMARY OF SMALL-POX CASES IN THE STATE IN THE PRESENT EPIDEMIC.

The following table is believed to be approximately correct. The number of cases here presented is probably below the correct number We have learned of but nine deaths in the state. So far as we have been able to ascertain, we are of the opinion that not two per cent of the patients were ever at any time in their lives vaccinated successfully. Those who did claim a former vaccination had the operation done twenty to forty years prior to the attack of small-pox. The protective power of vaccination was never shown more conclusively than during the present outbreak of small-pox. And yet the most intense prejudice against this most beneficial measure is found throughout the rural regions of the state.

[blocks in formation]

SCARLET FEVER AND DIPHTHERIA.

Both of these diseases have prevailed in many parts of the state during the past year. The former especially has existed in several places in a virulent form. In Tucker county many cases occurred with a large mortality. In and near Thomas there were about 70 cases with a mortality of over twenty per cent. I visited the town of Horton in Randolph county in July with Dr. Harper, the county health officer, to investigate this disease which had been imported from Tucker county. There had been quite a number of cases of a severe type and a number of deaths occurred. Many cases have existed in Mason, Kanawha, and several other counties, but the reports reaching this office are so very meager that no definite information can be drawn from them. No doubt that both diphtheria and scarlet fever are spread sometimes by carriers, but chiefly, I think, through children attending school in the incipient stage of the disease, or with attacks so mild that their gravity fails to be appreciated and the disease goes undiagnosticated. We have recently learned of a child in one of the larger cities who attended school several days with a mild sore throat that attracted little attention, but which was later, by a bacteriological examination, shown to be diphtheria. A rule should be adopted in every community and rigidly adhered to, to exclude from school every child who presents any evidence whatever of sore throat, even in the mildest form. In this way many cases will undoubtedly be prevented.

We would be glad to present a table of infectious diseases reported to this office to July first, 1914, but, as remarked above, the reports received are so very imperfect as to convey no accurate information as to the amount of infectious disease prevailing in the state. Some improved method of collecting our morbidity statistics will have to be found before we can expect to institute preventive measures that will be at all effective. We must know where disease exists and know it promptly in order to be of service to the people.

TYPHOID FEVER.

During the year 1913, and early in 1914, this disease prevailed quite extensively in various parts of the state, but few reports of local outbreaks, however, have been communicated to this office, hence we are unable to present anything approaching a complete report as to the prevalence of the disease. It is a well recognized fact that West Virginia has every year entirely too much of this disease, and its control is one of the great sanitary problems of the state. On this point we shall have something further to say before closing this report.

On September 26th, 1913, I was summoned to Dallas, Marshall county, on account of a local outbreak of typhoid fever. The only physician of the village, Dr. E. W. Woodruff, with his wife and only child, were all down with the disease in a Wheeling hospital,

Dallas is

Sammons of Calis, a neighboring village. located on very high hills and has a population of about 225. The total number of cases of typhoid fever in the village numbered 23. They were of a mild type and but one death occurred. The large majority of the cases occurred among children. Dr. Sammons used the prophylactic typhoid vaccination in many of the young people of the village. In but one case where this injection was used did the fever occur.

The cause of this outbreak was not definitely determined. The town has no sewerage. It has no common water supply, each family having its own pump. It has no common milk supply, many families having their own cow. There was nothing particularly bad in the sanitary condition of the village with one exception, and that is common to all rural districts, namely, the imperfect and unsanitary privy system. I was informed that there was but a single vault in the village. The other privy accommodations consisted of the ordinary building erected on the ground, open in the rear where was found the usual accumulation of fecal matter. There were several suspected wells in the village and the water of these was at my request analyzed by Dr. Arkin of the State Hygienic Laboratory, whose report is as follows:

"Well No. 1, Crider well 700 bacteria ped c. c.; 500 B coli, 200 B. Subtilis.

"Well No. 2, Hart's well, 8000 bacteria per cc. of which 2/3 were bacillus coli and 1/3 B. proteus.

