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Full text of "Annual report of the State Board of Health and Vital Statistics of the Commonwealth of Pennsylvania"

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SEVENTH ANNUAL REPORT 



State Board of Health 



VITAL STATISTICS 



COMMONWEALTH OF PENNSYLVANIA. 



HABBISBUBG; 

BDWU K. HETBBS, STATE PSIMTEB. 



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OfPIOIAL DOCDMENT, 



BBSOLUnOK OF THB BOABD BBLA.TIVB TO PAFBBS PUBLISHED 
IN ITS ANNTJAL REPORT, PASSED JOLT 3, 1886. 



Besotved, That no papers shall be published in the annual report of 
this Board except such as are approved for the purposes of such publi- 
cation by a majority of the members of the Board, and that any such 
paper shall be published over the signature of the writer, who shall be 
considered as entitled to the credit of its production, as well as respou- 
aible for the statement of facts reported and the opinions expressed 
thexein. 



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Official Document, 



cohhonwealtu of penmsylvania, 

State Board of Health, 
Executive Office, 1532 Pise Street, 
PhiladeLPHU, December 7, 1891. 

To His Excellency, Bobebt E. Pattison, (Sovemtn- : 

Sir : In compliaDce mth the provision^ of stiction ten of the act to 
establish a State Board of Health for the better protection of life and 
health, and to prevent the spread of contagious and infectious diseases 
in this commonwealth, approved June 3, 1885, 1 have the honor to 
transmit the Seventh Annual Beport of the Board for the year ending 
November 13, 1891. 

BENJAMIN LEE. 
Seci'tiary. 



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Official Document, 



STATE BOARD OF HEALTH 

AND 

VITAL STATISTICS 

OF THE 

COMMONWEALTH OF PENNSYLVANIA. 



OFFICERS ANB MEMBERS. 

PRESIDENT. 
JAMES II. MoCLELLAND, M. D.. ofPitMburKh. 

SEORBTARY. 
BENJAMIN LEE, M. D., of Philailelphin. 

MEMBERS. 

PBMBERTON DUDLBY, M. D., 1338 North Fifteen lb street, PhlUdelphlB. 
JOSEPH F. EDWARDS. M. T)., cor.Siiteenth and Che«taut atreeU, PblladelphiH. 
J. H. MoCLKLLAND, M. D., 411 Penn Avenue, Pltlaburgh. 
HOWARD MURPHY, <:. E., SM Walnut street, Philadelphia. 
GEORGE G. OROPF, M. D.. Bupknell Univereitj, Lewlsburg. 
Hon. SAMUEL T. DAVIS, M. D.. 134 North Prince Btrwt, Lancaster. 
BENJAMIN LEE, M. D., 1532 Pine street. Philadelphia. 



if Vital Statibth,«, 
Department of Internal Affairs, State Capitol, Harrisburg. 

ATB !4l'PEniHTB!fDBNT OP RSPISTBATIO.'C OF VlTAL STABISTICB, 

BENJAMIN LEE, M. D. 



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Okfioul Docckest, 



TABLE OF OfJNTENTS. 



Part I — Report and Mihdteh. 



Appendix A. RepQita of HlMiilin); Cominiltees-. 

Report of tbeExeoutiTe Cotnuiittee, 

Report oftbe Committee on Registration and Vital stailHtlCH, 

Report of the Committee on Water Buppty, DralnH^ei Hi-'werage, Topog- 
raphy and Mines, 

Reportof the Committeeon Publiu InstilutioiiiiandSchool Hjglene, . . . 

Report uf the Committee on Kaniiary Legislation, RulsBand Reitulations, 
Appendix B. Reports of Inspections — 

1. Inspection at St DavidH, Delaware Coimty, by Wm. B. AtliliDion, M. 

D., Medical Inspector, ... . 

2. Inspection at Parsons, Luzerne county, hy L. H. Taylor, M. D., .Meili- 

cal Inspector, 

3. Inspection at Scotland, Franklin county, by R. L. Slbbet, M. D., Med- 

ical Inspector, . 

4. Inspection at Grae I isljurg, Westmoreland county, by W. R. Mattlicws, 

M. D., Medical Inspector, 

5. Inspection at Two Licks, Indiana county, by W. E. MattlieuH. M. D., 

Medical Inspector, ... 

6. Inspection at Qettysburg, Adams county, by R. L. Hibbei, M. D., Meil- 

l<al Inspector, ... .... 

T. Inspection at Sandy Lake, Mercer county, by A, A. WooiIh, M. D., 

Medical Inspector, 

H. Inspection at ('lieawick, Allegheny count3-, by J. R. Thompson, M. D.. 

Medical Inspector ... 

a Inspection at Media, Delaware county, by Wni. B. Atkinson, M, D., 

Medical Inspector, .... 

10. Inspection at Chestnut Hill, Montgomery county, by Wm. B. Atkin- 

son, M. D., Medical Inspector, .... , . .... 

11. Inspe<'tiou at Preston ville, Montgomery rounty, by Woi. R Atkiiisiin, 

M. D., Medical Ins|>ector, 

Inspection at Carliondale, Lackawanna county, by L. II. Taylor, M. 

D., Medical Inspector, . . 

Inspection at Glen Riddle, Delaware county, by Wm.*a Atkinson, M. 

D., Medical Inspector. ... 

I*. InHpections at Bitners, I.iancaster county, hy P. A. Ilarlnian, M. I)., 
Medical Inspector, and S. T. Davis, M. D., .Memlwr of tlio Board, . 
(vil) 



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viji Contests [Off. D 

Api^ndlx B — f^ontinaeil. I 

15. InBpeciion at Millvllle, Columbia county, by Wm. Leiwr, M. D., Med- 
ical InBpoclor, . . . 

Id. luspec-tion at TuUytown, Bucks county, by Wm. B. Atkinson, M. D., 
Medical Inspector, 

17. Inspection at Nicbolson, Wyomlug county, by L. H. Taylor, M. D., 
Medical Inspector 

IS. iDHpectlon at Shippensburg, Cumberlancl county, by R. L. SIbbet, M. 
D., Medical Inspector 

19. Inspection at CresBonartSchuylklll county, by W. Murray Weidman, 

H. D., Medical Inspector, ... . 

20, Inspection at Cliadd's Ford aild Cossart, Delaware county, by Wm. 

B. Atkioaon, M. D., Medical Inspector, aud Benjamin Lee, M. D., 

Secretary, 

■iL Inspection at Wallingford, Delaware county, by Wm. D. Atkinson, M. 
D., Medical Inspector, , 

22. InspectlonatHowellville, Chester county, by Wm.B. Atkinson, M. D., 

Medical Inspector, . 

23. Inspection at, Rochester Mills, Indiana county, by W. EL Matthews, M. 

D., Medical Inspector, 

24. Inspection at Camp Sherman, Chester county, by Wm. B. Atkinson, 

M. D., Medical Inspector, 

25. Inspection of the Dialna^ System of Wayne, Delaware county, by 

Wm. B. Alklneor, M. D., Medical Inspector, . . .... 

2a Inspection at Schuylkill Hai-en, Schuylkill county, by W. Murray 
Weidman, M. D., Medical Inspector, 

27. Inspection at Tyrone, Blair county, by George G. Groff, M. D., Member 

of the Board, 

28. Inspection at Washington, Washington county, by J. R. Thompson, M. 

D., Medical Inspector, 

21). Inspection at Butler Butler county, by J. R. Thompson, M. D., Medi- 
cal Inspector, 

sa Inspection at LennI, Delaware county, by Wm. B. Atkinson, M- D., 

Medical Inspector, 

31. Inspection at t'orest City, Forest coon ty, by L. H. Taylor, M. D., Med- 
ical Inspector, 

■SB. Inspection at Sbanksyille, Somerset county, by J. 8. Hackney, M. D., 

Medical Inspector, 

33. Inspection of the Datn, Lebanon county, by W. Murray Weidman, M. 

D., Medical Inspector, 

.14. Inspection at Montrose, Susquehanna county, by L. H. Taylor, M. D., 

Medical Inspector, 

Appendix C. Annual Beporta of Cities and Towns — 

I., Carbondale, 

2. Chester, 

8. Coatesvllle, 

4. Johnstown, 

G. Leiianon, 

6. Meadvllle 

7. Morristown 

8. Oil City, 

9. Philadelphia, 

10. Soranton, 

11. TItuavtIle, . .' 

12. Weilsboro, 

13. Williamsport, 



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No. 16.] Contents. tx 

Appendix D. Meteorol<^csl ObMrvatioDa— Pa^. 

Pennsylvftnia Slate Weather Service, 188 

Appendix R. Reports or (.'onferenceH and Conventions — 

L Proceedinga of tbe National Conference ofState Boards of Health, 1B9I, 287 

2. Report of the Secretary as Delegate to the Meeting of tiie Public Health 

AsBociatloD, 1890, SSB 

3. Repon of the Secretary as Secretary of the Section on State Hedltdne of 

tbe American Medical Association, 1890, S67 

School house construction, 867 

School bjgiene, SMI 

MetAorology ajid diseaae, 806 

Sewage disposal, 864 

Hygiene tu rural districts, . S71 

Beneficence of disease, A. K. Bell, 875 

Coroner system, H. O. Marcy, 882 

Sickness and mortality in army, J. R. Smith, 396 

Tutterculosis, prevention, L. P. Fiick, 401 

Disinfection of excreta, Q. 'M, Stemt>erg, 409 

Underground waters, 8. H. Dryce, 416 

Simple method of sewage disposal, C. W. Chancellor, 420 

Heating and ventilation of schools, R. H. Reed, 430 

Construction of schools, D. F. Lincoln, 442 

i, Procaedingsof the Fifth State Sanitary Convention, 44B 

Annual address, S. O. Oixon, 452 

Should tuberculosis be returnable, L. F. Flick 467 

Howsomepeople treat au epidemic, C Mclntire, 472 

Difficulties in rural districts, S. M. Free, 476 

Wateraupply in mountain towns, C. B. Dudley, 480 

Records of A Itoona board, C. H. Closson, 489 

Neglected points in railroad aanitaiion, H. R. Smith, 494 

Appendix F. QnamntiDe, Disinfection, Epidemics and Special %>urcea of 



QuaranUne, 600 

Maritime sanitation in use at Charlestim, 600 

Appointment of Dr. B. Lee as quarantine commissioner, 600 

Philadelphia Lszaretto. Modea of disinfection, 607 

Abstractof sanitary reports, 609 

Resolution on importation of Spanlsli rags, 618 

Communication ttom the Ohio Stat« Board on shipment of diptitberla 

dead, 618 

UommunlcaUon front same relative to contagious diseases, G20 

Epidemics, 62S 

Diphtheria at Bangor, 622 

Small-pox at Hcranton, 625 

SmaLt'pox at Erie, , 627 

Small-pox at Johnsonburg, 628 

Dysentery at Norristowa Hospital, 632 

Diphtheria at Hecksherville, 688 

Diphtheria at Galeton, 634 

Typhoid in the Bethlehems, 536 

Hpei>lal Sources of Diseaxe, 646 

Disinterment of bodies, 646 

Small-pox on, 8. S. Helmaley, 647 

Leprosy in Delaware county, 548 

Useof Hesh of pregnantcows Bsfood, 662 

Pollution of water of South Bethlehem, 662 

Defective drainage at SL Clair, 668 



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Z OONTEKTS. [OtF. DOO. 

Appendix V—ConHnued. 

Special Sources of DUmm. Aft. 

Streams polluted by BBwage, GM 

PolluUoaofwellatSherldaavlUe, 566 

Stagnant pond at Walasporl, fi67 

Nnlaance at Nazareth, 668 

Slaughter-shops, R. H. Reed, Gfi9 

Analyaea of drinking water, C. M. Cresaon, 664 

Appendix O. Correspoadence — 

Prom the Attorney General— powen of the board, 673 

From Rev. a M. Miller, caroaaaes in river, 675 

From the board of heallJi of Lancaster, 676 

Appendix H. CompUintaand Orders for Abatement of Nulsanoes, 67B 

Appendix I. Circulars and Forms — 

1. Precautions against Hunstroke, 6ST 

2. School hygiene 589 

Appendix K. Organization, Constitution, Bj-lawa and Regulations of the 

Board. Compendiumof the Laws relating to Public Health and Safety. . . 600 
Appendix A. Laws passed at Ibe sesaion of 1889. 

Appendix B. Laws passed at the session of IBOl, with the general atatule 
of public nuisances. 

