NUMBER 117, LAWS OF 1902. AN ACT REQUIRING PHYSICIANS TO NOTIFY THE STATE BOARD OF HEALTH OF THE EXISTENCE OF ALL CASES OF HUMAN TUBERCULOSIS. It is hereby enacted by the General Assembly of the State of Vermont :SECTION 1. Every physician engaged in the practice of medicine in the state of Vermont shall, immediately upon the passage of this act, submit to the secretary of the State Board of Health the names and addresses of all persons under his treatment for tuberculosis and thereafter each case within one week after applying for treatment. SEC. 2. The secretary of State Board of Health shall keep a careful and accurate record of reported cases of tuberculosis, not for publication, but for such purposes as are necessary for the State Board of Health in the discharge of their duties, and immediately after being notified of each case shall send to the address given a printed circular containing proper information in regard to the disposal of sputum and such other facts, hygienic or otherwise, as are necessary for the welfare of the person afflicted and the protection of the community in which he lives. SEC. 3. Failure on the part of a physician to conform to this act will constitute a misdemeanor punishable by a fine of not less than five nor more than fifty dollars or ten days' imprisonment or both. NUMBER 70, LAWS OF 1902. AN ACT TO PREVENT NUISANCES IN CARS AND RAILROAD STATIONS. It is hereby enacted by the General Assembly of the State of Vermont :SECTION 1. If a person shall spit upon the floor or platform or upon the interior furnishings or furniture, except cuspidors, of any steam railroad passenger car or street railway car, in operation upon any railroad in this state, or upon the floor, furnishings, registers, or radiators of any railroad passenger station or public waiting room in this state, he shall be fined not more than ten dollars, to be recovered in a prosecution before any justice of the peace in the county where the offense is committed, provided, however, that no prosecution shall be commenced for such offense unless notice of the provisions of this act shall be posted in a conspicuous place in the cars, stations and waiting rooms of said corporations and suitable cuspidors furnished excepting in street railway cars. 614.0979 Bulletin No. 3, Volume VI. Issued Quarterly by Vermont State Board of Health, March 1, 1906. Entered October 21, 1901, as second-class matter, Post Office at Brattleboro, Vt., CONTENTS: Notes on Cerebro-Spinal Meningitis, by Daniel Lewis, M. D., late Commissioner of Health of the State of New York. Disinfectants, by F. C. Robinson, Consulting Chemist Maine State Board of Discussion on Disinfectants, by Mr. Edgar B. Moore of Rutland. Health Officers, Their Duties and Responsibilities, by Henry D. Holton, A. M., NOTES ON CEREBRO-SPINAL MENINGITIS. BY DANIEL LEWIS, M. D., LATE COMMISSIONER OF HEALTH OF THE STATE OF NEW YORK. The country has just been passing through a newspaper epidemic of cerebro-spinal meningitis. By this expression it is not intended to depreciate the great value of the influence of the press in preventive medicine, and as purveyors of medical knowledge to the public. It is one of the most striking evidences of the dissemination of knowledge that the people now require and read all newspaper articles upon medical topics, the phraseology of which is sufficiently popularized for their understanding. We must to-day take our patients into our confidence, give them some explanation of the ætiology and pathology, and discuss the methods of treatment to an extent unknown twenty years ago. This desirable change can be almost wholly credited to the newspapers. You, as health officers, will appreciate an example of how the newspaper man may often aid you by a little experience of my own at Richmond Hill, New York City. A report was made at the office of the state department of health that worthless, crippled and superannuated horses were being slaughtered in a grove not far from Richmond Hill, and the meat prepared for market. The fact was verified by personal inspection, but no trace could be found of the actual owners of the establishment. The complaint and the facts of the case were given to a prominent evening paper in New York City, which published the account of their own reporter's experience in finding the slaughter house, together with a description of the animals waiting for slaughter, etc., and within a week all traces of the business had disappeared and it has never since been heard from. The somewhat tardy operation of legal process in such cases was thus rendered unnecessary, and the power of the press to regulate the conduct of law breakers was thoroughly demonstrated. But press reports of epidemics are liable to be greatly exaggerated, and since early in January until about June 1 cerebro-spinal meningitis has been heralded as making most startling progress, mortality unprecedented, health authorities anxious but powerless, and physicians without any plan of treatment to offer, etc. Many of the contributions to medical journals have been colored by the same pessimism which the newspaper correspondents have offered to the public. It is my purpose to open the discussion of this subject by a comparison of some actual statistical facts concerning this disease with popular ideas, supplementing the same from personal experience, and a brief discussion of the duties of the health official concerning its management. We may assume that the figures given by Dr. Gallup of the epidemic in Vermont in 1812-13 are very nearly correct, although Dr. Caverly, in the last number of your bulletin, expresses a possible confusion of some other affection with it in some cases. These figures of Dr. Gallup's give a record of 6,400 deaths out of a population of 217,915. In other words, in those two years thirty deaths occurred to every 1,000 inhabitants. The figures for the great epidemic in Dublin in 1846-48 are not before me, but they were very large indeed. From the latest information at hand, the death rate of Selicia during the present season is also in excess of any records in this country for the past generation. All reporters agree that New York City and state have been the chief sufferers, and a study of the figures thus far bear out the statement with which we started, that it is largely a "newspaper epidemic." Comparing the 1,200 deaths in New York City since January 1, 1905, in a population of 4,000,000, with Dr. Gallup's, it appears that it is only one one-hundredth of the rate in Vermont in 1812-1813. In other words, the deaths in New York City would have numbered 120,000 instead of 1,200. In the Hudson Valley district, in the month of April this year, there occurred twenty deaths out of a population of 696,000; the Mohawk Valley district twelve deaths out of a population of 435,600. Four deaths occurred in Buffalo out of a population of 400,000; two in Rochester out of a population of 175,000; four in Syracuse out of a population of 120,000, while in the entire southern tier district, with a population of 435,000, only three deaths occurred. If this record from the state of New York (outside of the city) be rated by Dr. Gallup's figures, we should have 67,830 deaths instead of the fortyfive which have been reported. When the death rate was at its height in New York City (it being at this time nearly normal), a computation showed the weekly rate to be one to each 40,000 of population, in no sense an alarming exhibit. These figures are given as showing that no great excess of deaths thus far has resulted from this small epidemic. If, however, it is a preventable disease (as we all admit typhoid fever to be) and subject to control by faithfully executed sanitary precautions, even this small number of deaths should have been prevented, and the record is a stigma upon the fair fame of modern sanitation. This brings us at once to the question of ætiology. There seems to be little doubt that the exact cause is to be found in a germ which Weischselbaum, in 1887, isolated and described. This microbe is of the order to which the germ of pneumonia or inflammation of the lungs belongs. It is known as the diplococcus intracellularis on account of the fact that it occurs in the interior of white blood cells. But while the source of the ailment may be traced to this germ, yet another and larger question remains for solution. It is not sufficient for the determination of the cause of an ailment to note the discovery of a specific microbe which is to be found in the fluid of the brain and spinal cord. That which is the chief concern of bacteriologists and health authorities is the determination of the conditions under which the microbe gains admittance to the nervous |