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considerable prostration, cough, dry coated tongue, pain in legs, mentality dull and active delirium at times.

There was no rash on any of the patients and a careful clinical examination elicited the facts as given above. The chief characteristics of the illness were the extreme virulence and ready communicability; everyone who had been in contact with the first case became ill. In all, the onset was rapid with high fever 103° to 105°- vomiting and active delirium, dry coated tongue and muscular pains, especially in the legs. Two of the cases had marked pain on the right side. One case had well pronounced herpes of the lips. One case had bloody expectoration. Abdomen not distended or tender. Spleen not palpable.

Pulmonary signs: In one case signs of consolidation in right upper lobe, dullness, bronchial breathing and crepitant rales (this case was seen shortly after onset of illness); in the others more or less rude breathing, sibilant, and moist rales all over chest. Fever in all terminated by lysis. Widal reaction and smears taken for malaria were negative. A tentative diagnosis was made of pneumococcal infection, perhaps combined with B. influenza.

At the suggestion of Dr. Nicoll, Secretary of the State Department of Health, the Rockefeller Institute in New York city was communicated with and Dr. Chickering was assigned to make a bacteriological investigation.

The cases were revisited on May 26, in company with Doctors Chickering, Palen and Merritt. It was found that the mother had died two days before, two of the children were still acutely ill and the others were convalescing. Specimens were taken as follows:

Blood in broth cultures from the two acutely ill
Blood for white cell count from two acutely ill
Blood smears from all
Throat cultures from three
Sputum from all in house

Results obtained were as follows:

Blood cultures, both sterile

White cell count:

Arthur — 19000 total white cells

76% Polymorph.
16% Mononuclears

8% Lymphocytes
Floyd - 91000 total white cells

84% Polymorph.

6% Small Lymphocytes

10% Large Mononuclears. Blood smears negative. Throat cultures showed mixed

strains of Gram negative and Gram postive diplococci.

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BACTERIOLOGICAL RECORD

From the sputum of five of the six cases investigated was recovered a pneumococcus which corresponds in its immunological reactions to the pneumococci of Group 1.

At the time of the investigation three of these cases had been, and still were, suffering from pneumonia; the other cases — the father of the family and the nurse -- were apparently healthy individuals who were in close contact with the patient. The sputum of the baby, Fred, showed streptococci.

The influenza bacillus was also present in the sputum of some of the cases. This organism is so frequently found in sputum from many pathologic conditions that its presence in these cases should not be accepted as necessarily a factor in having caused the disease or influenced the course of it.

So far as is known at the present time this series of six cases of acute lobar pneumonia, apparently caused by pneumococci of the same type and spread from one person to another by direct contact, is unique in the epidemiological records of the disease.

Smallpox The following is a summarized report covering the prevalence of smallpox in the State, prepared by the writer for HEALTII News (March, 1918), with corrections made necessary by receipt of delayed reports:

Smallpox" is a word startling to the average individual, and to those familiar with the history of the disease brings to mind visions of yellow flags, armed guards and neglected victims dying by thousands or left wit! faces pockmarked as the result of its ravages. While universal vaccination has robbed it of most of its terrors, it is well to bear in mind the fact that if our sense of security leads to a neglect of general vaccination, it may again secure a foothold, and assume some of the characteristics which formerly made it the most dreaded of all scourges.

It is reasonable to assume that at the close of the present world war there may be an influx of immigrants from countries in some of which smallpox is still a scourge. Even the vigilance of the guardians of our ports will not assure safety to an unvaccinated generation against the entrance of persons bringing with them fresh and virulent strains of the organism causing the disease.

CASES OF SMALLPOX REPORTED IN NEW YORK STATE, 1914-1917, INCLUSIVE

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The first case of smallpox reported “up-state” in 1917, occurred at Union, Broome county, in January, the patient being a negro who had been closely associated with negro laborers brought from the south shortly before. The case was promptly diagnosed and all nonimmune contacts vaccinated. No further cases occurred locally, but in the following month a case was discovered at Bath, the patient apparently having received his infection at Union.

During the spring and early summer scattered cases occurred, notably in certain Hudson River counties and in western New York. In each instance, as a result of the joint efforts of state and local health officials in locating contacts and promoting general vaccination, outbreaks were controlled and nowhere did they assume epidemic proportions. Most of these local outbreaks were directly traceable to imported cases. The disease was prevailing extensively in and about Waterbury, Connecticut, whence it entered New York State in several instances. The primary case in one instance came from Massachusetts, while others were from Canada, from Ohio and from Pennsylvania. In April, infection in a group of cases in Buffalo was traced to an employee of a traveling opera troupe.

In June, a local health officer whose district adjoins the Cattaraugus Indian reservation discovered a well-developed case in an Indian on the reservation. An investigation revealed the fact that a number of undiscovered cases existed there, and that a large number of Indians, and possibly many people residing nearby, had been exposed. As a result of the vaccination of some 1,500 Indians and general vaccination in the villages adjacent to the reservation, reinforced by a vigorous quarantine, the outbreak was limited to 101 Indians, nearly all previously unvaccinated, who had been exposed too early to be protected. The first case is believed to have been an Indian who developed the disease shortly after being discharged from the Buffalo penitentiary. The disease was carried to the Allegany reservation by an Indian who left the Cattaraugus reservation before quarantine was established. This case was promptly discovered, and but seven cases resulted therefrom.

Smallpox has prevailed to some extent in Buffalo since early spring and during October and November, 13 cases were discovered in Niagara Falls. Several scattered cases have occurred during the fall and early winter in towns adjacent to Buffalo.

Early in November the disease made its appearance in central New York, the first case found being at Rome. Shortly after cases came to light in Utica. Upon investigation it was found that apparently the first case had been a bellboy, who had been ill some time before. He had infected a sister, who in turn had been responsible for two other cases in a school attended largely by children of Italian parentage. Up to February 1, 47 cases had occurred. , Several thousand vaccinations have been performed, and the outbreak is regarded as under control, notwithstanding the fact that a very large number of exposures had occurred before the situation came to the attention of the health authorities.

By February 1, 95 cases had been discovered in the county, 78 of them in the town and village of Frankfort. Its control, in the midst of a large and constantly changing industrial population, has required united and vigorous efforts on the part of health officials and has been accomplished with the cordial cooperation of school and public officials, of employers and employed.

Smallpox is prevailing not in New York State alone. In spite of vigilance, those who travel or who mingle with others may at any time come in close contact with persons capable of transmitting the disease. Within the past few weeks a salesman suffering from the disease traveled over several counties before his condition was discovered. With the possibilities so clearly before us,

a word to the wise" should be sufficient.

The epidemic which occurred at the Cattaraugus Indian Reservation, mentioned in the foregoing summary, deserves special comment.

The reservation is sixteen miles long and about two or three miles wide and covers an area of approximately fifty square miles. It lies in three counties, Cattaraugus, Chautauqua and Erie, in five different townships, and its confines border upon five villages, the largest of which is Gowanda. There are about sixteen hundred Indians of various tribes residing upon the reservation.

When information regarding the presence of smallpox was received from Dr. H. F. Senftner, the sanitary supervisor stationed at Buffalo, Dr. J. J. Mahoney, sanitary supervisor at Jamestown, and Dr. Edward S. Godfrey, Jr., epidemiologist stationed at Albany, were directed to cooperate with him in the suppression of the outbreak, a state nurse being assigned to assist.

When the news of the presence of smallpox spread abroad, there

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