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1916, there was nothing striking in regard to its distribution. The municipalities having the largest numbers of cases were Hudson (6), Buffalo (8), Rochester (5), Syracuse (3), Albany (4), and Troy (3). In all, the cases were scattered both as to dates of onset and localities. New York City, with 139 cases in 1917, recorded 53 deaths, a case mortality of 38.1 per cent; in the rest of the State, with 156 cases and 41 deaths, the percentage is 26.2. It will be recalled that New York City, during the epidemic of 1916 had a case mortality of 27.2 per cent, while that for the rest of the State was 21.3 per cent. It is interesting to note the continuance of the higher case mortality in New York City. The higher case mortality for 1917 as compared with 1916 may be accounted for, in part at least, upon the assumption that many cases were no doubt diagnosed in 1917 as poliomyelitis of the abortive type, and reported as such, which would have been otherwise diagnosed or overlooked in 1916.

Anthrax

Thirty-two cases of anthrax were reported during the year, 14 of these occurring outside of New York City. Of the 14 upstate cases 9 occurred in Broome County.

In April and May the writer, then Sanitary Supervisor of the district including Broome County, made an investigation of cases among employes of E. J. & Co., operating one of the largest shoe manufacturing plants in the State. A summary of our report upon the investigation follows:

According to information received from a representative of the company 16 cases have occured up to the date of investigation, among employes. It was stated that cases rarely if ever occurred until, after the beginning of the European war, it became necessary to buy Brazil hides and certain poorer grades of India hides. This representative was therefore of the opinion that Brazil and India hides were responsible for infection.

From January first to the time of investigation seven cases had occurred:

NAME Onset Employment just before infection Evans. . . . . . . . . . . . . . . . . . . . Jan. 5 | Foreman, freight gang, at tanneries. Bedner. . . . . . . . . . . . . . . . . . . Jan. 20 | Oiling “kickers” sole leather tannery. Overacher. . . . . . . . . . . . . . . . Mar. 10 || “Calf skin '' tannery. Disinfecting freight car in which India hides were received. Tchchuck. . . . . . . . . . . . . . . . Mar. 28 || “On the beam ” sole leather tannery near “kickers.” Colego. . . . . . . . . . . . . . . . . . . April 6 | Sole leather tannery “on the beam ” often near “kickers.” Cook. . . . . . . . . . . . . . . . . . . . April 30 Machinist, working on “kickers.” Polarasky. . . . . . . . . . . . . . . . May 4 || Unloading India hides from car.

It will be noted that all of the recent cases were among employes of the two tanneries, one designated as “calf skin '', the other as the “sole leather ” tannery. Only one was definitely employed in the calf skin building. He received his infection after leaving the employ of the company, as will presently appear. Four days before leaving he was engaged in disinfecting a car in which presumably infected India hides had been received. About 6,000 hides go through the tanneries daily and about 38,000 weekly. All are secured through a buyer in New York City. They are received from Java, India, China and Brazil, the rest being spoken of as “New York’’ or domestic skins which are collected from the United States, Mexico and sections of South America other than Brazil. Most of the skins, with the exception of the “New York” or domestic, are balcd at the place of shipIment. Generally speaking skins from various sources go through both tanneries regularly, heavy skins going to “sole ieather” and the light to “calf skin.” As a rule, Java skins go only to “ calf skins' while India and China skins may go to either. On certain days, depending on shipments received, certain kinds predominate. Each is marked with a lot number which remains on the skin throughout the tanning process. There are three general classes with reference to conditions in which they are received: “ dry flint’ hides are those which are sun-dried and hard; “dry salt hides have been first dried and then salted; “green salt hides are salted before drying. Java skins are said to be usually clean and of a grade above the average. Many of the China and India hides are of a relatively poor quality. Most of the latter are from the small Indian cow. Incidentally, it was stated that this cow is sacred and not often killed, the skins being presumably from animals that have died a “natural death.” An effort appears to have been made to disinfect China and India hides before shipment, and many of the holes and skins contained in them are covered with lime. It is customary for the buyer to notify the company when hides from anthrax infected districts are being shipped, in order that skins and freight cars may be disinfected upon arrival. In the course of treatment, skins which are to be disinfected are held for three days in a vat containing solution of bichloride of mercury in the approximate strength of 1:1000. The general feeling was that this treatment would not affect anthrax spores. Other skins are first soaked in water. All are then transferred to containers called “kickers” through which water flows continuously and in which the skins are constantly agitated by mechanical arms, the object being to soften them. It was noted that the dirty looking liquid which resulted was, in every instance, being spattered in every direction, so that everything in the vicinity, including the parts of the machines themselves, were constantly soaked with it. Anyone passing through the narrow aisles between the “kickers” could scarcely avoid being spattered. The subsequent treatment of the hides includes soaking in a lime mixture and a later washing with a solution containing ammonia. Employes handling hides are required to wear gloves — canvas for handling dry hides and rubber for wet hides — and to wear armlets. We were told, however, that men who have been engaged at this work for some time become careless and in spite of instructions leave off their gloves or, perhaps, upon an impulse to scratch a wrist or arms, push the gloves or armlets aside. Men were noted handling wet hides with bare hands. That eanvas gloves themselves become infected and are an indifferent protection is suggested by one of the case histories given below. Briefly, the histories of cases investigated were as follows: 1. Evans; onset January 5; foreman of freight gang, and for two days

before onset had been unloading a shipment of hides. By tracing car numbers, it was found that the cars contained China and “New York’’ hides.

