of small-pox in this State. It is, therefore, deemed important to direct attention thereto: The ectrotic action of vaccination upon the course, severity and duration of small-pox; the power to abort or modify it, numerous instances of which can be cited. While it is not the province of the State Board of Health to recommend curative or even palliative measures, or in any manner direct the treatment of diseases, it is clearly a duty of the Board to prevent disease. The preventive efficacy of vaccination is so inseparably connected with its curative or palliative properties that all must be had combined. It has come to be generally accepted and admitted that vaccination has prophylactic power. It has also been very satisfactorily demostrated that vaccination possesses therapeutic value. Hence, there may be time to secure the latter where the time to secure the former has elapsed. Thus, if a person be vaccinated after exposure to small pox, during the febrile stage, and the virus acts promptly, the aroela stage will be reached in five to seven days, or before the critical tenth day of the variolous disease, thus aborting and modifying the variola. So that while it is never too early to vaccinate, it may be said with equal confidence it is never too late to vaccinate, if done before the manifestations of variola have actually begun, or the disease has become inevitable. It may also be confidently asserted that an epidemic of small-pox can be stamped out by vaccination alone. From the meagre returns the following statistics are made, illustrative on this point: At Shelby Small-pox, unvaccinated..... 14 Small-pox, modified by vaccination, 55 and 56 years prior.... 2 27 Exposures and total escape by prior vaccination.... 150 5 At Shenandoah Small-pox, unvaccinated..... Varioloid, vaccination after exposure. Small-pox, modified by prior vaccination, 30 years. 18 15 1 In one family the husband died, the wife and two children were vaccinated after exposure: The wife had varioloid mild; the children escaped entirely. In one case there was vaccination after the appearance of the areola stage, but no modification of the disease. One nurse who attended during the sickness and burial of a patient, escaped entirely through vaccination had sixty years ago. At Van Horne Small-pox, unvaccinated... Varioloid, vaccination after exposure... 1 4 1 The repeated introduction of small-pox into this country and into this State by foreign immigration, nearly every steamer from Europe having it on board, and its wide-spread existence in this country, suggests the necessity for compulsory vaccination, and especially among children of the public schools. No child should be admitted to a public school who has not been vaccinated, and a certificate of the fact should be required to be furnished the teacher or superintendent of the school. By reference to the table on page 123, it will be seen there were reported one hundred and seventy cases of small-pox in 1883, thirtysix in 1884, and one hundred and twenty-six in 1885, with fourteen deaths. There were in 1885 fifty-nine cases of small-pox, sixty-seven cases of variola, with fourteen deaths. In 1882 there were reported three hundred and twenty-four cases. In nearly every case of smallpox in 1885, the disease had progressed to the areolar stage, or beyond the prophylactic power of vaccination, before the true nature of the disease was determined. Prior to 1885 the records of vaccination are meagre and furnish no basis for conclusions. For 1885 they are quite unsatisfactory, yet are sufficient to establish] the efficacy of early vaccination, for in every case the variolous disease was modified or completely aborted. SCARLET FEVER. This scourge of the little ones has prevailed largely over the State during the biennial period, more marked in the northern section, with a decreasing mortality rate during the last half of the period by reason of more efficient action of local boards in restricting and preventing its spread. Reports are too meagre to give statistics of any value. IOWA AGRICULTURAL COLLEGE, AMES, May 25, 188.} R. J. Farquharson, M. D., Secretary State Board of Health: DEAR SIR-If you can furnish me a few copies of your regulations regarding scarlet fever please do so. We have had six cases of the disease in the college, mild in form but typical. The cases have been removed to an isolated building fitted up as a hospital as soon as they appeared, and every means have been employed to prevent extension of the disease. The cases appear where they are least expected, apparently having no regard for the supposed laws of contagion. Those least exposed are taken, while those most exposed escape. The great difficulty I have is in the interference of friends. They insist on taking the patient home as soon as he is able to move, while the desquamation is taking place, thus exposing people on the train and others at home. This is often done at the advice of the family physician. One of the first cases was taken home in spite of my protest, other members of the family were exposed and had the fever, and as I learn to-day one died. Something ought to be done to prevent this recklessness of the rights of others. We can take care of those waiting the completion of desquamation, and there is no reason or necessity for this course on the part of the friends; it is only a consultation of their own convenience. If the Board of Health can furnish us with authority in this matter it will be of service to the State. Please write me concerning the matter. Yours respectfully, D. S. FAIRCHILD, M. D IOWA STATE BOARD OF HEALTH, D. S. Fairchild, Iowa Agricultural College: DEAR DOCTOR-Your kind favor of the 25th inst. came duly to hand. In the absence of law I do not see what the State Board can do in the matter of restraining persons from disseminating diseases by traveling. For strange as it may seem it is nevertheless true, that in the Code of Iowa there is no clause making it a penal offense to spread even small-pox. An illustrative case occurred recently in Clinton, Iowa, where the "health authorities" of Wheatland shipped a case of small-pox in a night passenger train of the Northwestern railroad to Clinton. The health authorities of Clinton applied to this office for advice in the matter, but nothing being found in the Penal Code applicable to such a case, they were advised to sue the Wheatland officers for damages. The Chicago & Northwestern Railroad company have also sued them for damages. I have referred your letter to our president, Dr. Robertson, and as soon as I can get his views will let you know. Very truly, R. J. FARQUHARSON, Secretary. DIPHTHERIA. Diphtheria, which was epidemic in the State in the Fall and Winter of 1882-3, has nearly disappeared. Sporadic cases were reported during 1884-5, but nowhere has it during the past year assumed inordinate proportions. It is believed the people are gaining a better knowledge of the causes and means of prevention of this disease; and that the rule of the State Board, prohibiting public funerals where deaths occur from it, will tend largely to decrease it. |