FAIR

HAVEN

town an official visit to look into the sanitary condition of the town. Our board of health would certainly be benefited by your visit and would be better qualified for the office.

Respectfully,

J. J. JOHN,

Secretary Board of Health.

At Curwensville, Clearfield County.

October 21, 1895.

Dr. Benjamin Lee, Secretary State Board of Health:

Dear Sir: We have a few persons who have typhoid fever that refuse to be controlled by the rules and laws as prescribed by the State Board, and will not stay in doors but insist on going to their work. What is our remedy, and has the local board any power to control them? Of course, some families have no support, only the husbands day's work and are very much in need of full time so as to enable them to meet their obligations. It does seem rather hard to keep them in without any remuneration. Some say to us to give them what they need for their families and they will then stay indoors. Is it the duty of the board of health or overseers of the poor to furnish them with provisions and medicines, etc., or can we compel them to stay in-doors and not provide for them and their families?

Should children from typhoid fever families be allowed to go to our public schools?

We wish an answer in a purely legal way, as we have constantly such cases to contend with.

Very respectfully yours,

W. P. TATE, Secretary Curwensville Board of Health.

4-SPECIAL SOURCES OF DISEASE.

History of an Epidemic of Acute Anterior Poliomyelitis.

By C. S. CAVERLY, M. D., Rutland, Vt., President State Board Health.

During the month of June, 1894, there appeared in a portion of the valley of the Otter creek, in the state of Vermont, an epidemic

of nervous disease, in which the distinctive and most common symptom was paralysis. The great majority of the sufferers were children under six years of age. The city of Rutland and town of Wallingford were first affected, later the towns immediately contiguous to these, and to this tier of towns, thirteen in number, the outbreak was almost exclusively confined.

A remarkable series of cases occurring in the city of Rutland first attracted the attention of the physicians, and later, popular interest. Many of these cases were taken sick without apparent cause. In others it was ascribed to getting over-heated, or chilled suddenly when heated, indigestion, and occasionally to trauma. After a few weeks deaths were heard of, and during the latter part of July every one was discussing the "new disease."

From my own observation and conversation with other physicians, it was plain to me that an epidemic of unusual, if not of unique, type was prevailing, and I decided that my connection with the state board of health imposed a duty upon me in connection therewith. The investigation thus undertaken in an official capacity soon showed me that the information I was acquiring, while unusual and valuable from a public health standpoint, was doubly so from nat of the practitioner. I am sure, therefore, that the physicians who have so kindly given me, as a member of the state board of health, the bulk of the data on which this paper is founded, will pardon the use to which I propose to put this material.

This epidemic has been confined, with very few exceptions, to the narrowest part of the Otter Creek valley. The territory is bounded on the east by the Green Mountain range, and on the west by the Taconic range of mountains. North and south it has no natural boundaries. Its area is about fifteen miles wide, including the sides of the bounding mountains, and thirty miles long. The rock formation through this valley, as a whole, is limestone. This is especially true of the western side of the valley and the Taconic hills, where the marble deposits of Vermont are chiefly found. I am informed by Prof. Geo. W. Perry, the state geologist, that this valley, which was, at a remote time, a lake basin, possesses no remarkable features from a geological standpoint-in fact, is quite an ordinary valley. Through this valley, from south to north, flows the sluggish stream of Otter creek, dammed at several points. This stream, which has its source just south of Rutland county, is fed by mountain brooks of very pure water from both sides of the valley. It receives no appreciable contamination above Rutland, where is poured into it all the sewerage of the city, and below this point it receives constant accessions of sewage. The extreme heat and drouth of the early summer had rendered the stream unusually low. The only reliable

figures obtainable as to temperature, humidity and rainfall for Vermont are furnished me by the United States Weather Bureau Observer at Northfield, Vt. Since the opening of the station at that place, in 1877, the average temperature, humidity and rainfall per month, for the months of April, May, June, July and August, the months in which these conditions could have any influence on an epidemic occurring during the summer months, were as follows:

It will be notice by these figures that the only marked deviation from the recorded meteorological conditions of the past eight years, which has occurred during the past summer, has been in the average monthly rainfall. This has been thirty per cent. less during the past spring and summer months than the average for the past eight years during these months. While it was a matter of frequent remark that our early summer was this year unusually hot, the official figures do not bear out this statement.

The population of the towns affected in this valley aggregates twenty-six thousand, of which eighteen thousand dwell in the quarrying and manufacturing centres of Rutland, West Rutland and Proctor. The usual sprinkling of foreign elements prevails in these centres, while in the outlying farming towns the population is chiefly of the regular New England type.

The first cases in this epidemic of which I find notes occurred in the city of Rutland and town of Wallingford, simultaneously, about June 17. The characteristics of the disease can be illustrated by a few cases, among the one hundred and twenty-six of which I now have notes.

Case I-Boy, three years of age, American. Previous health good; active child; healthier than his brother two years older. No apparent cause. Moderate fever; coated tongue; loss of appetite; sluggish bowels. As these symptoms improved, it was observed that he could not walk or even stand alone. Reflexes normal; sphincters normal; no hyperaesthesia. The weakness was most noticeable in the extensors of the thigh. After ten days he began to improve, and in three weeks was quite well.

This case is an illustration of the mildest type of these cases. Many of the cases classed below as "fully recovered" were of this