Quarantining Mild Cases of Scarlet Fever. absence of satisfactory œtiological evidence, the scarlatinal nature of the attack is proved by the subsequent occurrence of the characteristic desquamation, even when there has been no previous trace. of an eruption, and by the appearance of a moderate amount of dropsy and albumenuria." (The italics are mine.) "In cases Again, under the sub-head "Diagnosis," on page 285, he says: where an early diagnosis is impossible, the doubt will be cleared up at a later period, by the occurrence of desquamation, particularly the occurrence of desquamation in the palmar and plantar regions, or perhaps by the appearance of albumenuria, with or without dropsy, or other symptoms of Nephritis." The statement made in my former letter regarding the importance of desquamation as a diagnostic sign in Scarlet Fever was based upon a statement made to me several years ago, by an eminent and well-educated physician of this city whom I had called in consultation in one of those very mild cases of Scarlet Fever so difficult to diagnose. Since then it has been one of the most valuable, because an always present sign. I am glad to find, on looking up the authorities, since receiving your letter, so strong an indorsement as is given in the foregoing quotations from Prof. Thomas. I fully appreciate all you say in regard to Scarlet Fever occurring in families among children where the only apparent cause-the only source of infection discoverable, were slight fever and sore throat, without fever or noticeable eruption or desquamation occurring in the person of one or more of the adult members of the family. Still, Doctor, notwithstanding the great importance of desquamation as a diagnostic sign, and one so generally if not always present in Scarlet Fever, I would not have you, on a failure to discover its presence, turn loose any one presenting other, however slight signs, or symptoms of the disease. Speaking of just such cases, Prof. Thomas well says: "Such attacks generally disappear in a few days, but they should receive the same attention which is paid to the unmistakeable disease; every throat affection during a Scarlet Fever epidemic is suspicious!" In regard to the length of quarantine, I must say that the rules of the State Board of Health requiring quarantine for forty days in all cases of Scarlet Fever and Diphtheria, is binding upon all the State, whether adopted by local boards or not. No period short of this is safe. There must of necessity be many cases where even the period of forty days is not safe. It is important, however, to adopt some period, and the Board after much deliberation, and in accordance with the results of the most careful and extensive observations by those who have had ample opportunities, and who have made preventive medicine a special stuty, have accordingly made the period forty days. To have named twenty or thirty days would have been just as arbitrary and not as safe. I would therefore recommend the following: In all suspicious cases, isolate and quarantine until no doubt exists as to the true character of the disease. This may require ten days or two weeks. If the disease be found not an infections one, release at once. If in the meantime it has proved to be Scarlet Fever, or any infections disease however mild, quarantine for the 1 Quarantining Mild Cases of Scarlet Fever. specified time. No other course promises so nearly absolute safety, unless it be a more extended period. I know such a quarantine is very inconvenient, and seems arbitrary, yet this fact is to be borne in mind, if such a quarantine were rigidly enforced in all contagious and infections diseases, its necessity would seldom occur. To have an attack of any contagious disease is a great misfortune, and generally is the result of somebody's carelessness; to have such disease in a mild form so as to recover fully, and in a short time, is certainly a source of congratulation, and should inspire its subject with gratitude so profound as to lead to a cheerful compliance with those rules that experience has proved are best calculated to protect others from an attack that may be malignant in form; or though similarly simple in form, may prove fatal from complications that are too often liable to supervene. Quarantine is nothing more than a forced or voluntary compliance with the golden rule "Whatsoever ye would that men should do unto you, do ye even so unto them." I am respectfully, J. F. KENNEDY, Secretary. IOWA, March 15, 1889. J. F. KENNEDY, M. D., Secretary State Board of Health: DEAR SIR-For the guidance of a number of local boards will you be kind enough to answer the following question at your earliest convenience: When an undoubted case of Scarlet Fever is quarantined, is it obligatory on the board to keep up the quarantine for forty days, or may they let the patient out when the physicians say there is no danger? The case in question is a teacher, and when released will go into the school-room. Yours, etc., OFFICE SECRETARY STATE BOARD OF HEALTH, MR. DEAR SIR-In reply to your question I have to say, no party having Scarlet Fever should ever be released from quarantine until the expiration of the forty days fixed by the State Board. In Scarlet Fever there is always a desquamation, that is, a scaling off of the scarf skin. These scales are regarded as most infectious agents, the most common and effective means by which the disease is propagated. Often this scaling off process is delayed-I think seldom fully completed before the seventeenth day. It would be especially unwise to thus release a teacher and to allow him or her to go into the school-room and thereby endanger the health and lives of children who are specially susceptible to the disease. Respectfully, J. F. KENNEDY, Secretary. Quarantine in Diphtheria. QUARANTINE IN DIPHTHERIA.. The subjoined correspondence is of such a practical character that a careful perusal, especially by health officers and local boards of health throughout the State, is especially recommended. It affords a practical illustration of the questions requiring solution, and often involving litigation. The interrogator is an attorney as well as the mayor of his city: J. F. KENNEDY, M. D., Secretary State Board of Health, Des Moines, Iowa: Will you please send me a copy of your latest regulations regarding length of quarantine in cases of