Medicine: Epidemics

Septic Sore Throat. In ten days, an epidemic of septic sore throat has killed 26 people in Lee, Mass. Of the remaining 4,000 population, more than 400 lay in fevered agony, last week, unable to swallow; their glands hard and swollen; their heads hammering with constant pain. Doctors, nurses, supplies were rushed to Lee.

The source of the epidemic was traced to the principal milk dealer. Two of his men who handled the milk were found with sore throats from which Streptococcus hemolyticus was isolated. The guilty microbes were also found in the udder of a cow now excluded from the herd. All Lee milk is being rigidly pasteurized; all milk products made before or during the epidemic (butter, cheese, ice-cream) are prohibited.

Septic sore throat is caused by Streptococcus hemolyticus, a tiny germ closely resembling and related to the streptococci of scarlet fever. It is generally distributed in milk, but is a disease of man, not of cows. The milk may become infected by human hands, or, what seems more logical in view of the widespread character of the epidemics,* the udder of the cow becomes infected from human hands, releasing a stream of contagion at every milking time. Most of the epidemics have occurred during the winter and spring months. Always they are explosive: a sudden appearance of sore throat throughout the community, accompanied by chilliness, headache, muscular soreness, nausea, vomiting. The glands of the throat swell up; complications as peritonitis, pneumonia, arthritis are not rare. The abrupt violence of the illness gives little scope for serum, and so far little success has been had with it.

Rabies. Nineteen Chicagoans have died in the last ten months from hydrophobia caused by dog bites. For the eight years previous to 1927 no single human death had occurred. Since August, 1927, 1,046 Chicagoans known to have been bitten by rabid dogs have been given the Pasteur treatment by the department of health. Never before has there been such a situation in Chicago or any other large American city. These facts, reported last fortnight, by Health Commissioner Dr. Arnold H. Kegel caused the Institute of Medicine of Chicago to recommend:

“Strict enforcement of the city ordinance (against unmuzzled dogs running at large) for at least 90 days should be effective. Valuable dogs may be protected to some degree by vaccination against the bite of their rabid fellows . . . it is inconceivable that the prevalence of rabies in Chicago shall be allowed to go on from bad to worse until scores of children and hundreds of valuable dogs have been sacrificed.”

There are two types of rabies: cerebros final irritation (furious rabies); nerve system degeneration (dumb rabies). Both are fatal after symptoms occur. The only hope lies in an early application of the Pasteur treatment.

This vaccine depends for its efficacy on the slow progress of the rabies germs which travel along nerve fibres to the brain; there entering the nerve cells; first stimulating, then destroying them. In dogs, the incubation period* runs from eight days to a year, with an average of two to eight weeks; in man from twelve to 90 days with an average of three to eight weeks.

* There have been ten major epidemics of septic sore throat in the U. S. during this century; many minor ones. Boston had 1,400 cases in 1911; Baltimore 1,000 in 1912; Chicago 10,000 in 1912; Concord, N. H. 1,000 in 1912.

*Interval from the bite to the appearance of first symptoms.