SMALL-POX. Measures instituted by the Board of Health of the State of Louisiana, t FOR THE JAIRLR-IEST OF SMALL-POX —IN— NEW ORLEANS, LOUISIANA. D(1RI.\« THE YEARS 1880, 1881,'188* A\ll 188». -BY— JOSEPH JONES, M. D., PRESIDENT BOARD OF HEALTH,STATE OF LOUISIANA. NEW ORLEANS, LA. : F. A. Bkakdao & Co., Print, 34 Magazine at. usttu^oxductio^t. MEASURES FOR THE PREVENTION ANI) ARREST OF EN- DEMIC, EPIDEMIC, CONTAGIOUS AND INFECTIOUS DISEASES. All facts and measures relating to the prevention of endemic, epidemic, contagious and infectious diseases, are of interest and importance to san- itarians, physicians and political economists. Efforts to exclude and arrest contagious diseases possess peculiar value, when exerted in behalf of the inhabitants of some great commercial met- ropolis, like New Orleans, whose existence and prosperity are indissolubly bound up with those of the people living upon the banks of her great river, and within the bounds of the fertile plains of its mighty valley. During the years 18£>0, 1881, 1882 and 1883, embracing the term of ser-. vice of the author as President of the Board of Health of the State of Louisiana, the diseases which have most seriously engaged the attention of the health authorities have been Small Pox and Yellow Fever, and it is of moment that a concise account should be rendered of the measures instituted for the prevention and arrest of these diseases. SMALL-POX. MEASURES INSTITUTED BY THE PRESIDENT AND OFFICERS OF THE BOARD OF HEALTH FOR THE ARREST OF SMALL- POX IN NEW ORLEANS, LOUISIANA, DURING THE YEARS 1880, 1881, 1882 and 1883. In 1880, one case of small-pox occurred in the Third District, in the month of May; death resulted after transference to the Small-Pox Hos- pital. The dwelling in which the case occurred was fumigated, and the inmates, as well as the inhabitants of the surrounding houses, were vaccinated. The disease was arrested, and no other cases appeared, or were reported to the Board of Health during 1880. New Orleans was seriously threatened with small pox early in 1881, but, owing to the prompt and vigorous measures of the Board of Health the danger of an epidemic was arrested for a time. The first case of small-pox, in 1881, within the bounds of Louisiana, made its appearance January 11, with the arrival at the Mississippi Quaran- tine Station, of the emigrant steamship Nurnburg, from Bremen, having on board 85 crewT and 173 passengers. The patient, a woman, and a steerage passenger,was attacked in mid-ocean. The presence of this case of small-pox on the steamship Nurnburg was telegraphed from the Quarantine Station by Dr. J. F. Finney to the President of the Board of Health. Orders were immediately issued for the transference of the patient and isola- tion in the Small-Pox Hospital; vaccine virus was dispatched; all on board were vaccinated, the officers, crew and passengers, by the Quaran- tine Physician. One hundred undone of the number vaccinated (257) took the vaccine disease, thus showing their susceptibility to the variolous poison. The steamship Nurnburg was thoroughly cleansed and fumigated, and held at the Mississippi Quarantine Station for twenty-onedays beforebeiug allowed to come to New Orleans. The small pox was arrested by these measures, and not a single case oc- curred at the Quarantine Station on the vessel, or amongst her crew and passengers after her arrival. The next case of small pox occurred in the Parish Prison. As soon as it was manifested, the patient was isolated from other prisoners, every one of whom were vaccinated by order of the President of the Board of Health, and the prison was subjected to fumigation and cleansing, under the super- vision of the Sanitary Inspector of the Board of Health for the Second District. The disease was arrested, and no other case occurred amongst the large number of prisoners confined in the Parish Prison. 5 The rule of the Board of Health with reference to the vaccination of school children was rigidly enforced. The next case occurred in the month of February, on the twenty-third; and the third case nearly a month afterwards, on the twenty-second of April, and was brought to the city by the towboat McDonald. Cases were brought to the city from Grand Lake and Cincinnati, on the twenty-sixth, twenty-seventh and twenty-eighth of April. All these cases were removed to the Small-Pox Hospital, and the prem- ises were fumigated and thecitizeus in the infected localities were vaccinated. One case was removed from the Bark Pablo to the Small-Pox Hospital on the first of May. By measures instituted by the Board of Health, the disease was again completely arrested and stamped out, until the ninth of November, when a case was reported at the Charity Hospital, having comelrom Point Celeste, Plaquemine Parish, La. One of the assistants of the Charity Hospital was attacked with it on the twenty-first; on the twenty-eighth a case was brought through quar- antine concealed in the hold of the steamship Hutchinson, of the line controlled by Messrs. Charles A. Whitney & Co. Six cases of Small-Pox were reported to the Board of Health in Novem- ber and twelve in December. Of the twenty-six cases reported in 2881, sixteen were transferred to the Small-Pox Hospital; six terminated fatally. During the months of March and April every department in the public schools was visited, and the arms of the pupils carefully inspected. Those showing evidences of improper vaccination were directed to be revaccinated. Dr. Joseph Holt, Inspector of the First District, alone, vaccinated 320 school children. In the First District one case of small pox was discovered on the Spanish bark Pablo Sinsat, at Post No. 33, head of Market street. The patient, a sailor, w as removed immediately to the Small-Pox Hos- piral, and thorough and repeated disinfection and fumigation were enforced. The crew’ had already been vaccinated, and they therefore escaped. The first case of small-pox, in