January 13, 1888.] 



SCIENCE. 



15 



four hours. I give the iron as a germicide, believing it equally ef- 

 fective in scarlet-fever and diphtheria. I would respectfully refer 

 you to ' Health Exhibition Literature ' of the Epidemiological So- 

 ciety of Great Britain, the publications of the American Public 

 Health Association, to reports of State boards of health, to Ziem- 

 sen's Encyclopsedia on scarlatina, and to articles in the Ame>-ican 

 Joii}-nal of Medical Science. 



Jerome Cochran, M.D., Montgomery, Ala., State health-officer, 

 says, " Our law requires all cases to be reported (i) by the physi- 

 cian in charge ; (2) if there is no physician, by the head of the fam- 

 ily. We have boards of health in all of our counties, and isolation 

 and disinfection are practised. Isolation and disinfection properly 

 done would go far to prevent its spread. Absolute isolation would, 

 I think, prevent it absolutely." 



J. W. Parsons, M.D., Portsmouth, N.H., believes that scarlet- 

 fever has arisen de novo, on the ground that after due inquiry no 

 source of infection could be discovered. He thinks that heads of 

 families, as being most interested, should be required to make re- 

 ports of cases to health boards, and not physicians, who already 

 have enough of such gratuitous work to perform. 



George H. Rohe, M.D., professor of dermatology in the College 

 of Physicians and Surgeons, Baltimore, says, " I have never seen 

 any evidence which seemed to me to establish the de novo origin of 

 scarlet-fever at the present time. In 1877, I was medical attend- 

 ant to a poor family, in which there were three children, — a boy of 

 eleven, a girl about eight, and another younger child. The boy 

 contracted scarlet-fever, it was supposed, at school. The other 

 children were both attacked a few days later. Two out of the three 

 died. In this case isolation was impracticable, as the family (of 

 :si,x) lived in two rooms. In 1882 an almost identically similar in- 

 stance occurred in my practice. A girl of six was taken ill with 

 scarlet-fever, and several days thereafter two younger children, 

 aged four and two respectively, were also attacked within twenty- 

 four hours of each other. The youngest child succumbed to the 

 disease. Isolation was attempted in this instance when the first 

 child was taken sick, but the stupidity of the parents rendered all 

 attempts at prevention nugatory." 



Dr. Rohe accepts the general professional opinion that from six 

 to eight weeks should be allowed to pass before the period of 

 danger of infection can be said to be over. He is convinced that 

 thorough and repeated disinfection of the surface of the patient 

 would decidedly reduce the period of infectiveness of the patient, 

 and has so expressed himself in his address on State medicine (see 

 Journal American Medical Association. July 2, 1 887). He further 

 says, " All cases of scarlet-fever (and all other infectious diseases) 

 -should be promptly reported, as soon as the diagnosis is made, to 

 the health authorities. These reports should be made by the at- 

 tending physician, in order (i) to have a prompt report, (2) to 

 avoid false and malicious accusations, which would be easy if this 

 duty were left to irresponsible persons. Further, a neglect of this 

 duty, if it devolved upon the householder, might cause disastrous 

 results, and afterward give rise to disputes and questions of vera- 

 -city between the physician and the patient's family. This duty of 

 compulsory notification, if imposed upon physicians, should, how- 

 ever, be made as easy as possible, and should not involve any ex- 

 pense to the practitioner. The question of compensation for such 

 service is one open to debate. No member of the legal profession, 

 whether an official or not, will perform any service for the State 

 without exacting a fee. There is no equitable reason why a physi- 

 cian should be required to act otherwise. Both sickness and death 

 notices furnished to the authorities should be paid for by the latter. 

 It seems to me the duties of boards of health, if notified of the ex- 

 istence of contagious diseases, and when empowered by law, would 

 be to secure the isolation of the patient, dismfection of apartments 

 after recovery or death, private funerals, notification of school- 

 officers if children from the infected house are attending school, 

 supplying disinfectants, and, whenever necessary, invoke the aid of 

 school authorities to close schools. In addition to the public meas- 

 ures mentioned, personal disinfection of the body of the patient, 

 by daily sponging with an effective solution of chlorinated soda or 

 thymol, or inunction with a disinfecting unguent or oil, with im- 

 mediate disinfection of all discharges and bed-linen, would, I feel 

 sure, result in a marked restriction in the disease. I believe isola- 



tion hospitals would aid materially in restricting this disease. Prop- 

 er instruction of the public (and, I may add, of the medical pro- 

 fession) would be a strong help to practical sanitarians. There 

 are even health officials known to me who might profit from such 

 instruction. I do not think the prophylactic administration of 

 remedies would accomplish much good. Avoiding contact with 

 the infective material is the best and surest means of prevention." 

