EPIDEMICS.

The only wide-spread epidemic which has visited the State has been that of influenza, which, in itself, will render the year a memorable one. Reaching our shores from Europe about December ioth, the first cases were reported in the city of Philadelphia on the 20th of that month. The disease began to appear as a factor in the mortality tables of the city on the fourth day of January, when one death is recorded from the disease. An increase in the number of deaths from inflammation of the lungs, however, from thirty-three in the week previous to seventy-one in the first week in January, sufficiently indicates that the epidemic had become fairly seated. It spread with a rapidity which is scarcely conceivable, and gained in intensity as the numbers of its victims increased. By the 23d of December it was estimated that there were 2000 cases in the city. On the 9th of January 6000 of the pupils of the public schools were reported as prostrated with the disease. The number of deaths increased the first week in January from 404, in the week previous, to 492. In two weeks it reached the startling figure of 770, more than twice as great as the mortality of the corres ponding week of the year of 1889. The over-worked physicians were prostrated both by fatigue and by the disease itself, and many succumbed finally.

Business was now almost at a standstill. In several instances places of business of manufacture were compelled to close for want of hands. Whole families were confined to the bed at once, so that neighbors were obliged to provide them with food and nursing care. This week, ending January 18th, marked the high tide of pestilence so far as mortality was concerned, the city death rate having fallen to its normal by the end of February. In the meantime the epidemic influence had spread like wild-fire, literally on the wings of the wind" throughout the entire State. On the 27th of December the disease was rife in Lancaster, and genuine cases had appeared in Pittsburg on the extreme western border and Wilkes-Barre on the northern border of the State.

It is probable that not a single individual entirely escaped its pernicious effects. Its manifestations were so various, affecting in one the bronchial tubes, in another the nervolls system, now the brain and now the bowels, here peritonitis and there pneumonia, that it was a long time, comparatively, before physicians even recognized it in its protean forms. It is scarcely conceivable that a disease which spreads with such astonishing rapidity, goes through the process of re-development in each person infected and is only communicated from person to person by infected articles. And yet this theory has been maintained by a few authorities who claim that it is always more prevalent along lines of travel and that it did not progress more rapidly than modern means of communication would enable it to do.

Whatever theory we may adopt of its 'means of propagation, it was felt by your Sec. retary that an affection so fatal in its results and so widespread in its domain, possessed an importance which entitled it to especial study. He therefore prepared the following circular, cyclostyle copies of which, to the number of 7000, were distributed to the members of the medical profession throughout the State :

Dear Doctor:

I am desirous to obtain reliable statistics in regard to the recent pan-demic of influenza as observed in this State; will you, therefore, kindly furnish the information called for below, by filling up the blanks from the data in your visiting list or note book and returning the sheet to me as early as practicable? Yours very respectfully,

Up to the first of May 4500 of these letters had been sent out.
The following is an analysis of the results obtained at that date:
Number of physicians reporting.

265

37,275

26,302

10,973

6,913

16,434

5,829

56

205

8

217

42

21

Supposing, which there is no reason to doubt, that the 265 physicians who replied represent a fair average of the practitioners of the State, this would give us 88,416 persons as having been sufficiently ill with this disease to demand medical aid. We know that there were many who suffered mild attacks who never sought advice, and many more whom physicians, in their excessive haste, never entered on their visiting lists, although they may have prescribed for them.

The Board has aided the local authorities in their attempts to suppress local epidemics of typhoid fever in fourteen instances, and of diphtheria in twelve instances.

TYPHOID fever.

Those of typhoid fever could, in every instance, be traced directly to the use of polluted water, generally from wells. In that of Lock Haven a connection seemed to be traceable between the floods of the previous summer as affecting the reservoir and the supply pipes and the existence of the disease.

DIPHTHERIA.

Diphtheria has invariably been found in the midst of conditions of the greatest filth, and has been distinctly propagated by gross disregard of sanitary regulations, and especially in the matter of public funerals.

PUBLIC FUNERALS IN CONTAGIOUS DISEASES.

So strongly has this last fact impressed the Board, that the Secretary was authorized to issue two circulars, one addressed to the clerical profession throughout the State, earnestly requesting its members to discourage the practice of holding public or church funerals in the case of persons who have died of contagious or infectious diseases, more particularly of diphtheria, scarlet fever, and measles; and another to undertakers and funeral directors, warning them of this danger, and also urging the adoption by them of certain precautions in the preparation of such bodies for burial, the conduct of the funeral, and subsequent disinfection of vehicles and apartments.

