December i6, 1887.] 



SCIENCE. 



295 



"has any thing to do with the disease. Next the proper officer 

 should be sent to the house to instruct the family in methods of 

 ■disinfection, and to note the condition of the house. He should 

 leave with the family a circular, issued by the board of health, giv- 

 ing an account of the disease, its methods of spreading, and its 

 dangers, also brief directions for disinfection. On the recovery of 

 the patient, or in case of death, the premises should be disinfected 

 by an officer of the board. People from infected houses must be 

 excluded from school, church, factories, etc., and a strict quaran- 

 tine maintained until the premises shall have been disinfected. In 

 case of death, the body should be interred as speedily as possible 

 and no public funeral allowed. No person should be allowed to 

 enter the house except the regular attendants. 



to. If the above plan is rigidly carried out, it is possible to check 

 the spread of the disease ; but at present it is not possible to 

 strictly quarantine or isolate cases of this disease, because many 

 think it a mild one and of little consequence. Again, many cases 

 are so mild that the sick person is not confined to the bed or even 

 the house, and hence mingle with the well, and these mild cases 

 are often not recognized. 



11. I know of no instance where the spread of scarlet-fever has 

 been certainly and completely stopped by restrictive measures ; but 

 •could we enforce rules as rigidly as is done in epidemics of small- 

 pox or cholera, where the public is prepared for harsh methods, it 

 is probable that the disease might be stamped out for a time. 



12. I know of none. 



ISamuel W. Abbott, M.D., Boston, Mass., secretary State Roard of Health of 

 Massachusetts.] 



In answer to your circular relative to scarlet-fever, I have the 

 "honor to reply as follows ; my reply being based upon an active 

 country-practice of twenty years, and also upon five years' experi- 

 ence as the health-officer, and secretary of this board, during which 

 time I have had opportunity to observe a considerable number of 

 -epidemics of scarlet-fever of varying extent and severity. 



I and 2. No. 



3. An instance under my observation is the following : A health- 

 'officer visited a public institution for the purpose of giving advice as 

 ■to preventive measures. While there he saw several children ill 

 with scarlet-fever, in various stages of the disease, and examined 

 them at the bedside. He then returned to his home, a hundred 

 miles distant. On his way home, and before returning to his 

 iamily, he took the precaution to take a thorough bath, and, on 

 reaching home, sent his clothing to a cleansing establishment. 

 -About eight days afterward, three of his children were taken ill 

 ■with scarlet-fever, one of whom died on the fifth day afterward. 

 There were no other cases of scarlet-fever in the town at that time. 



4. A limited outbreak occurred last spring in the town of Welles- 

 ley. Four children were taken ill in two families who took milk 

 from one man who had two cows. There were no other cases in 

 the town at that time. One of these cows had an eruption on the 

 udder, which, on examination by a com.petent veterinary surgeon, 

 ■did not appear to have the characteristics described by recent Eng- 

 lish reports. I do not regard this as a conclusive case. 



5. Not until after desquamation has been completed, and all germs 

 of the disease originating from the patient have been destroyed. 



6. I have no doubt that such is the case, but have no positive 

 •evidence on this point. 



8. Yes, by the attending physician, who is the only competent 

 authority to judge of the character of the disease. The law of this 

 State makes it incumbent on both physician and householder to re- 

 port, but reports from the latter are rare. 



9. To isolate the sick, and see that proper measures are taken 

 for the continuance of such isolation, and of disinfection upon re- 

 covery ; and in case of death the funeral should be private. 



10. Nothing short of complete isolation of the sick, and absolute 

 destruction of all germs of the disease. 



11. The following statistics are suggestive. By circulars, reports 

 of boards of health, public lectures, and by every possible means, 

 the contagiousness of scarlet-fever has been taught, and the com- 

 munity has been led to see the dangerous character of the disease, 

 and its destructiveness as compared with other diseases, until pub- 

 lic opinion will tolerate much more decisive measures than were 

 possible twenty years since. The following table (from the 



'Massachusetts Registration Report for 1886') shows that the dis- 

 ease has not been so destructive in the past fifteen years (1872-86) 

 as it was in the previous fifteen years (1857-71) in this State: — 

 Mortality from Scarlet-Fever, 1857-86. 



Undoubtedly several extensive epidemics might upset these statistics. 

 I think, however, that the length of time included (30 years), and 

 the size of the population(l,23i,o67 in i860, and 1,942,141 in 1885), 

 may be taken as conclusive that something has modified the prog- 

 ress of the disease, the death-rate in the last fifteen years being 

 less than one-half as large as that of the fifteen years previous 

 (1857-71). If the period of ten years 1857-66 be compared with 

 the last ten years (1877-86), the result is still more striking, the 

 death-rate of the latter period from scarlet-fever being less than 

 one-third as great as that of the former period. 



12. By remedies. No. 



13. I beg leave to mention one or two popular errors in this con- 

 nection. There is a singular notion that physicians' families are 

 comparatively exempt from infectious diseases. On the contrary, I 

 can call to mind at least a dozen families of country physicians 

 in active practice, within five miles of my present home, which have 

 been invaded by this destructive disease. Another error is the 

 notion that a dead body is more dangerous than a living one. 

 There is no evidence, so far as I can learn, in support of such a 

 notion. One living, breathing body, sick with infectious disease, 

 must necessarily produce more infectious material than a dead one. 



[R. B. S. Hargis, M.D., Pensacola, Fla.] 



In relation to the questions concerning scarlet-fever stated in 

 your circular, 1 proceed at once to answer them in order : — 



I. I have seen scarlet-fever on two occasions, in an isolated 

 house, — no other cases in the city nor in the neighboring places, 

 — the source of which could not be traced to any focus of infection 

 outside the walls of the dwellings in which the cases existed. I 

 have also seen measles, a congener of scarlet-fever, undoubtedly a 

 contagious disease, spring up spontaneously, and spread from a 

 single isolated place all over the city, thus apparently arising de 

 novo. Upon careful and anxious inquiry in regard to the above-men- 

 tioned instances of spontaneous development of scarlet-fever and 

 measles in isolated places, I was informed that none of the parties in 

 those houses had had any correspondence, by letter or otherwise, or 

 purchased or received any fabrics, or indeed articles of any kind, from 

 persons at a distance anywhere. All infectious and contagious dis- 

 eases are associated, as a rule, with cutaneous eruptions or glandular 



