Milroy, Mifflin county. Coalmont, Huntingdon county. Smith's Station, York county. Colley township, Sullivan county. Essington, Delaware county. Palmer township, Northampton county. Hazle township, Luzerne county. Perkasie, Bucks county. Paoli, Chester county. Leiperville, Delaware county. Cheltenham, Montgomery county. Folsom, Delaware county. Waynesboro, Franklin county. Pike, Franklin county. Monongahela township, Greene county. Gradatim, Washington county. Colwyn, Delaware county. Sheffield, Warren county. Coudersport, Potter county. Concord township, Erie county. Dawson, Fayette county. Galeton, Potter county. Scranton, Lackawanna county. Carelessness on the Part of Parents and Teachers the Principal Cause of the Continued Prevalence of Diphtheria. In accordance with instructions received from His Excellency, the Governor, and in compliance with a resolution of the Board, the President and Secretary held a conference in the borough of Hanover, York county, on the evening of February 26, 1898, with representatives of the borough council, the board of health, the board of education and other prominent citizens of the place, for the purpose of elicit ing information in reference to the frequent appearance of diphtheria in that borough. The following morning certain buildings and localities which had been suspected by some of the residents of being responsible for the existence of the disease were inspected. The conclusions arrived at were, that the history of the several outbreaks had been in no way materially different from that of the prevalence of the disease in other towns in the State of about the same size. No local insanitary conditions were found which could be assigned as a cause. While certain cases existed in which offensive industries were permitted to be carried on, they were kept constantly under surveillance by the local board of health, and any considerable accumulation of filth was prevented. Objections were made to a small stream which flows through the town receiving pollution sufficient to make it offensive in warm weather. To none of these conditions, however, could the disease be attributed. Since August, 1897, forty-three cases had been reported; the majority were found to have occurred among children attending school, particularly the primary school known as No. 1. The sanitary condition of this building was found to be good. The continued prevalence of the disease was decided to be due to the carelessness of parents who failed to appreciate the infectiousness of the disease, and the readiness with which it could be communicated, thus allowing children suffering from sore throat, which might have been, however, diphtheria in its early stages, to go to school; also carelessness in families where the disease was known to exist, and to evasion of quarantine, either on the part of members of such families or of the neighbors desiring to offer sympathy and assistance. The occasional failure of physicians to report the disease to the local board of health was also in part responsible; as also the incomplete disinfection of infected premises, and the use of infected books, slates and pencils. This incident has been considered of sufficient interest and importance to dwell upon somewhat at length, for the reason that it is simply typical of what is going on all over the State. Boards of health are roundly denounced and Divine Providence even is held responsible for the mysterious occurrence of sickness and death, when the whole blame rests upon the carelessness or criminal obstinacy of those who are so ready to accuse the authorities of neglect of duty. Scarlet Fever. The aid of the Board has been solicited in suppressing scarlet fever at nineteen different points, as follows: Lee, York county. Boiling Springs, Cumberland county. Derry Station, Westmoreland county. Penllyn, Montgomery county. Erie, Erie county. North Lebanon township, Lebanon county. Eddystone, Delaware county. East and West Millcreek townships, Erie county. Union District of Coal township, Northumberland county. Cheltenham, Montgomery county. Goldsboro, York county. Pen Argyl, Northampton county. Morgantown, Berks county. Greenfield township, Erie county. Mount Clare, Montgomery county. In this instance we note an increase of about one-third as compareȧ with the year previous. Typhoid Fever. The Board has been called upon for assistance in twenty-nine outbreaks of typhoid fever during the year, at the following places: Watsontown, Northumberland county. Valley township, Armstrong county. Kutztown, Berks county. Milford, Pike county. West Millcreek township, Erie county. Chestnut Hill, Montgomery county. Coatesville, Chester county. Mifflinburg, Juniata county. Allentown, Lehigh county. Charleroi, Washington county. Whitford, Chester county. Laurelton, Union county. Jeannette, Westmoreland county. Hustontown, Fulton county. Lundy's Lane, Erie county. Brisbin, Clearfield county. Emporium, Cameron county. Penllyn, Montgomery county. Lancaster, Lancaster county (in the country). Girty, Armstrong county. Corry, Erie county. Conewago, Lancaster county. Shippensburg, Cumberland county. Conshohocken, Montgomery county. Clarion, Clarion county. While the assistance of the Board had been solicited at but seventeen points last year, the apparent increase during the present year is partly due to the vigilance