Officers and members, 600 

Medical inspectors of the board, 601 

Constitution, 602 

By-laws, 607 

Organization of the board, 611 

Regulatlonsof the board, 612 

Compendium of the laws relating to public health of the Slate of Penn- 
sylvania together with the decisions of the supreme court and county 

courts relating thereto, 62S 

Index to the Compendium, 813 

Appendix A. Laws passed at the session of ISSe, SS9 

I. Stale Board of Health, 82B 

II. Boardsofheaithforcitieeoftfaetbirdclsss, .' 831 

III. Boards of health authorized to Ale writs upon liens for work done, HM 

IV. Sewerage, water supply, cesB-pools, 835 

Y. The practice of veterinary medicine and surgery, 861 

VI. Protection of empioyds— .women — children— (Ire-escapes, S6S 

VII. Registration of pharmacists — sale of provisions, 861 

VIII. Coal mines, SOi 

IX. The state weather service, 862 

Appendix B. Lsws passed at the session of 1891, with the general statute 

ofpublic nuisances, 864 

I. State Board of Health 864 

II. Protection of water supplies, drainage, 871 

III. Adulteration and sale ol food, 874 

IV. QuaranUne— port of Philadelphia, 876 

V. Practice of veterinary medicine and surgery, 876 

VI. Cremation, 877 

VII. Regulation of the practice of pharmacy and the sale of poisons, . . 878 

VIII. Healthandsafatyofralnere, 879 

Anthrsclte coal mine commission, 880 

The genersl law on public nuisances, 919 

Appendix L. Additions to Lilirary, 9S1 

Appendix M. Report of the State Pharmaceutical Examining Board, .... 25 



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REPORT AND MINUTES. 



1 Bd. Heai/th. 



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Official Docdmbmt, 



SEVENTH ANNUAL REPORT OF THE SECRETARY. 



Dr. J. H. McClelland, Presidenioftha State Board of Health and Vital 
Statistics of the OommonwetUth of Pennsylvania : 
Sjr: In offerio^ this, bis Seventh AimiiBlBeport, it is your secretary's 
pleasiDg duty to confrratalate the Board on the fact tluit its umnbers 
continne tmbroken. The reappointment of Dr J. F. Edwards, and the 
appointment of the Bon. Samuel T. Davis, M. D., by his Excellency 
Governor Beaver, were confirmed by the Senate early -in the recent regu- 
lar session of the legrialature, and Drs. G. Q. Groff and Femberton Dud- 
ley, having been reappointed by his Excellency Governor Pattison, on 
the expiration of -their terms of office in June of the present year, pre- 
sented their commissions and took their seats at the July meeting. 

Changes in Medical Inbpectobbhips. 
The Board has not been so fortunate, however, as regards its medical 
inspectors. Dr. James Ii. Stewart, of Erie, medicaS inspector of the 
lake district, embracing the counties of Erie, Crawford, Warren, Mercer, 
Venango and Forest, closed his long and useful career soon after the 
beginning of the new year. As the leading practitioner of his section 
of the state, and a former president of the state medical society, he 
commanded the respect of his medical peers, as well as of the public 
generally, and made the influence of the Board strongly felt in his large 
and important district. Dr. A. A. Woods, of Erie, the successor of our 
lamented president, Dr. Germer, in the position of health officer of that 
city, and the associate of Dr. Stewart in much of his work as an in- 
spector, fills the place left vacant by that officer's death. I!>r. C L. 
Gummert, of Brownsville, medical inspector of the Southern Tier Dis- 
trict, including the conntiee of Folton, Bedford, Somerset and Fayette, 
died early in the'Snmmer. He was one of the many unfortunate, and 
probably one of the first, who hastened to Berlin on the premature an- 
nouncement of the discovery of Prof. Koch of the cure of tuberculosis 
by inoculation, in order to make trial of it in bis own case. He re 
turned to his home apparently improved and much encouraged, but bis 
hopes proved illusory, and be soon sank under renewed inroads of the 
disease. He was an intelligent and energetic officer, and had enjoyed 
the advantages of military service under the United States government. 



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4 State Board of Health. [Off..Doo. 

HiB place has been filled by the appointmeiit of Dr. J. S. HackDey, of 
UniontowD, president of the Fayette Oonnty Medical Society, who has 
already given proof of the wisdom of his selection. 

MEITINliS. 

Dorinp the year eight meetings-four times the namber required by 
hiw — have been held, three regular, including the present, and five spe- 
cial. They were in order as follows : Special meetings, December 22, 
1890, March 6 and May 1, 1891 ; regular meetings May 11 and July 9. 
1891 i special meetings August SI and October H, 1891, and a regulai- 
meeting November 12, 1891. 

Sanitabv Leuislation. 

The committee on sanitary legislation looked forward to the session 
of the state legislatore during the |)re8ent year with much hopefulness 
as an opportunity for obtaining statatoty enactments which would place 
the work of the Board on a firmer basis, confirm its powers, and extend 
its usefulness by increasing its pecuniary means. Especially did it feel 
encouraged by the strong recommendations of bis Excellency Glovemor 
Beaver, in bis message at the opening of that body, in favor of such 
legislation, and still stronger arguments which he used in support of 
them. The following extracts rom that document will indicate the 
grounds on which they based their expertations: 

Extracts fbou Oovebnor Beaver's Message to the Leoislati;r£, Jan- 
UABX 6, 1891. 

"Soon after the adjonrnment of the preceding legislature, to wit^ on 
the 31st of May, 1889, the commonwealth was visited by a calamity 
which has no parallel in its history. Throughout the mountain region 
of the central part of the state a rain storm of unprecedented duration 
and severity prevailed, which so increased the volume of water that the 
ordinary channels of drainage were unable to carry it away. The result 
was wide-spread desolation and ruin, extending over some twenty of the 
sixty-seven counties in the commonwealth. Thousands of lives were 
lost, and property, municipal, corporate and individual, aggregating 
many millions of dollars, was d^troyed. 

" The people inhabiting the regions drained by the west branch of the 
Susquehanna, the Juniata and the Conemnugh rivers, were the principal 
sufferers. Many vQlages, towns and cities on the eastern slope of the 
Alleghenies were, for the time being, rendered utterly helpless, and 
their people prevented from pursuing their usual vocations. In addi- 
tion to the loss of life and property sustained, the public health was 
greatly endangered, and municipal officers deprived of the power to ex- 
ercise their authority, or to furnish the means by which the situation 
could be relieved. 

"On the western slope of the mountains, Johnstown and its neighbor^ 



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No. 16.] Retobt of the Secbbtary. 5 

in^ boTooghs were almost obliterateil. Id some cases' tlie officers of 
municipalities were lost; whole communities were swept away; streets 
and other boundaries utterly obliterated, and municipal ^vemment 
g'enerally broken up. The people were for a time thoroughly helpless. 
Food and clothing were furnished by those who were charitably dis- 
posed, and a relief committee from the neighboring city of Pittsburgh 
commeuced the work of removing the debris which had collected at the 
confluence of the Oonemaugh and Stony Greek, so as to relieve those 
who remained of the danger of pestilence which seriously threatened 
them. The State Board of Health was early upon the ground and took 
immediate and energetic steps toward the preservation of the public 
health. 

"On the 8th of June, after issuing a formal proclamation to the peo- 
ple of the world, appealing for their charitable help for the distressed 
within our commonwealth, and an-auging for the receipt and careful ac- 
count of the charity which was sure to follow the appeal, I made a per- 
sonal visit to Johnstown and a thorough inspection of all its surround- 
ings. The Fittsbmgh relief committee was practically in charge of the 
distribution of charitable relief, of the burial of the dead and the abate- 
ment of nuisances which seriously threatened and affected the pubhc 
health. Although the State Board of Health, under the provisions of 
the sixth section of the act of the 3d of June, 1885, had power and au- 
thority 'in cities, boroughs, districts and places having no local board 
of health, or in case the sanitary laws or regulations of any place where 
boards of health or health officers existed should be inoperative, to order 
nuisaDces, or the cause of any special disease or mtniality to be abated 
or removed, and to enforce quarantine regulations as said Board of 
Health shall direct,' and the power thus conferred seemed to be absolute ' 
and unlimited, yet no appropriation having been made by the legisla- 
ture in view of such an overwhelming calamity, and no sufficient funds 
being available tor enforcing the authority conferred by said act, it was 
practically helpless. The authorities of the Pittsburgh relief committee, 
however, recognizing the fact that the state was bound to abate these 
nuisances, which not only threatened the health of the entire commu- 
nity, but absolutely blotted out municipal authority, and in some cases 
municipal existence, demanded that work should be undertaken at once 
by the State Board of Health. 

"It was urged that it would requite at least three millions of dollars 
to clear the valley of these threatening nuisances, and that in order to 
provide the funds for this purpose the legislature should be immedi- 
ately assembled in special session. A careful examination of the dltt- 
trict convinced me that the amount required to discharge the duty which 
the state owed to the community was greatly exaggerated, and that the 
work could be done for about what it would cost to assemble the legis- 
lature iu special session and secure the necessary legislation therefor. 



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6 State Boabd of Health. [Off. Doc. 

The work was of immediate aod pressing: importance. The flood had 
so interfered with telegraphic and raOway communication that it was not 
then possible to reach some parts of Pennsylvania, and the le^latore 
could not have been assembled in time to afford the needed relief, even 
if it had been deemed desirable to provide for it in this maimer. 

"Upon the representation of the State Board of Health that nui- 
sances prejudicial to the health and safety of the people eusted in vari- 
oos parts of the state, proclamations were issued requiring them to be 
abated at the expense of the commonwealth. In a personal cousoltation 
with members of the Pittsburgh relief committee and of citizens of 
Johnstown, I agreed that the state would take chaj^re of the strictly 
sanitary work at Johnstown, on Wednesday, the 12th day of June, 1889, 
and in order to carry out this agreement authorized tibe State Board ol 
Health to take charge of the work and to employ such means as were 
necessary to ctury it into effect. The Adjutant Qeneral of the State, who 
was upon the ground, was authorized to co-operate with the State Board 
of Health as my immediate representative. 

"The necessity for and the work done by the State Board of Health 
throughout a large portion of the commonwealth for many months suc- 
ceeding the floods of 1889, demonstrates the necessity for the existence 
of the Board and the wisdom of enlarging its power. The waterways of 
the commonwealth are becoming more and more the source of water 
supply to all our cities and larger towns. The purity of the water 
therein becomes, therefore, a question of vital importance. The inves. 
tigations of the Board of Health prove condusivety that in many cases 
of epidemic diseases prevention is easy if the water supply can be con- 
trolled and purified. The time has come when the legislature should 
take decided grounds and prompt action upon this subject. 

"It may become necessary to revolutionize our entire system of sew- 
erage tor cities, towns and public institutions. Instead of emptying 
Uiis mass of corruption into our streams, caixying disease and death to 
those who depend upon them for their water supply, it will be necessary 
to devise and carry into execution some e£Scient system of disposing of 
the sewerage of dense communities. I recommend that the authority 
of the State Board of Health over such subjeote be increased, with such 
safeguards as may be necessary, and that the appropriation for their 
general expenses be so increased as to enable them to make careful 
and thorough investigation and experiment as to the best means of 
avoiding the dangers herein recited, and at the same time affording an 
efficient and healthful system of sewerage." 

PSOTEOTION OF WaTER SdPPLIES. 

The efforts of the secretary and the committee were first in the direc- 
tion indicated by the Oovemor, namely to procure legislation for the 
protection of the purity of streams and other inland waters, more par- 



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Mo. 16.] Bepobt of the Secbbtabv. 7 

ticnlarly of saoh as are, or are likely to become, the sources of water 
sappUee for cities and towns. In this attempt they had the sapport of 
the water companies and water commissioners of the western part c^ 
the state who met in oonvention in Pittabnr^h and adopted reaolations 
in favor of such so enactment, and were aided by the pubUc press of 
that caty. They also sent a delegation to Harrisbnrg to meet the Board 
and nnite with it in a personal appeal to the le^slatnre. 

The committee on public health and sanitation of both branches of 
the l^^atore became strongly impressed with the neoesaity for this 
step, and that of the House of Bepreaentative extended to the Board the 
coortesy of the nse of the hall of the House on the evemng of March 
6th, 1891, and invited the entire legislative body to hear the arguments 
of the friends of the messnre. The attendance was large and the im- 
pression made was evidently favorable. The meeting was presided 
over by the Hon. Henry F. Walton, of Philadelphia, a member of the 
House committee on public health and sanitation. Addresses were made 
by members of the Board, medical inspectors, water analysts and repre- 
sentatives of water companies, presenting the subject from every point 
of view in a forcible manner, and letters were read from municipal cor 
p<nrations showing the necessity for protection of the streams from which 
their people were drinking. If s vote could have been taken at the con- 
clusion of the meeting it would have resulted in favor of the desired ac- 
tion by a large majority. The dread, however, of interfering with the 
manufacturing interests of the state finally prevailed in the minds of 
l^islators, and the bill was defeated. 