"Well No. 3, Miller well, 13,900 bacteria per cc. of which 1/4 were B. coli and 3/4 streptococci."

The water of the above wells was thus shown to be polluted and of course unfit for use without boiling, but as the water of these wells was used by a limited number of persons, it does not account for the fact that 10 per cent of the population became the victims of typhoid infection. It probably did give rise to the origin of the outbreak. Contact of the well with the sick, which is always entirely too common in rural communities, is probably responsible for some of the cases, and it is almost certain that the free exposure of the excreta from typhoid cases, together with the fly, the weather being very hot, will account for a number of other cases.

A recent letter from Dr. E. W. Woodruff who is practicing in this village, under date of November 6th, 1914 says, that "no cases of typhoid fever have occurred here this year. This is due, I believe, to a general cleaning up and the use of prophylactic vaccine." I would add, that something is also due to the fact that many of the susceptible young persons of this community were attacked last year, and, as already told, a number of others were vaccinated against the disease. It may be also worthy of note, that the past summer has been notable for the scarcity of flies, as communicated to me from different parts of the state.

During the several years past typhoid fever has prevailed to a greater or less extent in the regions supplied by the Potomac River and its

[ocr errors]

surgeon general of the U. S. Public Health Service and this office contains information that should reach the public. It is therefore, here presented. Suffice it is to say that we at once requested the detail of an officer of the U. S. Public Health Service, and, as will appear later, we have received invaluable aid from this source. The state is under a debt of gratitude to the U. S. Public Health Service.

Dr. S. L. Jepson,

Washington, D. C., Oct. 6, 1913.

Secretary State Board of Health.

Wheeling, W. Va.

Dear Doctor:

I am in receipt of a preliminary report of October 1st, from two officers of this service who are now engaged in systematic investigations of the pollution of the Potomac River and its tributaries. Their report is in part as follows:

"We have made a sanitary survey of the South Branch of the Potomac River, including the towns of Romney, Hampshire County; Moorefield, Hardy County; Petersburg, Grant County; and Franklin, Pendleton County, all in the state of West Virginia, together with the surrounding rural districts.

While more detailed data is reserved for the final report the serious sanitary conditions in the valley warrant, indeed demand, such a preliminary report as may bring action by proper authorities toward lessening the heavy morbidity and mortality with consequent sorrow and no less serious economic loss, due to preventable disease, especially typhoid fever.

The "South Branch" arises near Monterey, Highland County, Virginia and flowing rapidly in a northerly direction, joins the Potomac below Green Springs, West Virginia, having received sewerage effluents from the towns inspected, several small hamlets, and from the rural population most of whom live in the valley near or immediately upon the banks of the river or its tributaries which together have a drainage area of about 1490 miles. The river is about 100 miles long and its valley varies in width from mere gorges cut through rock such as "The Trough" to beautiful and fertile areas five or ten miles wide bordered by precipitous mountains rising in some places to a height of 300 deet.

A descent of 12 to 15 feet per mile makes the stream rapid throughout and the time required for pollution to descend from town to town even to the Potomac may in consequence be reckoned in hours rather in days.

On this watershed, especially in the valleys, live about 27,000 people who are as a rule prosperous, industrious and intelligent, but who have, particularly in the rural sections, an annual mortality from typhoid fever which is appalling. For instance, in a radius of seven miles known as Upper Tract there live about 500 persons among whom, according to local physicians, there have been this year, twenty-four cases of typhoid fever with two deaths, a ratio of 6400 cases with 533 deaths per 100,000 per annum. Of 14 persons who camped on the stream below Brandywine, another epidemic center, 9 contracted typhoid fever.

None of the county health officers could even approximate the number of cases in their districts but we think it conservative to reckon the annual typhoid morbidity at from 500 to 600 and the resultant mortality at 40 to 50. Whipple in his classic "Typhoid Fever" concludes: "It may be fairly assumed therefore that $600.00 is a very moderate estimate of the financial

« ÀÌÀü°è¼Ó »