Provision for safety in time of storm or shipwreck might be improved by the substitution of mattresses which would float, such as cork mattresses, or what is probably better, "Ostermoor's Elastic Mattress," now in use in the Navy. And all cabin doors should be so made as to be readily unshipped and used as floats. Seamen on shore, as will have been observed from the various reports quoted in this paper, are a peculiar class, and are sadly in need of national legislation for their protection. In the shipping act of 1872 it was supposed such protection was attained, and so it was in a measure, but the amendments secured for it the following year left "poor Jack" where he was before, only worse, for it gave him a law with an exception which placed him legally at the mercy of the shipping broker. It is suggested that section 4504 Revised Statutes be eliminated of its proviso, omitting all after the penalty clause; it would then read: "Any person other than a commissioner, under this title, who shall perform or attempt to perform, either directly or indirectly, the duties which are by this title set forth, as pertaining to a shipping commissioner, shall be liable to a penalty of not more than five hundred dollars." It is also suggested that sections 4607 and 4609 Revised Statutes (given in full on a former page of this report) be enforced, thereby protecting the seamen in their rights to shipment without having to pay "blood money" for a "chance"; and that sections 4531-32-33, and '34 be stricken out of the Revised Statutes, and a law substituted abolishing the "advance wages" system. Too much importance cannot be attached to these measures; in fact, they underlie the whole groundwork of the future of our merchant marine, and upon the enforcement of the one and the abolishment of the other depends much of the efficiency of the service. Next to the above necessary reforms, and perhaps equally important and far-reaching in its effect upon the future of the mercantile marine, I regard the physical examination of seamen before shipment as a hygienic measure of the greatest importance (in a business point of view it stands first in importance). I would therefore suggest that the physical examination of seamen before shipment be made compulsory, and the management of such examination be placed under the direction of the Surgeon-General of the Marine-Hospital Service, who has already inaugurated its voluntary observance. National legislation is much needed in providing a home for aged and permanently disabled seamen, and it is suggested that a United States snug harbor be established at some convenient point, where this class may be cared for in like manner with other of the nation's wards whose lives have been imperiled for the nation's benefit. In order to increase the efficiency of the merchant marine it is suggested that training-ships, or schools for boys similar to those authorized for the Navy, be established at convenient points; and also that masters of vessels be compelled to carry, proportioned to the tonnage, a certain number of boys as apprentices-of course a physical examination of the boys should be required in each case, preparatory to shipment. As a sanitary measure it is believed that the cubic air space for seamen should never be less than 200 feet per man, and that a "hospital bay" should be required on all vessels carrying large crews, and on passenger vessels it should be located amidships and on the upper deck. Bathing accommodations on large vessels and water-closets on documented vessels of all classes should also be required by law. The abuse called "shanghai-ing," which is prohibited by law, should be enforced, and a severe penalty attached to its perpetration. This practice consists in shipping a man against his will, or while drugged or drunk. Respectfully submitted. WASHINGTON, D. C., December 15, 1879. H. Ex. 10-18 P. H. BAILHACHE, APPENDIX L REPORT ON MALIGNANT DIPHTHERIA IN NORTHERN VERMONT. BY DR. E. HARRIS. DEAR SIR: In compliance with instructions from the Board I have visited the district of Northern Vermont, in which the alarming sickness and mortality were reported, and which, from the suddenness and fatality of the outbreak, was attributed to the pollution of a stream. Proceeding to visit the locality as soon as practicable after receiving your official request, I conferred, while on my way, with Prof. Henry D. Holton, of Brattleboro', and Dr. C. G. Adams, of Island Pond Village, Vermont, as those esteemed physicians had already opened correspondence with me concerning the reported events. Upon reaching the township of Newark, in Calidonia County, accompanied by Dr. Adams, we conferred with the "first selectman," or superior of the town, and began an investigation of every case that had occurred. After three days I had inspected the premises, obtained the evidence and records, as given in the following report: Returning from the afflicted district by way of Saint Johnsbury, West Burke, and Lunenburgh, for the purpose of conferring, with the physicians and other scientific gentlemen who had been consulted by the people of Newark, all available information and facilities were afforded to me for reviewing the results of my inspection and the records of the outbreak. The subjoined