There might be difficulty in making a diagnosis during the first days, under some circumstances, but when smallpox is epidemic all over the country, and all have reason and warning to be on the lookout for cases, or even for suspicious symptoms, there is no longer any excuse for physicians who fail to recognize the disease and to cordially co-operate with the authorities in preventing its spread. Excluding chickenpox, which is essentially a disease of childhood, it does not look like anything else, and the symptoms point to nothing else. The pain in the back; the hard, shot-like papules, appearing first in the edge of the hair on the forehead, and then on the wrists, and all the time more abundant on the face and other exposed portions of the body; the disappearance of the fever and the feeling of relief when the eruption appears, and the regularity of the successive stages of the eruption, taken all together, make a picture never to be forgotten by a careful observer. The fact should be emphasized, over and over again, too, that adults almost never have chickenpox. When unvaccinated, grown people have a contagious eruptive disease, under existing conditions, they should be isolated, and at least reported as suspicious until some some competent authority decides that it is not smallpox. It should be constantly borne in mind, also, that there are no such diseases as "elephant itch," "African itch," "army itch," "cedar itch," or "Cuban itch," but that these are "nigger" names for smallpox. In all of the hundreds of instances where the disease was reported under these and other misleading designations, our expert inspectors have found only genuine and unmistakable smallpox. As an aid to the inexperienced, and as a means of education to the public, cuts are incorporated in this paper representing the various types and stages of the mild form of smallpox now prevailing so extensively. Frequently all of these types and stages are found in the same house or locality. All of these people were unvaccinated. But for the expense involved, these pictures might be multiplied indefinitely, from photographs sent in by our officials from all sections of the State. Bad as these pictures look, they represent little of the real horrors of the disease, and yet scores of cases like these, and as well marked, have occurred in almost every county in Kentucky and been misnamed and disputed by inexperienced physicians. These cases do not look mild to an inexperienced person, but except in the aged and intemperate, little fatality occurs as a rule, and little pitting or other trace of the disease is usually left after a few weeks. The law plainly requires physicians and heads of families to report all cases of smallpox or other communicable diseases to their respective county or municipal boards of health within the first twenty-four hours, and that they shall obey the rules and regulations of such boards relating thereto, and ample penalties are provided for failure to do so. The law also gives such boards full authority to provide hospitals, physicians, nurses, guards, and all other things needful in managing and stamping out the disease at the expense of the county or municipality, where the persons afflicted are indigent, and this authority has been sustained and even extended in frequent decisions of the court of appeals. It is greatly to be desired in the interest of economy and harmony, as well as because it is a matter of common concern, that the health and fiscal authorities shall work together hand-in-hand, but it is important that the former should be advised as to their rights in the matter when a disagreement is unavoidable, and, in the presence of a grave public danger, not to hesitate in exercising them. When its true nature is recognized, early smallpox is the easiest of all contagious diseases to stamp out. When it spreads beyond the first case, or, at most, beyond the first family, somebody has violated the law and is seriously to be blamed. All cases should be immediately and rigidly isolated, in the county or municipal hospital, if possible, and the house in which the disease exists, or from which it was taken, should be flagged or placarded, and guarded, unless in trustworthy hands, until it has been systematically disinfected and officially released from quarantine. Every member of the household and every other person who has been exposed to the disease, should be traced out, vaccinated in three places, and kept under observation for sixteen days, or until the vaccinations have taken well. If any exposed perso has gone away, or afterwards makes his escape, immediate notice of the facts should be sent to the health officer of the jurisdiction into which he has gone. The rules laid down appear easy and simple upon paper, but their effective enforcement when smallpox breaks out in a settlement of negroes, or the class of white people who neglect vaccination, and consequently have a monopoly of smallpox, and especially when the situation is complicated by ignorant or contentious doctors, and selfish business men, who vehemently assert that it is not smallpox, and a fiscal court which hesitates and hinders where immediate and decisive action is so important, will fully test the patience, firmness and tact of the most experienced and judicious health officials. Fortunately more and more of the fiscal officials and intelligent people are recognizing the necessity of enforcing the law at the outset as a means of minimizing the expense and trouble of management. Most of our county and municipal boards are having distinctly less trouble in securing moral and financial support than in former years. If this could be further developed so that the precautions herein suggested could be effectively enforced throughout Kentucky for six weeks, we would have no smallpox. If successive generations were systematically vaccinated, we would never have any more smallpox. |