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Laboratory studies. The work of the laboratory has consisted of analyses of foods, feeding experiments, and certain metabolic studies. The work on food analysis has consisted chiefly of a study of the diet used by Goldberger and Wheeler in the production of experimental pellagra in the human subject. Analyses were made for protein, carbohydrate, fats, ash, and calories. Proportional quantities of the different articles of food as used during the previous study were mixed for experiments on fowl. Two distinct sets of feeding experiments were made. In the first set a large batch of the mixed cooked food was dried at 80° C. and kept in storage for In the second set the same kinds and proportional quantities of ingredients were used, but they were prepared by a different cook in small batches every two or three days, mixed and used fresh.
These feeding experiments showed that the pellagra-producing diet was more or less lacking in the antineuritic food accessories. Beginning about 20 days after the feeding experiments were started, the fowl began to show marked signs of polyneuritis, with spastic gait, etc., which gradually led to complete paralysis and death. The administration of the purified "vitamine fraction" of yeast appeared to alleviate the polyneuritis in many cases. Experiments are still under way as regards the nature of the deficiencies in this diet. As stated elsewhere in this report the physiological and pharmacological action of vitamines and accessory food substances are receiving special attention by Prof. Voegtlin in the Division of Pharmacology of the Hygienic Laboratory. Feeding experiments were also made at Spartanburg with breads from various wheat flours and from various corn meals. The results of these experiments are now being prepared for publication.
The metabolic studies have consisted of a study of the chemical composition and physiological activity of the mixed saliva of individual pellagrins as compared with that of nonpellagrins. In some the rate of flow was found to be very slow, in others very rapid. In no case, however, was the diastatic power totally lacking. As a rule the sulphocyanate was found to be greatly decreased and the total solids and inorganic content increased, particularly in those cases with increased flow.
A comparative study of the urine of pellagrins for normal and abnormal constituents, in particular for physiological bases, is now well advanced.
Some progress has been made in the study of milk and milk separates, carried on to determine to what ingredient or ingredients milk owes its therapeutic power in the treatment of pellagra.
Coincident with the laboratory studies of Prof. Voegtlin while he was at Spartanburg, a special study was undertaken by him of 19 families in which pellagra had prevailed and other families in which no pellagra had prevailed, both groups being in the same community. These families were kept under observation for a year and the food supply and economic status in relation to the incidence of the disease studied. It is expected that the results of these observations, together with pertinent laboratory findings, will be published.
1 Reprint 311 from Public Health Reports (Nov. 12, 1915).
EPIDEMIC IN NEW YORK AND THE EAST.
As was stated in the last annual report, an epidemic of poliomyelitis appeared in New York City early in the summer of 1916. This epidemic rapidly assumed alarming proportions. Based upon an offer of the Secretary of the Treasury and its acceptance by the mayor of the city, the service, in cooperation with the city department of health and other local health authorities, undertook scientific investigations of the epidemic in and around New York City.
On July 6, 1916, Surg. C. H. Lavinder was directed to confer with the commissioner of health of New York City. As a result of this and other conferences the following were directed to report to Surg. Lavinder: Surgs. Edward Francis and W. H. Frost, Passed Asst. Surgs. J. R. Ridlon, J. P. Leake, W. F. Draper, L. R. Thompson, J. A. Watkins, and G. A. Kempf; Asst. Surgs. H. F. Smith, J. G. Wilson, P. M. Stewart, Epidemiologist A. W. Freeman, and Technical Assistant M. B. Mitzmain.
Briefly stated, the work of the service included: Epidemiologic and statistical studies of the entire epidemic in Greater New York and elsewhere; intensive field studies of 729 cases in various places, especially the Borough of Richmond; investigations with regard to paralytic disorders among domestic animals and their alleged relation to poliomyelitis in human beings; brief entomologic and rodent surveys in several places and the collection of autopsy material, both human and animal, for the Hygienic Laboratory.1
The number of cases in Greater New York, according to the figures of the department of health, was 9,023. The number in the entire epidemic area was upwards of 20,000. The epidemic spread rather rapidly over a wide area. The infection was a virulent one and the mortality high.
This epidemic is a notable event in the history of poliomyelitis, being, in numbers involved, many times larger than any epidemic previously recorded for this disease. Poliomyelitis as an epidemic disease seems really to be a development of our own time. Its rapid and continuous spread with the culmination in an epidemic of such size has placed this malady in the list of epidemic communicable diseases which demand the serious attention of all public-health officers. A report of the entire investigation is in course of preparation and will be published as Public Health Bulletin No. 91.
PARALYSIS IN DOGS AT LITTLE ROCK, ARK.
On request of the State and local authorities, investigation was made by Epidemiologist A. W. Freeman of the prevalence of an unusual paralysis in dogs at Little Rock, Ark. History was obtained of between 15 and 20 cases occurring in the fall of 1916. mostly in valuable hunting dogs, but it was concluded that there was no valid reason to consider that the affection had any relation to human poliomyelitis. In fact, investigations of similarly reported outbreaks in other places have invariably failed to show any such relation.
1 See p. 62 of this report.
EPIDEMIC AT SALUDA, VA.
A remarkably heavy infection of poliomyelitis occurred at Saluda, Va., in October and November, 1916. On request of the State_and local authorities investigation was made by Passed Asst. Surg. J. P. Leake. At least 9 cases had occurred in a population of 240 within a period of 30 days. This is a morbidity rate of 3,750 per 100,000, against the rate in New York for 1916 of 180 per 100,000. Quarantine of the infected district was recommended by Dr. Leake because of its isolation and rural character.
EPIDEMIC AT ELKINS, W. Va.
On request of the commissioner of health of West Virginia, Passed Asst. Surg. J. P. Leake was detailed on January 4, 1917, to investigate an outbreak of poliomyelitis at Elkins, W. Va. Asst. Surgs. Joseph Bolten and H. F. Smith assisted him. About 100 cases of the disease occurred in Elkins and vicinity. A house-to-house canvass of the city was made to discover abortive and unreported cases of poliomyelitis. This is the first time that a community so large as Elkins (7,000 population) has been surveyed for this purpose by physicians having experience in the disease, and it is believed that results of value in future campaigns against the disease were obtained. The virus of the disease was preserved for purposes of comparison with the virus of other epidemics. Dr. Leake also made recommendations for preventing the spread of the disease. As the epidemic took place in the winter, a new occurrence in the United States, the data obtained, together with a review of all other known winter outbreaks, have been compiled for publication.
SCARLET FEVER AND OTHER INFECTIOUS DISEASES OF CHILDREN.
At the request of the department of health of the city of Cincinnati, Ohio, Asst. Surg. H. F. Smith was detailed in January, 1917, to assist the department in special epidemiological investigations of scarlet fever in Cincinnati, to study the obscure epidemiologic features of its spread in an urban community. Considerable data were compiled, but this work was interrupted in order to begin the surveys of extra cantonment areas in the Southeastern States.
In this connection mention may be made of the preparation of a report by Asst. Surg. J. G. Wilson in regard to his study of 6,078 cases of infectious diseases of children among immigrants at Ellis Island. The report, which is in course of publication, includes a description of the nursing, technique, and general management of the contagious diseases hospital operated by the service at this place.
TRACHOMA WORK IN APPALACHIAN MOUNTAINS.
During the past fiscal year the trachoma work has been conducted in much the same manner as in the preceeding three years, and the original objects of eradication and prevention have been adhered to.
The organization has been constantly improved in accordance with the experience gained.
One additional hospital has been established at Tazewell, Tenn. The clinics at this hospital have been large from the first, and the number of patients constantly under treatment at the hospital, which contains twenty-five beds, taxes its capacity.
As formerly, the hospitals have been used as the centers both for treatment of the disease and for educational purposes in eradication. It is very pleasing to note that the campaign of education in public health is having a very decided effect. Good results are noted in the patients, not only when in the hospitals, but when visited at their homes by the doctors and nurses in routine district work.
Patients from practically all parts of the United States have been treated in these hospitals, and the more generally the hospitals and their results become known, the more patients are received from a distance.