of the Board through its deputy inspectors, who have been greatly augmented in number during the past year. History of the Typhoid Fever Outbreak in Philadelphia. During the spring of the present year in Philadelphia, the typhoid fever rate (number of cases and deaths) very suddenly jumped up. It was very soon noticed that this increase was confined to a certain portion of the city. This led to a careful investigation and the fact was discovered that on the 16th day of November, 1897, the great intercepting sewer, which is intended to receive the sewage of the western side of the city above Fairmount dam, was flushed backwards, and the entire contents were poured into the Wissahickon creek. The sewer emptied into the creek just before its entrance into the Schuylkill river, and just below this entrance is the intake of the pumping station for Queen Lane reservoir, which reservoir supplies exactly that portion of the city in which the disease was found to exist to a greater extent. The demonstration therefore, seemed to lack no element of precision. The Assistant Bacteriologist to the Robert L. Pitfield, took samples of the State Board of Health, Dr. reservoir water, and in every one of them was found colon bacillus. This was some weeks after the introduction of this immense amount of pollution. Yellow Fever. The possibility of the introduction of yellow fever into this country as a result of the return of the soldiers or others engaged in military operations in the West Indies during the recent war, was early appreciated by the Board, and the Secretary was instructed to prepare and disseminate a circular of precautionary instructions on the subject. This has been done. In the preface to the circular occurs the following statement of the objects in view in issuing it: First, to correct the impression so generally entertained that yellow fever is a very fatal disease, and thus to prevent the occurrence of panic, in the event of a case appearing here and there as a result of the recent war with Spain, and our greatly increased intercourse with the West Indies, long its home and breeding place. Especially has this been true of the Island of Cuba, where Spanish mis-rule with its utter neglect of all sanitary precautions has been most flagrant. Secondly, to induce all municipal and health authorities and all householders to put the places and properties under their jurisdiction and ownership into so thoroughly cleanly a condition that, should the germs of the disease be brought here, they will find no congenial soil in which to breed, and, Thirdly, to furnish boards of health, health officers and medical inspectors throughout the State such explicit instructions as will enable them to at once set on foot measures to stamp out the disease with the first case, should it make its appearance. The nature of the disease is thus brifley indicated: Yellow fever is a communicable, infectious (but not contagious) fever, of short duration, which leaves no permanent unpleasant aftereffects (sequelae), and one attack of which renders the patient entirely protected from future attacks (immune). It is a disease of low mortality. At least three-fourths of those attacked recover under the most unfavorable conditions of climate and environments, unless they are worried or frightened to death by overanxious nurses, or drugged to death by over-zealous physicians. With thoroughly judicious care and management, and under favorable conditions, not more than four out of a hundred should die. It will be seen, therefore, that it is two and a half times less fatal than typhoid fever, eight times less fatal than diphtheria, ten times less fatal than Asiatic cholera, and twenty times less fatal than the plague. In little children it is especially mild, scarcely ever proving fatal, often escaping observation. A distinguished New Orleans physician declared that he would rather treat one hundred cases of yellow fever in children than seventy-five cases of measles. It is a disease of the tropics, requiring high temperature for a considerable period to enable it to propagate. Nothing is better established with regard to the vitality of the yellow fever germ than that a temperature below 32 degree F. (freezing point) destroys it, and that a continuous temperature of not less than 70 degrees F., is necessary for its germination and spread. As noted by the distinguished Dr. Rauch, "in this country, even in the gulf states, yellow fever occurs as an epidemic only when the mean temperature rises to that of the tropical regions, and there is no instance of its epidemic spread in places north of 35 degrees north latitude, except when, in the language of Professor Hirsch, "the heat has equalled the mean annual temperature of the tropics; and it has on no occasion become diffused in a temperature below 68 degrees F., the winter temperature of the tropics." Yellow fever is not contagious. The germ when it leaves the human body is not poisonous, but requires to pass through certain stages of development outside of the body before it acquires its pernicious activity. There is therefore no danger in nursing a yellow fever patient outside of the infected district, as it is not difficult to destroy the infectious material as fast as it is thrown out in the various excretions, and thus prevent the growth of the germ. But, while not |