report may be regarded as complete, with the exception of the record of the last series of events, still in progress, but which ought soon to terminate with the sanitary suppression of the causes that have hitherto propagated and spread the disease. Whatever more occurs worthy of record may be appended to this report as additional information. DIVISIONS OF THE REPORT. The information on which the National Board of Health instituted the investigation. Brief description of the locality. Map, diagrams, and lists. Consecutive record of cases. The preliminary cases. The first series, following. The second series of cases. The third series of cases. The fourth series of cases. Various contributions of information from physicians in Vermont and New Hampshire. NATURE OF THE INFORMATION UPON WHICH THE NATIONAL BOARD OF HEALTH PROCEEDED TO THIS INVESTIGATION. In numerous leading newspapers and by letters from competent medical gentlemen in Vermont, the statements concerning a sudden and destructive outbreak of a malignant disease in Northeastern Vermont warranted the investigation which the Board directed me to undertake. Appended statements and letters, marked A, B, and C, show precisely the nature of the information received from sources here mentioned." THE ALARM, AND WHY THE PEOPLE REGARDED THE SUDDEN SICKNESS AND MORTALITY AS A TRAGEDY CAUSED BY POISON IN THE WATER. The township of Newark, Caledonia County, with a population of 600 upon 36 square miles, is reported one of the most salubrious, and its inhabitants are notably temperate, thrifty, and well housed. In the central district of the township, in which dwell 85 persons in 14 households, there were 39 children under 16 years of age, and of these there were 22 who attended as pupils at the opening of the summer term of the common school, May 12, 1879. The school-room, having less than 200 cubic feet of aerial space for each child, was occupied during the usual hours from Monday morning. May 12, till Thursday afternoon of the 15th. It is situated in the bottom of a narrow glen that slopes steeply to the southward, and an eddying and tortuous streamlet flows close along by the rear of the school-house; of this water all the pupils except one drank freely, for the noonday temperature was 80 Fahr. and upwards. On Wednesday evening several little children of this group were sick, and on Thursday evening several were alarmingly ill with symptoms which to their parents seemed inexplicable. The physician, who was summoned from a distant town at midnight, found his services demanded in four families. The teacher and officers of the school closed its doors on Friday morning, May 16, and before Sunday night, May 18, several of the children were already dying, and 16 out of the 22 pupils were severely sick with the disease, which, before half the number died, caused great alarm. Within three or four days of the beginning of sickness in the families that were thus represented by the pupils the other children and the care-takers in the same families were smitten by the same malady, and at last nearly all who gave themselves freely to nursing the sick, or to the care and washing of the garments defiled by the putrid matters from mouth and nostrils, were violently attacked by the malady, even in the instances in which the dwellings of such persons were several miles apart upon different hill-sides. Up to the date of my return from the district there had occurred 48 cases and 14 deaths, and other deaths have occurred since my return. These events were adapted to terrify as well as cause deep anguish in so tranquil and social a community. More than half of all the inhabitants were attacked, and 16 per cent. are dead already, while nearly 30 per cent. of the cases were fatal. This has occurred in a section of the township which comprises only one-seventh part of its area and population, and where only one or two deaths in that section, or in the whole township only eight or nine, usually occur in the whole year; that is, where the annual death-rate has steadily been from 14 to 17 per 1,000 of the living, it now, for the period of five weeks, from diphtheria alone, became 140 per 1,000, yearly rate, and in the district itself, had the same rate of destruction continued for a year, none would have remained alive. The accusation of the water of the streamlet that supplied the school children in that district, and the discovery of obvious causes of pollution of that brook, very readily exaggerated the relation of that suspected source of peril, which the afflicted families denounced in positive terms. This source of suspected defilement of the brook-water was carefully examined, and although the actual causes of the spread of the disease as a virulent contagion are ascertained, as described in this report, the neglect of sanitary care and provisions for that little school-room and its pupils will ever be a most important part of the record of this fatal outbreak and propagation of diphtheria. The explosion phenomena of the outbreak and spread of the contagious factor of the malady certainly depended upon causes which were present in and near the little school-room in the glen. The children of nine of the ten families that were represented in that school became sick from the same