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Entered according to Act of Congress, A. D, 1897, by A. N. BELL, in the office of the
Librarian of Congress, at Washington.
BY BENJAMIN LEE, M.D., SECRETARY OF THE STATE BOARD OF HEALTH.
The last Legislature having passed a number of laws affecting directly the administration of local boards of health, it became the duty of this Board to acquaint them with the additional powers thus conferred upon them and to indicate the readiest means of carrying these laws into effect. Accordingly the Secretary addressed a circular letter to the secretaries of 526 local boards of health in the State, calling their attention to the new duties thus assigned them and the coincident amplification of their authority. The following acts were reprinted and freely circulated, not only among health authorities but also through the medium of the public press, in order that the general public might become familiarized with the fact that the law imposed duties upon them as well as upon health boards and health officers, and in that way be induced to comply with less reluctance with the orders of the local health authorities:
Act No. 107, entitled "An Act to provide for the better protection of life and health by diminishing the danger from infectious and contagious diseases through the creation of a State Board of Undertakers in the cities of the first, second and third classes, with systematic examinations, registration and licenses for all entering the business of burying the dead and penalties for the violation of the provisions thereof."
Act No. 124, entitled "An Act to provide for the more effectuai protection of the public health in the several municipalities of this commonwealth.”
Abstract of the Twelfth Annual Report of the Secretary of the State Board of Health, November 12th, 1896.
Act No. 133, entitled “An Act authorizing the boards of health in the cities and boroughs of this commonwealth to regulate house drainage, the registration of journeyman and master plumbers and the construction of cesspools."
Act No. 165, entitled "An Act to promote cleanliness and healthfulness in and about the public schools of this commonwealth."
Act No. 263, entitled "An Act for the prevention of blindness, imposing a duty upon all midwives and other persons having the care of infants, and also upon the health officer, and fixing a penalty for neglect thereof."
Forms were prepared and distributed to the various local boards of health requiring the registration of undertakers, master plumbers, journeyman plumbers, nurses and midwives; vaccination of school children; reports of contagious diseases by physicians; certificates of recovery and disinfection from physicians; certificates of successful vaccination by physicians; and health officer's notification.
The Act for the better protection of the public health originated with some of the oldest and most experienced municipal healtlı authorities in the State, and represents the results reached by long years of practical work. It constitutes, in fact, a sanitary code for the restriction of epidemic diseases, and was issued by the Board under this title. It is equally operative for every portion of the State, the boards of health of cities and boroughs being required to enforce its provisions within the limits of their several jurisdictions and the State Board of Health in all districts and places having no health authorities of their own. Its value lies principally in two facts: first, that it makes sanitary administration, so far as the suppression of epidemics, including the enforcement of domiciliary quarantine, disinfection and the vaccination of school children, are concerned, uniform throughout the State; and, secondly, that it authorizes boards of health to enforce its provisions, independently of municipal regulations.
The Act authorizing and requiring boards of health to regulate drainage in cities of the third class and boroughs, places the plumbers under the direct supervision of the health authorities, requiring the former to take out licenses in order to be allowed to follow their trade.
BLINDNESS AND ITS PREVENTION. The Act for the Prevention of Bliidness is founded upon the follow
Ist. There is in the State of Pennsylvania, as in the United States, an apparently rapid increase in the number of the blind.
2nd. A large percentage of the blindness is due to the disease known as purulent ophthalmia of the
born. 3rd. By the use of known methods this could be very materially lessened.
When we compare the report of the United States census of 1870 with that of 1880 we find that the increase of population for Pennsvlvania for that period was 21.6 per cent., while the apparent increase in blindness for the same period was 119.8 per cent., showing that blindness increased over five times more rapidly than the population.
A single disease, ophthalmia of the new born infants, the most productive cause of blindness.
In the second place, the most important factor in the production • of blindness is the purulent ophthalmia of infants, or ophthalmia
neonatorum. Fuchs found that among 3,204 cases of blindness collected from asylums in different parts of Europe 23.5 per cent. were due to ophthalmia neonatorum. In the New York Institution for the Blind, at Batavia, 23.4 per cent of the inmates were there as the result of the same disease.
Horner has shown that among 100 blind asylums in different countries the variation was from 20 to 79 per cent.-average, 33 per cent.
Haussmann gives the number in the asylum in Copenhagen made blind by this disease as 8 per cent., in Berlin 20 per cent., in Vienna 30 per cent., in Paris 45 per cent.
According to the report of the Royal Commission on the Blind, of the English Government, publislied in 1889, 30 per cent of the inmates of the institutions and 7,000 persons in the United Kingdom have lost their sight from this cause.
Professor Magnus, of Breslau, finds that no less than 72 per cent. of all who become blind during the first year of life are rendered so by purulent ophthalmia; and even of those who become blind before the twentieth year of life, it constitutes as much as 23.50 per cent. Looking at the subject in another way he shows that of 10.000 children under five years of age, 4.28 are blinded by purulent ophthalmia. In the blind asylums of Switzerland the proportion who have lost their sight from this disease is 26 per cent., in the asylums of Austria, Hungary and Italy about 20 per cent.; while in Spain or Belgium it falls to about 11 or 12 per cent. An investigation into the causes of the blindness of 167 inmates of the Pennsylvania Institution for the Blind, made by Dr. George C. Harlan, of Philadelphia, developed the fact that 55 owed their affliction to purulent ophthalmia, and that more than half of these cases occurred in infancy.
Ophthalmia of the new born is an infectious, and therefore a preventable disease.
Whenever the fact is demonstrated that a disease is infectious, contagious, communicable from person to person, either by direct contact or through the medium of infected articles, it becomes the duty of the physician and the sanitarian to discover, if possible, the source and character of the infectious matter, and to devise means for preventing its transmission.
Ophthalmia of the new born is an infectious disease, and can only occur after infectious matter has come into actual and somewhat prolonged contact with the eye.
As regards the period when infection occurs, this may take place either during or immediately after birth, or at some subsequent moment. If the former, the disease manifests itself by redness and puffiness of the lids at from the second to the fifth day; if it does not appear until later, infection has taken place subsequent to birth.
It is hardly too much to say that no one should become blind from this disease; not only because it is quite amenable to treatment, if this be instituted from the beginning, but because the disease itself can be prevented in most instances if those who have the care of mother and child understand the nature of the affection.
From the facts above given it will be seen that this is simply another way of saying that one third of those who are now blivid might have been saved from this calamity.
The precautions necessary to prevent ophthalmia of the new born and resultant blindness, now adopted by scientific physicians, comprehend the plan known as "the Crede method," from the name of the physician who introduced it. It consists in first carefully washing the eyes of the child with pure warm water, and then droping into them one or two drops of a two per cent. solution of nitrate of silver. The proof of the good results of this simple precaution is overwhelming.
Dr. Lucian Howe, of Buffalo, las collected two lists of cases, the frst showing the result obtained and published by different obstetricians who used no treatment for the eyes of 8,798 children