ing, and afterward the pointing of the true pustules, with the increase of the fever or "secondary fever." The physician did not keep a record of the temperature, so can only say that it ran the usual way in true small-pox.

She is doing finely. Doctor F. discharged her yesterday. The babe had what might be called hemorrhagic form, in some respects. The great share of the vesicles were filled with blood instead of lymph. I think that accounts for its sudden death— that seems singular to us here. Did you ever know of any such cases?

The rest of the family still well.

The school board decided to close the schools this week, thinking that we might thus escape serious trouble should there be any new cases among those whom the old Finn nurse exposed. Yours respectfully,

A. W. HOPKINS, M. D., H. O.

P. S.: We got off finely with the Finn nurse, at least there are no more cases that we know of, and we have stopped looking for them from that source. School began again yesterday. We enforced the vaccination of all the scholars and teachers.

The Daugherty family are still in quarantine. Policemen still on duty. The balance of the family still keep well. I would like your opinion as to how soon it would do to fumigate and clean up that house, and turn its inmates loose upon the world. Please give me all the suggestions in regard to the best and safest method of cleaning. Yours in haste,

A. W. HOPKINS, H. 0.

SMALL-POX AT TWINSBURG.

I returned from Ashtabula to Cleveland, and visited Twinsburg, Summit county, to learn the condition regarding small-pox reported at that place.

I was met at the depot by Dr. L. G. Griste, the attending physician, who drove me to the patient's house, which is located about one-half mile from the village of Twinsburg.

The patient, Mrs. L, the wife of a well-to-do farmer, was taken sick January 11. On that day she presented herself at the office of Dr. Griste, showing a tolerably well marked case of varioloid.

The township trustees were notified, and served notice on the family to remain strictly at home until all danger of contagion had passed. The inmates, consisting of the husband and wife and two children, and the wife's father, were at once vaccinated.

The patient was confined to bed but one day, and associated with her family as usual.

The origin of the disease could not be certainly established. Mrs. L. had been to Cleveland two weeks prior to becoming ill. She had also been visited by a tramp ten or twelve days before her illness, the tramp coming in the house and showing signs of sickness of some kind.

The case was so mild that quarantine regulations had been very lax. There was much doubt in the community as to the real nature of the case, and several persons had been to the house.

The township trustees had made no provisions to supply the family with the necessities of life, or for some person to carry them such things. Consequently the husband went to the village on two occasions.

There is but little doubt that the case was one of genuine varioloid. The history, as detailed by Mrs. L., was well marked, and the eruption had been unmistakable in character.

The two children complained of slight illness, which the mother attributed to vaccination.'

An examination revealed a slight papular eruption about the face and head, which, under the circumstances, looked very suspicious.

I informed the family that they would possibly have two more cases of varioloid to deal with, and endeavored to impress them with the fact that the contagion from mild cases was as dangerous as that from more

severe.

They were ordered to remain strictly excluded from the public until the physician had discharged all of them, and measures for disinfection had been properly carried out.

The clerk of the township trustees was seen and instructed to serve a notice of quarantine upon the family, to establish quarantine boundaries by placing yellow flags at proper places, and to post notices warning all persons to remain without these boundaries, under penalty.

The following letter, showing the termination of these cases, was received from Dr. Griste:

C. O. Probst, M. D.

TWINSBURG, O., February 14, 1889.

MY DEAR DOCTOR: Yours of the 11th inst. just at hand About Mrs. Leach and family, they are all right; their clothing and bedding have been thoroughly cleansed, the house fumigated, and the family was released from quarantine on the 9th inst. The little girl had one fully developed pustule on the temple, which will leave a permanent The eruption in the little boy's case did not fill at all; it just showed as little hard, round pimples, which dried up without filling or blistering. There are no new Hoping that this is the end of it, I am

scar.

cases.

Yours truly,

SMALL-POX AT CORNING.

L. G. GRISTE.

On February 7, a letter was received from Dr. C. B. Holcomb, of Corning, reporting an outbreak of small pox in the family of a "woman of the town," and saying there was considerable danger of the disease being

spread.

I wired Dr. Holcomb, requesting him to have all exposed persons vaccinated, and to have guards stationed at the house to prevent all. communication.

t

I also wrote for full particulars and sent him a package of vaccine virus.

The following telegram was received on the afternoon of the same day:
CORNING, O., February 7, 1889.

To State Board of Health:

By the request of the citizens of Corning, we, the undersigned trustees and school board of Corning, ask your Honorable Body to send a competent doctor to our village and investigate a case which our doctor pronounced small-pox. Come at once. Answer. SCHOOL BOARD AND TRUSTEES.

I visited Corning on the next day, and was met at the depot by the Mayor, Dr. Holcomb, and a member of the school board.

Dr. Holcomb, the attending physician, gave me the following brief history of the disease:

January 25, the doctor vaccinated the patient, a boy about twelve years of age, and a younger sister, the family consisting of a mother and four children. The boy and his sister were attending school. Two or three days after vaccination, the boy complained of being sick, and remained at home. He had a high fever, and complained much of headache, and aching of back and limbs. On February 3, an eruption appeared, and his arm presented three well-formed vaccination sores. On the 5th, the other members of the family were vaccinated, and the disease pronounced small-pox. Up to this time the family had been freely on the streets, and other public places. No accurate record of the patient's disease had been kept. The temperature had not been taken, and the relation, as to time, between the fever and appearance of the eruption, could not be learned. Dr. Holcomb conducted me to the house of the patient, and requested me to examine him while he remained outside.

