OCCURRENCE OF SMALL POX IN

VARIOUS TOWNS.

REPORT OF SMALL POX IN ANSONIA.

By R. H. TUCKER, Clerk of Board of Health.

C. A. LINDSLEY, M.D.,

ANSONIA, CONN., February 6th, 1888.

Secretary of State Board of Health, New Haven, Conn. DEAR SIR:-Yours in regard to the case of small-pox received. The party was an unknown tramp who was taken sick at the lock-up in Birmingham and by the selectmen sent to the almshouse, where his case developed as small-pox. He was immediately isolated and Louis S. Cooper, M.D., sent there to attend him. Every precaution considered necessary was taken to prevent its spread. As the patient died three weeks ago yesterday (Jan. 15th) we think our precautions were successful.

REPORT OF SMALL POX IN NEW HAVEN.

By DR. S. W. WILLISTON, Health Officer.

NEW HAVEN, CONN., April 25, 1888. DEAR DOCTOR LINDSLEY :-The history of the small-pox cases at 73 Kimberly ave., as nearly as I can get from Mrs. E., is as follows:

Mr. E., an engineer on a switch engine in the Harlem Yards, came home on Saturday, March 3d, complaining of feeling badly with some headache and pain in the back, but no vomiting. On the 5th an efflorescence appeared upon his face at least, how extensively elsewhere, I do not know. Very shortly afterward macules appeared "perhaps in all about 50, scattered irregularly over the body, and distinctly raised above the surface." These macules went into suppuration, and afterward scabbed over. Was in bed one week.

Mrs. E. was taken sick on the 21st of March. She had severe pain in back, some headache, but no vomiting. About 40 macules appeared, scattered irregularly, on the 24th. The eruption followed the same course as in Mr. E.'s case, forming white pustules. Physician was called in on the 3d to Mr. E. Made four visits, the last one on the 11th, I believe. Diagnosed the case as measles; was told that Mr. E. had previously had the measles. The same physician was again called to attend Mrs. E. on the 22d. Diagnosed the case as "threatened with pneumonia," and that the "left lung was solidified." (Mrs. E. had some cough.) When the eruption appeared, diagnosed the case as measles. Was told that Mrs. E. had, like her husband, previously had the measles. Made six visits, the last on the 27th. On the 26th he was asked by Mr. E., what was the cause of the pustules, as he (Mr. E.) never knew measles to result that way before. Was told that "they came from bad blood, and that they should take a needle and prick each one, otherwise the humor would stay in the

blood." The foregoing was derived from Mrs. E. I cannot vouch for its correctness, of course, but believe it to be substantially true.

very severe

Mr. and Mrs. E. reside on the upper floor. On the floor below lived Mr. and Mrs. D. and their daughter Flossie, aged 5. There had been free communication between both families during the whole of the time of these two cases. On the 26th of March, Mrs. D. made up the bed on which Mrs. E. had been lying, and before leaving her, stooped and kissed her on the mouth. On Sunday, April 8th, Mrs. D. complained of general malaise. Monday morning, though feeling badly, she arose and got her husband's breakfast. An hour or two later, she was taken with vomiting, headache, and pain in the back. Another physician was called in, but did not arrive at any certain opinion of the nature of the disease (I am told.) Late Wednesday night macules were detected. On the following morning the eruption was extensive. The physician did not accept the disease as measles. The next morning (he was unacquainted with the history of the previous cases at the time) but was inclined to call it roseola. Upon his visit Saturday morning he recognized the true nature of the disease, and, after calling in a friend to confirm his diagnosis, reported the case to me.

When I first saw the case Saturday afternoon, I recognized the well-marked pathognomonic umbilication. The daughter

Flossie had never been vaccinated. I immediately secured some Martin virus, and returned and vaccinated them all in the house, including Mr. D., a nurse, and a sister-in-law of Mrs. D., who had been there during the week. Sunday noon I again visited the family with fresh virus and again vaccinated them all. The vaccination not taking upon the child, I repeated the operation Tuesday. In the following day, seeing no evidence of the pock working on Mr. D.'s arm, I re-vaccinated him. On Thursday I revaccinated the daughter. The two vaccinations on the nurse and Mrs. H., made on Sunday, acted promptly and fully; they now have well-marked pustules. None of the vaccinations produced any effect upon the child. Up to Wednesday (March 11th), the child had been constantly with her mother. On Thursday (the 19th) she began to complain, but her prodromic symptoms were comparatively mild. Saturday the eruption first made its appearance; to-night (25th) the secondary fever has just begun. In the mother the disease was largely confluent-one couldn't place the tip of the finger anywhere on the entire body without touching a vesicle. She died on the beginning of the 14th day from lung complication (lobar pneumonitis, or at least capillary bronchitis.) In placing her in the coffin, the epidermis slipped readily from beneath my fingers in large patches. The case did not go into the suppurative stage-the cedema redness, and vesiculation unfortunately subsiding too early. On the third day of the eruption, severe pharyngitis set in; on the fourth, complete aphonia, with continuous and abundant expectoration.