 For information touching the communication of bovine scarlet- 

 fever to man. Dr. Roh^ refers to the reports of Mr. W. H. Power 

 and Df. E. Klein in the Practitioner. 



T. B. Heimstreet, M.D.,Troy, N.Y., thinks that cases of scarlet-fever 

 should be reported to health boards by medical attendants, and that 

 these boards should prevent the attendance at school of other chil- 

 dren of the same family in which the disease exists, and should dis- 

 infect the apartments, etc. 



George Glenn Wood, M.D., Muncy, Penn., writes, " My plan of 

 preventing the spread of scarlet-fever would be to establish one or 

 more scarlet-fever hospitals, according to size of city, on the same 

 plan that small-pox is managed. Inasmuch as the large cities are 

 the usual hot-beds for this, as all infectious diseases, and its sup- 

 pression there would mean the escape of rural cities and towns, the 

 proper management would be to stamp it out at the former places. 

 If, then, scarlet-fever patients were instantly removed, and quaran- 

 tined in such special hospitals, there attended by the family phy- 

 sician if desired, and nursed by parent, friends, or professional 

 nurse, advantages would occur not only to patient, but to other 

 members of same family, and the public at large. Of course, to be 

 effectual, the whole matter must be compulsory." 



Lincoln R. Stone, M.D., Newton, Mass., says, " I can hardly 

 say that cases can arise de novo, but a few years ago, in July, in a 

 farmhouse during haying, a case occurred where no case had been 

 known for years. There had been no intercourse with other 

 people, no other case known in town. The house was situated on top 

 of a high hill, half a mile from any family. The patient was a young 

 child about three years old. There was no other case in the house, 

 though young children in the family. Most careful mquiry could 

 throw no light on the case : it seemed almost de jiovo." He reports 

 a case where a blanket, used by a child before and during an attack 

 of scarlet-fever, by some accident or carelessness, was not cleansed 

 or destroyed after recovery, and a child, a relative, visiting, played 

 with the blanket and had a severe attack. 



D. W. Hand, M.D., St. Paul, Minn., member of the State Board 

 of Health, thinks that placards should be placed on the houses 

 where scarlet-fever exists, so as to give the public notice of the in- 

 fection. He knows of several instances where strict isolation and 

 disinfection have confined the disease to one child in a family. 



A. J. Howe, M.D., Cincinnati, O., in reference to the de novo 

 origin of scarlet-fever, says, " I do so believe, but may be mistaken. 

 My belief is based on the fact that typhus, erysipelas, and diph- 

 theria do arise de novo, under influences which develop zymotic 

 poison. Possibly scarlet-fever virus is too strictly specific to come 

 from any thing but the scarlatina germ." Dr. Howe relates the 

 following incident : " A gentleman of my acquaintance, living in 

 the countcy, brought a child, a boy five years old, from a city fifty 

 miles distant. On the way, when near home, he stopped at a 

 schoolhouse a few minutes during recess, and several of the pupils 

 gathered around the little stranger. The next morning I was pro- 

 fessionally called to the child, and found him violently sick with 

 scarlet-fever. In eight days from that time, thirteen out of twenty- 

 seven of the school-children were down with scarlet-fever. There 

 had not been a scarlatina case within five miles for three years." 

 He recalls another instance in which a wadded hood, that of a 

 child which died of scarlet-fever, was the bearer of the disease to a 

 child in the country, to whom the garment was given. In this case 

 the article retained the infective virus two months, — March and 

 April. 



J. Howard Morgan, M.D., Westerly, R.I., reports, " I have now 

 under care eleven cases in one family, who are convalescing from 

 scarlet-fever of rather mild type, the first three of which (viz., the 

 youngest three of the family) began to sicken seven days after the 

 coming of their grandmother to visit the family, from a place some 

 six miles away, where she had been attending for a week or two 

 another grandchild who had ' sore throat and the same sort of rash,' 



