Hon. State Board of Health: PORTER, PINE GROVE P. O., GALLIA COUNTY, OHIO. ESTEEMED SIRS: As requested in your letter of March 1, 1889, we forward to you the history of the cases of the supposed contagious disease, now the subject of this correspondence and investigation. The facts, as far as possible, have been carefully ascertained and examinations made with the utmost care. The family of Anthony Davis (colored) consists of eight persons, and there is one young colored man in the house with them, making nine in all. Ages of children from 6 to 18 years; colored man, 24; mother, 46. The father works on the Ohio river from Louisville and Cincinnati toward Pittsburgh, Pa., and was at home January 23, 1889, and remained about twenty-four hours and has not been at home since. The mother, colored man, and four of the children have been thoroughly vaccinated, all boys. One of the girls is not known to have been vaccinated; the other was vaccinated by Sisson, M. D., seven years ago but did not make agood scab; is seemingly imperfect, almost a failure. Whether the father had been exposed to any contagious disease is not known. Seven years ago a case of varioloid (Mr. A. Summers) a clerk of Sisson, M. D., was con fined four or five weeks in the same room. The house was supposed to be thoroughly disinfected. Disinfectants used-carbolic acid and sulphur fumigation very freely. About nine days after the father left home one child was taken sick with fever; head and back ache, accompanied with gastric trouble which continued more or less for about three days, when an eruption began to make its appearance, which was not seen by a physician for several days. During the next ten days the other five children were taken sick, some with chills, all with fever, head and backache, nausea and vomiting, which continued about three days, when the eruption began to make its appearance on the face in some cases, on the breast and shoulders and back in all. The eruption was mostly connidal acuminated, papular chiefly, if not entirely, at first and afterwards in some cases vesicular, never reaching a full umbilicated pustule with central depression. The papulae, which constituted the larger part of the eruption at all stages, and vesicles all dried up together, and from 20 to 200 scabs found on most of the cases which have adhered from thirteen to fifteen days, leaving a superficial mark. In two cases the affection of the throat was well marked, painful, and gave the patients some trouble. In the supposed unprotected case, a little girl six years old, the eruption was not as abundant as in the other cases, but a few scabs were heavier and adhered a little longer; the period of incubation being from nine to eighteen days, and invasion about three days, attended with fever, head and backache, nausea and vomiting; the primarily, papular, acuminated eruption a little hardened at the base under the touch, and the throat affection, were considered a combination of symptons pointing a little more in the direction of variola than of any other known disease. The period of desquamation being also from thirteen to fifteen days. About the 3d or 4th day of the eruption the boy first attacked went to school (the school-house being about 150 feet from the residence), and after about twelve or fourteen days two children in one family and one in another have had eruptions suspicious in character, but in no case was there any absolutely diagnostic symptoms. The families are quarantined. As far as known all exposed persons have been vaccinated. Many thanks are tendered by us for the generous and liberal action of the State Board. We will accept thankfully of all suggestions and instructions from the board and co-operate with the same to limit, at all times, the spread of infectious diseases. We remain, very respectfully yours, N. B. SISSON, M. D. PORTER, PINE GROVE P. O., GALLIA COUNTY, OHIO, Hon. C. O. Probst, Secretary Ohio State Board of Health: DEAR SIR: The family of Anthony Davis, in which the disease originated, consisted of eight persons, the husband and father having returned to Cincinnati, where he still remains. Whether he had been exposed to small-pox, or has ever had any symptoms of disease, is unknown. In this family there were six cases. All had fever, backache, headache, five nausea and vomiting, two sore throat, with papular and versicular eruption mixed. For convenience I will designate the Anthony Davis family as No. 1; John Daniels family No. 2. In No. 2 there were two cases only, and these were the mildest and most insignificant of all that occurred, and hardly deserve a notice, except that they were at school with the Davis boy, and had a papular and vesicular eruption without any marked premonitary symptoms. E. E. SUMMERS No. 3.-In this family five children had the disease. Ages, eighteen months to about nine years; all had papular and vesicular eruption. In some of the cases the papules were found in mouth, fances and tongue, with other premonitory symptoms not as strongly marked as in the Davis family. MANUAL ENO No. 4.-In this family four children and the wife, thirty years of age, had the disease, and children, ages from one to nine. In most of these cases, in addition to other premonitory symptoms, the throat and mouth had the papules, with the papular and vesicular eruption. (Children). The wife was quite sick three or four days. Then the eruption appeared, including the throat. The eruption was Į apular and vesicular, and in all cases the crusts adhered from ten to sixteen days. In no case was there a well-developed umbilicated pustule with indented center, though some of the vesicles became opaque, with some depression and flattening at the center. The eruption in all cases was found on the face, back, breast, head and extremities, limited in degree in some cases. No cases have occurred outside of these four families, and the children of all these familes were with the infected boy in the school-house. The Anthony Davis residence is only 250 feet from the school-house. Vaccinations have been thorough in the community, and the subject pressed on all parents. Omit the Daniels family (No. 2) and we have remaining: Now, anything further that I can add or say, will be most cheerfully and promptly DEAR SIR: Many thanks for reports of State Board of Health. The patients are all well, and there have been no cases of eruption or disease outside the four families named. In the Davis family (the family in which the disease originated) the disinfecting has been very thorough, and safe, I believe, in all the others. Will be pleased to have a copy of third