DIRECTIONS FOR SHIPPING SPECIMENS Inasmuch as the brain is used for laboratory diagnosis, it is very important that this material be received at the laboratory in good condition. The head of a suspected animal should be removed after death and packed in a small bucket which in turn should be placed in a larger bucket which can be filled with ice. Specimens packed in this manner will keep in good condition, even during several days in transit. Specimens should not be expressed so that they will reach the laboratory on Saturday, Sunday or a holiday, but instead should be kept on ice and shipped later. Where there is any doubt that the package will not get prompt delivery it should be brought to the laboratory by a messenger. Transportation difficulties at present make this procedure advisable in serious cases. Information concerning the specimen, date of shipment, etc., should be sent to the laboratory at the earliest possible date by special delivery letter, telephone or telgraph. CARE OF PERSONS BITTEN Local. When a person has been bitten by a rabid animal or otherwise exposed to rabies virus, he should at once consult a physician. The wounds should be thoroughly cauterized, preferably with fuming nitric acid or formalin. Carbolic acid is practically valueless and tincture of iodine is of comparatively little value. Pasteur (antirabic) Treatment. The Pasteur treatment consists of the injection of modified rabies virus in order to establish immunity in the patient before the virus injected by the rabid animal can reach the vital nerve centers. This treatment is preventive and not in any sense curative. There is no known cure for rabies, once the disease has developed. There are a few deaths in Ohio from rabies each year. The question, "Who should receive the antirabic treatment?" is difficult to answer at times but it has been well summarized by the Minnesota State Health Department as follows: 1. All persons bitten or scratched, either by the teeth or claws of a rabid dog or other rabid animal, should receive the Pasteur preventive treatment for rabies 2. All persons having wounds upon the hands, face or elsewhere upon the body that have come in contact with a rabid animal in such a manner that the saliva of the animal has gained entrance into these wounds, should likewise receive the preventive treatment. 3. All persons bitten by or otherwise exposed to infection from an animal within a period of two weeks preceding the development of symptoms of rabies in the animal should receive treatment. Four to six days is usually reported as the limit of time preceding the onset of symptoms of rabies, in which rabies virus has been shown experimentally in the saliva of a dog. The above time limit of two weeks has been fixed upon by this department as a proper one to guard against all possibility of danger. Persons bitten, etc., earlier than two weeks before the exhibition of symptoms of rabies in the animal are in no danger of the development of rabies. In other words, if the offending dog is living and well at the end of two weeks from the date of biting, it is certain that the animal did not have rabies at the time of biting and could not have had rabies virus in his saliva. 5. All persons exposed to possible infection from a known rabid animal, and all persons exposed to possible infection in a suspected rabid animal or in an animal in which it is impossible to exclude rabies at once should receive treatment. Antirabic treatment is not supplied or administered by the Ohio State Department of Health. It can be obtained by the attending physician either from physicians who are equipped to prepare this material or from commercial firms who supply it. If desired the physician can administer the treatment at home. This saves expense and inconvenience to the patient. The county commissioners are authorized to reimburse individuals for expenses incurred in the treatment. The state has nothing to do with this. Treatment should never be delayed pending the decision of the county commissioners regarding payment but whenever convenient it is well to advise them that treatment is being administered so that there may be no misunderstanding about expense accounts to be submitted after the treatment is completed. CARE OF ANIMALS BITTEN The care of animals exposed to rabies infection is a matter that comes under the jurisdiction of the veterinary department of the State Board of Agriculture. It is advisable to call a competent veterinarian for advice regarding animals that have been bitten and he in turn should take up the question with the state veterinarian. On account of the danger to the public from rabid dogs the health officer should provide for the control of these animals. When it is definitely known that a dog has been bitten by a rabid animal, the health officer should give the owner of such animal the option of killing it or keeping it confined on his own premises for a period of at least three. months. If the dog leaves the premises of the owner it must be properly muzzled, otherwise the health officer will order such animal killed. When a dog suspected of having rabies has been astray in a community the Board of Health should adopt measures to require the muzzling of all dogs for a period sufficient to cover the incubation of any cases that may develop as a result of exposure to such animals. PREVALENCE OF RABIES The increase in rabies cases in Ohio as indicated by the examinations made in the laboratory of the State Department of Health is shown in the figures in Table II herewith. Statistics collected in Ohio in 1912 (Phillips) show that the amount paid out for the treatment of persons exposed to rabies infection was over $30,000, while the loss in live stock for the same year was estimated at about $35,000.. These figures have no doubt increased in the years. since this data was collected. The spread of the disease in the United States is shown by figures collected by Kerr and Stimson to have extended at one time or another to every state and territory in the Union. At the time of their inquiry (1908) there were only 10 states or territories free from the disease. Some of these states have reported cases in large numbers since that date. One must bear in mind of course that statistics of this character do not represent actual increase in cases because facilities for diagnosing and recognizing rabies have in recent years brought cases to the attention of officials while in earlier years many cases undoubtedly went unrecognized. CONTROL AND PREVENTION The Rabies is a disease which is easily controlled and prevented. experience of England, where, through proper muzzling of all dogs, rabies has