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in number, were taken ill last week, and a few days ago one was buried privately, after the arrival of the father from Goldfield, Nevada, where he has been engaged in mining. Four physicians are in attendance on the children, two declaring the ailment to be a bad form of diphtheria, while the other two claim it is not. The city health officer has been notified, and even he cannot agree that it is that dreaded disease. Other physicians have been called into consultation, and they agree that it is diphtheria. The case is a very serious one, on account of the disagreement of the physicians. The house is not quarantined, and if it should be diphtheria the town has a good chance for an epidemic. It is thought that the public schools will be closed."
The above is taken from a daily paper and is supposed to be approximately true. It is quoted to demonstrate the use to which the State Hygienic Laboratory can and should be put. Lodi is within one hundred and ten miles of the laboratory, with quick and frequent connection, and a swab from the child's throat could be in the laboratory in a few hours. Taken in the morning, it could be sent to the laboratory, a culture made and a reply could be returned the next, with no expense to the patient or health officer except postage and the telegram. If the reply was by mail, the postage on the package would be the only expense. Such an examination would clear up a doubtful diagnosis, and should always be made when that condition exists.
It is often impossible for a physician to be sure of a diagnosis from the appearance of the throat, or from general symptoms, but science has come to his relief in the bacterial examination, and the State has established a laboratory for just this purpose.
An early diagnosis means everything in diphtheria, for the use of plenty of antitoxin in the early stage of the disease will save nearly all, if not all, cases. Every health officer should write to Dr. A. R. Ward, Director of the State Hygienic Laboratory, Berkeley, and secure a supply of mailing cases and directions. They are sent free, and if properly used will lessen in a great degree the death-rate of diphtheria.
In the last Bulletin we published a report of the work which was being done by the State Laboratory in connection with diphtheria in Berkeley. That work has gone steadily on, not, however, without some opposition from those whose children were being saved, and now the disease is practically stamped out. Two thousand five hundred separate examinations have been made, but no one can tell the number of lives saved. Some parents certainly have reason to offer thanks for the salvation of their little ones.
The following report from Dr. A. R. Ward, Director of the Laboratory, is of interest:
Diphtheria in Berkeley.—The work on diphtheria in the Lincoln School in Berkeley, as reported in the last issue of the Bulletin, has been continued vigorously. On January 10th cultures were made from the throat and nose of all of the pupils in the school—some five hundred and seventy-five. Twelve per cent of them showed diphtheria bacilli. Each of these children, together with all the other school children in the family, were excluded from school and placed under quarantine.
A corps of student inspectors has made it possible to take cultures from each family once a week. When a negative report has been obtained twice in succession from the person positive originally, and
once from the other children and the mother, quarantine has been terminated and a permit to attend school has been issued. Thirty-eight families have been released and thirty-seven remain under quarantine. Of these thirty-seven families, fourteen have refused to allow examinations, leaving twenty-three families under observation.
Two cases of diptheria have been reported among those excluded after the examination of January 10th. One of these cases passed the school examination successfully two days before the attack, but had been excluded because a brother had shown diphtheria bacilli at the school.
With the exception of the two cases among those excluded on January 10th, no diphtheria has occurred among the children attending the school in question up to the present date, February 11th. During the same period, five cases only of diphtheria have been reported from families in Berkeley having no relation to the school.
The relation of the preventive measures enforced at the school, to the prevalence of diphtheria among the children of the schools and others, is presented in the table below:
Cases in Families Cases in Families Period.
Connected with Not Connected with
1 November 1 to 19.
1 November 19th. First school examination. November 19 to 30
4 December 1 to 31.
12 January 1 to 10
January 10th. Second school examination. January 10 to 31.
0 February 1 to 11.
It will be seen that the first examination of the school produced practically no effect as compared with the second. It should be noted that the first examination, in which the culture was taken from the throat only, showed but five per cent positive and no quarantine was placed upon those excluded. The second time, cultures were made from both nostrils as well as the tonsils, and all those excluded from school were quarantined.
