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audience did not have the benefit of Dr. Kohnke's stereopticon lecture, Dr. Fred J. Mayer, Special Medical Inspector of the State Board of Health, delivered illustrated addresses explaining the mosquito doctrine of the transmission of yellow fever, about which the people in the parishes had shown themselves so skeptical in 1905, but the truth of which had been so triumphantly demonstrated in stamping out the fever in New Orleans.
These popular conferences, in which the local authorities and other influential citizens took the leading part, were of inestimable benefit in helping to educate the people and in securing their acquiescence in the work of sanitation.
CAMPAIGN OF SANITATION.
Pursuant to the policy announced by the President of the State Board in his inaugural address, an active campaign of sanitation was pushed forward as rapidly as was possible during cold weather with the object of destroying any infected mosquitoes which might still lurk in localities where fever had occurred in 1905. It was felt that if effective fumigation could be practiced in every house where cases, positive or suspicious, had existed, the danger of recrudescence would be practically eliminated.
The magnitude of this undertaking can be appreciated when it is remembered that in 1905 yellow fever was reported in twenty-eight parishes of Louisiana, in some of which there were numerous known foci of infection, widely remote from each other. In Jefferson Parish, for example, there were fourteen such foci, extending from Grand Isle to Kenner. Plaquemines, St. Bernard and Terrebonne each had ten known foci, and so on through the list.
The people of those parishes were more or less discouraged and worn out after their hard struggle with sickness and quarantines, so that all the influence of the State Board and the persuasive powers of its President and Special Medical Inspector, aided by the local Health Officials, had to be exercised in the beginning of the campaign of education by which the apathy of the people was overcome and their concurrence in the work of sanitation secured.
Despite of all difficulties and obstacles the work was pushed steadily forward and was finished before the end of cool weather, calling for untiring exertions on the part of the officers and fumigating squads of the State Board and of the local forces co-operating at many localities.
The record of work accomplished in the parishes shows a total of 3,384 houses fumigated, containing 11,712 rooms.
The quantity of sulphur furnished by the State Board was approximately 100,000 pounds, besides which a very large quantity was supplied by wealthy planters and others for use on their own places, where fumigating was done under official supervision.
When the President of the Louisiana Board submitted a report of this work, with its array of figures showing every detail, at the annual conference of State Health Officials for 1906, in Washington, the Surgeon General of the U. S. Public Health and Marine Hospital Service expressed surprise and admiration.
CAMPAIGN OF THE CITY BOARD OF HEALTH IN New ORLEANS.
While the State Board of Health was prosecuting its campaign of education and sanitation in the parishes, the City Board of Health under Dr. Quitman Kohnke was hard at work promoting the enforcement of measures to banish the stegomyia mosquito from New Orleans.
On account of the available supply of wire gauze having been exhausted the time limit for screening cisterns had been first extended to January 1, 1906, and later to February 1. During January, 1906, attempts were made to have this limit still further extended, but Dr. Kohnke, Ctiy Health Officer, who for two years previously had vainly urged the municipal council to require the screening of cisterns, reinforced at this juncture by the State Board and by influential citizens, vigorously fought against any further procrastination and .carried the day.
After a number of delinquents had been fined for failure to comply with the screening ordinances there was no further opposition and the city was so thoroughly rid of the stegomyia mosquito that Dr. Kohnke, who offered prizes of $5.00 for the first female insect of that species caught alive in New Orleans, $3.00 for the second, and $2.00 for the third, had to wait quite a while before any of these prizes were earned.
While this fight for effective screening was being made by the City Health Board the volunteer organizations of citizens which had done such splendid service in 1905, reassembled under their leaders and again took up the good work in their respective wads.
In order to accomplish more thorough and harmonious results a central organization known as the New Orleans Health Association was formed under the Presidency of Hon. Chas. Janvier, who had
served as Treasurer of the Citizens' Fund in 1905, and had otherwise rendered distinguished service in the campaign of that year.
As part of the perfected organization for defense against fever the new and admirably equipped Isolation Hospital, on Rampart street, was kept in a state of complete preparation, ready to receive patients at a moment's notice. Fortunately, there was no occasion to take advantage of those facilities.
SUCCESS OF SANITARY WORK IN THE PARISHES.
In 1906, for the first time in the history of yellow fever outbreaks in the South, the long established rule about the recurrence of fever after a general epidemic was broken.
Heretofore it was regarded as inevitable that during the next year after such an epidemic there should be a recurence of the disease, usually on a smalle scale, but nothing of the kind occurred in 1906.
Therefore, if apparent results are to be taken as evidence of the effectiveness of sanitary work done by the State Board of Health in the parishes in the winter and spring of 1906, it may be claimed for that work that it was eminently successful, covering as it did more than a hundred separate localities from which fever had been reported, with an official total of 5,919 case in the State outside of New Orleans.