been practically exterminated, is sufficient evidence of the efficacy of this measure alone. In Australia, where regulations prevent the importation of dogs, except after a proper period of quarantine, rabies has never been reported. There have been no definite preventive measures adopted in Ohio and until some measures are taken rabies may be expected to increase. It is possible in any community to practically exterminate rabies by muzzling, although of course co-operation of adjacent communities would be absolutely essential- otherwise there would probably be reinfection due to imported cases. References (1) Stimson, Facts and Problems of Rabies, Hygienic Laboratory Bulletin No. 65, 1910. (2) Williams, “Rabies,” Reference Handbook of the Medical Sciences (3d ed., 1917), pp. 443-47. (3) Williams and Lowden, "The Etiology and Diagnosis of Rabies," Jour. Inf. Diseases, 1906, 3, p. 452. (4) Minnesota State Board of Health, Report of Laboratory Division, 1911-12. (5) Phillips, "Rabies and Its Prevention," Monthly Bulletin, Ohio State Board of Health, II (1912), 131. I Health Indications in Data on Draft Rejections NTERESTING indications as to the health conditions of the country's male population between the ages of 21 and 31 have, been given by the publication of detailed figures on the physical examinations of men called in the first draft. In general the statistics indicate that health conditions are better today than at the time of the Civil War, that they are better in the plains and mountain states than elsewhere and are worst in the North Atlantic and New England states, that there is little. difference between city and country health (what margin there is being in favor of the rural sections), and that eye defects are more common than any others. Of the men called for exami nation throughout the country 70.89 were found physically acceptable and 29.11 were rejected. The total figures are: Called 2,510,706, accepted 1,779,950, rejected 730,756. Draft rejections in Civil War days amounted to 31.69 percent, according to Provost Marshal General Crowder, who points out that the higher standards of medical diagnosis today make this difference even greater than it appears. West Rejects Few A striking feature of the draft results is that the Mississippi River forms an almost absolute boundary between two health zones of the country. East of the Mississippi only one state Alabama out of 26 passed as many as 75 percent of the men called. West of the Mississippi 13 out of 22 states achieved this record, and one of them-South Dakota stood alone among all the 48 states in passing more than 8ɔ percent. Only two states west of the river- Nevada and Louisiana fell below 70 percent; in the East 12 states were under 70 percent, seven of them being under 65 percent and four of them being under 60 percent. As applied to individual states, these figures cannot be taken as an infallible index to conditions, since those same differences in standards of medical diagnosis, which General Crowder pointed to as between Civil War times and the present, may exist also as between different states today. However, in the broad comparison between East and West, exceptions to the general indications are so rare as seemingly to preclude the possibility of this explanation. Others Discharged Later It must also be remembered in weighing the figures that these statistics do not take into account discharges of men whose defects were found after they had entered the service and gone to camps. This process of further sifting is still in progress and no figures are available. Grouped by the percentages of men accepted to men called, and by sections as well, the states stand as follows: Less Than 60 Percent East of the Mississippi: Maine, Vermont. Connecticut, Pennsylvania. West of the Mississippi: None. East New Hampshire, Massachu- 9. Physical underde setts, West Virginia. velopment 416 4.06 West: None. 10. Flat foot 375 3.65 60 to 65 Percent Scorecard System in Public Health Work By James A. Tobey, Scientific Assistant, U. S. Public Health Service T HE scorecard system in public health work has now been in use for a number of years and is increasing in scope and influence. A scorecard for dairies was first used in Washington, D. C., by Health Officer Woodward and soon produced excellent results. In fact, scorecards have proved useful and beneficial wherever they have been skillfully devised and intelligently applied. They help to systematize the keeping of records as they can be filed for reference and they serve as a ready comparison of conditions. which can be easily presented to the public. The advantages of the system are many. It assists the inspector by putting before him in black and white the items he should look for, so that he overlooks none and soon learns to evaluate the various factors of sanitary importance. It serves to instruct the person scored by attracting his attention to those points in which he is deficient. This is best done by marking in red ink all scores which are below the allowable limit, while those which come up to standard are marked in black. Thus, at a glance he sees where his faults are and his interest is aroused. If a card is marked only in black, too often it is placed aside for future perusal and then forgotten. Stimulates Competition The system creates rivalry and stimulates competition. No man wants to be at the bottom of the list, especially if it is to be published. Publicity is one of the most inspirational factors in health work. Even the announcement that scores are to be published in newspapers or bulletins causes a sudden increase in interest and a decided improvement among those scored. To be fair, however, only an average of a number of inspections should be published, as this procedure gives a man a chance to improve. Copies of the score should always be sent to those who have been inspected. The one objection which might be offered against the system is that a score is general and not specific. It is a form of standardization but sometimes two equally good places, as measured by results like milk analysis with respect to dairy scores, may be given very dissimilar scores. A trained inspector, however, who has good judgment and common sense will usually get fair comparisons. Obviously, to prevent differences in opinion due to the personal element, one man should wherever possible do all the scoring for a set of inspections. Scorecard Essentials The scorecard itself should be so framed that it covers the im portant items of the sanitary code which applies to that which is to be scored. Incidentally, the code itself should be accurate and up to date. The card should likewise |