annual report when completed. Yours very truly, N. B. SISSON. P. S. Mr. Anthony Davis has just returned home, and states that he was never vaccinated, and does not know of being exposed in any way to small-pox. The house the family live in was occupied by a varioloid patient seven years ago,, but it has been believed the house was disinfected afterward to the degree of safety. SISSON. SMALL-POX AT NORWALK. April 10th, a telegram was received from the health officer of Norwalk, J. A. Jones, announcing an outbreak of small-pox at that point. In answer to an inquiry as to the number exposed, origin, etc., he answered that there was but one mild case, the origin not being known; all exposed persons had been vaccinated and every precaution was being taken by the board of health to prevent further spread. He referred me to Dr. Ford for further particulars. A letter to Dr. Ford received no answer. Since the first of January we have had ten separate and distinct outbreaks of small pox in our State unconnected with each other. One was traced to Buffalo, N. Y., one to Rome, N. Y., and another to Toronto, Canada. In the other outbreaks the origin could not be learned. In but three instances did the disease spread beyond the family in which it first appeared. In the case near New Washington there was gross carelessness in allowing unprotected persons to act as nurses, and the patient was not isolated from his family. The wife, two children, and three nurses contracted the disease, the wife and one child dying. Five cases in Cleveland were pronounced chicken-pox before the board of health knew of small-pox being in their city. The case at North Solon was traced to one of these patients, and two other cases in Cleveland, subsequently occurring, were also traced to these cases of so-called "chicken-pox." The first case at Porter was also pronounced chicken pox, the patient attending school for several days after the eruption was well out. For the spread in these cases the health authorities are in no way responsible. The total number of cases reported in the State from January 1 to date (April 19), is 44; of this number 4 have died. The Board is certainly to be congratulated upon the fact that with ten centers of infection in the State at one time, the disease was so successfully controlled, and with such little interruption to business. BOARD OF HEALTH VERSUS BOARD OF EDUCATION. On March 7th, a telegram was received from Dr. Beckwith, asking me to go at once to Lorain to assist the board of health at that place. Arriving at Lorain that evening, I was conducted to the office of the board of health, the board being in special session at the time. The board stated their position as follows: Scarlet-fever and diphtheria had prevailed in Lorain to some extent, for several months. The board of education, on account of this, had postponed the commencement of school after holidays, for two weeks, but had opened the schools on the preceding Monday (this was Thursday). The board of health, which had only recently been organized, decided that it would be necessary to keep the schools closed for sometime longer, and had issued an order to the board of education to that effect. This board refused to recognize the order, and this was the cause of the trouble. The health officer and president were making a strong fight for supremacy, and the issue had been made public, the town being about equally divided in support of the two boards. The question had been brought up in council, resulting in a tie vote; the mayor, being also president of the board of health, cast the deciding vote in favor of that board. No action, however, had been taken. At my request, a vote upon closing the schools was taken, each member of the board of health present voting in the affirmative. It was evident that the future usefulness of the board depended upon enforcing this decision. An examination of the ordinance creating the board established that it had been granted authority to enforce rules and orders that would .cover this case. I asked that the action of the board should not be made public until I had consulted the board of education, and endeavored to effect an amicable agreement. Should this fail, it was advised that the board of education should be served with a notice to close the schools at once, and if this was not obeyed, that policemen be stationed at the school buildings to prevent all children entering. I refused, however, to uphold closing of the schools unless other measures for restricting contagious diseases were enforced. The board accordingly adopted rules requiring notification of infectious diseases, placarding of houses containing cases of such diseases, and the notification of the superintendent of schools of all such cases. Early next morning I met the president of the board of education, the clerk, and one other member of the board. This board's position was, that it was more dangerous to turn childrèn loose in the community-no precautions being taken to properly isolate scarlet-fever patients-than to keep them in school. They had already instructed the superintendent of schools to exclude all children from infected houses. When it was understood that the State Board of Health would insist on the local board at once putting into operation the proper measures for restricting scarlet-fever and diphtheria, and especially that the health of ficer would be required to promptly notify the superintendent of schools of the locations of all cases of these diseases, they agreed to close the schools from that day until the following Wednesday, and longer, if it should then, in the judgment of the board of health, prove necessary. The board of health expressed themselves as satisfied with this proposition, and the conflict of authorities was thus happily adjusted. On my return I sent the health officer and president of the board of education packages of our circulars on the prevention of scarlet-fever and diphtheria The latter wrote me they were just what was needed, and would be distributed in the homes of all school-children. Only a few new cases of the disease were subsequently reported. On March 22, Prof. Nelson telephoned me to come to Delaware on the following day, which I did. I learned that scarlet-fever had broken out among the inmates of Monett Hall, a building in which a number of female students of the O. W. University are quartered, and that school had been prematurely dismissed on account of it. In company with Prof. Nelson, I visited Monett Hall and there met Prof. C. B Austin, in charge of the building, and Dr. Constant, the physician in attendance. |