the Third District, occurred as early as the twenty-third of February, in the person of R. Rule!, w-hite, residing on Tricon street, near the United States Barracks; the case was a light one, and the patient recovered. The Second case reported was that of Charles Young, twenty-three years of age, white, residing at No. 5 Mandeville street. These w ere the only cases which originated in the Third District. In this district, as in all others, by order of the President of the Board of Health, the jellow’ flag was displayed upon every house in which a case of small-pox occurred; the neighbors were informed of the appearance of small pox in their immediate vicinity, and vaccination and re-vaccination were advocated as the only prevention. In all cases, not only the room, but the entire house, was fumigated. During the entire year sixteen cases of small pox were treated at the Hayes Hospital, in the Third District. In the Fourth District the only case of small-pox reported during 1881 was a medical student w ho contracted the disease in the Charity Hospital, from which institution not less than nine cases were removed to the Small- Pox Hospital, the disease having been contracted in the Eastern, Western and Northern States. 6 This case occurred at 21G Josephine street, in a crowded locality, and was treated by the President of the Board of Health; the premises were fumigated and disinfected, and free vaccination was offered to every citizen. No other case occurred or was reported in the Fourth District during 1881. Owing to the prevalence of small-pox in the Northern, Eastern and Western States, the disease continued to be introduced into New Orleans in a continuous stream. After its appearance in our cities, towns, villages and plantations along the Mississppi river, the number of cases increased as they were introduced, and at the same time the United States Government was without any hospital for the isolation and treatment of small-pox cases. Early in 1882, the President of the Board of Health, after a careful in- spection of the Small-Pox Hospital, urged the Board of Health to take the most vigorous means for the suppression of small-pox, and also urged similar measures upon the Common Council. The response of His Honor, Mayor Shakspeare, was prompt, intelligent and humane. In the able report of the Board of Health,drawn up by Drs. F. Formento, Chas. Turpin and J. C. Faget,many important measures were urged by the committee upon the Honorable Common Council ; such as the closure of the Small-Pox Hospital, on account of its location and bad management; the erection of a suitable hospital for the treatment of contagious anil infectious diseases, the proper isolation of patients, disinfection of clothing and bedding, the proper disposition of the dead, the employment of special wagons perfectly covered and cleansed for the conveyance of small pox patients. The action of his Honor the Mayor, Joseph A. Shakspeare, for the establishment of a Small-Pox Hospital, as well as the efforts of the Board of Health, were arrested by judicial proceedings. The following is the record of the cases of small-pox and deaths in the different districts, classified by race, sex and month for the year 1882 : 7 MONTHS. First District. Second Distr’t. Third District, Fourth Distr’t. Fifth District. Sixth District. Seventh District TOTAL. SEX. Number of Deaths. 1 W C. d o W. C. d o W. C. d O W. C. d O W. c. d W. C. d © W. C. d W. c. d M. F. W. c. o H H H pH H H H H H 1 3 4 3 3 3 3 6 1 1 9 9 n 1 5 6 8 8 3 l 4 6 10 16 1 1 9 10 3 7 10 7 23 30 10 30 40 30 40 70 1 1 1 4 4 1 52 61 11 49 60 8 28 36 21 33 32 47 79 1 3 6 9 1 64 11,1 73 24 48 72 10 19 29 17 37 54 35 67 102 1 1 2 3 5 3 3i 194 105 17 52 69 Tun* 11 7 18 17 39 56 37 61 98 1 1 2 10 ID 1 1 67 98 22 47 69 July 31 4 7 12 9 21 Id 13 23 6 4 10 6 0 3 3 31 39 4Hi 30 13 18 31 10 10 3 2 5 17 22 1 i 5 4 1 1 13 23 6 12 18 3 3 1 3 4 5 14 19 2 4 6 81 19 1 14 15 16 16 1 1 5 2d 25 1 1 ...,1 6 25 1 15 16 7 13 20 1 121 13 3 3 5 5 2 8 25 3 8 11 25 17 42 2 1 3 12 19 21 21 15 36 .... 2 60 44 104 50 54 14 24 38 72 51 223 86 159 245 181 313 494 31 25 56 16 38 58 2 9 ii 10 10 388 705 1093 565 528 116 299 415 CASES AND DEATHS OF SMALL POX IN NEW ORLEANS IN 1882. Classified according to the District in which they occurred—Color and Sex. 8 The Board of Health,as at present organized, has offered free vaccination during the years 1880, 1881, 1882, 1883. The following data illustrate the operations of the Baard of Health with reference to free vaccination performed by the Sanitary Inspectors of the Board of Health during the years 1881, 1882, 1883: 1881 1,370 1882 4,725 1883 First nine months 5,549 Total free vaccinations 11,644 Eleven thousand six hundred and forty-four citizens of New Orleans have been vaccinated free of charge by the Sanitary Inspectons of the Board of Health during the years 1881, 1882 and 1883, first nine months. Each and every citizen of New Orleans has had the opportunity of free vaccination at the hands of the officers of the Board of Health. In accordance with the organic acts of the Legislature of 1882, about one hundred and seventy physicians have registered at the office of the Board of Health up to July 1, 1883. The physicians of New Orleans number at least 225, or about one physician to every 1000 inhabitants. Without doubt a large number of vaccinations have been performed by the physicians of New Orleans, many of which have been gratuitous. The six sanitary officers of the Board of Health have performed, during the present small-pox epidemic, 11,644 free vaccinations ; or an average of 1940 vaccinations to each inspector. If the physicians of New Orleans had performed one-half the vaccina- tions, say about 1000 each, then they would amount to about 225,000. We have no means of ascertaining the exact number of vaccinations, but from an inspection of the orphan asylums, houses of refuge, educational institutions and the Parish Prison in this city, conducted by the President of the Board of Health, during a period of fourteen days, Slay 31 to June 14,1883, it was established : 1. That in the period mentioned not a case of small-pox existed in any of these institutions. 