Two bills pertaining to this snbject however passed, both of the 
nature of special legislation. One of these exemplifying Qie carious 
fact pointed ont by yonr secretary in his last annual report that the leg- 
islature is willing to extend protection to the water supply of Philadel- 
phia which it denies to that of other cities, forbids the establishment of 
cemeteries on lands located within one mile of any city of the first-class, 
the drainage from which empties or passes into any stream from which 
any portion of the water supply of such city is taken. The other is an 
act to prevent the pollution of springs, water-wells and streams by water 
escaping from abandoned oil wells and gas wells. This also is of ex- 
tremely limited application. 

POLLDTICyf OF THE WaTEB SUPPLY OF A NeIQHBOEDIG StATE. 

The necessity for a general statutory law of this kind has been em- 
phasized since the adjournment of the legislature, by the receipt of a. 
remonstrance from the State Board of Health of Delaware, by the sec- 
retary, to the effect that the Brajidywine river, which is the source of 
water supply for the city of Wilmington with its population of sixty 
thousand sonls, was receiving pollution of a very serious character, about 
eight miles from the in-take of the city water works, at a point within the 



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8 State Boahd of Health. [Off. Doc. 

botmdaries of Penaarlvania. While Delaware has herself an ezcelleot 
law to prevent the pollution of her streamB she Ib powerless p rotect 
her citizens becanae the ^reat and progressiTe State of Pennsylvania is 
withoat snch a law. The Board at once interfered in this case and 
caused the abatement of the nuisance -, but the incident soffices to show 
that the question is one of wider import than a mere state issue. The 
Board, therefore, having labored in vain with the successive legislatures, 
finding itself no nearer the goal of success than when it began, has ap- 
pointed s committee to consider the expediency of applying to congress 
for the enactment of 

A National Law to Pbevent the Pollution of Streams Pabsiho from 
ONE State to Another. 

The national conference of state boards of health which meets next 
summer in Detroit will lend its powerful influence in the same direction. 
It is therefore quite within the limits of probability that before the 
state legislature has another opportunity to vindicate its intelligence 
in this regard, congress will have passed a law which will, for certain 
of its waters atjeast, render its action unnecessary. 

Pdkification of Sewage. 

In this connection the secretary would call attention to the fact that 
new methods of purification of sewage are at present on trial at two 
points in the state, that of the Devon Inn, Chester county, and of the 
village of Wayne, Delaware-county. Up to the present time the Board 
has not been able to pronounce either of them satisfactory. The issue 
of the report of the State Board of Health of Massachusetts on " Filtra- 
tion of Sewage and of Water and Chemical Precipitation of Sewage," 
constituting a volume of 900 pages, marks a new era in the discussion 
of this qaestion. It is based on experiments on a large scale at the 
board's experiment station at the city of Lawrence, and on analyses and 
microscopic examinations made at the board's chemical and biological 
laboratories. These observations have been actively carried on since 
the year 1887, and have been conducted at sn expense of $107,076.16. 
To attempt to give the slightest idea of their scope and completeness 
in this report would be out of the question. Suffice it to say that they 
point to the solution of this troublesome problem, in tlje adoption of a 
system of intermittent filtration, through filter beds so constructed that 
theair shall have free access to the fluid as it passes through them, and to the 
fact that success depends on-the abilities to cultivate the bacteria of nitrifi- 
cation in the filters. So that the fact to which so much prominence has 
been given that germs or bacteria have been discovered in large mimbers 
in the filtering medium of muiy household filters does not condemn the 
latter, unless it can be shown tliat these bacteria are those of disease. 

The other measure of reform which the board urged upon the atten- 



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No. 16.] Report op the Secbetaby. 9 

tion of the assembly was, the eatablishment of local boards of health 
throughout the state, iu cities, boroup^hs and towushipB. 

This is not only demanded most urgently in the interests of health, 
bat is an essential preUminary to the inao^uratioQ nf any complete sys- 
tem of re^iration and vital statistics. It is a fact of which a citissen of 
Philadelphia can scarcely feel prond, that a man may die and be put 
under the f^round, any where outside of the largest cities, and it shall 
be less a matter of record than if he were a stallion or a bull with a pedi- 
gree. Can we wonder that graveyard insurance flourishes on such a 
soil! To show how this carelessness in burial impresses the ordinary 
mind, allow me to call your attention to the following extracts from a 
letter by the wife of a journeyman carpenter who had applied to the 
State Board of Health for information with regard to the place and date 
of birth of a deceased person : 

" Philadelphia, February 9, 1891. 
"Benjajuh Lee, M. T>.: 

"Dbab Sir: Tour letter of 9th instant before me. The statement you 
present me with regarding the State Bureau of Vital Statistics is so 
strange and astounding that I can scarcely realize such a condition of 
afiairs in a' large and thickly populated state like Pennsylvaaia. It is, 
in my opinion, a sad disgrace to the state. And even our lai^ and 
beautiful city, I am informed, has no records of births or marriages prior 
to July, 1860. Is it not a deplorable condition for a city and state like 
ours * It is high time our city and state authorities should awaken to 
home interests, and dust the cobwebs from their eyes, and drive the 
lethargy from their brains. If some of the funds spent to entertain and 
amuae titled foreigners were appropriated for such useful and necessary 
bodies as the board of health Emd board of vital statistics, our bur 
state and city would not be the laughing stock uid bntt of every little 
town and country village outside of the state. But pardon me, I am en- 
tirely forgetting myself, and I beg you will excuse my astonishment at 
such a vile state of affairs, which is the only excuse I can offer for my 
tiresome letter. If possible to obtain me the information I request, I 
shall be very much obliged indeed. More, were I of the moneyed class, 
I would willingly pay for the trouble, but I am not, as my husband is a 
working carpenter, and in poor health at that, i. e., heart disease and 
riieumatism from the army. 

" Respectfully," 

The original bill for this object meeting with serious opposition, it 
was modified in various ways iu order to meet the view of objectors, 
but concessions were of no avail and the measure failed. 

Your secretary is not willing to adopt the sentiment expressed by so 
many of the opponents of this bill in the legislature, that the citizens of 
Pennsylvania living outside of the large towns are so far inferior in in- 
telligence and civilization to those of other states as to be incapable of 



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10 State Boabd of Heai,th. C^^^- J)oc. 

self-^overumeut in thiB important particular, and he tmsta that yon will 
ahaie in his relnctance. With yonr approval, he proposeB to importune 
the leg:islatare at each aoccessiTe session until be conviDcee it of the 
error of thia belief and obtains the desired enactment. 

The act and joint resolution passed with reference to the immense 
expenditorea incurred in abating the collossal nuisance at Johnstown 
are of deep interest to the Board, first, as justifying the action of your 
secretary in immediately assuming control, in the name of the Board, in 
the devastated regions; secondly, in legalizing the action of the Gov- 
ernor in resorting to extra^wnstitntional means to obtain funds to an 
swer the demands made upon him by the Board, and endorsing the ex- 
penditure by the secretary of amounts enormously in excess of the limit 
allowed by law, in view of the exceptional enormity of the disaster, and 
thirdly, as affording the Board a firm basis for action in the future 
when confronted suddenly by emergencies of unusual magnitude. It 
is also a matter of congratulation that the bill made substantial recog- 
nition of the efficient services of two members of the Board in the work 
of sanitary relief. 

As regards the provision for carrying on the manifold work of the 
Board, the appropriation was increased from $5,000 to f6,000 aai- 
noally. This increase, while far from meeting the requirements of the 
case, is yet encouraging as showing that the Board has the confidence 
of the law-makers, and that they are disposed cautiously to enlarge its 
means of active usefulness. 

On the whole, then, in reviewing the sanitary work of the last legis- 
lature there is reason to feel that a certain advance has been made, and 
to anticipate that the next will more fully adopt the reoommeadation of 
Governor Beaver to increase both the authority of the Board and the ap- 
propriation for its general expenses. 

Epidemics — Small-Pox at Johnsonbubo. 

The only outbreak of contagious disease which has caused your sec- 
retary serious anxiety during the past year has been one case of small- 
pox at Clarion Junction, near Johnsonburg, Elk county. On the even- 
ing of February 2, 1891, the following telegram was received: 

" Db. Bknjahin Leb, Secretary State Board of Health, Philadelphia : 

Bad case of confluent varioloid. Many expected. Come, send or 
advise at once. 

W. K. Palmer." 

The secretary at once telegraphed Dr. Spencer M. Free, medical in- 
spector of the western slope district, to visit, inspect, and if necessary, 
quarantine. Early the f oUo^ving morning Dr. Free was on the ground, 
verified Dr. Palmer's diagnosis and declared quarantiue in the name of 



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No. 16,] Beiport of the Secbetaby. 11 

the Board. At the same time a telegram vaa sent to Dr. H. M. Alexan- 
der of the Marietta Tacolne eetabhshment, ordering virus to be sent to 
Dr. Free. 

The hamlet in which the first case occnrred, consiBted of six or eight 
small frame booses, grouped closely together, and distant from John- 
sonburg about two milea. Exposure of many individuals in this settle- 
ment having taken place. Dr. Free decided to inclnde the whole in his 
quarantine lines, and to make it the qnarantine station and hospital in 
the event of other Cfises occurring in Johnsonburg. 

One case, exposed to the first before the nature of the disease was dis- 
covered, did so occur and was promptly removed. On the day of his 
arrival the inBpeotor called a meeting of prominent citizens, iTohnson- 
borg not being an incorporated borough, at which a sanitary fund was 
started and sanitary and quarantine committees appointed. The follow- 
ing circular was authorized and promptly issued : 

Notice. 
To the Citizens of Jokn»o7iimrg and Vieinity : 

Small-pox has broken out at Clarion Junction. At present there is 
but one case. There is no occaeion for needless alarm, but you should 
use every means in your power to prevent its spreading. Keep 
away from that neighborhood, clean up yonr cellars, yards, water 
closets, stables, etc., sprinkle chloride of lime freely in and about your 
premises. 

Have every member of your family vaccinated. Free vaccination will 
be furnished. The State Board of Health, in conjunction with the com- 
mittee of citizens has established strict quarantine, and will do all in 
their power to stamp out the disease. 

We request your hearty co-operation in these sanitary matters, but in 
case of failure to comply, the committee has full authority to compel the 
work to be done. 

Benjamin Lee, M. D., 
Secretary State £oard of Health. 

8. M. Fbbe, M. D., Inspector. 

Committee on Santtaiion. — M. J. Maanoell, Samuel Lowrey, James 
McGloskey, W. TV. Gore. 

Committee on Quaraniine. — John Bryan, W. I. Secrist, E. F. Cum- 
minge. 

Quardfi were established night and day, and absolute non-interconrse 
maintained. Two thousfuid vaccine points were sent to Dr. Free, and 
considerably more than that number of vaccinations were performed by 
himself and Drs. Murphy and Palmer of Johnsonburg, who grave up 
their private business in order to aid in the protection of the pnblic 



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12 State Board of Health, TOff. Doc. 

health. Drs. Wright and Geisiuger of the Philadelphia and Erie rail- 
road, and Dr. Frank Earley of Ridgway also rendered valuable aid. On 
Febmar; 13th,. the secretary visited Johnsonburg, held a consnltation 
with Dr. Free and the medical inspectors of the Allegheny and Lake 
Erie districts, Drs. Thompson and Woods, and the officials ol two of the 
railroads entering at this place, with reference to the maintenance of the 
quarantine, provision for sick employes, and the establishment of rail' 
road quarantine should the disease become epidemic in Johosonbiii^. 
The secretary also addressed a citizens' tneeting, supporting Dr. Free's 
measures, and commending the spirit of ready compliance with the 
orders of the board and of self-help displayed in meetingthe emergency. 

