"I am enclosing some records taken from a study made in Bakersfield during the summer of 1930. In the spring of 1930 we discovered a very rapidly increasing number of these cases (epidemic kerato-conjunctivitis diversiformis), some of which rapidly became severe with acute symptoms not unlike trachoma but milder in degree. The most remarkable feature in my mind was the fact which you have emphasized that the condition is almost symptomless. The spread became so great however in some of the cases and so severe that we interested the school authorities sufficiently to take official notice of it. Complete check of every school child in Bakersfield below high school was made totaling about 5,000 students. The schools instituted a clinic for the treatment of this disease. During the summer of 1930, 3,544 attended this clinic or 70 per cent approximately. However, this is not an accurate estimate since many of the children were cared for in physicians' offices. My records at that time showed that my office treated from ten to twenty each day and no doubt the others had an equal or greater number. I think it safe to estimate that the percentage of children involved was greater than 80 per cent. "At the opening of school in September, entrance cards were required and 921 children appeared without any cards, many of whom had the disease but had no treatment. The examinations were all made by specialists and the children were graded 1, 2, and 3, according to the severity; Number 3 requiring both upper and lower lid involvements in both eyes and the presence of pads on the upper lid. 1,437 were graded Number 1, which is a milder form. In May, 1930, Doctor Joseph Heitger of Louisville, Kentucky, visited me. I secured about twenty-four of the worst type of cases for Doctor Heitger to examine. It was his opinion that about six of these cases answe red every requirement for a diagnosis of trachoma. "During the years 1930 and 1931 I contacted many exceptionally good eye men. First at the Academy meeting in Chicago and later at the College of Surgeons meeting. They were all rather non-committal and unanimous in the statement that they had never heard of anything of a similar nature. Just a little earlier than our epidemic I believe there was a similar one in Imperial County which tthe United States Public Health Service investigated. I talked to a Public Health Service man who worked in that area at that time and apparently the two epidemics, Imperial and Kern County were entirely similar. It is my recollection that they made etiological and bacteriological studies without results. "The condition has been present in Bakersfield ever since but to a much lesser degree. We still see cases and have been treating some cases since 1931. "One peculiar phase noticed at the time on the general examinations was that the better class of families apparently furnished more cases than did those families in which one might expect to find under-privileged or under-nourished children. "Another peculiar occurrence was in relation to my own son who had the disease in 1930 but was never graded more than Number 1. He has January 1937 had occasional attacks since. This past year he went to the University as a freshman in Colorado. He began to have some difficulties with his eyes there and went to a friend for treatment who advised him he had trachoma.") COMMENT UPON DR. MERRILL'S REPORT C. E. RICE Surgeon, U.S. P.H. S. This is an exceedingly interesting report. practical importance which will be spoken of later. It has considerable From this report by Dr. H. G. Merrill, it would seem that the process is primary in the conjunctiva and effects the cornea but slightly. The fact that the subjective findings in most cases are slight would also lead one to believe that the cornea plays a minor role in the infection. Because of this, one might question the desirability of including the word "Kerato" in the proposed name for this supposedly new clinical entity. From his very detailed description of this infection it might better be called "Epidemic granular conjunctivitis." Going further, and basing my ideas entirely on his description of this condition and what I have observed in conjunctival infections heretofore in other places, it would seem to be highly desirable to rule out the possibility of this infection being "Inclusion-body conjunctivitis" in epidemic form, "Inclusion-body conjunctivitis" being the adult form of "Inclusion-body blennorrhea" of the newborn as proposed by Lindner in 1909. Dr. Merrill mentions the resemblance of this disease to trachoma, he mentions enlarged pre-auricular lymph nodes, he mentions the presence of some sort of inclusion (on the order of Negri) bodies. Trachoma resembles inclusion-body conjunctivitis in the early stage of trachoma or vice versa, pre-auricular lymph nodes often enlarge in both conditions, the same sort of epithelial cell inclusions occur in both diseases. The California infection appears to take from 3 to 18 months to disappear and goes without leaving any trace or doing any damage. The same is true of inclusion-body conjunctivitis. Dr. Merrill states that this condition appears to do best under mild treatment or rather that strenuous procedures are not necessary. The same is true of either Inclusion-body blennorrhea of the newborn or of Inclusion-body conjunctivitis. Dr. Merrill's warning is timely as concerns this condition as many persons, including children, have probably been subjected to severe treatment and operative procedure under the mistaken idea that the infection was trachoma. Evi He states that the infection is very slightly communicable. dently it is more easily communicated than trachoma since it has reached rather wide proportions in California and neighboring States in a comparatively short time. If this reported condition has reached the proportions which Dr. Merrill mentions, one might expect an increase in the number of cases of ophthalmia neonatorum reported to the California State Health Department at least for certain sections of the State. Such increase in ophthalmia neonatorum due to inclusion-body blennorrhea of the newborn might be expected provided this epidemic is one of the inclusion-body infections of the conjunctiva and provided the reporting is good enough. POLICE COOPERATION WITH PUBLIC HEALTH AND SANITATION OFFICIALS (Abridged with the author's permission from a lecture delivered Let us start with the police officer himself, who, if he would have a keen appreciation of the importance of public health, must keep himself healthy. Aside from his regular work, he should indulge in moderate daily health-building exercises. He should use plenty of clean, pure water internally and externally. He must have needed rest and relaxation and have ample recreation (a hobby included with the latter would be found beneficial). He should have his teeth regularly inspected by a good dentist to assure good digestion and insure himself