2. During the years 1882, 1883, only four cases appeared; two prisoners, one employe and one orphan were attacked by small-pox in the twenty-six institutions specified; of these cases of small pox, four in number, all re- covered. 3. The President of the Board of Health ascertained, upon personal inspection, that every one of these inmates of these twenty-six institutions had been vaccinated by the appointed physicians. 4. Amongst four thousand three hundred and thirty-five inhabitants of the various charitable institutions of New Orleans, only one in one thous- and and eiglity-three suffered from small pox, and not one died during 1882 and 1883. 5. The escape of these citizens and inmates of the charitable institutions of New Orleans, was due to the faithful performance of vaccination by the physicians of New Orleans. It is but fair to conclude that the physicians of New Orleans have been equally faithful in vaccinating the families under their charge. We conclude further, that the vast proportion of the population of New Orleans has been properly and thoroughly vaccinated by the medical profession. 9 Small pox has been confined chiefly to the negro race and to the destitute whites. This conclusion is shown by the large number of deaths reported by the coroner, these victims of this foul pestilence having perished without medical attendance. * Shortly after the organization of the Common Council, in accordance with the provisions of the charter granted by the General Assembly of 1882, the sanitary necessities of New Orleans were urged by the President of the Board of Health upon this body, in accordance with the organic acts of the General Assembly of 1855, 1858, 1870, 1877 and 1882. The subject of smallpox audits isolation, the necessity of regulating funerals, the erecttion of a small pox hospital and all similar subjects, were urged, but without avail, upon the attention of the Mayor and Com- mon Council. The labors of the Board of Health have been fully recorded in the report to the General Assembly of 1882 and the first six months of 1883. 10 CASES OF SMALL-POX REPORTED TO THE BOARD OF HEALTH. DEATHS BY SMALL -POX January 1 to September 30 1883, classified according to Districts in which they occurred. From January 1 1883, to October 1, 1883. 1st District. 2d District. 3d District 4th District. 5th District. 6th District. 7th District TOTAL CITY. MONTHS. « 1 TOTAL. W. c. o W. C. O W. C. o W. C. W. C. 1 o W. C. o W C. £ W. C. o ! W. C H H H H 1 H H January 37 56 93 18 30 48 23 18 41 17 23 40 2 2 5 3 8 1 5 6 103 135 238 24 52 76 February 31 50 84 37 42 79 38 51 89 14 18 32 2 2 4 7 5 12 1 9 10 133 177 310 48 8i 131 March 52 65 117 75 104 179 97 110 207 4(! 18 58 5 ( 14 27 10 37 7 7 296 323 619 72 149 221 April 63 74 137 84 110 194 117 180 297 32 18 50 9 25 34 34 21 55 1 2 3 340 430 770 102 159 261 May 41 62 103 41 61 102 105 97 202 25 13 38 16 54 70 11 4 15 1 1 239 292 531 80 95 175 June 13 67 80 16 41 57 31 69 100 18 12 30 35 44 79 10 4 14 1 1 123 238 361 53 96 149 July 17 27 44 13 10 23 12 11 23 21 11 32 15 15 30 10 14 24 1 1 89 88 177 44 40 84 August 6 14 20 8 18 26 10 5 15 22 11 33 3 30 33 4 6 10 6 6 59 84 143 31 36 67 September 5 9 14 6 9 15 3 4 7 3 5 8 1 23 24 2 2 4 20 52 72 12 29 41 268 424 692 298 425 723 436 545 981 192 129 321 88 202 290 108 67 175 12 27 39 1402 1819 3221 1 466 739 1205 DEATHS BY SMALL-POX CLASSIFIED AS TO DISTRICTS. 1st District. 2d District 3d District. 4th District. 5tli District. 6tli District. 7th District. TOTAL. MONTHS. W. C. Total W. C. Total w. C. Total W. C. Total W. C. Total W. c. Total W. C. Total W. C. Total © rH a M 11 17 28 7 7 1 14 5 3 8 5 2 7 12 8 20 3 6 1 1 44 40 84 17 ID G 6 12 5 1 9 5 14 3 9 12 1 2 2 2 31 36 67 12 9 o 9 1 1 1! 11 1 1 2 12 29 41 6 * * V 19 ' 39 5? 18 22 1 40 12 4 16 15 7 22 15 28 43 4 4 8 4 1 5 87 105 192 35 11 Tlie labors performed under the directions of the President of the Board of Health for 1883 by the sanitary inspectors are fully unfolded in the fol- lowing reports : OFFICE SANITARY INSPECTOR, FIRST DISTRICT, New Orleans, October 15, 1883. Joseph Jones, M. D., President Board of Health : Sir—In the daily papers of late, as well as in the proceedings of the New Orleans Aux- iliary Sanitary Association on the eleventh instant, the small force of the Board ot Health available for sanitary purposes has been much dwelt upon, and especially so in connection with the stamping out of small-pox in this city, I would like to take ad- vantage of this opportunity to say a few words in behalf of the officers of vour honor- able Board, and assert that it is no fault of theirs that small-pox still lingers in opr midst, and that the force is an efficient one, and does all in its power. It is certainly true that in an epidemic, as in the past winter months, the available force of sanitary policemen is taxed to the utmost, but not to such an extent as might be inferred or commonly believed. The trouble is not that these men cannot attend to an epidemic, but in addition to the regular house-to-house inspections, and the latter work is usually deferred to a more favorable opportunity, complaints may be attended to which comprise any serious nuisances. In the First District, for instance, two officers looked after small-pox, and one officer to nuisances in general. The force was, therefore, adequate for all practical purposes. A large force is not necessary in any district to attend to infectious and contagious dis- eases, even when very prevalent. What is essential, is that the force be composed of con- scientious and trustworthy men—one good man is worth a dozen poor ones. This city may never have such a metropolitan force as New York boasts of, and be able to