B. Miscellaneous relations, including case relations in the family and others. (b) Previous to onset having had temporary association with a pellagrin.. (e) Onset while living in a house previously occupied by a pellagrin of another family..... Total..... 61 8 3 1 17 9 37 17 3 83 case. CONSIDERATION OF WHOLE SERIES. Incidence, etc.-I was unable to determine with any degree of accuracy the dates at which pellagra made its appearance in these vicinities. The earliest case in Spartanburg County now recalled by the physicians whom I saw seems to have been in the person of a white female living at Enoree on the Enoree River in 1893. The disease was not recognized at this time, but physicians who saw the case are now convinced that it was pellagra. A case is reported to have occurred at Cherokee Springs along a tributary of the Pacolet River in 1891, but I was unable to see the physician who had charge of the Physicians now recall having seen cases in other parts of the county before the time of the recognition of the disease and are now confident that they were seeing unrecognized pellagra. In 1904 two females died in Chester County of a disease which was diagnosed as pellagra at the time by Dr. H. E. McConnell, but no report of this observation was made. As far as I was able to determine the first published diagnosis of pellagra in the vicinity of Rock Hill, York County, was made in the spring of 1908. However, unrecognized cases had occurred there before that time. Numerous new cases have appeared from time to time in each one of these counties since the existence of pellagra was recognized there, and apparently each successive year has furnished a larger number of new cases than the year preceding. The date of onset of the first symptoms of the disease was ascertained in each one of the 83 cases personally visited and in 165 of the cases reported to me. These cases are grouped below with reference to the date of onset: Mortality and insanity rates.—As has been said, the series of 380 cases includes 89 deaths from pellagra. This gives a mortality rate of 23.8 per cent for the series. A number of the cases visited showed at the time, or gave a history of, some slight mental symptoms, as depression, etc. One of this number was insane and has since been committed to the State hospital for the insane at Columbia. Of the whole series 18 had become insane after the onset of the pellagrous symptoms, which gives a rate of 4.8 per cent for the incidence of insanity among the pellagrins in this series of 380 cases. Practically all of these 18 insane cases had been confined, at least for a time, in the State hospital for the insane. Some of these have remained there, while others have returned to their homes much improved. CONSIDERATION OF VILLAGE "EM." One little cotton-mill village in Chester County proved to be of special interest. This was largely due to the fact that the pellagra situation there had been followed from its beginning up to the present time (October, 1911), and all of the cases developing there had been seen by one physician, Dr. H. E. McConnell, of Chester, S. C. About 25 cases of pellagra are known to have developed while living in this village, some of whom are still residing there, while others have moved away or have died. A rough map of this village, designated "Village EM," is given here. The eastern half of the map represents the cotton-mill village proper and the western half a part of the suburbs of a neighboring town. The population of the area represented in the map is approximately 500, but of this number some are moving in or moving out all the time. The dots in the map are intended to show the locations of residences and the crosses with a circle around them are intended to represent the location of homes of pellagrins. The two groups of houses south of the mill are each situated on a slight elevation. A small stream flows between these two elevations and into a creek about 300 yards distant. I was told that no case of pellagra had been known to develop in the little group of houses represented in the northeast corner of the map. The homes of the pellagrins have been numbered for the sake of reference. Some notes are given below which refer to houses with corresponding numbers: 1. Case 250, developed pellagra here in 1904. Died. Case 257, of a different family, developed pellagra here in 1911. 2. Case 249 developed pellagra here in 1904. Died. 3. Cases 227 and 228 (brothers) developed pellagra here in 1909. Case 254 developed pellagra here in 1911. 4. Case 205 developed pellagra here in 1909. 5. Case 253 developed pellagra here in 1909. 6. Case 252 developed pellagra here in 1910. 7. Case 251 developed pellagra here in 1910. 8. Case 251 lived here after onset of disease. 9. Case 214 developed pellagra here in 1911. 10. Case 214 lived here after onset of disease. 11. Case 225 developed pellagra here in 1911. 12. Case 204 developed pellagra here in 1910. 13. Case 255 developed pellagra here in 1910. 14. Case 231 developed pellagra here in 1910. 15. Case 256 developed pellagra here in 1910. 16. Case 203 developed pellagra here in 1911. 17. Case 207 developed pellagra here in 1910. 18. Case 223 developed pellagra here in 1911. 19. Case 206 developed pellagra here in 1911. New House. 20. Case 281 developed pellagra here in 1906. 