against body infection from that source. He should have an annual examination by a qualified physician as a safety measure; and in general, keep cheerful and extend his knowledge of accepted health rules. So doing, by example, he will, in a small measure at least, promote the health of the public and will certainly perform better police work and enjoy life more fully. Secondly, I would say, he should devote a few minutes every day to acquainting himself with a knowledge of Federal, State, and municipal public health law. In this study and in getting the knowledge of how he can, as a police officer, best cooperate with public health agencies, he should have the guidance and help of a course introduced into the curriculum of the police school of his department and courses in all Federal and State police schools. It is a serious oversight that our police schools have not generally included such a course in their curricula. CITY CLEANLINESS AND PUBLIC HEALTH The state of city cleanliness bespeaks the character of any city. Every policeman from the chief to the patrolman, should report, through his department to the department of city government having this under January 1937 direct charge, any unclean and unhealthful condition of streets, sidewalks, vacant lots, and other unoccupied property, backyards, garbage receptacles, garbage wagons and the like. Admonition and warning will usually correct such conditions, but if this is found insufficient, arrest and prosecution under proper city or State laws may follow. Where construction work is going on, the police can effectively cooperate by using their authority to see that refuse, dust and nuisances are abated by the contractor or persons responsible. Unsanitary storage, the manufacture and transportation of food and other products in violation of health and sanitary laws having to do with the same come properly under police correction. POLICING SANITARY CONDITIONS The policeman, on his beat, should particularly note sanitary conditions of restaurants, hotels, ice cream parlors, slaughter houses, butcher shops, grocery stores, and other vendors of food-stuffs. He should quickly report the presence of offal and dead animals found on vacant property or in the streets which he patrols. The policeman can aid materially in the promotion of public health by informing householders, housewives, and merchants of their responsibility for overloading ash and garbage cans, infrequent sweeping of stores and fronting sidewalks, the danger of loose paper and excelsior being strewn about premises. Children, habitually playing in the streets, should be warned and taken to their parents, when the parents should be interviewed and informed in a tactful way of their responsibility for preventing their children from running the hazards of street traffic and from throwing fruit skins, sticks, paper, and other debris on sidewalks and in the streets. There should be no hesitation on the part of the police during performance of their duties to notify, through their own department, other city departments, of the carelessness of city employees in the cleaning of streets and the handling and removal of refuse when such cases come to their attention POLICING CITY NOISES It is becoming more and more recognized that city noises contribute to the public discomfort and ill health. City ordinances seeking to abate noises should be rigorously enforced. These noises emanate from traffic, transportation, building and other construction, homes, repair of streets; from the harbors of port cities; from collections and deliveries, and such miscellaneous sources as aeroplanes, factories, restaurants, and places of amusement and entertainment. Hawking peddlers, motors with open exhausts and tooting horns, unnecessary use of sirens, noisy late parties, loud-speakers, needless blowing of whistles, ringing of bells, and many other noisy occurrences within the common knowledge of all of us, should be attacked and suppressed. This can be most effectively done by the exercise of the police power vested in the municipal police. COMMUNICABLE DISEASES That part of the curriculum of a police school having to do with public health should instruct the policeman about communicable diseases, reporting of the same, quarantine laws, and so on. In cases of recog nized communicable disease, such as those noted, State and city law usually directs that any person must report cases known to him, in writing, to the proper health authorities. It is assuredly the duty of a police officer to so report such cases either through his department or directly to the proper public health agencies. POLICING VENEREAL DISEASES There is no field of public health promotion in which the police can work so effectively and with so rich results in both the conservation of public health and the prevention and reduction of crime and crime costs (which lie directly in the path of police duty) as in the control of venereal disease. Some day, it is hoped, the full force of the police power will be invoked against venereal disease, to work in effective conjunction with preventive medicine and treatment, public and private education. The Division of Venereal Diseases of the United States Public Health Service leads the fight in the United States against the inroads of venereal disease and for its control. State boards of health, together with county and city boards of health, aided by organizations of private citizens, valiantly back up this leadership. It remains for the public and the municipal police departments of the nation to join intelligently in this crusade, directly, and in cooperation with the established public health agencies. In the annual report of the United States Public Health Service for the fiscal year of the government ending June 30, 1934, it will be noted that the appropriation for the Division of Venereal Diseases to be used for study and control of these diseases, amounted to only $58, 000. Additional funds were made available to the Division by private organizations, but in view of the importance of this Division's work and its direct bearing on public health, I do not hesitate to state most emphatically, that I believe the direct appropriation is many times too small. I strongly recommend that you bring this matter to the attention of your local police department, and, through it, to that of your local and State health boards, that an effort may be made to have this annual appropriation increased, in order that the Division may lend even more effective cooperation with city and State health and police authorities to stamp out of our communities syphilis, gonorrhea and chancroid. The American Social Hygiene Association states: "Many of the larger cities have free venereal disease dispensaries equipped with staffs of specialists. Any health officer can give information about these dispensaries." It should be added, every police officer should be able to give the same information. |