station a policeman on every infected square to prevent ingress to or egress from flagged houses ; nor is that necessary, in my opinion, provided that the men are competent. I have been connected with the Board of Health of this city and State for the past eight years, and the present organization of the inspectors and policemen is as thorough and reliable as any I have known. I will illustrate my remarks by mentioning the labors of officers E. Bohner and Geo. Zeller, during the past nine months of the present year. The work of looking after small-pox and attending to complaints was placed in their hands, and I was never disappointed in the trust. The fact of so little complaint con- cerning the disease at our hands, appearing in the reporters’ columns of the papers, is self-evident, and sufficient to support my views. These officers kept every infected house under surveillance after flagging, and in this way discovered concealed cases re- peatedly, and also cases not reported by the attending physician. The disease was fol- lowed up closely, and known in the district as on a map, every infected premise was thoroughly disinfected and the rooms fumigated, at the earliest moment, and the bedding and covering and wearing apparel either destroyed on the spot or conveyed to the vicini- ty of the Small-Pox Hospital on Hagan Avenue, and there burned. Cases not properly isolated, or in attendance of a physician, were sent to the hospital. This was often done at the risk of these men, as friends and relations would often object. In a very few instances did the disease re-occur after fumigation and disinfection, unless the case occurred in a tenement house, where many families lived in adjoining rooms. The dis- ease has been stamped out in one locality after another, until it is about extinct in this district. I have made it a rule to order the owners of tenement houses so infected, to have them whitewashed throughout, including the outstanding wood-work. What is said for the First District applies to the others. It is a common thing for our officers to act as pall-bearers and pseudo-undertakers for the poor, forsaken wretches dying of this disease. The public, of course, is unaware of the extra exertions to stamp out the dis- ease in any locality. I have held the opiniop always that removal to the hospital stamps out the disease in any locality even more effectually than vaccination, with less danger of its subsequent spread. In answer to your communication ot the thirteenth instant. I will give a table of the work done in this district since the beginning of the year. 1 may add, that vaccination has been offered to persons residing in the neighbor- hood of small-pox cases, but with indifferent success. Nothing short of compulsory laws will ever accomplish the purpose. Yours respectfully, R. A BAYLEY, M. D., Sanitary Jnspector, First District. 12 [Table Attached. | Table showing the statistics of small-pox in the First District since January 1, 1883, to date, including inspection work, etc. : No. of cases of small-pox 640 No. of cases sent to hospital 167 No. of deaths from small-pox 186 ~~ No. of cases after fumigation 54 No. of premises fumigated _ 532 No. of premises disinfected - 532 No. of premises where clothing was destroyed 132 No. of house-to-house inspections 8742 No. of re-inspections 5481 No. of nuisances abated.... 2100 No. of vaccinations 650 No. of vaccination certificates 875 OFFICE SANITARY INSPECTOR, SECOND DISTRICT, New Orleans, La., October 18, 1883. Jeseph .7ones,M. I)., President Board of Health: Sir—I respectfully submit this report on the subject of small-pox, in answer to your communication of the thirteenth hist., on the following questions: 1. Number of cases of small-pox which have occurred in your district from January 1, 1883, to October, 1883 : 586 cases of small-pox ; 225 whites, 361 colored, have been reported to this office, or found out. by the sanitary officers and police. 2. Number of deaths 342 ; 107 whites and 165 colored, giving a percentage of more than one death to two of cases reported, showing that there is a great neglect in reporting of cases on the part of physicians, and also that many cases are treated without physicians, in order to escape being reported. 3. Number of premises, rooms, etc., fumigated for small-pox: 345 premises were fumigated for small-pox. 4. Mode of dealing with small-pox, etc.: when a case of small-pox is reported to this office hr foundont, a yellow tlag is immediately nailed to the house occupied by the patient. This is the best practical means of isolation, and also warns the neighborhood to provide themselves with vaccination at the earliest moment. This vaccination is offered by us to all infected localities and neighborhood where small-pox exists. 5 Number of cases sent to hospital: only those are sent who are willing to go, or have no person to take care of them ; ten were sent to the Small-Pox Hospital. Give number and a detailed statement of your efforts to suppress small-pox in your district; also number of vaccinations from January, 1883, to October, 1883. When cases are reported well, or when scabs have fallen off, the premises are thoroughly fumigated, and the clothes which have been used by patient washed in boiling water, ami sometimes burnt, with the consent of their owners. The number of cases reported is so much greater than that of fumigations because, as a rule, many cases occur in the same localities ; as an instance, thirty-one cases occurred in four houses on St. Peter street. I vaccinated from January to October, 1883, 1548 persons, 909 whites and 639 colored ; 1040 were secondary, and 508 primary, 563 were vaccinated at the office of the Board of Health and 965 at their homes and public in- stitutions. There were no applications for certificates of vaccination this year. Three thousand three hundred and thirty house-to-house inspections from January to October 1883; 1195 