DANGERS OF SWEAT-SHOPS AND TENEMENT HOUSES. “In England, in the early nineteenth century, a jet of poison spurted up out of a dingy Whitechapel sweat-shop into the splendid drawingrooms of St. James. Heavenly powers! Here was something to astound a nation. Disease and poverty were nothing to our bewigged and gartered parliaments, so long as they stayed pent up in the corrals and warrens of the disinherited poor. But when disease, fathered by poverty, showed its horrible face on polished floors, amazement stared, alarum sounded, England was on guard.
“What caused this cry at the gates, this rush to rescue ? The daughter of Sir Robert Peel was mysteriously stricken with typhus. The infection was traced to a stylish riding-habit ordered and fitted at a correct Regent Street shop, but finished in the tenement of a starving tailor with two children lying ill of fever. When their shivering spells were on, the destitute tailor had flung the heavy robe over his feverstricken little ones. It was not the first time that the plague of the toiling poor invaded the sanctuary of the mighty. It was not the last time. Hundreds of our own epidemics, emptying our schools and deso
* These had both been excluded from the school on January 10.
lating our homes, are due to the desperate conditions under which many of our workers are forced to do their work. And of the nearly two hundred million dollars' worth of garments manufactured yearly in New York City, nine-tenths goes to the wardrobes of our citizens, wholly or partly, by the weary and pestilent way of the sweat-shop."
The above burning words from Edwin Markham's article on "The Sweat-Shop Inferno as clearly points to the danger of concealed diseases as the wretched condition of the "sweat-shops.” That disease is spread from clothes infected in the process of manufacture there is little doubt, for the conditions are all favorable to such results. Physicians who have practiced in the tenement-house districts have many times seen the beds in which were children sick with contagious disease covered with garments being finished for the market.
It requires no great stretch of imagination to see a garment which is being made by a man or woman in the last stages of consumption become grossly infected with the secretions from the patient's diseased lungs.
Wouldn't it be cheaper to support that sick person at a public sanitarium than to let him infect the clothing which will possibly, yes probably, infect and kill some useful citizen?
This is looking from a mercenary point of view, but we have to look from all sides.
It is no fancy picture that Markham drew, and the same conditions pertain now as when Sir Robert Peel's daughter was stricken with typhus. You that are well fed, well housed, and enjoy all the comforts of life must not think you are not exposed to the contaminating conditions of sweat-shop and tenement house. They reach you constantly in the shape of physical as well as moral disease, and will continue to claim you and yours as long as they are allowed to exist.
. It is perhaps difficult for those who have not carefully studied the matter to realize the danger from the dust swept into the streets from houses, halls, hospitals, stores, and saloons. It is hardly possible to walk a few blocks along a city street any pleasant morning without encountering a storm of dust raised by some energetic servant beating a rug or sweeping the dirt from the house out across the sidewalk into the street. This dust may, and oftentimes does, contain the dried sputum of consumptives or diphtheria patients, or the discharge from a syphilitic sore mouth. Filth indescribable is represented in it, and the combination without selection is breathed into the lungs. Is it any wonder we get sick !
No dirt should be allowed to be swept from the house, but it should be taken up and burned. The time is not far off, we hope, when houses will be cleaned by the suction method. It will then be possible to unscrew the electric light bulb and screw on the cleaning machine and quickly remove all dust. The broom and feather duster will then be doomed as household utensils.
That time hasn't yet arrived, and we are dying from consumption at the rate of four hundred per month. One in every seven of us are doomed to travel that road unless we think best to close it up. We can not do it all at once, but we can begin.
There is among many people, and even among some physicians, a more or less strong opposition to the idea of reporting cases. It was the same in New York at first, but now it has practically the unanimous support of the physicians and laity, and the death-rate from consumption is decreasing, due alone to the efforts of the health authorities following up with honest, effective work the cases reported to them.