The fact that railroads radiated in four directions from this center 
made it a matter of great importance to keep the infection hedged in, 
and the fact that at least twenty families had been exposed, made it one 
of no little difficulty and retiuiring the most constant vigilance. The 
difficulty of obtaining nurses and a physician for the unfortunates thus shut 
up was very great, especially as the Board was unable to promise or assign 
the amount of payment for such servicea This brought into prominent 
relief the importance of the establishment of a state emergency fund, to 
be placed at the disposal of theGiovemor, and drawn upon by the Board 
with his approval m order to enable the secretary to take prompt action 
in such cases. The secretary drew up a bill for that purpose which was 
introduced iu the Senate by Senator Hall, but failed to pass. The diffi- 
culty with regard to a quarantine physician was solved by the generous 
offer of Dr. Murphy toremainwithinthelines. Thenumberof caseswas 
eleven, and of which six were small-pox and five varioloid, and the num- 
ber of deaths four. The dead were buried in the mountain side directly 
behind the cottages and inside the hne. Thorough disinfoction was 
practiced after death or convalescence before the quarantine was raised. 
The threatening epidemic was cut short there and then, no case having 
occurred elsewhere attributable to it, and Medical Inspector Free received 
a formal vote of thanks from the Board for the energy and good judg- 
ment displayed in his management of the affair. To indicate briefly 
what the state owes to him and to the Board for their successful inter- 
vention in this case, we have but to revert for a moment to the epidemic 
now in progress in the Province of Quebec, where the escape of a single 
wilful girl from a hospital where she was detained for observation, and 
her presence on public conveyances, has led to the development of 110 
cases with twenty-one deaths, and the establishment of eleven distinct 
centers of infection, covering an area of six counties, and the disease is 
still rapidly spreading. 

The local health authorities of Philad<!lphia, Erie and Scranton have> 
by thetexercise of a like promptness, and firmness cut short outbreaks 
of this disease in their own cities dtiring the year. 

The cases in Erie and Scranton were directly traceable to the receipt 



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Na 16.] Report of the Sechetabi. 18 

of letters from Texas, where the diseaBe was epidemic, thos clearly 
showing the neoessity for disinfeotion of the mailB under BQoh o 



The outbreak in Philadelphia was the result of the pi-esence of an in- 
fected steamship iu the port, the disease having escaped the observation 
of the port physician, in consequence of the eruption beiupr masked by 
that of another disease. After leaving this port several other cases de- 
veloped on the vessel, and the affair became the subject of correspond- 
ence between the Sorgeon General of the United States Marine Hos- 
pital Service and yooi' secretary. The incident only emphasizes the 
correctness of the opinion already expressed by your secretary that the 
city of Philadelphia is running an unwarrantable risk in dispensing with 
the protection of a quarantine station during six months of each year. 
It may not be inappropriate to allude in this connection to the appoint- 
ment of a 

QUABANTINE CoHMISSION 

by the recent legislature. In his third annual report to the Board, in 
1887, the secretary recommended that the Board urge upon his Excel- 
lency the Qovemor of the Commonwealth, the import ance of conferring 
with the chief executives of the neighboring States of Delaware and 
New Jersey and the United States government with a view to the 
establishment of a thoroughly equipped quarantine station at some 
point farther down the river or bay than the present station at Tinicum 
island. By resolution of the Board, such a recommendation was for- 
warded to the Governor, but no action was taken upon it. At the in- 
stance of citizens residing in the immediate neighborhood of the present 
station the question was brought up before the last legislature and the 
following joint resolution was passed : 

" In the Senate, May IS, 1891. 
"Resolved (if the House of Representatives concur), That the Governor 
be and is hereby authorized to appoint four persons who shall, with the 
Governor of the Commonwealth, constitute a board of commissioners, 
whose duty it shall be to communicate with the proper authorities of 
the Federal government, or of any state, with a view to obtaining such 
concessions as will enable the board of health of the city of Philadel- 
phia, or the Commonwealth of Feansylvauia, to secure a suitable site 
for a quarantine station at some point remote from the centers of popu- 
lation, on the Delaware river. The commissioners shall also inquire into 
the feasibility of establishing a joint-quarantine for the protection of all 
the ports on the Delaware river and bay, to be controlled by the several 
states bordering thereon. The commissioners shall report to the next 
legislature and shall receive no oompensation for their services, but shall 
be allowed their necessary and actual expenses for travelhng, stationery 



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U State Boabd of Health. [Off. Doc. 

and clerk hire, proTisions for which shall be made in the general ap- 
propriation bill/' 

l^e following-named persons were appointed members of this com- 
mission by the Governor: Hemy Leffioann, Beojamin Lee, John Hng- 
g&rd and Andrew Osborne. The members met at Harrisbnrg July 1, 
1891, on the call of the Qovemor, and organized by the election of Oot- 
emor Pattison as chairman and Dr. Heniy Leffinann as secretary. On 
the 7tb of Joly, the commission visited and inspected the quarantine 
station at Tinicom, known as the Lazaretto, and on the 14th of Octo- 
ber, made a voyage of inspection down the Delaware river and bay, as 
far as Reedy island, availing themselves of the courtesy of the Secretary 
of the United States Treasury, who, at the request of year secretary, 
placed the levenne cutter " Hamilton " at their disposal for the occasion. 
The engineer member of the Board, Mr, Mnrphy, and Medical Inspector 
Atkinson, of the Delaware district, were present by invitation, 
DiPHTHEBIA. 

This disease has been unusually prevalent both in city and country 
during the past three mouths and has been of rather a malignant form. 
In one instance the secretaiy has considered it necessary to close the 
public schools. While the disease is undoubtedly maintained, fostered 
and intensified by the filthy conditions which prevail in most of our 
small tDwns, yet the principal reason of its wide-spread existence and 
its long continuance in neighborhoods is to be found in uninterrupted 
communication between the sick, the convalescent, the inhabitants of 
infected houses on the one hand, and the well and residents of uninfected 
houses on the other. When we succeed in establishing this fact in the 
minds of the people and in inducing them to adopt the precautious which 
it necessitates, we shall have rendered epidemics of diphtheria as rare as 
those of small-poz now are. In view of the extremely infectious char- 
acter of this disease, and of the fact that there are numerous instances 
on record in which bodies dead of it have become centers of infection 
in districts previously free from it, even train hands having caught the 
contagion from a corpse in transit, the State Boards of Health of Iowa 
and Ohio have decided to forbid absolutely the transportation of the 
body of a person who has died of diphUieria. The secretary woald sug- 
gest the adoption of a similar regnlation by our Board. 

Typhoid Fevee, 
on the contrary, is not spread by direct contact and infection. It is im- 
portant that this fact should be as vridely disseminated as the other. 
In an inspection made by the secretary within the last month a hapless 
individntd who, vrith several members othisfamily,had recently suffered 
from this disease, complained that the neighbors were all so afraid that 
they would not come inside the house, and he and his family found it 
difficult to obtain the necessaries of life and nursing care. This belief 



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No. 16.] Repoet op the Seobictaby. 15 

prevails qtiite widely, and is entirely unfounded. A well person may 
naree atyphoidfeTerpatientnightaDddaywith impunity, only taking- 
the precaution not to eat or drink in the aick room and to drink no im' 
boiled vater. A knowledge ot this truth would save much sufferinKOud 
privation in smaJI communities. The disease has prevailed in the 
usual degree throughout the state, and a greater degree than nsoal in 
the neighborhood of Bethlehem and in the city of Philadelphia. The 
indications in both places point to a polluted water supply as the cause. 
The investigation of Medical Inspector Mclntire into the conditions in 
and about Bethlehem was very complete, and his report is commended 
to the careful attention of the Board. 

Leprost. 

The want of proper provision for persons suffering from this most 
loathsome of all diseases, who are unfortimately now occasionally dis- 
covered in our country, and the, dangerons natnre of the disease en- 
hanced by its long period of incubation often extending over years, 
makes it absolutely necessary that the United States Government 
should establidi an asylum or colony where they may be cared for. 
The secretary has brought this subject to the notice of all the large 
bodies interested in qaestions ot pubho health and has recently both 
personally and in correspondence communicated with the Surgeon 
General of the Marine Hospital Service in reference to it. The next 
report of that officer will, there is reason to hope, contain a recommen- 
dation tocongress to take action on the matter. In the meantime, might 
it not be well for this Board to adopt a resolution expressing its sense 
of the expediency of such action T There are no doubt in every large 
city cases in hiding in which are slowly developing centers of infection, 
and which would gladly avail themselves of such a refuge were it open 
to them. Once in this country they cannot return to their native land, 
from the simple fact that no vessel will knowingly take them on board, 
and their treatment under the present regime is more than disgraceful, 
it is simply criminal. 

COHFERBNCBS AND CONVENTIONS. 

In accordance with his appointment, your secretary attended the 
meeting of the American Public Health Association at Charleston, 
S. C, December 16, 17, 18 and 19, 1890. 

The subjects considered by the Association were as follows: Sani- 
tary constroction in house architecture, sewage disposal, maritime 
sanitation at ports of arrival, the prevention and restriction of tuber- 
culosis, isolation in hospitals for infectious and contagious diseases, 
and establishments in favorable climates for persons having tubercu- 
lous predispositions. Among the important reports of committees 



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IB State Boabd of Health. [Off Doc. 

were those on tbe sanitation of foreign ships, and on diphtheria. An 
opportunity was afforded the membere to visit the quarantine station 
of the t>ort, and examine the new apparatus for the disinfection of 
goods, wearing appare], etc., by means of superheated steam, and of ves- 
sels by bi-chloiide solution and sulphur dioxide fumigation. A de- 
scription of this apparatus, with illustrations, has been submitted to the 
Board, and it is suggested that it be reproduced in the annual report. 

The National Conference of Htate Boards of Health held its seventh 
anuaal meeting at WashinQix>n, D. C, May 2 and 4, 1891. Tour 
secretary had the honor of representing the Board at its sessions. The 
principal subjects discussed were those of "The requisites for a thor- 
ough system of quarantine and maritime sanitation," Interstate 
quarantine, disinfection of cargoes and vessels, measures for the pre- 
vention of the spread of consumption and the advanta^s of rivers 
conservancy commissions for the protection of streams against deforest- 
ing and pollntion. 

The section of state medicine of the- American Medical Association, of 
which your secretary was the secretary, convened at Washington, 
D, C. May 6, 6 and 7, 1891, A large part of its deliberation was 
devoted to the important subject of school hygiene. The report of 
committee on meteorological conditions of the atmosphere and their re- 
lations to coincident prevalence -^f diseases, by the venerable founder 
of the association. Dr. N. 8, Davis, was a paper of great value. 

The following gentlemen were elected officers for the ensuingyear: 

Dr. Benjamin Lee, of Philadelphia, chairman. 

Dr. Lawrence Flick, of Philadelphia, secretary. 

The fifth state sanitary convention of Pennsylvania was held in Al- 
toona, Friday and Saturday, May 15 and 16. The first session was 
devoted to papers bearing upon the subject of sanitary legislation, the 
second to those on general sanitation, and third to matters of local 
sanitation. 

The Hon. John Dean, of Hollidaysburg, judgeof theconrt of common 
pleas, presided over the deliberations, and deUvered an interesting and 
instructive address on the powers and limitations of boroughs and mu- 
nicipal authorities in promoting the public health. Many valuable 
papei-s were read, and the discussions were all well sustained. The 
annual address was delivered by Dr. Samuel Dixon, professor of hygiene 
in the University of Pennsylvania. It was a masterly exposition of 
the latest views on the subject of the causation and prevention of tuber- 
enlosis, and advocated the enforcement of stringent precautionary meas- 
ures to prevent the diffusion of the bacillus of this-disease through the 
atmosphere or its introduction into the system in meat and milk. The 
secretary would suggest its separate publication in pamphlet form. 
The illustrated paper by Dr. M. L. Davis, president of the Lancaster 
Oounty Medical Society, on "Garbage Cremation," describing a new 



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No. 16.] Bepobt of the Secbetaby. 17 

faniaoe for this purpose, was listened to with much interest. The effect 
of these conTentioos in calling attention to the sanitar; problems pre- 
sented by the special features of location, geolo^cal formation and ao 
on of the places in which they are held, the means for their solution and 
the necessity for combined intelligent effort in order to carry out these 
measures is extremely beneficial. 

The International Congrress of Hyffiene and Demography held its 
seventh annoal meeting- in London, August 10-17, 1891, under the 
patronage of the Queen and the Prince of Walea, both of whom take the 
deepest interest in matters pertaining to public hygiene. At the re- 
quest of the secretary, Oovemor Pattison issued a commiBsion to our 
president. Dr. J. H. McClelland, to represent the State of Pennsylvania 
at the coD^n^esB. The latter was also supplied with appropriate creden- 
tiids from this Board. 

PBECAUnONAItY CmOCLABS. 