nuisances were abated. Respectfully yours, C. FAGET, M. D., Sanitary Inspector, Second District. SMALL POX IN SECOND DISTRICT. No. of cases of Small-Pox in the Second District from January 1, 1883, to September J30, 1883. January. w o Ct * February. Cl 05 to * March. s ° *1 * April. Q tv Mav. y ° 05 O ' P June. 01 01! O July, 05 August. - 05 to September to O S Ol 3 3 H tc 05 p t-i 2 H S 1 13 DEATHS FROM SMALL-POX FROM JANUARY 1, TO SEPTEMBER 30. JAN. FEB. MARCH APRIL. MAY. JUNE JULY. 1 AUG. SEPT. TOTAL. Total W. C. W. C W. C. W. C. W. C. W. c. 1 w. c W. C. W. C. W. C. W. & C. 11 11 18 23 36 27 38 17 21 10 20 1 8 7 6 6 5 8 107 165 342 PERSON'S VACCINATED FROM JANUARY 1, 1883, TO SEPTEMBER 30, 1883. JAN. FEB. MARCH APRIL. MAY. JUNE. JULY. AUG. SEPT. TOTAL. Totil W. c. W. C. W. c. W. C. W. C. W. c. W. c. w' C. W. c. W. C. W. A C. 52 119 193 134 306 187 278 142i 39 22 10 12 12 10 9 7 10 6 909 639 1548 NUMBER OF PREMISES FUMIGATED FOR SMALL-POX JAN. i FEB. MARCH APRIL. MAY. JUNE. JULY. AUG. SEPT. TOTAL. 14 1 38 04 04 02 | 44 28 20 n 1 345 Number of cases of small-pox sent to Small-Pox Hospital from January 1, to September 30,1883, 10. OFFICE SANITARY INSPECTOR, THIRD DISTRICT, New Orleans, October 14, 1883. Joseph Jones, M. D., President Board of Health: Sir—In compliance with your communication of the thirteenth inst., I beg leave to report as follows, to the data contained. 1. From January 1, 1883, to October 13, 1883, 887 cases ol sinall-pox have been record- ed at the office : 463 males and 424 females ; 443 white, 444 colored ; 348 adults over sixteen years of age and 539 children under sixteen years of age. For further par- ticulars please see Table 1 accompanying this report. 2. The total number of deaths from that disease in the Third District during the same length of time is 284 ; whites 149, colored 135 ; please see Table 1. 3. 2059 rooms were fumigated and 877 premises were disinfected, (See Table 2). 4. As regards the mode of dealing with small-pox, the isolation, disinfection and fumigation of premises and transfers to hospital, we have conformed to the rules and orders given by the President of the Board of Health, viz : As soon as a case was reported at our office, our inspector made it his duty to visit the patient at once in order to ascer- tain for himself the reality and severity of the case ; this being done the yellow flag was immediately displayed, free vaccination offered and urged as much as possible to the occupants of the infected house, strict orders given to prevent visitors from entering the premises, free vacciuation offered to all neighbors, warnings given as to the dangers of attending the disease and advice given for their protection against the malady. At the termination of each case, the house where the case had occurred was thoroughly fumigated with sulphur for at least four hours ; all articles that served for the patients during illness were either destroyed or boiled for at least twelve hours in a solution of carbolic acid, privies were ordered emptied and notice served to that effect; the premises thoroughly disinfected with a solution of copperas and carbolic acid. It may be well to state here that your inspector and his sanitary officers, Messrs. J. Nowell and H. F. Evans, also during six weeks, Messrs. Taylor and Wittie, officers of the city police, who were detailed to the Board of Health during that time, are the only persons who have attended to the enforcement of the rules and regulations of the Board of Health in regard to small-pox in the Third District. All cases that were not attended by a regularly practicing physician or where their management was bad, were sent to the hospital in the charity wagons in charge of the city. 5. Thirty-five cases were sent to the hospital by our special order, ten whites, and twenty-five colored. 14 Quite ■a number of cases of small-pox having at their own request been transferred to the hospital (we do not count this in our total thirty-five), having already given in section four a detailed statement of our efforts to suppress small-pox, I will, nevertheless, put to account several reports on the management of the Luzenburg Hospital, which probably have had something to do with the closure of this establishment, the largest focus of infection and contagion in the city. It may be well to state here that on the twenty-sixth day of September, 1883, accompanied by Mr. A. De Fonblauque, British Consul, and my officer, Mr. J. Nowell, a general and thorough inspection of the hospital was made by your inspector. All articles of bed-clothing, wearing apparel, curtains etc., belonging to the patients that were soiled or could carry contagion were set apart and burnt the following day by the officers under my supervision. All the wards, public and private, the apartments of the late Dr. Hayes, the kitchen, washing-rooms, were thoroughly fumigated and disinfected; the privies were first thor- oughly disinfected and then notice to have them emptied given and served'. 6. Total number of house-to-house inspections from January 1, 1883 to October 13, 1883, 7023. For further particulars please see Table 2. 7. Total number of persons vacillated during the sUme length of time, 1069. 8. Total number of nuisances abated since January, 1872. For particulars see Table Number 2. 9. It is impossible for me to give a definite and correct account of the number of certificates issued to school children, as I have kept no memoranda of those given, but I may, however, safely say, from 250 to 300 such certificates were given by me since January 1, 1883; all of which is most respectfully submitted. EUG. J. MIOTON. M. D., Sanitary Inspector, Third District. TABLE 1. SHOWING NUMBER OF CASES OF SMALL-POX From January 1 to October 13, 1883, in the Third District. MONTHS. Males. 00 © IS © PH Whites. Colored. Adults. 