The family was found living in the utmost squalor, the patient being in a room by himselt, up-stairs. He presented an indistinct, fading eruption, which was partly concealed by the dirt with which he was encrusted from head to foot. He pathetically remarked that the rats were his only visitors, and he amused himself by watching them fight over the remains I of his food.

Although the diagnosis was somewhat doubtful, it was thought best to pronounce it a case of varioloid.

A meeting of the board of health, school board and township trustees was called, a number of other citizens being present.

The excitement was quite high, and the attending physician had been severely criticised for visiting the patient, and then appearing on the street without, it was claimed, having taken any precautions to prevent spreading the disease. I was asked what precautions I had taken, and replied

that I used a rubber suit, cap and bi-chloride of mercury tablets for disinfection.

The board of health stated that they had prohibited all public meetings of any kind, and had partially enforced vaccination of schoolchildren. A guard had been appointed, who was stationed at the front entrance of the house, the common entrance, however, being in the rear. I advised closing the front entrance, and guarding the one at the rear to prevent night visitors. Also, that parents should be notified that no chil d would be admitted to school without a physician's certificate of proper vaccination, and that schools should be opened the following week. It was also advised that restrictions upon the public meetings might be removed.

A card was published in the Corning Times, correcting current exage rated reports, and advising general vaccination.

Dr. Holcomb called at the office several weeks later, and reported that these measures had been carried out.

The prolonged course of the disease, lasting over a month, convinced him that it was a case of varioloid.

He asked and was given instructions for disinfection, fire being recommended for most of the household effects.

No other cases occurred, either in the family or town.

SMALL-POX AT FOSTORIA.

The following letter was received February 20:

Dr. C. O. Probst, Columbus, Ohio:

PEMBERVILLE, OHIO, February 19, 1889.

DEAR SIR: In regard to your order about vaccination, our board of health has issued the proclamation of which I enclose you a copy. Since then (in fact just this morning) I learned of a case pronounced to be small-pox in Fostoria, Ohio, 16 miles south of us, and there has been three young men of this town working in the stave factory there, where the man worked that has got it, and the works have closed down, and the young men in question have come home, and are now around town. We don't know just what to do about the matter. The young men think they have not been exposed, as they were in a different part of the factory, and had no communication with One of them was vaccinated Monday before he came home. Would like your advice in regard to the matter as soon as we can get it.

him.

I telegraphed an answer, advising immediate vaccination of the young men, and also their isolation, if their exposure had occurred more than four days before. Small-pox circulars were also sent for distribution.

case:

I telegraphed Fostoria, and learned that but one case existed there. Dr. Hale, attending physician, furnished the following report of the

C. O. Probst, M. D., Secretary State Board Health:

FOSTORIA, O., February 21, 1889.

DEAR DOCTOR: It becomes my disagreeable duty to inform you that on last Thursday morning my attention was called to Mr. Charles Creighton, who I found suffering from varioloid. Upon consultation with the board of health, the house was immediately quarantined, family kept strictly at home, and nurse installed who has had small-pox. Wife immediately re-vaccinated, and child three years old vaccinated, and have continued to vaccinate child every day since. The onset was of a malignant type. Temperature for three days reached 1044 to 105° "F," but pustulation was somewhat imperfect and temperature dropped to one hundred, and surface began to brown. He had been sick from Saturday previous to my seeing him on Thursday morning, at which time eruption was plain.

Family consists of wife and one child three years old, not vaccinated previous to my call. Up to present impossible to account for exposure. Man is a teamster for Fostoria Stave and Barrel Co.

Schools have been ordered vaccinated, and all physicians have plenty of vaccine. Most respectfully yours,

R. M. HALE, M. D.

Any suggestions as to sanitary regulations thankfully received.

HALE.

Circulars were sent to the health officer, and he was instructed to tel

egraph at once should another case appear.

The following letter of April 1, gives the termination of the case:

FOSTORIA, OHIO, April 1, 1889.

C. O. Probst, Secretary Ohio State Board Health:

DEAR SIR: Your letter of the 27th received. The small-pox patient was discharged March 15, and the contents of the house were destroyed; and we used disinfectants, took the paper off of the wall, and cleaned the house out generally. There are no signs of his wife and child taking the disease. I have used every precaution to prevent the spread. There is no contagious disease of any kind in the city at present. If it is required I will make weekly reports-if you send me blanks.

Yours truly,

J. A. HESS, H. (.

SMALL-POX AT PORTER. (Pine Grove P. O).

A card was received from our correspondent at Rio Grande, Dr. Jacobs, stating that small-pox was reported at Porter, Gallia county.

There being no telegraph station there, a letter was addressed to Dr. Fletcher, of that place, asking for particulars.

The following letters relating to the cases at Porter, have since been received: