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There was no case of small-pox in the city in 1889. The only cases since 1875 were one fatal case in 1883 and one mild case, which recovered, in 1887. The principal contagious diseases which prevail in Providence, and of which reports are required from physicians, are scarlet fever, typhoid fever and diphtheria. The following tables show the prevalence of each during the past six years. It will be seen that there were, in all, 658 cases of these diseases in 1889. All but 25 of these were reported by the attending physicians. This shows a failure on the part of the medical attendant in complying with the law in less than 4 per cent. of all cases. In most of these it was forgetfulness on the part of the phy. sician, rather than wilful neglect. Indeed, I believe there is only one physician now in the city who deliberately intends to disregard the law whenever he deems it safe to do so. In some cases, also, failure to report is the result of failure to recognize the disease, or the existence of a reasonable doubt as to its nature ; though in the latter case the attending physician should call in the health officer to bear his share of the burden of that doubt. The teachers in the public schools all report to this office cases of contagious disease coming to their notice ; and in making his visits of inspection the medical inspector always inquires about the existence of the disease in the neighborhood. Rarely, in following up reports so obtained, does he come upon true cases of the disease in question ; in most instances he finds the rumor ill-founded. In these various ways it is believed that very few cases of contagious disease escape the notice of this department. I have no doubt that when this does occur it is due almost always to a failure to recognize the disease, either because it is a mild case and no physician is called in, or because the medical attendant himself is led astray in bis diagnosis. This is borne out by the fact that there was failure to report scarlet fever, which is usually easy to recognize, in only four instances ; in typhoid fever, which is more doubtful, in six; while diphtheria, about which it is much more difficult to come to a conclusion than in either of the others, there were fifteen failures to report. I do not mean to claim that this department is infallible in diagnosis, or that the medical attendant can be expected to determine the disease in all cases. I fully appreciate his difficulties; and if this department has been able

in doubtful cases to determine the nature of the disease only after it has run its course, and perhaps other and typical cases have developed from it, I certainly can attach no blame to another for failure to recognize it earlier.

SCARLET FEVER.

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Scarlet fever, when left to itself, tends to recur in epidemics about every five years. But if active measures are taken for its suppression, this regularity may be considerably interfered with. This is well illustrated by the history of the disease in many cities, notably Boston, where the energetic action of the health department has resulted not only in markedly diminishing the death rate from this disease, but has interrupted the marked periodicity in it which formerly occurred. A severe epidemic began in Providence in the autumn of 1887, but it was speedily checked, owing to the interest which was taken in the epidemic by the great body of our citizens, and the care which they consequently exercised. Since that time there has been only a very moderate amount of scarlet fever in the city ; particularly since June, 1889. During the last half of the year only 45 cases were reported, with five deaths, and four of these were in July. The mildness of the disease is particularly remarkable ; and this, together with the greatly lessened tendency to spread, has led me to mistrust that some of the reported cases were not scarlatina. This mistrust is strengthened by the fact that I have several times, during the past few months, been called in consultation by physicians to see suspected cases, which shows that similar doubts have existed in the minds of others. During the past year, scarlet fever has several times been imported into the city; and these cases and those which sprang from them, have been the most severe which have occurred. A record of some of these cases may be of interest and value.

A family from Ireland moved to SM street in the latter part of September. Five days after leaving the vessel two of the children were taken sick with scarlet fever. Other members of the family had had scarlet fever a few months before. There was no scarlet fever at this time among their neigubors or friends.

On September 20-22, the children of Mrs. G- , on S avenue, visited friends in an adjoining town. A child in this family had had what, from a descripti on of the case, was scarlet fever, about two weeks before the visit. On their return from this visit, the G- children were taken sick with scarlet fever : one on the 28th of September, and the others about a week later. There was then no scarlet fever in that part of Providence.

In May, 1889, Mrs. - moved to 38 B- street. Her child had died two years before, of scarlet fever. The clothes of this child were placed in the attic, and the children of another family in the house-the X's-played among them and were taken sick with scarlet fever in July. The house was only imperfectly disinfected by the family. On September 21st, a family just from England moved into this tenement and stayed five days, moved out, and came back to the lower tenement October 1st. Scarlet fever developed October 11th. The disease spread to several families in the immediate neighborhood.

In October, a boy came from Connecticut to visit some friends on E- street. He had had scarlet fever two weeks before and was desquamating at the time of his visit. Within a few days of his arrival, scarlet fever appeared in the family where he was visiting.

Two years ago, I began the collection of data in regard to scarlet fever; in each case of the disease waiting for sufficient time to elapse for all in the family to have the disease who would be liable to have it. At least two months is al

lowed to elapse. I have continued this plan ever since, and the following table presents the results of the three years' work :

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Number of fainilies in which there was more than one suscepti.

.............

.....
Number of these in which there was no second case...........
Number of susceptible children in all the above families.......
Number of these children who were attacked..................
Number of additional families with susceptible children in the

same house where the disease appeared ...................
Number of susceptible children in these families...........
Number of these additional families attacked.......
Number of children in these families attacked .................
Number of families where inunction was practiced............
Number of instances in the above families where the disease

spread beyond the first case.... ............. ..........
Namber of susceptible children in these families..............
Number of these children who were attacked ..................
Number of tenements which were fumigated ..................
Number of instances where fumigation was done, and where

the disease spread to other families in the house. Number of instances where susceptible children were at once

removed.................................................. Number of instances where they were attacked on their return.

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It will be seen that the figures indicate about the same results for each of the years, except that in 1889 the disease shows less of a tendency to spread. This may be due partly to increased precaution and better methods of disinfection, but is rather, I believe, to be attributed to a milder form of the disease and to the errors of diagnosis, before referred to.

The following tables show the ages of 1,009 persons attacked by scarlet fever, the proportion of those exposed of each age who were attacked, and the propor. tion of those attacked at each age to the total population of the same age. The figures cover the past three years :

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There were 198 cases of typhoid fever in 1889, with 59 deaths. In 1888 there were 403 cases and 103 deaths. The exceptionally large number in 1888 was due to the epidemic, the cause of which was considered in my last report. A considerable number of the cases in 1889 were as usual evidently coutracted outside of the city. The accompanying table shows the number of cases occurring in the city and State since 1856.

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