2 Recovered. Died. Sent to Hospital. cc rs S © 111 J © « 3.5 © « Total Cases Remarks. W. C. W. C. r Ifi 15 21 10 16 15 23 8 75 31 31 36 37 38 35 53 40 51 12 10 1 2 141 73I 73 112 103 107 108 92 123 160 21 34 5 12 302 215 215 O 126 103 104 125 73 156 150 38 41 5 514 229 229 92 95 104 83 77 110 135 27 25 2 2 475 187 187 53 44 36 61 35 62 45 30 22 1 3 304 97 97 -G GO July 17 12 16 11 11 18 21 6 2 165 29 29 S August 4 10 10 4 8 6 8 5 I 1 1 62 14 14 ° rf September 7 2 4 5 2 7 7 2 19 9 9 © e» 3 1 2 1 2 3 2 3 3 © Total 463 424 443 00 s 539 603 149 135 10 25 2059 887 887 TABLE 2. HOUSE-TO-HOUSE INSPECTION. Premises inspected 7023 Premises occupied—whites 3399 l’remises occupied—colored 1326 Nuisances abated 1872 No. of squares disinfected 110 No. of premises disinfected 887 No. of rooms fumigated 2059 No. of persons vaccinated 1069 E. J. MIOTON, M. D., Inspector. OFFICE SANITARY INSPECTOR, FOURTH DISTRICT, New Orleans, October 18, 1883. Joseph Jones, M. D., President Board of Health: Si,-—I herewith submit the following report of small-pox in the Fourth District from January 1883; to October, 1883. The method adopted to prevent the spread of this dise'ase has been that so urgently recommended by yourself. As soon as notified of a case of small-pox, the house is immediately flagged in a con- spicuous place, and the case isolated as much as possible ; free vaccination is offered to all persons within a radius of four squares. In case of death all gatherings around the body were prohibited, and also large attendance at the funerals. 15 The rooms were thoroughly disinfected by burning sulphur for from ten to twelve hours. The vaults are emptied and disinfected with sulphate of iron and carbolic acid. The rooms are white-washed, and when practicable, bedding and clothing was destroyed. Free vaccination was offered to several colored congregations, but they declined to avail themselves of the opportunity. During the past two mouths but few persons have presented themselves for vaccina- tion at this ofiiiee Small-pox cases were only transferred to the Small-Pox Hospital, when found to be in want; of these there were twenty-nine. As a rule , they object strongly to being sent to the hospital; they consider it death. At the present time, we have not a single case of small-pox in the Fourth District. Very Respectfully, W. R. MANDEVILLE, M. D., Sanitary Inspector, Fourth District. SPECIAL REPORT OF W. R. MANDEVILLE, M. D., SANITARY INSPECTOR, FOURTH DISTRICT, From January 1, to October 13, 1883, on Small-Pox. Number of cases i 326 Number of deaths 99 Number of premises fumigated 225 Number of rooms fumigated 573 Number of yellow flags displayed 225 Number of eases sent to hospital 29 Number of house-to-house inspections 4906 Number of nuisances abated 1425 Number of free vaccinations 663 Number of certificates issued 698 W. R. MANDEVILLE, M. D., Sanitary Inspector, Fourth District. New Orleans, October 16, 1883. OFFICE SANITARY INSPECTOR, FIFTH DISTRICT, > New Orleans, October 13, 1883- \ Joseph Jones, M. D., President Board of Health; Sir—I respectfully submit herewith my report from January to October, 1883 : Enclosed is a tabulated report of cases of small-pox in the Fifth District, with the number of deaths, etc., as requested by the Honorable President of the Board of Health; also a statement of the efforts to suppress small-pox in the Fifth District, isolation, disinfection, fumigation, etc., yellow flags and cases sent to the hospital. I herewith state that as much as it was in my power to prevent gatherings at funerals or communication, from house-to-house where there was a case of small-pox, I have done so; among the white class I was able to make them understand the necessity of such a measure, to prevent the spread of the disease, but with the negroes it was nearly useless, as they will not understand. I will also state, that in every house where there was a case of small-pox reported, a yellow flag was exhibited on the house visited by me, and if there was no physician in attendance or nurse, or unable to be provided for, the case was sent by me to the hospital. I have thus sent, as the report will show, four whites and ninteen colored ; total twenty-three. I will state, that in every house where a case of small-pox has been, the premises were entirely disinfected by sulphur and carbolic acid, the privy ordered to be cleaned and free vacciunation offered, but in many cases refused. I have also destroyed in thirty-two premises, beddings, and clothing, etc. Enclosed herewith is also a statement of house-to-house inspections, and total number of nuisances abated from January 1 to October 13, 1883 ; also a table, showing free vaccinnation in the Fifth District. Very respectfully, your obedient servt, A. M. BERET, M. D., Sanitary Inspector, Fifth District. 16 TABLE 3. FROM JANUARY 1 TO OCTOBER 13, 1883, Showing Number of Cases of Small-Pox in Fifth District. No. of Cases No. Sent to Died. o o No. of Hospital. MONTHS. Flags. — Room s Premises W. C. W. C. W. C. Fumigated Disinfected T 2 3 1 6 1 3 13 April D 25 3 8 31 4 May 15 55 8 15 59 3 i 120 59 35 44 10 16 67 7 148 July 27 25 3 6 29 1 o 71 32 1 o. 1 ll 18 1 30 18 l 1 4 14 Total 116 206 39 66 259 4 19 520 259 Grand total 322 105 259 23 520 259 A. M. BERET, M. I).. Sanitary Inspector, Fifth District. Nuisances abated 595 | Inspections made 2425 Total vaccinations—white 78 Total vaccinations —colored 321 Total certificates given 69 Grand Total Vaccinations 399 OFFICE SANITARY INSPECTOR SIXTH AND SEVENTH DISTRICTS, \ New Orleans, October 15, 1883. j Joseph Jones. M. D., President Board of ITealth : Sir—I respectfully submit to you the following report of the sanitary condition of the Sixth and Seventh Districts, commencing January 1, 1883, and ending October 13, 1883; whites 117 colored 87 Cases of small-pox in both districts Cases seut to hospital whites 7 colored 22 Deaths, whites 33 colored 27 Recovered. whites 77 colored 38 Persons vaccinated, whites 497 colored 723 Certificates issued 835 Number of premises where small-pox existed 139 Premises disinfected and fumigated 221 Rooms disinfected and fumigated 491 At all places where small-pox existed we placed a yellow flag on the premises, in con- spicuous positions, so as to warn the people of the existence of this disease. The sur- rounding neighborhood was visited, and free vaccination offered to all the citizens. Isolation was made as complete as possible ; houses were fumigated with burning sul- phur, which was left in the room from ten to twelve hours. Patients were transferred to the Small-Pox Hospital in public wagons, provided for that purpose. Circulars containing the instructions of the Board of Health in regard to cleanliness, etc., were distributed freely; also disinfectants were distributed free. We have visited house-to-house and solicited vaccination. In cases where it was im- possible to isolate, 1 sent them immediately to the hospital. Total nuisances abated, 545 ; inspections and re-inspections, 7981. This work has been accomplished with only one officer, who has to leave one district for the other in case of an emergency, and there is very much valuable time lost in so doing. T also forward you a complete report of sanitary work in the Sixth and Seventh Districts, from January 1, 1883, to October 13, 1883 I am, respectfully, yours, WM. RYAN, M. D., Sanitary Inspector Sixth and Seventh Districts. 17 HOUSE-TO-HOUSE INSPECTION IN THE SIXTH DISTRICT, From January 1, to October 13, 1883. Premises inspected 2695 Number of persons occupying premises—white 5440 Number of persons occupying premises—colored 1559—6999 Inspections made 3761 Re-inspections * 561—4322 Nuisances abated 465 Premises disinfected 200 Premises fumigated 200 Rooms fumigated and disinfected 429 Number of cases of small-pox—white 110 Number of cases of small-pox—colored 10— 170 Number of premises where small pox existed 127 Number of cases sent to hospital—white 7 Number of cases sent to hospital—colored 15— 22 Number of deaths from s.nall-pox—white 28 Number of deaths from small-pox—colored 18— 46 Number recovered from small-pox—white 75 Number recovered from small pox—colored 27— 102 Persons vaccinated—white 344 Persons vaccinated—colored 389 —733 Number of certificates issued v 531 WM. RYAN, M. D., Sanitary Inspector, Sixth District. HOUSE-TO-HOUSE INSPECTION IN THE SEVENTH DISTRICT, From January 1, to October 13, 1883. Premises 987 Persons occupying same—white 1826 Persons occupying same—colored 2479—4305 Inspections made 3571 Re-inspections made 1 88 Nuisances abated •• 80 Premises disinfected 21 Premises fumigated 21 Rooms fumigated 62 Cases of small pox—white 7 Cases of small-pox—colored 27 —34 Number of premises where small-pox existed '. 12 Number of cases sent to hospital—colored 7 Number of deaths—white 5 Number of deaths—colored 9— 14 Recovered—white 2 Recovered—colored 11— 13 Vaccinated—white 153 Vaccinated—colored 339— 492 Certificates issued 324 WM. RYAN, M. D., Sanitary Inspector Sixth and Seventh Districts. From the preceding reports of the Sanitary Inspectors of the Board of Health of the State of Louisiana we obtain the following general results as to the operations, designed more especially for the arrest of small-pox. In the First District 640 cases of small-pox, with 186 deaths, were reported; 167 cases of small-pox were sent to the Small-Pox Hospital. 532 premi*3s were disinfected and fumigated; clothing and bedding de- stroyed in 132 premises. . The inspections and re-inspections numbered 14,223; and 2100 nuisances were abated; the vaccinations numbered 650, and 875 certificates were issued. Vaccination has been freely offered to all persons in the vicinity of small pox cases. By the energetic measures instituted by Dr. Bayley the small pox has been extinguished in the First District of New Orleans. In 1880, the population of the First District was: white, 43,319; colored, 14,126; total, 57,445. At the present time, the population of this District is not less than 60,000, and it probably includes within its area, more wealth engaged in 18 commercial and mercantile pursuits than in all the other Southern cities, exclusive, perhaps, of Baltimore. But one case in the entire First District, October 24,1883. Second District—586 cases of small-pox ; 225 white and 361 colored; 342 deaths; 107 whites 105 colored. 345 premises fumigated; 10 cases sent to hospital; vaccinated 909 whites and 039 colored; total 1548; 4297 house-to-house inspections, and 1195 nuisances abated. Third District—887 cases small-pox; whites 443, colored 444; deaths 284; whites 149 and colored 135; 2059 rooms were fuminated, 887 premises disinfected; 35 cases small-pox sent to hospital; 7023 house-to-house in- spections; vaccinations 1009; nuisances abated 1873. Only three cases of small pox in this District at present time, October, 1883. Fourth District—At the present time not a case of small-pox in this District; total number of cases 326; deaths 99. Premises fumigated, 224; number of rooms fumigated, 573; yellow flags displayed, 225; cases sent to hospitel, 29; house-to-house inspections, 4006 ; nuisances abated, 1435; number of vaccinations, 063; certificates issued, 038. Fifth District—cases small-pox, 323; whites 200, colored 116; deaths 105; whites 66, colored 39 ; number of flags 259, sent to hospital, 19 whites and 4 colored; total, 23; rooms fumigated, 540; premises disinfected, 259; house-to-house inspections, 3840 ; nuisances abated, 595; total vaccinations, 399; certificates issued 69. Sixth and Seventh Districts—Cases of small-pox; 204; white 117, colored 87 ; sent to hospital 29; deaths, white 33, and colored 27; total 60; certifi- cates issued, 835; vaccinations, white 497; colored 723; premises fumi- gated, 491; nuisances abated 545 ; inspections 7981. From the preceding facts we deduce the following conclusions: 1. Small pox has been arrested in New Orleans by the measures devised and executed by the Board of Health of the State ot Louisiana. 