Wheeling register. [volume] (Wheeling, W. Va.) 1878-1935, 1900-02-24

The following paper by DR.. S. L
| Jepson, Health Officer of the City OF
Wheeling, and an acknowledged ex-
| pert in smallpox and variola, is pub
| lished by request of members of the
medical profession from the Journal
| of the American Medical Association.
| 1t is somewhat abridged from the
| original, but no important fact has
| been omitted:
A pebble in the streamlet scant
Has changed the course of many river.
Vigorous sanitation applied at the
right time and in the right way will
always prevent an epidemic OF small
pox. No acute infectious disease is
so easily controlled, because: l. 1t
manifests itself externally and should
rarely be mistaken for any other dis
ease; 2, it is greatly dreaded, and
hence people are as a rule careful to
avoid it; 3, it's germs are easily de-
stroyed; 4, we have in vaccination an
absolutely certain protection. The
last statement may be disputed, but
the exceptions are so very rare that l
think better to ignore them.
My experience as a sanitary officer
has brought to light great amount
OF prejudice against vaccination. This
is largely based on the densest ig-
norance, but not small part of 1t is
due to the many bad results of care
less vaccination-results often caused,
not by impure virus, but by vicious
methods of introduction or neglect by
physicians of the commonest anti
septic precautions. Arms are seldom
cleaned before the operation Not
rarely absorbant cotton or cotton
rag is bound tightly over the arm;
and at least two physicians whom l
know apply adhesive plaster after the
insertion of the virus, allowing it to
remain during the development Of the
vesicle. The result is broken vesicle
or pustule, an imperfect protection,
often an infected and consequently
very sore arm, with constitutional dis
turbance; and, worse than all, grow
ing prejudice against this most benefi-
cent of all known preventives of dis
ease.
The past year has given several
demonstrations of the carelessness,
ignorance, or perversity of physicians
that are by no means creditable to
our profession. In the very enlight-
ened States of Ohio and Pennsylvania
have errors been made in the dag
nosis of variola and persistently ad-
hered to until the disease spread far
beyond the limits of it's origin. No
man is infallible, and some unusual
81 70 mo crr1a MI tho
hemhorrhagic, and some cases greatly
modified by vaccination, may mislead
for time the most experienced. But
to persist in error in opposition to
more enlightened and expert opinions,
and thus allow the disease to spread
which ruins the business of a COM
munity and entails upon it large ex-
penditure of money, to say nothing
of the resulting inconvenience, suffer-
ing, Disagreement and death, is little
short of criminal.
When a disease is so widely pre-
valent as smallpox has been for sew
eral years past, physicians should
keep it in mind, and when called to
strangers or those who may have been
in an infected locality, they would do
ANA~SAOAA'
SIS this a case of smallpox" Until
this question can be definitely an
swered in the negative, let the case be
isolated and every sanitary precaution
be taken Better quarantine hun
bred cases of varicella than to run
any risk of starting a smallpox cpl
demic.
Little less culpable than persistent
errors in diagnosis are long delays in
making diagnosis, unless the strict
est sanitary precautions are observed
while awaiting developments. Some
physicians never report a case OF
variola, even when it is prevailing in
community, until the second or third
day of the eruption, free intercourse
with the patient being allowed in the
meantime, with the result of commu-
nicating the disease to one or more
persons who, under proper manage
ment, would have escaped it. While
such a practice is absolutely without
excuse, personal experience has taught
me that it is by no means uncommon.
The facts here recited lead me to
impress these suggestions on the gen
eral practitioner:
1. Insist on general vaccination and
use only the glycerinized virus in
closed glass tubes.
2. Try to avoid error in diagnosis.
8. Make your diagnosis as early as
possible and at once report the case to
the health authorities. AS soon as
suspicious symptoms present, isolate
the patient and yaccinate every ex-
posed person.
AS a result of ten years experience
as a health officer / have formulated
these rules for my own guidance in
/. the sanitary management Of smallpox,
and hope they may be respectfully
considered by any who may be called
on to control this disease unaided by
such complete organization as is pro-
vided by the boards of health of our
larger cities.
1. Clothed in macintosh and with
the hair covered, promptly visit
every reported case and vaceinate
every person in the house and in ad-
joining ones Make a list of all per-
sons who have in any way been expos
ed to the patient Remove the at
fected one to a hospital, or to an
isolated building that may be thus
| used. If this can not be accomplish
ed. put the patient in the most isolated
room in the house, with every unnec-
essary thing, including all domestic
animals, removed. Hang a sheet
| over the doorway, allowing it to touch