The former of these has been printed and already widely circulated. The latter has

been prepared, and is now submitted to the Board for its consideration, as it involves points of considerable importance. (See page 629.)

The epidemic of diphtheria in Delaware County is so widespread and persistent, and the conditions so unusually detrimental to health, that the Secretary has deemed it necessary to issue the following proclamation in the name of the Board :

COMMONWEALTH OF PENNSYLVANIA, STATE BOARD OF HEALTH.

EXECUTIVE OFFICE, 1532 Pine Street,

PHILADELPHIA, November 4th, 1890,

PROCLAMATION.

In consequence of an inspection, made on the twenty-seventh day of October, 1890, by the Medical Inspector of the Delaware District, the State Board of Health hereby declares diphtheria to be epidemic in the township of Middletown, Delaware County, including the villages of Glen Riddle, Lima, Parkmount, and Lenni; and in the township of Ashton, Delaware County, including the villages of Crozerville, Rockdale, and Village Green. In the absence of any local health authorities in these townships, the Board establishes the following

REGULATIONS.

First.-There shall be no public or church funeral of any person who has died of diphtheria, or of any person who has died of any other disease in a house in which diphtheria was present at the time of such death.

Second. The body of any person who has died of diphtheria shall not be exposed to view. Such body shall be immediately after death wrapped in a sheet which has been soaked in a solution of corrosive sublimate, in the proportion of two drachms to the gallon of water, and privately buried within twenty-four hours.

Third.-No person shall unnecessarily visit any house in which diphtheria is known to exist, or has existed within a period of six weeks.

Fourth.-No member of a family in whose house diphtheria exists should attend school, Sunday-school, church, theatre, or any other public assembly.

Fifth.-Every school, among members of which there have been cases of diphtheria, should be closed; and no child should be received into a non-infected school who has been attending one, among the pupils of which the infection is known to have existed.

Sixth.-No person recently recovered from an attack of diphtheria, or in whose family diphtheria exists, shall go to work in any factory or mill in which their work requires them to be in close contact with their fellow workmen in confined rooms, without a certificate from their attending physician stating that in his opinion they run no risk of conveying the contagion.

Seventh. The period during which a person who has had diphtheria is in danger of conveying the contagion is from four to six weeks.

Eighth. All rooms and houses in which diphtheria has occurred, and all clothing, bed clothing, and articles of furniture which have been exposed to infection should be disin fected in accordance with the subjoined instructions.

Ninth. No dead animal, garbage, or filth of any kind shall be thrown into any stream, race, dam, pond, or other water, or upon any public road or place. All such material should be either burned or buried.

Tenth. All cellars should be thoroughly cleaned and whitewashed, and all house yards and privies disinfected with copperas, and kept clean.

NOTE. The State Board of Health has "power and authority to order the cause of any special disease or mortality to be abated and removed." Any person who shall fail to obey or shall violate such order becomes liable to a fine of $100 for each such act of neglect or

violation.

The circulars of the Board (No. 19, Precautions against Diphtheria, and No. 29, on The Dangers Arising from Public Funerals, of those who have died from contagious and infectious diseases), can be obtained of the minister of the Calvary Church at Lenni, of Dr. Morton P. Dickinson, of Glen Riddle, or by addressing Benjamin Lee, M. D., Secretary of the State Board of Health, 1532 Pine Street, Philadelphia.

To this proclamation were appended careful instructions, taken from the circulars of the Board, as to disinfectants and the mode of using them.

SMALLPOX.

Smallpox has appeared only in three places, namely, Pittsburg, Canonsburg, Washington Co., and Glen Lyon, Luzerne Co., and by the prompt action of the State or local authorities has, in each instanee, been at once crushed out.

LEPROSY.

Leprosy has occurred in two cities, Philadelphia and Chester. Both cases were promptlá isolated by the local health boards, and are under strict surveillance. The Secretary has addressed a communication to the Surgeon-General of the United States Marine Hospital Service, suggesting that in accordance with the new regulations of that service, inasmuch as the patient is not a naturalized citizen of the United States, he is extradited to his native country, Sweden, where he could be comfortably cared for, in a leper colony, where he could enjoy the society of his fellows, instead of enduring the torture of solitary confinement.

