Infectious Diseases-Scarlet Fever-Small-pox.

Resolved, That upon the outbreak of epidemic or contagious diseases reported to the secretary of this Board, he be authorized and directed to immediately notify some member of the Board, whose duty it shall be to proceed to the infected locality and investigate the causes of said outbreak, and assist in its removal by active co-operation with the local boards of health, and issue such orders as may be necessary in the premises.

In view of the large number of deaths reported from Membranous Croup, Croupous Diphtheria and Diphtheritic Croup, occurring in communities where Diphtheria is prevalent, and the generally accepted opinion that these diseases are etiologically and pathologically identical with Diphtheria it was ordered by the State Board that Membranous Croup be included in the rules and regulations of the Board for the restriction and prevention of Diphtheria and for sanitary purposes to be deemed and considered as dangerous to public health and subject to the same quarantine regulations as Diphtheria.

SCARLET FEVER.

Scarlet Fever has prevailed as an epidemic during the biennial period. There have been outbreaks in a large number of counties, and in many instances unnecessarily prolonged by reason of the neglect of local boards. The most prolific source of trouble with this disease is the reprehensible practice of physicians to call mild forms of it "Scarlatina" and "Scarlet Rash," thereby misleading the people, and deceiving them into false security. Mistaken diagnosis, and the consequent delay and exposures is also a great source of danger. To guard, so far as possible, against this, the State Board has prohibited the use of the terms "Scarlatina" and "Scarlet Rash."

SMALL-POX.

During the biennial period Small-pox has appeared in the State. In January, 1888, a gentleman contracted the disease in California, and brought it to his home, near Colfax, in Jasper county, and three of his family were infected, with no deaths. He stopped at a hotel in Ottumwa. Soon after, a man residing in Ida county, stopped at the same hotel, occupying the same room occupied by the Jasper

Infectious Diseases-Typhoid Fever.

county man. From him his family became infected, resulting fatally in one of his children.

In September, 1888, the disease was brought to Council Bluffs by a railroad passenger, resulting in fourteen cases, with two deaths. In the same month a traveler brought the disease to a hotel in Monticello, Jones county. He was removed to a pesthouse, where he died. Several inmates of the hotel became infected, but without fatal results.

In October, a resident of Ainsworth, was infected while traveling in the west. Five of his family were infected from him, resulting in the death of a small child. Another case, of a man, exposed to this family, resulted fatally.

In January, 1889, six cases were reported in the family, at Waverly, Bremer county, of a man who had been traveling in the west. All recovered.

In June, 1889, a German family of immigrants, infected with the disease, were discovered on a railroad train near Galva, in Ida county. They were side-tracked at once, and rigidly quarantined. From this family, one case developed among railroad employes, at Boone, one at Spirit Lake, two at Clinton, one at Marshalltown, one at Nevada, with one fatal at Clinton. The case at Spirit Lake was fatal, though probably from other causes. At Jefferson, in Greene county, were four cases in one family, the origin of which was probably the immigrant family at Galva.

In this latter outbreak, with exposures on a crowded passenger train, extending nearly across the State, from the disease at the full period of eruption, so prompt and vigilant were the local health boards in vaccination and quarantine, the disease was confined in each localty to the family in which it appeared, and was stamped out in less than thirty days. An important fact, firmly established during this outbreak, was the prophylaxis of vaccination.

TYPHOID FEVER.

In November, 1888, an outbreak of Typhoid Fever was reported at Alden, in Hardin county. There were eight cases in two families,

Infectious Diseases-Typhoid Fever.

who used water from the same well. There was one death. The use of the water was suspended and the disease at once subsided. In September, 1888, a serious outbreak of this disease was reported at a hotel in De Soto, in Dallas county. Suspicion attached to the well which furnished the water supply, by reason of its proximity to privies and stables. An analysis of the water confirmed the suspicion, to-wit:

The second column is the standard of water permissible for potable use, the quantities being the maximum in grains per U. S. gallon.

During the year 1888, several cases of Typhoid Fever occurred at the State Institute for Deaf and Dumb, at Council Bluffs. At the request of Superintendent H. W. Rothert, a special committee of the State Board was appointed to investigate the sanitary condition of the buildings, and suggest such remedies as they deemed necessary, which the committee did. A second committee was appointed to ascertain to what extent the recommendations of the former committee had been executed. That committee made the following report to the State Board at the May meeting, 1889:

Mr. President and Gentlemen of the State Board of Health:

Your committee to whom was referred the report of Mr. Loring and Dr. W. H. Dickinson on the sanitary conditions of the Deaf and Dumb Institute, would most respectfully report:

That Dr. J. C. Shrader, a member of the committee, has visited said Institute, and after making a careful examination of the premises, finds that many of the causes of complaint referred to in the report of the committee have been removed.