The constantly increading demand for the circulars of the Board 
plainly indicates that their value is appreciated by the people and that 
they are doing a good work. Other evidence of this recognition of the 
wisdcHn of this method of carrying out the duty prescribed by law of 
"disseminating information upon sanitary aabjects among the people " 
is not wanting, as the following quotations from an editorial article in a 
paper published in the northern part of the state suificiently dem- 



"Of all our state inatitntiona there is none which arrived more directly 
at the practical way of accomplishing its allotted duties than the State 
Board of Health. Being composed of six eminent physicians and a 
civil engineer, it is but natural that practical methods should attend its 
work. What that work is, all know in part. Let an epidemic disease 
appear in any part of the state, and in a short time, almost im mediately, 
the representatives of the Board are on hand, investigating into the 
origin of the trouble, suggesting practical methods for staying the pro- 
gress of the epidemic or taking active and sweeping methods for its 
suppression. Should any disaster, like that of Johnstowu, create un- 
sanitary conditions that threaten the health of a community, the Board 
is on hand to exercise a counteractins: influence. If, through careless- 
aess, malice or selfish motives, any important water supply is contam- 
inated or any food product of dangerous character put upon the market, 
the Board brings a corrective power to bear. All these are its duties 
prescribed by the law, and though they labor without profit to them- 
selves and often at a sacriCoe, the Board has at all times proved faithful 
and efficient." 

"One of the most practical features of their work is the distribution, 
free of all coat but postage, of pamphleta and circulars treating of the 
preservation of health and the precautionary methods advisable in cases 
of contagions disease. 
2-16-91. 



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18 State Board of Health. [Off. Doo. 

" These circulars tell how to avoid oontractingr the several diseases, 
how the patient ahoold be isolated who is eaSenag from them, how 
the health of the other members of the household and the public ^n- 
erally is to be protected, methods at disinf ectiDg, precaotious at ftmerals, 
etc. The information thus given is thoroughly scientific, clothed in 
plain languoKe, and the suggestions are all practical." 

Apathy of Local ADTHOBmEs. 

The law of 1861, autboriziiig the inoorporation of boroughs, places the 
responsibility of the preservation of the public health in each such 
borough upon its council. The instances are comparatively few where 
this responsibility appears to be properly appreciated by the members 
of that body. An ordinance to prevent swine running at large, and 
keeping filthy pig pens, is often the extent of the sanitary legislation 
which they attempt, and even this is not enforced. Tour secretary is 
constantly receiving complaints of nuisances of the most disgusting and 
dangerous character existing in the midst of thriving towns, in which 
it is declared that the council has been appealed to repeatedly for relief 
and either has paid no attention to the complaint or has been unable to 
enforce its own ordeis for abatement. 

Xational Politics in Town Elections. 

This state of things will continue so long as national politics is per- 
mitted to be a factor in municipal elections in small towns ; so long aa 
men are elected to councils, not because of their known integrity, intel- 
ligence and public spirit, but because they are good workers for their 
party. It matters not an iota whether the men who are called upon to 
administer the municipal affairs of Hugginsville, are in favor of bimet- 
alism or believe the tariff to be a tax, but it mattera tremendously, even 
to the extent of life and death, whether they are men of sufficient edu- 
cation and intelligence to understand the importance of forbidding pub- 
lic funerals of those who have died of certain contagious diseases, and 
of sufficient backbone to close up a filthy slaughter-house that is pollut- 
ing the air of their town, even if it belongs to the richest man in the 
place, and of sufficient forethought to provide an abundant supply of 
pure water for their fellow citizens to drink. Sanitary reform in short 
rather than tariff reform should be the test and watchword of the can- 
vass for all small towns; and large cities would be none the worse for 
making the same change in their political methods. 

Adoption of a Reoolation poe the Bural Distsicts. 

When the Board was first established, it anticipated little opposition 
to such a complete sanitary organization of the state as would relieve it 
to a great extent of the administration of sanitary law in the villages 



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No. 10.] Kepobt of the Sbcbetaby. ■ 19 

and rural districts. It therefore drew up a samtsry code for the instruc- 
tion of local health authorities, which, as it was designed as a basis for 
the organization of their work, it denominated the "Model OrdinaDce." 
The anticipated establishment of lo'jal boards thronghont the state, 
however, aeems as far off as ever. The paucity of sanitary statutes often 
seriously embarrasses the Board in its efforts to remedy conditione pre- 
judicial to the pubhc health. The recommendation is therefore offered 
that the Model Ordinance be adopted as a regrnlation of the Board, and 
that in all places in which the Board is made responsible for the preser- 
vation of the public health, the provisions of this regulation be consid- 
ered binding and a sofScient justification and warrant for action taken 
by the secretary. 

VOLDNTABY SaHITAEY PBOTECmVE AbSOCIATIONS. 

In the absence of legal provision for the sanitary care of villages, 
their residents, especially in the neighborhood of large cities, deeply 
impressed with the necessity for the removal of the dangerous condi- 
tions which surround them, have in some instances united in the forma' 
tton of a local committee having for its object the better protection of 
life and health in their communities, and have sought the advice of the 
State Board of !^alth as to the most effective method of organization 
for such purposes. 

Snch information in a succinct form is contained in a paper read by 
your secretary before the state sanitary convention at I^wisbui^, 
founded on the success of a well-known society for that object at New- 
port., R L He therefore suggests the issue of that paper, or such por- 
tions of it, as the committee on sanitary legislation, roles and regu- 
lations may deem expedient, in circular form. 

SANTTAIiy MANAaslCENT OP BaIRY FaBHS. 

The positive proof that we possess of the frequent transmission of 
typhoid and sourlet fevers through the medium of polluted milk, and 
the extent to which tuberculosis has been found to prevail among milch 
cows, especially those of the finer unmixed breeds, are a cause ot great 
anxiety. When we add to these facts the possibility, to say the least, 
that the use of the milk of tuberculous cows may be a means of com- 
municating that most fatal of all diseases, consumption, to human beings, 
ample reason must be acknowledged toexiat for efforts to place all milk- 
giving cattle under the best possible hygienic conditions. The secre- 
tary woald, therefore, suggest the propriety of the preparation of a cir- 
calar on the sanitary management of herds and dairies, for distributiou 
among farmers and dairymen. 



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20 State Board of Health. [Off. Doo. 

COMHTNICABLB (O0NTAOIOD8 AND InFECTIOTJA) DISEASES. 

The occurrence of contagiouB or communicable diseaseB has been re- 
ported to tbeBoard from the following places during the year, and buc- 
cessful action taken to prevent their spread : 

Typhoid fever at Pottsville, Schuylkill county. 

Typhoid fever at Scotland, Franklin county. 

Typhoid fever at Bethlehem, Northampton county. 

Typhoid fever at Two Lick, Indiana county. 

Typhoid fever at Lancaster, Lancaster county. 

Typhoid fever at Beaver Meadow, Carbon county. 

Typhoid fever at Wallingford, Chester county. 

Typhoid fever at Devon, Chester comity. 

Typhoid fever at Cressona, Schuylkill county. 

Typhoid fever at Forest City, Susquehanna county. 

Typhoid fever at Millville, Columbia connty. 

Typhoid fever at Lebanon, Lebanon county. 

Malarial fever at Sandy Lake, Mercer county. 

Malarial fever at Shanksville, Somerset county. 

Malarial fever at Montrose, SnsqaehanDa connty. 

Cerebro-spinal fever at Cheswick, Allegheny connty. 

Diphtheria at Parsons, Luzerne county. 

Diphtheria at Minersville, Luzerne connty, 

Diphtlieria at English Centre, Lycoming county. 

I>iphthena at Bangor, Northampton connty. 

Diphtheria at Chestnut Hill, Montgomery county. 

Diphtheria at PTestonville. Mout^mery county. 

Diphtheria at Tyrone, Blair county. 

Diphtheria at Oaleton, Potter county. 

Diphtheria at Nazareth, Northampton comity. 

Diphtheria at Hecksherville. Schuylkill county. 

Diphtheria at Media, Delaware county. 

Small-pox at Erie, Erie county. 

Small-pox at Scrautou, Lackawanna county. 

Small-pox at Pittsbiurgh, Allegheny county. 

Smallpox at Johnsouburg, Elk county. 

Small-pox at Philadelphia, Philadelphia county. 

Scarlet fever at Shippensburg, Cumberland county. 

Scarlet fever at Howelville, Chester county. 
Complaints of pollution of streams have been received as follows : 

Of the Susquehanna river at Steelton, Dauphin comity. 

Of a stream near the Devon luu, Chester county. 

Of the Loyalhanna river at Saltzburg, Indiana county. 

Of the Monongahela river at Braddock, Allegheny county. 

Of a stream at Bulger, Washington county. 



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No. 16. 1 ItEFOBT OF THE SeCBETARY. 

Of the Brandyrine river s,t Chfidd's Ford, Chester county. 
Of the Bnmdywin© river at Cossart'B, Chester county. 
Of the Lebanon water supply, Lebanon, Lebanon county. 
Of the Bethlehem water works, Bethlehem, Northampton county. 

iNSPECnONS 
have been made by the Board or its members: 
At the Devon Inn, Chester county. 
At Altooua, Blair county. 
At Tyrone, Blair county. 
At Bitnerville, Lancaster county. 

By the secretary : 
At Chadd's Ford, Chester county. 
At CoBsart's station, Chester county. 
On the Delaware river, Delaware county. 
At Wayne, Delaware county. 
At Camp Sherman, Devon, Chester county. 

By medical inspectors : 
At Parsons, Luzerne county. 
At Miuersville, Lozeme county. 
At Scotland, Franklif county. 
At GreensbuiK, Westmoreland county. 
At Erie, Erie county. 
At Johnsonburg, Elk county. 
At Giettysbur^, Adams county. 
At Bethlehem, Northampton county. 
At Two Lick, Indiana county. 
At Sandy Lake, Mercer county. 
At Cheswick, Allegheny county. 
At Media, Delaware county. 
At Chestnut Hill, Montg^omery county. 
At Bulger, Washington county. 
At Prestenville, Montgomery county. 
At Millville, Columbia county. 
At Shippensbnrg, Cumberland county. 
At Nicholson, Wyoming county. 
At Cressona, Schuylkill county. 
At Camp Sherman, Devon, Chester county. 
At Wayne, Delaware county. 
At Lancaster, Lancaster county. 
At Tnllytown, Bucks county. 
At Washington, Washington county. 
At Leuni, Delaware county. 
At Forest City, Susquehanna county. 



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22 State Board of Health. [Off Doc. 

At Schuylkill Haven, Scbtiylkill county. 
At HowelTille, Chester county. 
At Wallingford, Delaware county. 
At Lebanon, Lebanon county. 
At Shanksville, Somerset county. 
At Montrose, Susquehanna county. 
At Butler, Butler county. 
At Bochester Mills, Indiana county. 

Interstate Notipioation of Contaqious Dibeasrs. 

Notification of the existence of contagious diseases has been given to 
And received from the secretarieB of the boards of health of other states 
and provinces as follows: 

Smallpox. 

Notification sent to all othor state boards of health on seven occasions 
covering five outbreaks in Pennsylvania. 

Notification received from Alabama on one occasion, covering one out- 
break. 

California, on one occasion, covering one ontbreak. 

Connecticut, on three occasions, covering three ontbreaks. 

Florida, on one occasion, coveiing one outbreak. 

Blinois, on two occasions, covering two outbreaks. 

Massachusetts, on two occasions, covering two outbreaks. 

Michigan, on two occasions, covering-two outbreaks. 

Minnesota, on two occasions, covering two outbreaks. 

New York, on two occasioDS, covering one outbreak. 

North Carolina, on one occasion, covering one outbreak. 

Ohio, on two occasions, covering two outbreaks. 

Quebec, on cine occasions, covering foiu: outbreaks. 

South Carolina, on one occasion, covering one outbreak. 

Tennessee, on three occasions, covering two outbreaks. 

West Virginia, on one occasion, covering one outbreak. 

Wisconsin, on four occasions, covering three outbreaks. 

CiRCULABS. 

The following is a list of the circulars which have been issued during 
the year: 

Circular No. 28. Precautions against Consumption (second edition). 

Circular No. 29. The Dangers arising from Public Funerals of those 
who have died from Contagious and Infectious Diseases. Addressed to 
the clerical profession (second edition). 

Form 24. Annual Report of Local Boards of Health. 

AnnouQcement of State Sanitary Convention at Altoona. 

Programme of State Sanitary Convention at Altoona. 

Circular No. 32. Precautions against Sunstroke. 



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No. IC] Repobt of the Secretaby. 23 

CircalarNo. 33. School Hygieoe No. 2. Addiesaed lo achooi direc- 
tors, controllere and tinstees. 

The number of circulars sent oat durinf^ the year has beeu 20,506. 

The nomber of boxes ot circulars sent out during the year has been 
426. 