2. In the efforts to isolate and arrest small-pox during 1881, 1882 and 1883, the main difficulties were due to the following causes : a. The large number of colored inhabitants and poor whites, who disre- garded and refused vaccination. b. The fact that the prevalence of the disease was due chiefly to filthy habits and neglect of vaccination is conclusively shown by the large num- ber of deaths reported by the coroner. c. The constant introduction of the disease by strangers from the sur- rounding States and cities. 3. If the statistics be carefully examined it will be seen that the most marked increase of the disease was concurrent with the movement of the great staples of the valley and the congregation of large masses of people in this city States. The decrease of small-pox during the hottest months was due to the efforts of the officers of the Board of Health at a time when commerce and trade was at the minimum. 4. The small pox increased in proportion to the prevalence of the disease in surrounding States and cities and on the plantations along the banks of the Mississippi Biver. 5. New Orleans will be perpetually exposed to the introduction of small- pox when the disease prevails in the Mississippi Valley, 6. The entire subject of small-pox and vaccination in Louisiana is of paramount importance and should engage the earnest attention of the General Assembly at its next regular meeting in June, 1884. 19 The preceding report was read at the regular meeting of the Board of Health of the State of Louisiana, October 25, 1883. VIEWS OF HON. I. N. MARKS. Mr. Marks reviewed at length the efforts of the Board of Health for the suppression of small pox, and called attention to the vast amount of valu- able sanitary work performed by the medical officers in the various dis- tricts. The free vaccinations performed by the sanitary inspectors had reached 11,G44, and had conferred great benefits upon the citizens ; and if persons had neglected vaccination in New Orleans it was not the fault of the Board of Health, for vaccination had been offered freely to all citizens, ir- respective of color, race or present or previous condition. If each physician had accomplished only one-half the work performed by each sanitary inspector of the Board of Health, then we should have had, as shown by the President, at least 225,000 vaccinations. The assertions emanating from the executive committee of the New Or- leans Auxiliary Sanitary Associations were incorrect; every measure,such as the use of small-pox flags, the erection of small-pox hospitals, the con- veyance of the sick in wagons devoted specially to this purpose, the isola- tion of the sick, and the prevention of gatherings at funerals, had been urged, and as far as the means of the Board extended, been exerted by the faithful and zealous officers of the Board of Health from the first appear- ance of small-pox in 1881. These remarks, he said, were made because the step lately taken by the Auxiliary Sanitary Association and the appointment by that association of a number of physicians to inspect the various residences and vaccinate all persons not vaccinated, seemed to lead to the impression that the board had not done its duty. The Sanitary Association had appropriated $5000 for that purpose, and begain their labors at the present time, when there is no necessity for such action, for, by referring to the mortuary reports, it will be seen that during the past two weeks only six deaths had occurred by small pox, and these at the small pox hospital, showing that there had been no deaths in private practice of physicians. The board and its officers had done their duty, as their reports showed, and that the work done by the sanitary inspectors has met with its just reward by the arrest of •small- pox in the city, and deserves commendation on the part of the people. The following resolutions were offered by Mr. Booth, and adopted: Resolutions of Hon. Edward Booth with reference to the efforts of the officers of the Board of Health of the State of Louisiana for the suppression of small pox in New Orleans. Resolved, That the board have heard read with profound satisfaction the report of its President, giving an outline of its labors and the detailed re- ports made by Drs. Bayley, Faget, Mioton, Mandeville, Beret and Ryan, respectively medical inspectors of the seven districts of the city, upon the subject of small-pox. 1. As to the methods adopted for its isolation and suppression. 2. As to the difficulties encountered and overcome. 3. As to the enormous amount of careful and systematic work done, and finally the abundant success which, under Providence, has crowned their labors, by a reduction of the weekly mortuary of small-pox from a maximum 20 of 8G for week ending Aj>ril 7, 1883, to the present minimum of three for week ending October. 20, 1883, a point which has not been reached since November, 1882. Resolved, That the board recognize the impossibility of forecasting what the future may have in store for our people, but will not refrain from con- gratulating the community upon the substantial cessation of small pox, as well as the entire absence of any form of contagious or infectious disease. Resolved, That the President and medical staff of the board have merited, and are hereby tendered, at the close of the season, the thanks of the peo- ple, as.far as the board can express them, and are requested to continue their well-begun work for the absolute eradication of small-pox, trusting for their reward to the appreciation of the beneficiaries, and remembering the appositeuess of the maxim that “nothing succeeds like-success.” jResolved, That the President be and is hereb}" authorized and requested to embody in his annual report to the General Assembly of Louisiana the valuable and important facts reported by the medical inspectors, and to make such other use of the same as he shall deem to be for the public in- terest.