The trustees and superintendent immediately went to work to place the institution in as good a sanitary condition as possible, and have done all that was possible with the means at their disposal.

The matter of better ventilation has received particular attention. The soil pipes from the water-closets have been thoroughly trapped, and pipes

Infectious Diseases-Typhoid Fever.

leading therefrom extend some ten feet at least above the roof of the building. There are now no tile soil pipes within the building. The sewer near, and extending within the building at one point, has been taken up; it was found in bad condition, but has been replaced in a substantial manner, thus rendering the drainage perfect and preventing the noxious gases from entering the building. Some of the basins in the water-closets have been replaced with more modern and a better class of goods.

I was assured all the defective, or rather the old style basins, would have been removed had the finances justified the expenditure.

The registers have been carefully looked after, and the ventilating flues cleaned where necessary, so that the ventilation from this source seems now to be in as good a condition as they well can be under the plan adopted by the architect when the building was constructed.

We especially commend the action of the Board in providing better hospital accommodations. We are happy to state that the hospital is now supplied with as good accommodations as is possible under the circumstances. The upper story of the main building has been thoroughly overhauled. The rooms are large, airy, well ventilated apartments; the floors are laid with hard pine flooring, finely finished; the walls and ceilings newly plastered and whitewashed; a good elevator has been put in; hot and cold water in every room; the water-closets of the latest design; two large rooms especially set apart for contagious diseases, and these as completely isolated from the others as is possible under the circumstances.

There has been a ventilator put in the sewer some distance from the building at the point marked “cess-pool" in the report of the original committee. It is contemplated to change the direction of the main sewer so that it will debouch into the creek, many rods below the present outlet.

There has not been any sewer connections made with the water-closet near the school house, but I am informed that it will be done as soon as possible. After considering what the board of trustees and superintendent have done since the first report was made, we must consider their action as prompt and commendable. There seems to be a sincere desire on their part to place the institution in as good a sanitary condition as possible, that there may be no cause of sickness or sources of filth that may engender disease about the premises.

The inmates look healthy, happy and contented; entire harmony seems to prevail throughout all the different apartments. The superintendent and his excellent wife seem to be devoted to their work, and the results are plainly visible in the perfect cleanliness of all parts of the institution, and it is indeed a happy home for this unfortunate class of human beings.

Your committee would recommend that an appropriation be made by the next legislature to extend and render more perfect the system of sewerage. To erect a building on the cottage plan for a hospital, separate and apart from the other buildings. This is especially needed should there be an outbreak of any of the contagious diseases in the institution. They could then be more perfectly isolated and better cared for.

Infectious Diseases in Public Schools.

In April, 1889, sixty cases were reported at Oakland, Pottawattamie county, of Typhoid Fever, the source of which was a polluted well.

CONTAGIOUS DISEASES IN SCHOOLS.

As great diversity of opinion exists among teachers and school boards regarding the importance of protection of public schools against contagious diseases, the State Board, at its May meeting, in 1889, issued the following rules and regulations to school teachers, superintendents, and principals in the public schools in Iowa:

What is to be done in case of the appearance of any such disease in a child attending any public or private school in the State, is so essential that its consideration will precede the description of the diseases themselves.

1. Don't close the school. By so doing a great wrong is inflicted upon the well. The children meet on the play-ground and intervisit, and the teachers are more apt to visit the afflicted scholar. Teachers must not visit sick children, and must carefully guard against exposure to these diseases.

2. Send the pupil or teacher so affected home at once, and, unless the other children in the family go from home to live, they must also be excluded. Report the name of the pupil or teacher, together with the supposed character of the disease, to the principal or superintendent of the school; or, if in a country district, to the school board, at once, as well as to the parents of the child. Such a child, or teacher, must not be, under any circumstances, re-admitted to the school, except upon a certificate from the attending physician, or a health officer, showing complete recovery, thorough disinfection of his or her person and clothing, and the disinfection of the home.

3. In case of an outbreak of Small-pox in any community, or a threatened outbreak, every child attending the schools, and every teacher must be examined relative to having been successfully vaccinated, and if not so vaccinated, must be excluded from the schools until so protected.

4. If a person is ascertained to have attended school when affected with either Diphtheria, Measles, Scarlet Fever, Membranous Croup, Whooping Cough, or Small-pox, the local board of health must immediately close the room wherein such person attended, and direct its proper disinfection.

5. In all cases of doubt the public must have the benefit of the doubt. It is infinitely better to isolate and quarantine a suspicious case for a few days, and find a harmless mistake had occurred, than to allow such an one to attend the school, and, after many had been wantonly exposed, find that a fearful and fatal mistake had been made. Prevention is inexpensive and sensible-exposure is always dangerous, and hence senseless.