infectious malady, and the 16. pupils who went home infected and rapidly succumbing to the disease unquestionably planted the virus in their widely separate dwellings in the valley and on hill-sides.. The alarm and grief which in this insulated region called the attention of the National } Board of Health have given occasion for carefully investigating and reporting the preventable causes by which diphtheria produces its ravages and seems to become epidemic. The hill-sides of a mountain district and the domestic and social circumstances of their inhabitants have enabled us to place on record the facts which more completely demonstrate the sanitary problems of control and extinction of the infectious and transportable factor or cause of diphtheria, than could in cities and populous villages be clearly divested of doubt in the line of evidence. This report comprises, in concise statments, the records of the groups of cases, viz,. those cases that constitute the primary group, and those which followed in successive. series, a review of the physical circumstances of the households, the locality, and the season, together with an abstract of medical evidence, and the maps necessary for the illustration of the subjects referred to. THE LOCALITY. Newark is the most northern township of Caledonia County, Vermont, and is 6 miles square, situated about 60 miles in a northeasterly direction from Montpelier, in latitude 44°25′ north and longitude 70°55′ west. Its deepest valleys have an altitude of nearly 1,250 feet above the level of the sea, while the crests and plateaus of its hills vary from 100 to 300 feet above the beds of the valleys. The eastern side of the town is flanked by a sharp spur of the Green Mountain range, shutting off a view of Mount Washington, and having an altitude 1,700 feet above the sea. Ridges and smoothed slopes of diluvial gravel and disintegrated calciferous mica schists and the eroded valley and glens that are worn in the latter, as left in the glacial period, now are prolific grass lands and forests. The valleys have a general direction from north to south, bearing eastward, and their streamlets converge to make up the west branch of the Passumpsic River, which flows onward to the Connecticut. The accompanying map shows the geographical and historical points which are to be mentioned in this report. It presents the outlines of school districts and indicates the location of the dwellings, public roads, bills, valleys, and water-courses in the township. The outbreak of diphtheria was in district No. 4, and extended to district 2 and 9, and has also been transplanted in a remote quarter of No. 7. The pond and its sluggish outlet in district No. 4 occupy the most swampy depression in the main western valley of the town. That water-way, notably the half-mile south from the Center Pond, with a hundred acres of boggy land on either bank, comprises the most stagnant water in the town. The map will serve as a road and chart, but the profile view from a standpoint on the most southern hill-side in district 4 shows the several hills and streamlets converging in the valley southward from the school-house and Center Pond. The small circles inclosing numerals mark the site of dwellings invaded by diphtheria, those which are beyond the limits of the fourth district (Nos. 11, 14, and 15), being the exceptional dwellings, marked like the other afflicted households, by a red circle and number. CONSECUTIVE RECORD OF CASES. April 13, 1879.—The family of Mr. A. F. Carpenter, whose dwelling is marked 1 on the map, called a physician from the neighboring town of West Burke, a post village, 7 miles distant, to attend two of his children. There were two children younger than these in the family not then sick. A teamster and his invalid wife resided in the family as boarders. The two sick children, and soon the teamsters wife, were sick and under treatment until the 23d of April. The physician pronounced the disease to be diphtheria. The invalid wife had a difficult convalescence, with her nostrils and mouth loaded repeatedly with the diphtheritic membrane. The husband recovered more rapidly, but with "sore eyes," from which he had not recovered at the time I saw him, six weeks later. One of the children, Emma, aged about 11 years, recovered to such a degree as to be able to run about for a fortnight before the school was opened; but during the few days previously to the opening, and most notably on the day of opening (May 12), both eyes, particularly the eyelids, and conspicuously the outer carithers on one side, were loaded with "an offensive discharge." Pain in the eyes, added to this offensive condition of the eyelids, led the child to stay away from school after her first day's attendance. I saw this child and took her own testimony; and, aside from any events which we know ensued upon her attendance at school, I should have inferred that her ophthalmia was diphtheritic. Probably the teamster, who lived in the same apartments and ate at the same table and had been sick with diphtheria at the same time, suffered this form of disease, as before mentioned, for his eyes were not fully recovered when I saw him in June. The four cases of diphtheria in the Carpenter dwelling, upon the bog, certainly had a slow and dubious convalescence; two of them were vexed with ophthalmia that continued until June; their sore throats and nostrils gave ample evidence of the nature of their sickness even at the time I saw them; therefore these four will be entered in this report as the preliminary cases. I was unable to trace these to any antecedent cases that would in any manner account for transmission of diphtheritic contagion to them.