As will be mentioned further on, the only case which was found by the State Board to be yellow fever among the few reported for investigation in 1906, was one at New Iberia late in August.
Cases REPORTED TO THE STATE BOARD FOR INVESTIGATION IN 1906.
After the experience of 1905 there was a general determination in Louisiana, both among the medical profession and the laity, to keep vigilant watch for the first suspicious case of fever, should any occur, and to lose no time in reporting same to the proper authorities for investigation.
To aid in discovering such cases the U.S. P. H. and M. H. Service voluntarily detailed three of its young officers for this duty in Louisiana. These officers arrived early in March and remained until after the middle of April. Their posts of observation were chosen in districts where fever had prevailed most extensively in 1905. The one located in the Lafourche district reported three cases which he thought suspicious, but none of them proved to be yellow fever.
The other cases reported for investigation, taken in chronological order, were as follows:
Case at Kenner-On January 9, 1906, Dr. Gustine, Health Officer of Kenner (since deceased) asked for an investigation in the case of a patient who came from another portion of the parish and appeared to present suspicious symptoms. Dr. Brady, Medical Inspector of the State Board, made a thorough investigation, and from the clinical course of the case readily eliminated the diagnosis of yellow fever. However, all proper precautions were taken and subsequent developments confirmed Dr. Brady's tentative report indicating that the case was one of mild typhoid.
Charity Hospital Case_On the afternoon of March 12, 1906, the case of Jules Ebrenz, a patient in the Charity Hospital of New Orleans, was reported to the President of the State Board of Health as being considered suspicious by the visiting physicians of the ward.
Two experienced physicians of the city were requested by the President to see and report upon this case. After three days' careful observation one of those physicians made a diagnosis of yellow fever, which was concurred in by several members of the Visiting Staff, while the others agreed with the House Surgeon, Dr. J. M. Batchelor, that the case was merely one of catarrhal jaundice.
The President of the State Board therefore telegraphed the Health Officers of Alabama, Mississippi and Texas, March 15, as follows:
"Committee appointed to investigate suspicious case of fever at Charity Hospital differ as to diagnosis. Invite you to come.'
The Health Officials who came to New Orleans in response to this invitation were Dr. W. H. Sanders, State Health Officer of Alabama; Dr. Rhett Goode and Dr. C. A. Mohr, of the Mobile Health Board; Dr. H. A. Gant, representing the State of Mississippi; Dr. J. H. Florence, Acting State Health Officer of Texas, and Dr. W. F. VI. Thompson, State Quarantine Officer of Texas.
Every facility was given these visiting physicians to study the case of Ebrenz, but no general decision as to the nature of the fever had been reached prior to the death of the patient, which occurred Saturday night, March 17.
At il o'clock the next morning an autopsy was held in the presence of all the visiting physicians and of those of the local profession interested in the case, with the result that by unanimous consent it was decided that the case was not yellow fever.
A statement to this effect was immediately drawn up and signed officially by those concerned in the verdict, which was telegraphed to their respective State Governments by the representatives of Alabama, Mississippi and Texas.
In view of the great publicity given this case, and of the positive clinical diagnosis of yellow fever made by several experienced physicians prior to the patient's death, it was so instructive as to call for more than a passing mention.
Jules Ebrenz was known to have been a resident of New Orleans for years, and not belonging to the class who are able to leave the city at will, must have passed through all the yellow fever in New Orleans from 1897 to 1905, inclusive. It was therefore regarded as highly improbable that he would have escaped the fever during four successive outbreaks, only to develop a case at a time when the most searching vigilance had failed to discover a case in New Orleans during the previous three months, while the city had been practically free of stegomyia mosquitoes.
Then again, it was learned from reliable witnesses that Ebrenz. who was an oyster-opener in a saloon where he was seen and known by hundreds of people, had been leading a dissolute life and was observed to be distinctly jaundiced for days before becoming so ill that he had to be sent to the Hospital.
The clinical diagnosis of yellow fever made by the visiting physician of the ward and those who concurred with him was based on the presence of so many typical symptoms of the disease that nothing less than an autopsy could possibly have disproved such a diagnosis when made by such men, however improbable it might appear under the circumstances.
A similar instance is recalled as having occurred at the Charity Hospital in the summer of 1899, when a positive diagnosis of yellow fever in an isolated case from another portion of the State was made by recognized experts during the patient's illness, only to be completely disproved by an autopsy performed in the presence of Health Officials summoned from adjoining States.
Such cases point unmistakably to the necessity for great caution in pronouncing any isolated case yellow fever in the face of improbable conditions, however strong the clinical evidence may appear. On the other hand, successive groups of cases, however mild, and especially among young people, if occurring under circumstances at all suspicious, should be regarded with serious apprehension and all precautions be taken.