The number of written commaoications received during- the year has 
been 1,794. 

The number of written commanicatiuns Bent out during the year was 
1,777. 

The additions to the library during the year have been, in books, 98 ; 
in pamphlets, 34 ; books purchased, 6. 

Financial Eefobt. 

The following have been the expenditures of the Board during the 
year ending November 12, 1891 : 

Traveling and other necessary expenses of members, inspec- 
tors and lecturerB ; $486 29 

Inspectors 766 70 

Qoarantine, disinfections and vaccination 180 96 

Advertising and printing 120 28 

Distribution of reports by state printer 289 79 

Sanitary convention expenses 66 65 

Registration 18 10 

Incidental expenses of office; 
Traveling expenses of secretary and clerk .... $183 31 

Clerical assistance 990 06 

Postage 184 94 

Freight and express charges 67 72 

Books, jonmals, transactions and stationer; . . 47 92 

Apparatus and furniture 19 00 

Analysis, 10 00 

Storage, porterage, etc, 113 97 

Telegrams 26 31 

Janitor, messenger and sundries 11 05 

$1, 654 28 

Total $3, 582 05 

Respectfully submitted. 

Benj. Lee, 
Secretary and Treasurer. 



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State Boajid of Health. [Off. Doo. 



MINUTES OF THE BOAKD. 



Special Meetlns, December 22, 1800. 
A special meeting of the Board was held Monday, De- 
cember 22, at the executive office, at 3 p. m. Present, 
Drs. Groff, Dudley and Lee, 

The secretary presented the pay rolls and yoachers for 
the expenditures incorred in abating; the nuisances caused 
by the floods of May 31, 1889. amountiuf? to (39,928.75, 
which had been approved by the executive committee. 
They were on motion approved. 
The Board then adjourned. 

Benjahin Lee, 
Secretary. 



A. special meeting of the Board vas held at the Bolton 
House, Barrisburg-, Thursday, March 5, 1891, at 2 p. m. 

Present, Dra. Groff, Edwards, Dudley and Lee; the 
president, Prof. George G. Gro£^ in the chair. 

On motion, the reading of the minutes of the previous 
meeting was dispensed with. 

On behalf of the committee on sanitary legislation, the 
secretary presented drafts of bills for the following pnr- 
poses, viz: 

To appropriate the sum of tlO,000 per annum for the 
uses of the Board for the next two years. This bill was, 
on motion, approved for presentation to the legislature. 

"An act to prevent the pollution of and relating to the 
purification, improvement, construction and use of sys- 
tems of water supply, and authorizing the State Board 
bf Health to have supervision over the same, and pro- 
viding remedies in relation thereto." 

The secretary explained that the committee had intro- 
duced a bill for the same purpose at the opening of the 
legislative session, that the same had been laid before a 
meeting of representatives of water companies at Pitts- 
burgh. At this meeting certain objections to the bill 
were pointed out and amendments suggested. The 
present bill was the result of this conference. Dr. Fd- 



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No. 16.J Minutes. 

wards sof^gested that section 6, requiriiig the State Board AmerKio 
dE Health to report every violation of this act to the dis- 
trict attorney of the proper county, did not make it the 
duty of this oiScer to proseoate. After diacassion, on 
motion of the same gentleman, it was decided to add to 
the section referred to the following : "Whereupon the 
said district attorney shall withont imnecessary delay 
enter soit in the name of the commonwealth against the 
person or persons committing such violation." The sec- 
retary was instructed to request the committee on pnbUc 
health and sanitatioQ of the Honse of Bepresentatives 
to cause this amendment to be offered. 

A bill entitled "An act for the better preservation of Actum 
the public health, to establish local boards of health, and 
to secure the registration of vital atatistics in cities of 
the third class, boroughs and townships." The special 
object of this bill was to secure uniformity of sanitary 
organization and the registration of vital statistics 
throughout the state, and particularly to provide a form 
of sanitary organization for the rural districts. This bill 
elicited considerable discussion. The general impression 
of the Board appeared to be that the townshipij were not 
yet ready for local boards, and that the township officers i,j^a,,ho. 
named in the bill were not sufficiently intelligent, edu- '"""'™'' 
eated or responsible to be entrusted with duties of so 
much importance. The president suggested that possi- 
bly a bill could be drafted providing simply for the regis- 
tration of vital statistics, and appointing the town clerk 
of each township as registering officer for the Boarct- 
Tbe secretary was instructed to draw up a bill on this 
basis. 

The secretary announced that the committee on pub- UJ^*"^,^ 
lie health and sanitation of the House of Bepresentatives u'tLiH"^ 
had secured the use of the hall of the Honse for the even- 
ing of the same day for the purpose of hearing the ai^^- 
ments of the Board in favor of the bill for the protec- 
tion of the parity of sources of water supply, and had 
invited the members of both branches of the legislature 
to be present. He, therefore, moved that when the 
Board adjourns it adjourns to meet at the hall of the 
Honse at 8 o'clock this evening, in response to the invi- 
tation of the committee on public health and sanitation 
of the House of Bepresentatives. 

Presentation of accounts being in order, the secretary Presenui 
presented vouchers numbered 109 to 425 inclusive 



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36 Stats Boabd of Health. [0pp. Doc. 

amouaiinj: to $750.82, wbicb had been audited and ap- 
proved by tbe exooutiTe committee. On motion they 
Were approved and their payment anthorized. 

DMih ot t>T. Juno The secretary reported tbe death of Dr. James L. 

pMnuii7ntiiti>r I. StewArt, of Erie, medical inspector for the lake district. 

tc^j lupKtor. To fill the vacancy tbns created, he nominated Dr. A. A, 

Woods, health officer of Erie, who bad for some years 
been assisting Dr. Stewart in his inspeotions, in conse- 
quence of tbe failing health of tbe latter, and bad proved 
himself a reliable and competent officer. On motion, tbe 
nomination of Dr. Woods 'was confirmed, and be was de- 
clared elected to tbe position of medical inspector of the 
Lake District. 

AdjoummeDt. The Board then, on motion, adjourned, to meet at 8 p. m. 

Gemisi nuatihii In At 8 p. m. of tbo Same day (March 6, 1891), the Board 

utiTM^lt^Su?!"- I'oconvened in the ball of tbe House of Representatives. 

'"^' A general meeting was then held, composed of members 

of both branches of the legislatnre, and the Hon. Henry 

F. Walton, member of the committee on pablio health <^ 
tbe House, was called to the chair. In addition to tbe 
members present at the previous meeting. Dr. Samuel 

M™"M^hS^^Ert "^^ Davis, of Lancaster, was in attendance. Addresses 
indoiben. were made by the president of tbe Board, Prof. Geoixe 

G. Groff, Dr. Pemberton Dudley, Dr. Benjamin Lee, Dr. 
J. F. Edwards, Dr. Samuel T. Davis, Dr. Wm. B. Atkin- 
son, medical inspector, Dr. Spencer M. Free, medical in- 
spector. Dr. Henry Leffmaun, water analyst, Mr. H. W. 
Hartman and Mr. Meredith, both the latter gentleman 
representiag the association of twenty-six water com- 
panies west of the Allegheny mountains. Letters were 
read from Dr. Charles M. Cresson, water analyst, from 
Dr. E. D. Payne, medical inspector, on behalf of the 
borough of Towauda, and from representatives of muni- 
cipal corporations or water companies of a number of 
cities and boroughs in the eastern part of tbe state, ex- 
pressing their approval of the bill. 

So far as it was possible to form an opinion, the mem- 
bers of the legislature present were favorably impressed 
by the arguments advanced. 
Adjoumioeni jij^g Board theu, on motion, adjoume<1. 

Benjamin Lee, 
SecretaTy. 



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No. 16.] 



Special Meeting, Hay 1, 18Q1. 



A special meeting of the Board was held at the execu- t 
ti-ve office on Friday, May 1, 1891, at 3 p. m. 

Present, Hon. Samuel T. Davis, M. D., Pemberton 
Dadley, M. C, Benjamin Lee, M. D., and J. F. Edwards, 
M. D. (by proxy). 

In the unavoidable absence of the president the Hon. 
Samael T. Davis was called to the chair. , 

The secretary presented an invitation from the Na- 
tional Conference of State Boards of Health to the Board ot'suwai 
to send delegates to the approaching meeting at Wash- 
ington, D. C. 

On motion, Drs. Groff and Lee were appointed as dele- 
gates. 

On behalf of the committee for sanitary convention, ^"'^[So" 
the secretary presented and read a copy of the announce- gl^SJ^" 
ment of the fifth sanitary convention to be held at Al- 
toona, on the 15th and 16th instant. A copy of the an- 
nouncement of the convention, sent to the leading papers 
nnd other journals in the state, was also read. Also a 
proof copy of the pro^^ramme. 

The report was accepted and programme approved 
with slight alterations. ■ 

The secretary reported that the borough council of Nuuuee ■ 
Steelton had recently complained that the Susquehanna 
river at that place was being serionsly polluted by the 
deposit of night soil and garbage on the banks thereof, 
and their inability to prevent this nuisance. They asked 
for the intervention of the Board in this matter. 

The secretary was instructed to proceed in the usual 
way tor abating this nuisance. 

A recent outbreak of typhoid fever among the em- TrphoM u 
ployos of the Pottsville Iron and Steel Company had led 
to suspicion of the water drunk by the employes. I>r. 
James S. Cnrpent«r, of Pottsville, had submitted samples 
of water taken from the suspected spring to the Bt^rd. 
Dr. Gresson prononnced the water as swarming with 
typhoid bacilli. The secretary wired Dr. Carpenter of 
the result of Dr. Cresson's examination, and the spring 
was at once closed, an immediate abatement of the cases 
of fever being apparent. Subsequently the company had 
BDbmitted samples of water from this spring to Dr. For- 
mad for analysis, who pronounced the water pure. A 
further examination of samples of water from the same 



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State Board of Health. 



[Off. Doc. 



spring by Dr. CresBon, taken at a later period, were by 
him also prouoimced as pure. 

The aotioD of the Becretary was approved. 

Dr. Pemberton Dudley submitted Touchers Dumbered 
426 to 436, amoanting to $460.14 of accounts examined 
and appFOved by the executive committee. 

On motion, they were approved, as was also voucher 
438 for fS.ie. 

The Board then odjonmed. 

Benjamin Lee, 
Secretary. 



KiRbiHDth nta\Mr The eig'htceoth rej^ar meeting of the Board was held 
°"" "'' at Altoona, May 14, 1891, at 4 p. m., at the Logan House. 

u*mb«n pnMDt. Present, Dr. George Q. Groflf, president; Dr. Pember- 
ton Dudley, Dr. J. H. McClelland, Dr. Benjamin Lee, 






The president in the chair. 

The secretary read a telegram from Dr. S. T. Davis, 
stating that he was unable to be present owing to pro- 
fessional duties. Dr. J. F. Edwards had personally ex- 
pressed to the secretary his regrets that he would be un- 
able to attend the meeting. 

An order of business, presented by the secretary, was 
adopted as the order of the day. 

The minutes of the last regular meeting held at Hnr- 
rieburg, November 13, 1890, were read and confirmed. 

The minutes of special meetings held at Harrisburg, 
March 6, 1891, and at Philadelphia, May 1, 1891, were 
also read and confirmed. 

The secretary stated that the resolution of the Board 
with regard to prohibiting the importation of rags from 
Spain, had been sent to the authorities of all ports of 
entry in Pennsylvania; also to Dr. John B. Hamilton, 
of the marine hospital service, Washiogtou, D. C, and 
all maritime ports on the eastern coast of the United States. 

The secretary then presented his report, which con- 
tained the following items : 
, 1. Report of secretary as delegate to the meeting of 
. the American Public Health Association, held at Wash- 
ington. D. C. 

2. Report of secretary as delegate to the national con- 
ference of State Boards of Health, held at Washingtout 
D. C. 



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No. 16.] MlKUTES. 

8. Beport of secretary as secretary to the section on Bsenurr h 
state medicine of the American Medical Association. 
The secretary saggeet^ that a valoable paper on school 
hygiene, prepared by Dra. Lincoln and Beed, be inserted 
in the annual report. The matter wad referred to new 
business. 

1. The fifth annual report of the Board, containing 726 mihanDu* 
pages and index, comprising 12 appendices, one of vhicb "^ 
is devoted to the history of the work of the Board in 
Johnstown, had been partially issued since last meeting. 
Some delay had taken place in the distribntion owing to 
the lack of fnnda. Included with this report are the re- 
ports of the State Weather Service and that of the State 
Pharmaceutical f^xamining Board. 