In conducting the hospitals due consideration has been given to as strict economy as was consistent with the accomplishment of the work. Removal of hospital from Hindman to Pikeville, Ky.-As the hospital, which was established in Hindman, Knott County, Ky., in the fall of 1913, had accomplished its purpose at this location, it was transferred to Pikeville, Pike County, Ky., in September, 1916. 1913 it was estimated that the trachoma cases in Knott County were about 10 per cent of the population, but according to actual canvass of the homes by the doctors and nurses, the county has been practically cleared of trachoma, and the few remaining cases who had, for one reason or another, not applied for treatment were recognized and left for the county health officer to treat, as well as any other cases which might arise subsequently. While this hospital was maintained at Hindman one of the local doctors, the county health officer, was instructed in the methods of diagnosis and treatment of trachoma, and he is now thoroughly capable of properly treating any cases which may subsequently come under his observation.
Pike County provided an excellent house, accommodating 25 patients. The new location has proved a good one, as is seen by the fact that the amount of work done is limited only by the capacity of the institution. The enthusiasm of the patients and the people in general has constantly increased.
Effects of trachoma.-While blindness often results from trachoma, it is now recognized that this is only one, and possibly not the worst, feature of the disease. We know that it lasts for years with constant irritation and discomfort to the patient, impairing his earning capacity and the fighting power of the State, ruining life and happiness of entire families, and finally terminating in total blindness. After nearly a lifetime of misery, the patient is often seen dwarfed in mind and warped in body with the trichiasis, entropion, and other sequelæ still remaining to harass and irritate the sightless eyes.
Relation of treatment of trachoma to the war.-Now that we are engaged in raising a large army, the problem of eradicating trachoma is of even more importance than formerly. The history of every
An article entitled Trachoma and the Army: the dangers incident to enlisting recruits affected with the disease," by Surg. John McMullen, was published (Reprint 408 from Public Health Reports.)
European war shows that trachoma has proven to be a grave menace to the efficiency of the fighting forces, invaliding thousands and blinding large numbers. In the Russo-Japanese War, trachoma was a formidable enemy in the Japanese Army, and a large number of troops were isolated and treated for it. It has also been reported that an epidemic of trachoma is causing considerable anxiety in France, the disease having been brought to that country by African soldiers and laborers.
Armies are originally infected with trachoma from the civil population in the areas from which recruits are accepted and carry it back to the people when men who have served their enlistment or become incapacitated are discharged. It is therefore very essential that the eyelids of all soldiers and applicants be everted. If they are found to be otherwise than smooth and pink, if there is any redness or secretion, such cases should be segregated and examined by those trained in the diagnosis of trachoma. An applicant who is found to be suffering with the disease should not be immediately rejected but should be given treatment and again examined to determine whether he has resulting visual defects sufficient to debar him. In this way a case of contagious disease is eliminated, and probably a good soldier gained. Any case of trachoma or suspected trachoma detected among soldiers or sailors should be immediately isolated and given care and treatment until cured, or found not to be suffering with it.
Serious consideration should be given to trachoma as a health problem in the environments of the cantonments and military reservations. Particularly is this true in some of the Southwestern States where the disease is known to be endemic and where it is likely that trachomatous persons will congregate in the vicinity of military
Report as to hospitals. The locations of the various hospitals are in the most infected districts and therefore of the greatest importance in eliminating the disease from men enlisting in the military services. It has been the endeavor constantly to improve all six of these hospitals with a view to rendering better service in the work for which they have been established. Weekly talks are made to the hospital patients, and the educational portion of the work has been continued and improved upon where thought necessary. The district visits by the station doctors and nurses have been continued when their services could temporarily be spared from the hospitals. The total attendance at these hospitals during the year was 18,430 and the total number of individual treatments was 127,914. Onehalf of the trachoma cases applying at the hospitals for treatment were found to have defective vision as the result of this disease. This impairment of vision ranged from comparatively slight defects. to total blindness. One thousand nine hundred and seven patients were admitted to the hospitals and 1,686 operations performed. Of this number 442 were performed under general and 1,244 under local anesthesia. The same difficulty in securing the exact number of cures effected was experienced as in former years. Patients once cured and living a long distance from the hospital usually do not return and the result of the treatment is, therfore, not known or 18643°-17- -3