The case of the child is more favorable, but yet grave. The vesiculation on the face and extremities is fully as abundant as in the mother, but much less abundant on the trunk. Pulse, temperacure and respiration this morning normal, the course of the disease, so far typical, and so far no complication. I think her chances of recovery are fair.

Mrs. and Flossie D. had never been vaccinated. Mr. and Mrs. E. had been vaccinated in early childhood. I believe all the rest in the house will escape, though Mrs. H. has been complaining of ill feeling for the past day or two, which I attribute to the vaccination.

There was extreme exposure of the first two cases; visitors came freely to the house, and Mrs. E. a few days after getting from her bed, attended a sewing circle; nevertheless, I do not believe there will be other cases from the present ones.

Note. The child died also.-(C. A. L., Secretary.)

REPORT OF SMALL POX IN BRIDGEPORT.
By C. A. MOONEY, Clerk.

Bridgeport, Conn., April 26, 1888.

DR. C. A. LINDSLEY, New Haven, Conn.:

DEAR SIR:-Concerning the case of varioloid in this city, in compliance with the provisions of the statute, I submit the following statement of the facts as they have come to the knowledge of our local Health Board:

Mrs. residing at No.

street, in this city, being

ill, recently visited New York for medical treatment. While there she stopped at the Hotel Normandie, being attended by a professional nurse. She returned to this city on Friday, the 23d inst. On Saturday or Sunday she complained of feeling unwell, and Dr. H., a local physician, attended her. Drs. Janeway and Bulkley of New York, being sent for, pronounced the case varioloid. This decision was rendered early on Monday, and immediately after the Board of Health was notified of the facts. All possible precautions to prevent the spread of the disease have been taken. No one is allowed to enter or leave the house, and the inmates have all been vaccinated.

This is the only case in Bridgeport that we know of, and it was undoubtedly imported from New York.

The Health Officer has written you regarding circulars, which we will be glad to receive.

REPORT OF SMALL POX IN NORWALK.

By DR. J. G. GREGORY.

NORWALK, July 7th, 1888.

On the 19th of June a case of small pox was reported to the Board of Health. The case was at once investigated and the following history obtained:

The patient was found to be a Swede, who had but recently landed, having been in the country about four weeks, coming direct to Norwalk and remaining with a family who were relatives. About the 10th ult. he had been taken with a mild rigor which was followed by headache, pain in the back and loins and limbs. No physician was called. These symptoms continued about 48 hours when an eruption appeared upon his face and shortly after scattered upon his body and pretty generally upon

the back of hands and arms. A few also appeared upon the legs. With the appearance of the eruption the patient became better, took his place during meals at the table and associated with the family as before. As the eruption did not disappear and became pustular, a physician was called on the 15th ult. for "his opinion." He, after examining the patient, stated that he considered the disease contagious and advised quarantine, saying that he would call the following morning and advise further. The family, not satisfied, meanwhile summoned two other physicians who, though unable to give a diagnosis, declared absolutely that the man did not have small pox. Previous to this the Swede had been placed in a barn, but communication with him had been freely permitted. During all this time he was up and dressed and walking about, but keeping about the barn. On the 19th ult. the case was reported to the Health Board by the physician who first saw him on the 15th ult.

An investigation was at once made by the "Board of Health' and the case declared one of small pox without doubt, and evidently about the tenth day of the eruption.

A strict quarantine and general vaccination in the neighborhood was ordered.

On the 30th ult. another case of small pox was reported in the neighborhood, and upon investigation it was found that the patient a girl about 18 years of age-had been employed in the family where the first case had appeared and had been exposed by contact. She with her entire family have been quarantined and every care taken to prevent exposure. Later, on the evening of the 30th ult., a report came to the "Board of Health" that another case existed, and on July 1st, upon investigation, a woman, recently confined but a few days, was found also sick with a mild case of small pox. The case had not been reported by her physician. This case, with her family, was also at once quarantined. She is the sister of the Swede who first had the disease, and it was in her house that he was first taken sick.

No new cases have been reported, and by a thorough quarantine and vaccination the Board of Health trust that they have put a stop to the spread of the disease and can confine it to its present quarters.

We shall be pleased to have or receive any suggestions from you as to future action.

(The Secretary visited Norwalk at the invitation of the Board of Health see, page 44.)