There is no doubt that notification is the most important unit in the struggle with tuberculosis. There is much good in saving people already infected, but more in keeping others from being infected. The disease is communicable both directly from those infected to the well, and indirectly by means of things, and especially rooms. To check the spread of the disease the means of communication must be stopped, but how can a health officer do his duty in protecting the health of the community unless he knows where to work?
The object of notification is not to placard the room or house, nor to interfere with treatment, nor to make public the patient's condition, but to see in a quiet, non-public way that proper instructions are given the patient so that he may not be a danger to himself or others, and that after his removal from the rooms they can be disinfected. This would save many lives, and no hardship would be imposed on any one.
There is hardly a person but what has seen some one suffering from consumption spitting upon the floor of their room, or possibly upon the walls. This sputum, laden with the germs of the disease, dries and becomes dust." It settles on the walls, in the cracks, and everywhere, ready to infect the next person who unfortunately occupies the room. The disease is no doubt frequently spread by this means—a source of trouble that could easily be prevented by thorough cleaning and fumigation, but the know where is as necessary as the know how.
MOSQUITOES. The time of year is at hand when the mosquito, lean, hungry, and energetic, begins work. They will be few at first, but will multiply with great rapidity, and spread discomfort and disease; that is, if allowed to do so.
It is comparatively easy to destroy them entirely, and be relieved of one of the great discomforts of life. Every one should know and remember that the mosquito breeds only in water, never in grass and brush. They seek protection in these, but breed always in water. The wigglers seen in stagnant water are the mosquitoes in their early or larval form, and it is in that stage of life that it is easy to destroy them. If every one would see that no stagnant pools existed around their place; that no pail, tub, can, or any vessel is allowed to stand with water in it; that their cesspools and vaults are closely covered, or if exposed to the outside, that coal oil is frequently poured on the surface of the water; that watering-troughs are emptied once a week; that water tanks are tightly covered either with boards or a fine screen; in short, if all breeding places are protected or destroyed, there will be no mosqui. toes. In places it is impracticable to drain all pools, but they can be easily covered with coal oil, which will effectually destroy the pests.
Many committees are taking up the question, and have arranged to destroy the mosquitoes which in the past have been such a menace to health and comfort. In this work the entomological department of the State University has rendered efficient aid. No town or city should be infested with this pest, and ordinances should be passed and enforced requiring that conditions should be such on each person's property that they could not breed. This is done in many places, much to the comfort and health of the community.
BAR TO SANITARY PROGRESS. “Prejudice, apathy, ignorance, selfishness, and vested interests still exist as bars to sanitary progress as in the days of old, and they clog the wheels alike of legislation and administration. We.possess the knowledge of how to reduce speedily the sum of infantile mortality, of enteric fever, of smallpox, of puerperal fever, of consumption and of the diseases due to alcoholism, and to a less degree the mortality of scarlet fever, diphtheria, measles, and whooping-cough, yet existing social conditions make progress slow and difficult. Dwellings are still ill-ventilated, dirty, and overcrowded, public and domestic water supplies are still polluted. Food is still adulterated, chimneys still vomit black smoke and chemical fumes, sanitary work is still badly executed, local authorities are still indifferent, employés still exact labor under conditions which are disastrous to the worker's health, and individuals are still careless or ignorant of the simple laws of health passed in the days of Moses. The solution of many public health problems depends upon the solution of problems which are social and political: the magnitude of the social and political problems to be solved cannot be exaggerated. Problems of public health, moreover, change with altered circumstances and new ones are constantly evolving. Many of the old ones are becoming more complex year by year, and some are so dependent upon a high ethical level among the general public for their complete solution, that only the millennium can be expected to see them solved. The public health worker can never hope for a complete realization of his schemes and ambition, and to his labors there can be no end. But his reward is the satisfaction of witnessing, almost daily, beneficent results from his work, and it is this that stimulates and gives him zest.”— Exchange.
IT IS NOT UNWORTHY.
Wm. J. Lampton, in “Success."