5. The sixth annual report of the Board was now ready prenntion 
for the printer, awaiting the report of the state pharma- p^"- 
centical examining board, which had been mislaid in 

some other department. Unless this last named report 
was forthcoming in a few days the secretary would give 
ioBtructions for proceeding with the printing. 

6. In reply to a reqnest for the filling up of an abstract R«poru m ■ 
form (a copy of which would be presented to the board hhiui. 
later) of annual report of 1690, the Altoona, Bradfoid, 
Carbondale, Chester, Johnstown, Lebanon, Meadville, 
Norristown, Beading, Scranton, Titusville, Wellsboro', 
Williamsportand Oil City boards of health had complied, 

and their reports were presented. 

7. Information from the consul-general at Carthagena ^ 
that the steamship "Orpington," from that port, in which jj^^ 
two cases resembling cholera have just occun-ed, was ex- 
pected shortly at Philadelphia, was recently received by 
the secretary from the supervising surgeon general of 
Marine Hospital Service. He at once notified the Phila- 
delphia authorities of the fact. 

8. The secretary read copy of a letter sent by Dr. John iwimioo . 
B. Hamilton, sui^^on general United States Marine 
Hospital Service, to the president of the Philadelphia 
hoard of bealtli, in regard to the isolation of lepers in the 
United States, expressing the opiwon that congress shoold 
legislate upon the subject. 

9. The leper Anderson was still confined at the Dela- Lepnn^ a 
ware oonnty hospital, near Lima. The difficulty of his "" "'* 
removal being due to the fact that all the steamship com- 
panies decline to ship a case of leprosy. The question 



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State Boabd of Health. 



[Off Doc. 



of the ultimate disposal of this caee vsa referred to new 
busiDees. 

10. A report that diphtheria prevailed to ao alarming 
extent aod in a malignant form at Farsons, Luzerne 
county, was, on investigation by Medical Inspector L. 
H. Taylor, found not to be well founded. A similar report 
of an epidemic at Minersville was investigated with a like 
result. Oircuiatshad been freely distributed, and a copy 
of a letter of instructions sent to the burgess of Progress 
was now read. 

11. A complaint that diphtheria prevailed at English 
Centre had been received. Circulars were sent 

12. The bureau of public safety of Pittsburgh had com- 
plained that bodies were being disinterred and removed 
from one cemetery in that city to another without permit. 
The secretary replied at once, stating the Board would 
use its authority in this matter, in case a nuisance was 
being created. On further inquiry it was found that 
most of the bodies removed had been buried from thirty 
to fifty years. The Board, therefore, did not feel called 
upon to interfere. 

13. Several applications for certificates of deaths of 
Italians in Pemmylvania bad been received of late from 
the consul general of Italy. Snch information could 
rarely be obtained, owing to the lack of any system of 
registration. It was a humiliating fact that Pennsylvania 
was in some instances indebted to the State of New Tork 
for a record of vital statistics in her own bordera 

14. An epidemic of diphtheria at Bangor, Northamp- 
ton .county, had been met with prompt and effective 
measures for its suppression from the Hanitary committee 
of the borough council. Handbills and postets, warning 
persons against the disease, etc., had been freely dis- 
tributed thoughont the town and in families. No public 
funeral (except in one instance, in which there was an 
error in diagnosis) had been held. This commendable 
action on the part of the local authorities was referred to 
new business. 

16. The secretary had consulted the Attorney General 
by correspondence, as to the power of the State Board in 
the suppression of contemplated epidemics. His answer 
(which was now read) was to the effect that the powers 
of the Board were designed to be used only in the pres- 
ence of or on the near approach of an epidemic, and 



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No. 16.] Minutes. 31 

conld not be extended to g^eneral ref^ulatioDB of a pre- 
ventive character. 

The Board then adjourned to meet at 8 o'clock the AdiDummaiit. 
same evening. 

The Board reconvened at 8 p. m. The secretary con- 
tinaed the presentation of his report. 

16. A recent investigation into the cftuse of typhoid l^ohow f™ " 
fever at Scotland, Franklin county, by Medical Inspector mnntr. ' 

R. L. Sibbet, had lead him to attribute the outbreak to 
the use of impure drinking water from two wells. He 
had advised that cistern water be used for domestic and 
culinary purposes, there not being a pure well in the 
place. Owing to the porous nature of the soil, impure 
water found its way into the wells from several sources 
which he indicated to the people. 

17. A. complaint from the authorities of Carbondale Sf'^^J'f^^'" 
had been received, stating that impure ice was being 

stored by a dealer for use in their city. The secretary 
bad in Uie first instance advised that the man be re- 
quested to sell the ice only for cooling purposes. This 
was declined. He then advised that the local board give 
pnblic notice that the offender was dealing in impnre 
ioe, which was replied to by a threat of legal proceedings. 
In the event of this being done, the secretary further ad- 
vised that the dealer's wagons be placarded. 

18. An extract from the last message of Governor BitneufromooT- 
Beaver, commending the action and' measures of the meu>«e. 
Board at Johnstown, and advising the legislature to con- 
fer additional powers upon and make a larger appropria- 
tion to the Board for its uses, was read by the secretary. 

19. A very able paper, written by Dr. R. Harvey Beed, Rsporian impec- 
health officer of Mansfield, Ohio, condemnatory of the houw.'tiT'^r.'^R. 
usual mode of conducting slaughter houses, was now 

read. The paper was referred to new business. 

20. A complaint had recently been received from Mi'. muDiurr priion 
Frank Cowan to the effect that the sanitary condition of ™ " ™*°' ""' 
the court house at Greensburg, Westmoreland county, 

was deplorable, owing principally to the fact that the 
basement was used as a prison, and the cells were inade- 
quately ventilated and very filthy. Medical Inspector 
W. E. Matthews had inspected the jail and fully corrobo- 
rated the complainant's statement. The secretary had 
atonce condemned these cells, and suggested other reme- 
dies. The prison was shortly afterwards removed to 



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State Board of Health. [Off Doc. 

anotlier baildiug, and the cellars of the conrt house thor- 
oa^hly cleaned and disinfected. 

21. A case of varioloid at Scranton had been oootracted 
through handling mails from Texas; the patient being a 
letter carrier. The case was promptly isolated and 
children in the neighborhood freely vaccinated. No 
further case resnlted. 

22. A case of smallpox had occurred at Erie from a 
similar cause, in the person of a teacher in a brotherhood 
school. The health officer. Dr. WoodR, had at once placed 
the patient in hospital, and instituted gratuitous vacci- 
nation, which had been performed in 846 cases. The 
school was closed. No other cases occurred. 

23. An alarming outbreak of smcJl-pox at Johnson- 
burg, Somerset coimty, was reported to the secretary by 
Dr. J. W. Palmer, on February 8. Medical Inspector 
Spencer M. Free was notified at once, and toot charge 
of the district the samo day, establishing strict quar- 
antine and vaccinating over 2,000 children and adults 
The secretary had also visited the distnct, and had had 
a conference with the railroad officials ; and every effort 
bad been made to prevent the spread of the disease. 
Eleven cases and four deaths had occurred. What 
might have been a wide-spread epidemic was thus 
stamped out. The commendable action of Medical In- 
spector Free in this matter was referred to new business. 

I 24. Information that the steamship " Helmsley," from 
Philadelphia, had' put into Norfolk. Va., with a case of 
small-poxon board, was recently received by the secretary. 
Both the port^ physician and the local company surgeon 
had examined this patient on the previous Saturday in 
Philadelphia, and had failed to correctly diagnose the 
case. The secretary thought it possible that the four re- 
cent cases of small-pox in Philadelphia might have ema- 
nated from this steamer. 

26. An inquiry had been received from Middletown as 
to the use of flesh of pregnant animals The secretary 
had replied that there was no law on the subject, and 
had no knowledge that such meat was unwholesome. 

26. A complaint of an open sewer and deficient drain- 
age at Gettysburg has been received. Medical Inspector 
B. li. Sibbet had been instructed to investigate, and had 
verified the reported condition. He had conferred with 
the council, and also addressed a public meeting of citi- 
zens called at his suggestion to consider the subject. 



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No. 16.] Minutes. 

Ko definite etepa to remedy the condition had up to the 
present time been taken, the board h&Yiug no power to 
enforce Bewera^. 

27. A considerable number of typhoid fever cases had Trphoidtt 
occnrred at and near Bethlehem in the past few months. 
Medical Inspector Cbas. Mclntire, Jr., hadfuUy investi- 
gated the matter, and reported the origin of the cases to 

be the use of impmre water. He submitted a phin show- 
inur locality of cases and their relation to the water sup- 
ply. There had been 492 cases and 83 deaths. 

28. A recent inspection of Two Licks, Indiana county, Xj;i'''J'|f.'' 
by Medical Inspector W. E. Matthews^ showed that there 

had been 60 cases of typhoid fever, out of a population 
of 80 souls, one out of every eifht attacked having suc- 
cumbed to the disease. The supply of water was from 
impure wells. The secretary had advised that driven 
wells be provided, and received assurances from proprie- 
tors of manufactories that this should be done. 

29. A complaint having been received that much ma- uxwioi i« 
larial sickness prevailed at Sandy Lake, Mercer county, oouair.'* ' 
Medical Inspector A A Woods had investigated and 
reported that the village was built on swampy low 
ground The drainage was deficient, and neighboring 
streams sluggish, causing cellars to be frequently flooded, 

and thus producing sickness. No remedy, except im- 
proved drainage was possible, and the secretary advised 
the removal of habitations to higher ground, the Board 
having no authority to undertake engineering operationa 

30. On information of death from cerebrospinal fever ce™brt,-.pi 
at Cheswick, Allegheny county. Medical Inspector J. it. Aiiti^m- ■ 
Thompson had inspected the place. He reported two 
deaths in one family, of children five and seven years 

of age, of this complaint. He had recommended a gen- 
eral cleaning up of the place. 

31. A complaint had been received from the sanitary niptiiheria 
committee of Media, Delaware county, that proper pre- ^tHlf;.""" 
cautions had not been taken in a recent case of malig- 
nant diphtheria occurring in a school of that town. Med- 
ical Inspector W. B. Atkinson investigated this matter, 

and reported that very stringent pi-ecautions had been 
taken, and there was no ground for complaint whatever. 

32. The secretary had been in correspondence with the DwiniecHni 
United States marine hospital service at Washington, D. "atcr. 

C, with reference to rendering the quarantine service at 
the mouth of the Delaware Bay more efficient. With 



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State Boabd op Hkalth. [Off. Doa 

regard to the bill now before tha lej^latore. he read a 
coanntmicatioD from Supervising Surgeon General Ham- 
ilton stating that it was in contemplation shortly to pro- 
vide very efficient means for disinfection at the Delaware 
breakwater, the government iron pier having been lent 
to his department for the purjiose. 

33. The Iowa State Board of Health had submitted an 
amended form of transit permit for the shipment of 
bodies dead of contagious diseases, in which the trans- 
portation of bodies dead of diphtheria was forbidden. 
The matter was referred to new bttsinees. 

34. By request of the borough authorities of those 
places eight specimens of water from Punxantawney, 
Spring Creek, Marietta &nd Northamberland, had been 
submitted to aad examined by the board's analyst, all of 
which were found contaminated by vegetable and cess- 
pool material 

, 35. A further complaint of the pollution of a stream by 
drainage from the Devon Inn, in consequence of new 
houses having been conueoted with the system, was re- 
ferred -to new business. 

36. TheBethIehemSteam,Ga8 andWaterOompanyhad 
complained of the presencoof two dead animals is a stream 
ased for domestic purposes. The secretary had replied 
stating the fa43ts with regard to the bill on this sabject 
before the legislature and had suggested recourse to the 
courts. 

37. The Hon. J. M. Rusk, Secretary, Department of 
Agriculture, had requested an answer to oertaia questions 
with regard to the adulteration of food in Pennsylvania. 
The matter had been referred to Dr. Henry Leffmaun, 
food analyst to the State Board of Agriculture. 

38. The total number of written communications re- 
ceived by the secretary since the last regul&r meeting 
hafi been 981 ; the total number sent had been 962. 

39. The additions to the library during this period had 
been books, 20 ; pamphlets, 21. 

10. Circulars distributed, 15,118; annual reports sent 
out in exchange, etc., 1,325. 

It was DOW 

Resolved, That the report of the secretary, as detailed, 
be accepted and approved. 

The Board then adjourned to meet at 6:30 p. m.. May 
15, 1891 (the following day). 



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No. 16.] 