* But whether this malady may spring up indigenously and take on the contagious quality, or, on the other hand, may depend on the specific germinal matter of the disease itself, conveyed by whatever means possible in air and substance, the occurrence of these from primary cases was obviously natural so far as personal, domestic, and local circumstances were concerned. The type and history of the ophthalmic troubles must not be overlooked, and we have to add to this the testimony of the patient, Emma, that at the opening of the See appended statement q for latest account of preliminary cases. school she wore the same unwashed chemise that she wore when sick with diphtheria. This is important, if true, and all persons who undertook to test this child's memory and veracity believe her statements. Having studied these four preliminary cases that occurred in the same apartment, we have now to consider the several series. of cases that followed the primary group (whose medical history was supposed to have ended with the third week in April). In recording these successive series we found that the evidence classed them in four distinet and clearly dependent groups. Therefore, in reporting them consecutively, it will be logically correct, as well as convenient, to allow them to appear in four successive series, as we found them on our personal inspection from house to house. The school children.-The common school in district No. 4 opened its summer term the 12th of May, with 22 pupils, and as only one family escaped the seizure of some or all of the children they sent to this school, we will mention these families in their order. FAMILY OF J. ALDRICH. In school there were: James, eight years of age; Jennie, five years of age; Frederick twelve years of age. James was attacked with all the throat symptoms of diphthera on Wednesday evening, May 14, and on Thursday night he was very sick. The case proved excessively malignant, the diphtheritic exudation and masses invading all the mucous passages from the lips to the stomach. He died on the day. Previous to and closely following this first fatal case the two other little children (not pupils at school) and the father, mother, and an uncle, who constituted the household of eight persons, took the same disease; Jennie, aged five years, was attacked on Friday, the 16th of May, and died on the . Frederick, past twelve years old, was attacked about the same time as his sister, and was dangerously sick on Sunday, and died on the 26th of May, after unusual endurance of a virulent form of the malady a full week. He was carefully nursed during the last two days by a gentlemen to whom he was affectionately attached, and who came from a distant part of the township to give his attendance. This boy died on the 26th, and at that date the five other members of the family had come down with the same malady, and made the second series of cases more numerous and formidable than the first series. The residence of this family is marked No. 2 on the map. FAMILY OF E. MORSE. Delia, six years and ten months of age, became very sick in school on Thursday. the 15th of May. Symptoms: diphtheritic throat, headache, stiffness, and vomiting, The physician who was called to her at midnight from a distant town had three other families to demand his attention before the next sunrise, May 16. Delia died on the 6th day from attack. Irving, aged five years, was sick on the 16th and died on the 7th day from attack. Uncontrolled epistaxis seemed to be the cause of his death, after the throat had become clean. The septicemia was so marked in both these cases as to give currency to the belief and statement that the flesh was falling from their bodies while being wrapped hastily in blankets for burial immediately after death. The fact that necræmia and excessive sloughing and putridity of the parts attacked by diphtheria rendered the dying children the objects of intense commiseration in such a community sufficiently accounts for the extravagant expressions by which the sufferings of the families were discribed. The father's careful discription of his dying children's symptoms was definite and correct. The residence of Mr. Morse is No. 3 on the map. THE FAMILY OF JOHN COLE. Alvah and Frank, four and a half and six and a half years of age respectively, were attacked on Friday, the 16th of May, and died on the fifth or sixth day of their sickness. Their residence is marked No. 4. FAMILY OF A. F. CARPENTER. Charles, aged thirteen, who had escaped attack during four weeks of exposure to causes at his father's house, where his brother and sister and Mr. and Mrs. Woodrough were sick, was seized with diphtheria the fourth day of school (at noon). He recovered. This case is in evidence that the conditions that favored his becoming infected at school were greater than at home. His home is marked No. 1 on the map. |