21. Case 278 developed pellagra here in 1910. 22. Case 278 now living here. 23. Case 241 lived here in 1907. 24. Case 233 developed pellagra here in 1910. 25. Case 232 developed pellagra here in 1910. 26. Case 277 developed pellagra here in 1907. 27. Case 277 now living here. 28. Case 235 developed pellagra here in 1911. Died. 29. Case 211 died of pellagra here in 1911. I am greatly indebted to Dr. H. E. McConnell for his kindness and assistance rendered in locating cases of pellagra and in obtaining facts of the histories of the houses noted above. Much of the data was given to me by Dr. McConnell himself. Mosquitoes are prevalent in this village, and screened houses are the exception. A number of the pellagrins here stated to me that bedbugs were present in their homes, but no specimens were collected. The water supply is obtained from driven wells located at various places throughout the village. Much of the food used by these people is obtained from the store located near the railroad switch, but other stores are also patronized. It may be of interest to state here that Mr. W. V. King, of the Bureau of Entomology, United States Department of Agriculture, stated to me that he had collected specimens of the larva of the fly Simulium from the water of the little creek to the east of the village. In conclusion, I wish to thank the many physicians of Spartanburg, Chester, and Rock Hill who, by their kindness and cooperation in this work, greatly assisted me in collecting the data which has made this report possible. UNITED STATES. MUNICIPAL ORDINANCES, RULES, AND REGULATIONS PERTAINING TO PUBLIC HYGIENE. [Adopted since July 1, 1911.] BOISE CITY, IDAHO. COMMUNICABLE DISEASES-REPORTS OF CASES, DISINFECTION OF PREMISES. SECTION 1. That section 12 of ordinance No. 746 of the revised ordinances of Boise City, County of Ada, State of Idaho, be, and the same is hereby, amended to read as follows: SEC. 2. It shall be unlawful for any physician, Christian Science healer, Divine healer, faith cure, osteopath, chirpracter (sic), or any person or persons whatever, who profess to cure diseases by whatsoever means or method, or who has charge of or professionally prescribes for any person sick, injured, or diseased, regardless of whatsoever name or title he or she may assume, and any and all persons who have knowledge of any person sick, suffering, or afflicted with any contagious disease, to fail or refuse to report the same, in writing, within 10 hours of the existence of such disease, and the name of the person afflicted therewith, as soon as he or she shall become cognizant of the fact, to the health officer of the said Boise City, County of Ada, State of Idaho. SEC. 3. The diseases hereinafter designated shall be for all intents and purposes of this ordinance considered contagious and infectious, to wit: Cholera, scarlet fever, cerebrospinal meningitis, chicken pox, membranous croup, whooping cough, typhus fever, typhoid fever, diphtheria, yellow fever, smallpox, measles, bubonic plague, tuberculosis, and infantile paralysis. SEC. 4. Every person who finds a patient or patients showing symptoms as to indicate that such patient or patients may have any of the aforesaid diseases, as mentioned in section 3 of this ordinance, or in case there is no attending physician or nurse caring for such patient or patients, the head of the household or proprietor of any hotel, lodging house, hospital, or sanitarium shall report the same to the health officer of the said city, as herein before designated, and any person or persons failing so to do shall be punished as hereinafter provided. SEC. 5. Any person violating or failing to comply with the provisions of this ordinance shall be deemed guilty of misdemeanor, and upon conviction thereof shall be fined a sum not to exceed $100, or by imprisonment in the city jail not to exceed 30 days, or by both such fine and imprisonment. SEC. 6. That section 28 of ordinance No. 746 of the revised ordinances of Boise City, County of Ada, State of Idaho, shall be, and the same is hereby, amended to read as follows: SEC. 7. Upon the death or convalescence of any person or persons suffering from or afflicted with any of the contagious or infectious diseases named in section 12 of this ordinance, the health officer shall at once cause the premises, room or rooms, house or houses where said persons or person may be found, together with the contents thereof, to be thoroughly disinfected, cleaned, fumigated, or dealt with in a manner within the discretion of said health officer whenever he may deem necessary, in order to prevent the further spread or infection of said disease or diseases, and in extreme cases he shall have authority to destroy the contents of aforesaid premises. SEC. 8. Fumigating or otherwise cleaning of any premises aforesaid shall be done at the expense of the owner, lessee, tenant, or occupant of said premises, room or rooms, house or houses, and no quarantine shall be raised until after the expense incurred for such fumigating shall have been paid; and in the event that any person shall be unable to pay for such fumigating, then the same shall be paid by the said Boise City out of the general fund of said city. SEC. 9. This ordinance shall take effect and be in force immediately after its passage and approval. |