Diphtheria. You will also oblige me by answering the following questions: First. In houses where all the inmates under fifty years of age have already had the disease (Diphtheria) and are fully recovered from it, and the house and clothing have been thoroughly disinfected, what is the object of the forty day quarantine? Second. Will Diphtheria disease-germs be destroyed by a quarantine of forty days? Third. Can Diphtheria disease-germs be destroyed effectually and entirely by burning large quantities of sulphur, so that the fumes will come in contact with infected clothing, for several hours, and washing wood-work, ceiling, etc., in a solution of corrosive sublimate, one drachm to a gallon of water? Fourth. Suppose A to be a man of forty years of age, with a family of small children, all of whom have had the Diphtheria and are fairly convalescent, will he be permitted after thorough disinfection of his person, say by washing his body, hair and whiskers in a strong solution of carbolic acid, changing his clothing for clothes never near the infection, to leave the quarantined premises for the purpose of continuing his avocation, providing he does not again return to the quarantined premises, but eats and sleeps elsewhere? Fifth. In a family where the members come down one after another, when does the forty days begin to run, at the time of the coming down of the last patient or at the time when the last patient is fairly recovered? I ask you these questions in order that I may do my whole duty in this matter of quarantine and that I may have a better idea of your desire and opinion of the matter. Yours truly, Mayor. DEAR SIR-In reply to your letter of March 16th, and in answer to the interrogations contained therein, I have to say: 1. The object of forty days' quarantine in the case you speak of, is to insure a greater amount of safety than can be done by a shorter period. Free ventilation and time alone have a great deal to do in destroying the activity of any disease-germs, notably those of Diphtheria. Even for some time after all the inmates of a house have recovered, there are excretions from the lungs, skin, bladder and bowels that possess more or less the infectious principle. Disinfection alone, however thorough, will not always destroy these disease-germs, but disinfection, time, and the beneficent influences of plenty of fresh air combined, will secure the greatest safety practicable. The selection of forty days is an arbitrary one. Sixty days would have been much better. Experience has demonstrated, time and again, that a period less than thirty-five or forty days is too great a source of danger to be permitted. Then again, the quarantine for such an extended period is not alone, nor principally, against the parties affected so much as against the premises. To throw open premises where infectious diseases have existed, immediately after recovery, even after proper disinfection and ventilation, would be a great and unnecessary exposure to any susceptible persons who might enter. Hence, it is important to select some period, and the Board exercised its best judgment in naming forty days. In England, the provinces of Canada, and in nearly all the states of the Union, the period is either thirty-five or forty days. 2. No. That is, not in every case, perhaps in a few by quarantine alone; but proper disinfection, ventilation, and forty days, combined, would insure comparative safety, perhaps in most cases perfect immunity. The germs producing Diphtheria are generally regarded as short-lived-compared with those of Scarlet Fever. There are many cases on record where Scarlet Fever has been produced, after two or three years, by wearing clothing previously worn by persons who had been affected by the disease, and where disinfection had been neglected. ̧ 3. Sanitarians differ in regard to the efficiency of sulphur fumes as a disinfectant in Diphtheria. It is difficult to have the fumes in a sufficiently concentrated form, remain long enough in contact with clothing and articles of furniture to destroy the disease germs. Hence, because of its unreliability, the State Board has abolished its use. Better, and I should say, only satisfactory results, are attained from washing the walls, ceiling, and woodwork, after sulphur fumigation, if used, with a solution containing at least two drachms of corrosive sublimate to the gallon of water. Clothing or bedding that cannot be washed or boiled, should be either burned, or subjected to a dry heat of not less than 230 degrees Fah.; or, what Quarantine in Diphtheria. is better, to steam at a temperature of 230 degrees Fah. Boiling for an hour will destroy all known disease germs. 4. Yes, especially if he were not teaching children in a close room, or if his occupation did not bring him in personal contact with children. 5. The Board has no rule, so far as I am aware, covering such a case, but for the reason I stated in the first answer, I should not hesitate to say forty days from the time the last patient was taken down. I am very respectfully, J. F. KENNEDY, Secretary. The annual slaughter of children by Diphtheria is frightful to contemplate. This and Typhoid Fever are especially filth diseases. Rotting garbage, bad drainage, develop the germs of Diphtheria, while the specific poison of Typhoid Fever originates in decomposing human excrement. The local board, or the individual to knowingly tolerate either, is morally, if not legally, guilty of manslaughter, in the death of every human being caused thereby. Human laws may be violated with impunity, but laws of nature never they are immutable. The penalty may be delayed, but come it will, as sure as night follows day. The nasty, reeking drain; the kitchen slops; the filthy pig-pen and stable, the privy vault and defective sewer, will breed the germs that will take the life of the "little ones," and populate the grave-yards. The graveyards, and defective sewers, and cess-pools will propagate the Typhoid germ that respects neither age nor sex. Sanitary science has demonstrated beyond successful contradiction, that Diphtheria can be nearly if not entirely prevented by cleanliness in our environments. In the city of Pullman, built and maintained upon correct sanitary principles, the disease is unknown. Experience demonstrates the necessity for such legislative control as will secure the best hygienic results. |