In view of the rapid spread of this disease both in the East and West Indies during the last decade, it will undoubtedly become necessary, at no distant period, either for the United States to found leper colonies, or for each large city to establish its leper house. The former plan is evidently the more practical and rational. At the National Conference of State Boards of Health which met in Nashville in the month of May, your Secretary suggested that the United States should, either by purchase or cession, obtain possession of three tracts of land, one in the northwest, one in Louisiana, and one in California, already to some extent occupied by lepers, and establish thereon as many colonies, to the nearest of which every leper discovered should be removed, and on which he should be detained with every provision for his comfort until death should come to his relief. At the meeting of the American Public Health Association in the City of Brooklyn in October, 1889, which your Secretary and Dr. Edwards attended as delegates, the former presented a resolution at the close of a paper, detailing the results of his observation of leprosy in the island of Cuba, which read as follows:

Resolved, That this Association, recognizing the admirable precautions taken by the United States Marine Hospital Service and by the State Board of Health of Florida to prevent the introduction of yellow fever in this country, respectfully request Supervising Surgeon-General Hamilton, of the United States Marine Hospital Service, the Honorable the State Board of Health of Florida, and all quarantine commissioners of ports having intercourse with Cuban ports, to exercise the same vigilance with regard to leprosy that is already observed in the case of yellow fever during what is known as the quarantine

season.

Resolved, That the Secretary be instructed to transmit copies of the above resolution to the several officials therein indicated."

The resolution was adopted and forwarded as directed. In compliance with this request, the following circular was issued by the Treasury Department of the United States:

1889.

CIRCULAR.

REGULATION TO PREVENT THE INTRODUCTION OF LEPROSY.

Department No. 130.

TREASURY DEPARTMENT.

OFFICES SUPERVISING SURGEON-GENERAL, MARINE HOSPITAL SERVICE, Į WASHINGTON, D. C., December 23d, 1889. To Medical Officers of the Marine Hospital Service, Collectors of Customs, and others Concerned:

The National quarantine act, approved April 29th, 1878, entitled, "An act to prevent the introduction of contagious or infectious diseases," provides that no vessel or vehicle coming from any foreign port or country where any contagious or infectious disease exists, or any vessel or vehicle conveying persons or animals affected with any contagious disease, shall enter any port of the United States, or cross the boundary line between the United States and any foreign country, except in such manner as may be prescribed.

Attention is now directed to the increased prevalence of the contagious disease known as leprosy in several foreign countries, and the danger of its increase in the United States, through the immigration of persons affected with leprosy, and by direction of the Secretary of the Treasury, the following regulation is framed under authority of the foregoing act, subject to the approval of the President, to protect the people of the United States from the introduction of leprosy :

1. Until further orders, no vessel shall be permitted to entry by any officer of the customs until the master, owner or authorized agent of the vessel shall produce a certificate from the health officer or quarantine officer at the port of entry, or nearest quarantine United States officer, that no person affected with leprosy was on board the said vessel when admitted to free pratique, or in case a leper was found on board such vessel, that he or she with his baggage has been removed from the vessel and detained at the quarantine station. 2. Medical officers in command of United States quarantines are hereby instructed to detain any person affected with leprosy found on board any vessel, but such officer will permit the departure on outgoing vessels of persons detained at quarantine in pursuance of this regulation, provided such vessel shall be bound to the foreign country from which the said leper shall have last sailed.

Approved:

JOHN B. HAMILTON, Supervising Surgeon-General Marine Hospital Service.

WILLIAM WINDOM, Secretary.

Approved:

BENJ. HARRISON.

The anxiety which is felt upon this subject in California, which is in intimate commucation with leprosy-breeding centres, is sufficiently indicated by the following resolution, adopted by the State Board of Health of that State, which was forwarded to the Secretary in the early part of this year:

DEAR SIR: At a regular meeting of the State Board of Health of the State of California, held January 11th, 1890, it was

Resolved, That the California State Board of Health recommend that the Congress of the United States do enact a statute,

States.

'First, That no person affected with leprosy should be permitted to enter the United

"Second, That every person immigrating to the United States from any place where leprosy prevails shall procure a certificate from a competent physician, properly attested by some United States consul or health officer, certifying that he or she is not affected with leprosy, is not a descendant from a leprous family, and has no relations in the co-lateral line who are lepers.