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K., was disregarding the order of the board, visiting the house freely and taking no precautions. The Secretary called upon Mr. K., the brother, in relation to the matter and he acknowledged that he was doing so daily and should continue to do so, and a few hours afterwards, he went to the infected house, removed the placard from the door, and tore it in pieces. The local board promptly and rightly filed a bill of charges against Mr. K. Eventually the case was tried before a local justice, the defendant plead guilty, and was fined twenty-five dollars and costs. The defendant appealed to the Supreme Court, and the case was settled without being brought before the jury by his paying the costs, about seventeen dollars.

In spite of the earnest work of the local board of health new cases continued to appear nearly every week until the latter part of August; then on account of the continuance of the epidemic Dr. C. D. Smith of Portland, a member of the State Board, visited the town for the purpose of advising with the local board and learning the conditions which contributed to the continuance of the prevalence of the disease. The following was the doctor's report:

Dear Doctor Young:

PORTLAND, August 23, 1890.

I have this morning returned from Eastport and will report to you while the matter is fresh in mind.

I arrived at Eastport Thursday noon, and at once made an appointment to meet the local board that evening, as all were out of town at work during the day. I busied myself until night looking about the town and conversing with different citizens as to the past and present condition of affairs, and my interview with the board during the evening only confirmed the opinion I had formed during the day. I am satisfied that the cause of the trouble is due to these facts:

1. The present board entered upon its duties last spring without receiving any records from their predecessors. It does not appear that any were ever kept. They have adopted no formal by-laws, and have been continually hampered by the idea that they could do nothing unless it were in accord with something in the town by-laws. 2. They been deceived with regard to the presence of cases of diphtheria, because I find the impression prevalent that physicians have not reported all of their cases, and this is not contradicted by

evidence; indeed, I was assured by one physician that until last spring when the selectmen "asked" them to do so the physicians had not considered it at all worth while to report.

3. There has been and is a singular apathy in the minds of some of the people as to the danger of the disease, due to remarks freely made by some of the medical profession, creating the impression that the disease is feebly, if at all, contagious, and ridiculing the necessity of such stringent measures, as have been advised. This attitude of some of the medical profession has seriously impaired the usefulness of the board and embarrassed them and the selectmen in their endeavors to do their duty, as I believe they have honestly attempted.

4. The selectmen on their own responsibility, without consulting the board of health, appointed a Mr. Whelpley, an ex-deputy sheriff, as health officer, and the board tell me that for a fortnight at a time they would have no knowledge of where he was or what he was doing. Then the citizens rebelled against paying this man two dollars per day, and the selectmen dropped him. From what one of the physicians told me and from my conversation with prominent and reputable citizens, I have no doubt that the so-called isolation has been very feebly maintained.

During the evening I had a long conference with Mr. Clark, Secretary of the local board, and his associate Mr. Bibber, who was appointed in July to succeed Mr. Caldwell who took offense and resigned because his friend Mr. Kilby was prosecuted for tearing off a placard. I told the local board that having asked me what I considered the cause of the continuance of the disease, I should reply to them frankly. You have been working against great odds, because your local physicians have neglected to keep you fully informed of new cases, and because of prevailing false impressions as to the contagious character of the disease, and this latter has rendered your system of isolation almost of no avail.

I advised them to have a full meeting of their board to-day, and first of all adopt a system of by-laws and send it to Judge Emery for approval, making a careful record of everything done by them as a board. Then by careful and judicious inquiry keep themselves informed as to the progress of every case and the thoroughness of the isolation. They are to be careful not to interfere with any physician in the management of any case, unless satisfied that he is

deceiving them or that the measures of restriction fall short of those directed by the State Board.

I told them that when once appointed by the selectmen their duty was to administer the State health laws and their approved by-laws, entirely independent of anything or any body except their own decisions formed upon their own judgments in each particular case. That they must be the judges of their own action, and act accordingly. A question was here interposed by a physician present as to the need of certain cleansing methods in a "disease not yet proven to be contagious in all cases. I replied that I could not presume to occupy time to discuss that subject, or the question of contagion; that whatever his view or mine on that subject, one thing was plain, i. e., that the Law of Maine directed that when a case of diphtheria occurs, certain things must be done, by certain people and the duty of the local board of health was to see that such were done. That was the whole point of the diphtheria question, and there could be no other.