2. Bedner; onset January 20; employed in sole leather tannery, and immo‘diately before onset engaged in oiling “kickers.” 3. Overacher; onset March 10; left the employ of the company temporarily on February 22 to work on a farm, taking with him his canvas gloves. For three days before leaving helped to unload 10 freight cars. By tracing car numbers it was found that all contained India hides shipped from Agros. On or about March 9 he was working out of doors, having on his canvas gloves. He had upon his face a pimple which by previous scratching had become abraded. He recalled rubbing this with his gloved hands. The next day evidences of infection appeared. 4. Tchehuck; onset March 28; worked “on the beam ” in Sole leather tannery, handling hides which had been through the lime vats. He had occasion frequently to pass back and forth near the “kickers.” 5. Colego; onset April 6; employed in sole leather tannery, taking hides out of vats well along in tanning process. Had occasion to pass close to “kickers” frequently. 6. Cook; onset April 30; machinist, had been working upon “kickers.” 7. Polarasky; onset May 4; had been away upon a vacation for a week, returning May 3d. Was put to work that day unloading a car of hides, which upon investigation proved to be India and “New York’ hides. From the foregoing the following conclusions were drawn: (a) Hides infected with anthrax were received and handled frequently. (b) A large proportion of those infected were from India and China. (c) Infection was received through direct or indirect contact with hides just received or before they had passed through the lime vats, and the dissemination of infected liquid from the “kickers” was a source of danger. (d) The use of canvas gloves in handling infected hides is not an effective protection.

The writer was accompanicd and assisted in this investigation by Dr. Dudley, the company’s physician at the tanneries. The {}ompany was exceedingly anxious to discover and overcome defects and sources of danger.

Bacillary dysentery

During the year 479 cases were recorded in the State outside of New York city, which reported no cases (for general discussion, see p. 124), of these the greater number (349) occurred in T]utchess County, 315 of them in the city of Poughkeepsie.

The following is the detailed report of Dr. Edward H. Marsh, Sanitary Supervisor, upon the Poughkeepsie outbreak, as published in HEALTH NEws for December, 1917:

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AN EPIDEMIC OF BACILLARY DYSENTERY

During the summer of 1917 a widespread epidemic of bacillary dysentery again occurred in Poughkeepsie, N. Y. This disease has been recognized as being in existence in that city since 1914, when at one time every house on one of the streets near the waterfront contained a case of dysentery, according to one of the local physicians.

In the summer of 1916, 227 cases were reported with 49 deaths.” During the present epidemic, which started in the early part of July and spread rapidly throughout the western part of the city, there were 315 cases and only 13 deaths reported up to October 1. Only 10 cases had been reported to the health officer up to the first of August. A careful epidemiological survey was then made, with the result that 46 more cases were found, most of whom had had no medical attention and in which no precautionary measures against the spread of the disease had been taken. It is undoubtedly due to these missed cases that the epidemic assumed such large proportions. The first cases were reported to the health officer on July 12. The case incidence by weeks was as follows:

Cases w Cases Previous to July 12. . . . . . . . . 7 August 23 to 29. . . . . . . . . . . . 3%) July 12 to 18. . . . . . . . . . . . . . 10 August 30 to September 5. . . 32 July 19 to 25. . . . . . . . . . . . . . 12 September 6 to 11. . . . . . . . . . }S July 26 to August 1. . . . . . . . 28 September 12 to 18. . . . . . . . . 12 August 2 to 8. . . . . . . . . . . . . . 32 September 19 to 25. . . . . . . . . 6 August 9 to 15. . . . . . . . . . . . . 66 September 26 to October 1.. 3 August 16 to 22. . . . . . . . . . . . 50 Total . . . . . . . . . . . . . . . . . . 315

Of these 315 cases, bacillus dysenteriae was isolated on one or more occaSions from the stools of 47 persons. Four types of B. dysenteriae were found: (1) atypical Shiga, (2) Mt. Desert, (3) Flexner, (4) Strong. The Mt. Desert type predominated.

The symptomology of these 47 cases was quite variable. Onset was sudden in 41; gradual, lasting from one to four days, in 6. The disease was ushered in with chill in 16 cases. Diarrhea was present at the onset in 44 cases; three patients were constipated until relieved by catharsis. Of these, one again became constipated and at no other time had diarrhea. Vomiting occurred in 26 cases; nausea in 29; fever in 33; 23 complained of headache; 34 had abdominal pain, and l had intense pain in the back. Blood was passed by 28, and mucus by 22. Three of these 47 bacteriologically positive cases died.

The above record shows that we must change our conception of the symptomology of bacillary dysentery. We have been taught that there is a condition of prostration accompanied by copious, bloody stools and associated with a high mortality. Some epidemics, of course, have assumed this

* Smith, J. A.—N. Y. State Journal of Medicine, XVII, 9, p. 413.

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