I discussed freely and until midnight with Mr. Clark, Secretary of the board, the various bearings of the question. I am satisfied that the board is anxious and desirous to do its whole duty and will if it has the support of the municipal officers. Mr. Clark is a young man, keen, careful and intelligent, and is surprisingly well posted on health regulations and the different circulars issued by our Board. Mr. Flagg is equally so and both will do all they can. Friday morning I had a long conversation with Mr. Norton, one of the selectmen. He confirmed my impressions regarding the cause of the trouble, and said that his board had again discontinued the services of the health officer, and that they had received the resignation of Mr. Clark, but did not wish to accept it because they had confidence in him, and in Mr. Flagg. I told Mr. Norton that I was satisfied that Mr. Clark would continue on the board, but that the board must have the support of the municipal officers and citizens and that no obstacle ought to be thrown in their way by cramping them in their necessary expenses. That if these gentlemen gave their time and received no compensation, the least the town could do was to give them the services of some one to do the work of placarding and attending to these cases of diphtheria when needful. I impressed upon him that anyone whom his board should select must act under the direction of the board of health and report to them. He assured me that all this would be done and that the selectmen would stand

behind the local board in every case. If all concerned do not now have a clear conception of their several duties in the premises it is their own fault. I am convinced that reporting all the cases, and anything like a decent quarantine would have prevented such serious trouble as they have experienced, but I was amazed to find how thoroughly disseminated were the doubts as to the contagious nature of the disease. There has been the trouble, and I am satisfied that a few judicious prosecutions would have changed the opinions of some of the people in a radical manner. I advised all whom I met, with a full understanding that the question in a small village has some features which may be ignored in the city, and think my imstructions were adapted to the people and the place. I am confident that the local board can manage it if the physicians. don't counteract their efforts. The board has the right idea and is anxious to do its duty to the satisfaction of the State Board.

The village seems clean and well kept, and the drainage, except about Water street, has plenty of chance to reach tide water by the natural decline of the land. On the water front there are a number of private drains. The water supply is good in quality, but somewhat limited in quantity, and it is now proposed to tap a pond some miles from the village and utilize the stand-pipe which has been built for a protection against fire. The local board is looking after the privies and the fish offal about the packing houses, and will do good work if not hindered.

Just as soon as I can get leisure I want to go to Augusta and tell you much that I can't very well write, but I have herein given the gist of my labor which I hope will prove beneficial, and to your satisfaction.

you

Will you please mail to Mr. Clark, some copies for free distribution of circulars No. 38, 39, Notes on Disinfection, Abstract of Health Laws, Form 44, Form 11, and Form 12.

Very truly yours,

CHARLES D. SMITH.

This outbreak and continued prevalence of diphtheria in Eastport is another confirmation of the truths taught by the State Board that the infection of diphtheria once introduced and distributed in a village is an exceedingly hard one to eradicate, and that its introduction should everywhere and always be met by prompt measures to prevent its spread. In this case the golden opportunity for stamping out the epidemic had passed when the local board was

appointed; the further explanation why the disease still continued is given by Dr. Smith's letter.

SCARLET FEVER IN GUILFORD.

In the early part of October, I was notified by Mr. Henry Shaw, Secretary of the local board of health of Guilford, that some kind of eruptive disease prevailed in that town, and that there was a disagreement among the physicians who had seen the cases as to its nature, some contending that it was scarlet fever and some that it was not. As often happens, the citizens took side with the doctors, and, consequently, the local board of health was not supported as it to ought to have been in giving the public the benefit of the doubt until the question was settled. In this emergency the local board of health appealed to the State Board for advice, and Dr. J. O. Webster visited the town. As the difference in diagnosis in connection with this outbreak is fairly typical of some other differences of opinion that have arisen in other outbreaks of this same disease, the doctor's report should be of more than local interest, and should warn against the repetition of the error of demanding absolute certainty of diagnosis before anything is done. The mere suspicion that a given case is one of scarlet fever should always lead to prompt precautions against the spread of infection if it should prove to be infectious.

Dr. A. G. Young, Secretary:

AUGUSTA, October 10, 1890.

DEAR SIR:-In accordance with your request, I visited the town of Guilford, on the 9th inst., to investigate an epidemic of an eruptive disease there prevailing among children, there being a difference of opinion among medical men in that vicinity as to its nature. I was met at the station by Mr. Straw, Secretary of the local board, and taken to see a large number of cases.

The epidemic began with one or two cases in August, but did not spread to any extent until within the past two or three weeks, when there have been about twenty-four cases. As it had evidently been propagated through the schools, they had very properly been closed. The local board had used every effort to control the disease,

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