MiNIITES, 



Beports of atandiD^ committeea being in order. Dr. 
Pemberton Dudley Biibmitted a report from the exeoa- 
tive committee. Bhowing that two regalar and two special 
meetings of that committee hod been held since the an- 
noal meetinsr of the Board in November last, when sc- 
connta (vonchers Dumbered 409 to 438 inclusive) were 
examined and approved, amounting to fl,£i04.89. The 
report was accepted. 

Dr. Benjamin Lee, as chiurman of the committee on 
vital statistics, reported the preparation of a form for the 
return of reports of boards of health in abstract. The 
report was accepted and referred for publication. 

Mr. Howard Murphy, C. E., chairman of the committee 
on draina^, water supply, etc., had sent a communication 
urging the Board's attention to the Devon Inn drainage 
nuisance. The report was accepted. 

In the absence of Dr. S. T. Davis, chairman of the com- 
mittee on sanitary legislatiun, rules, etc.. Dr. Lee re- 
ported progress as regards the bills before the present 
legislature. A copy of the annual report for 1888, I'D- 
gether with specimen box of all the Board's circulars to 
date, and cyclostyle letter bad been sent to each member 
of the legislature. The report was accepted and referred 
for publication. 

Dr. J. H. McClelland, chairman committee on sanitary 
conveution, submitted a report which was accepted. 

Accounts, voucher No. 437, which had been audited 
and found correct by the executive committee, amounting 
to $288.97, were now submitted to and approved by the 
Board. 

The Board then adjourned to meet at 10 p. m. the same 
day. 

The Board reconvened at 10 p. m. the same evening. 

New business being in order, the secretary submitted 
a new antiseptic raw cotton blanket as a substitute for 
the wet sheet at present in use for enveloping bodies 
dead of contagions diseases. Ou motion, it was 

Resolved, That tbisBoard approves of and recommends 
the antiseptic envelope for the bodies of those who have 
died of contagious diseases, proposed by the secretary as 
a sabstitnte for the sheet s(^ed in corrosive sublimate 
Bolution heretofore required by the Board. 

The secretary submitted a circular prepared by the 
president on the treatment of the apparently drowned 
and suffocated, for distribution in families and schools 



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State Boabd op Health. [Off. Doc. 

aud posting on vessels, vharfs and near bathinff resorts, 
etc., in two forma. Also a circular on the conskuction 
of school houses, for diBtribution among trustees, school 
directors, etc. The circulars were approved, the school 
hygiene circular being ordered to be submitted to the 
committee on school hygiene, etc., for its consideration. 

In the matter of the nliimate disposal of the case of 
leprosy at Lima, Delaware county, the case was left in 
the hands of the secretary. 

With regard to the prompt measures adopted by the 
sanitary committee of the borough council of Bangor 
against diphtheria, it was ordered that the following reso- 
lution be sent to the committee : 

Resolved, That the State Board of Health has received 
with great satisfaction the report of the recent action of 
the sanitary committee of the borough council of Bangor 
in stamping out an epidemic of diphtheria, and heartily 
recommends the promptness and decision with which the 
emergency was met. 

A paper on "Beport of an Inspection of Slaughter 
Houses," etc., by Dr. R Harvey Reed, of Mansfield, Ohio, 
was referred to the committee on sanitary legislation, 
roles and regulations. 

The secretary was instructed to transmit the following 
resolution to Dr. Spencer M. Free, medical inspector for 
the western slope district; 

Resolved, That this Board desires to express its hearty 
appreciation of the good judgment and energy displayed 
by Dr. Spencer M. Free in his management of the recent 
threatening epidemic of small-pox at Johnsonburg, which, 
but for his prompt interference and constant presence, 
might have readily extended to every part of the state. 

With regard to amending the regulation for the ship- 
ment of bodies dead of contagious diseases, it was not 
considered expedient that diphtheria should be classed 
with those diseases from which the bodies of those who 
have died shonld be prohibited from transportation. 

In view of the fact that the term heart failure is often 
used to conceal the real cause of death, it was 
h Resolved, That all boards of health in this state be 
recommended to refuse certificates of death giving "heart 
failure" as the sole cause of death. 

The subject of the drainage of the Devon Inn being 
cdled up, it was 

Resolved, That in view of the recent additional com- 



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No. 16.] M1NDTE8. 37 

plaint, and of the lact that the Board was not satisfied on 
its inspection of the Devon [nn drainf^r^ pnrification sys- 
tem that the liqoid after leaving the filter was in proper 
condition to enter a public stream, this subject be again 
referred to the commibtee on water supply, drainage, etc. 
The Board then adjourned. i^joummeEt. 

Benjamin Lee, 
Secretary. 

Nineteenth B^rolar Ueetins. 

The nineteenth regular meeting of the Board was held ^tUJ""* "»"'" 
in the supreme court room, Harri&baiv, at 4 p. m., July 
9, 1891. 

Present, Drs. Geo. Q. Groflf, Pemberton Dudley, 8. T. m«idi.«. pre«ent. 
Davis and Benjamin Lee, secretary. 

The president in the chair. 

The secretary read a communication from Dr. J. H. 
S&<ilelland, stating thai he would be unable to be pres. 
ent. Dr. J. F. Edwards had also personally expressed- 
to the secretary bis regret at being unable to attend. 

An order of business, presented by the secretary, was omer of bu>iD«*. 
adopted as the order of the day. 

The minutes of the last regular meeting, held at Al- Appro«i o( minu- 
toona. May 14, were read and approved. 

Drs. Groff and Dudley, who had been reappointed as RMppamtmeni of 
members of the Board, presented their commissions, and '''^''^■ 
received the congratulatioas of the other members. 

TheBecretary then presentedhisreport, which included BB™urTtn>i«n.. 
the following items: 

1. In accordance with the instructions of the Board the RsHintiooiiunr. 
resolutions of approval to Dr. Spencer M. Free and the " « ™- 
sanitary committee of the borough council of Bangor had 

been sent immediately after the'last regular meeting. 

2. The secretary had received a communication an- co««>*i]]sti«niof 
nonncing the fact that a board of health had been estab- *"^*''' 

lished at Coatesville, of which Dr. Ida V. Riel had been 
appointed secretary. It was the first instance within his 
knowledge of a woman becoming secretary of a board of 
health. 

3. A complaint thatmalignaut diphtheriaandscarletfe- DipbUMnxwa 
ver prevailed at a bouse at Chestnut HiU had been inves- cbMuitBiiiV 
tigated by Dr. Wm B. Atkinson, medicalinspector. He 
reported that the drainage from a cesspool had found its 

way into the cellar and lodged there, owing to the imper- 
vious nature of the soil; and that the heater in the cellar 



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Lojklbwiiw rlTn ■ 



DetMtltfl OtUnice 



State Board of Health. [Off. Doc. 

assisted in dissemiuatiiig the germs of diaesse tbion^b- 
oot the entire bouse. One fatal caae had occtirred. He 
reoommeDded that the soil in the cellar be excavated and 
replaced with fresh earth, and the plombinf; thoroaghly 
disinfected. In regard to the service of a notice to abate 
this dangeroos condition, the secretary asked whether 
notice shoold be sent to the landlord or his agent. The 
matter was referred to new businses. 

4. A serious condition, canaed by the pollution of the 
Loyalhanna river at Saltsbur^by dead animals, night soil, 
etc., was recently reported to the secretary by tfae.Bev. 8. 
W. Miller, of SaJtsburg. The pollution was, in the opinion 
of the reporter, sufficient to contaminate the waters used 
by Pittsburgh and Allegheny for drinking purposes. In 
reply the secretary had pointedonttothe reverend gentle- 
man that the lant legislature had strenuously opposed 
legislative interference with the pollntion of streams in 
Pennsylvania, leaving the Board helpless in the matter. 
He bad asked the cooperation of the clerical and other 
professions in the effort to induce the legislature to pass 
enactments prohibiting such pollution. 

6. A verbal complaint of defective draina^ at Jenkin- 
town bad been made to the secretary. The nuisance was 
caused by the drainage from ten houses. The complaint 
was confirmed by one of the Jenkintown physicians. On 
receipt of notice from the Board to abate, a member of 
the borough council had replied, stating that the streets 
in question would shortly be paved and drained, and the 
nuisance abated. 

6. A complaint of defective drainage at Altoona had 
not been confinned by affidavit as required. 

7. A similar complaint at Chadd'sFord bad also failed 
of the proper support. 

8. A complaint of the pollntion of the Monongabela 
river at Braddock, caused by the dumping of garbage 
from a boat at the instance of the borough authorities of 
that place had been received. As the Pittsburgh author 
ities had ample powers extending five miles outside the 
city limits, and Braddock was situated within that dis- 
tance, no action was deemed necessary. 

9. A complaint of the pollution of a stream at Bulger, 
Washington county, by decomposing whey and refuse 
from a creamery had been made to the Board. A similar 
condition existed at this creamery last year and the 



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No. 16.] MuTOTES. S9 

abatement of the nniaance ad then been ordered. The 
Board directed that immediate action be taken. 

10. Application havinjir been made for a copy of the D«tti oenmcue ot 
death certificate of an Italian who was killed at Potts- 

viUs on the railt^ad, the secretary had applied to the 
burgess for certificate. The Board directed that appli- 
eatioD be made to the county coroner. 

11. Complaint has been received of a nuisance at Mor- Nni««i«nMom.- 
risdale minee, Clearfield county, from a slaughter house. 

The usual forms had been sent, but no reply has yet been 
received. 

12. A complaint that diphtheria prevailed in a malig- iHptiiharu m it«ii- 
nant form at Prestonville was investigated by Medical 
Inspector William B. Atkinson. He reported the defec- 
tive drains^ of a cellar where the fatal cases bad oc- 
curred, and had ordered the nuisance abated and cellar 

cleansed. 

13. TwocomplaiDteofdefectivedrainageatLansdowne, Dcf«ciTa dmuce 
Delaware ooonty, had been received, but not being in ' 

proper order had been returned for amendment. 

li. A communication was presented ^om the board of Banmi parmiu u 
health of Lancaster, complaining that undertakers de- 
clined to pay thecbargeof twenty-fivecentsfor burial per- 
mits, and asking for a decision ot the Board as to its 
power to make snch a charge The Board referred the 
matter to new business. 

15. The secretary announced his appointment by the Appomtaentsir 
Ck>verDor on the commission for considering the removal nanJDf'qunD- 
of the quarantine station of Philadelphia. A copy of the " ' 

bill was also read. The commission had recently met at 
Harrisbntg, and had appointed the Governor as chair- 
man, Dr. Henry Leffmann as secretary, and George J. 
Brennan as clerk. The commission bad already visited 
the quarantine station. The secretary requested per- 
mission to incorporate the regulations of the board of 
health of Philadelphia for the disinfections of vessels 
and ba|^;age in the ftrmnal report. Beferred to new busi- 
ness. 

16. In establishing a local board of health at Phcenix- uxna twum of 
ville, the authorities there had adopted the model ordi- "Uie. 
nance of the Board, and proposed to go to work vigor- 
ously to enforce it. 

17. A complaint of an epidemic of typhoid fever in a TjpboidfsTerat 
snbnrb of Lancaster, received since the opening of the ^"""^• 
meeting, was ordered to be investigated forthwith, Dr. 



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Mbool brglGR* 



State Boabd op Health. [Off. Doc. 

Davis supporting the complaiDt fromhis personal knowl- 
edge. 

Tbe secretary's report as a whole was now adopted. 
' Reports of the standing committees beinj; in order: 

The ezecutiTe committee (Dr. Pemberton Dudley, 
chairman) reported that one meeting had been held since 
the last regular meeting of the Board, wheu vouchers 
numbered 438 and 440 to 443 inoluBive, amonnting to 
$66.84 and $561.08, were audited and approved. The re- 
port was accepted. 

The committee on vital statistics (Dr. B. Lee, chair- 
man) stated that Dr. Hoppin, of the prothonotary's office 
of Philadelphia, reported that 362 physicians had regis- 
tered in Philadelphia during the year ending July 1. 
The names of sixteen physicians who had died in the 
city in the same period were also given. « 

The committee also presented a copy of the coroner's 
certificate respectingthe body of a still-bom child thrown 
into the Monongahela river at or near Mifflin township. 

Tbe report was accepted. 

The committee on preventable diseases, disiniecnon, 
and supervision of travel and traffic submitted a report, 
prepared by the president. Dr. Groff, being a circular on 
sunstroke, which had been submitted to Dr. H. C. Wood, 
of Philadelphia, for revision, and was recommended to be 
published in a leaflet form. 

The report was accepted. 

No report being forthcoming from the committee on 
school hygiene, the secretary was directed to request 
from the chairman (Dr. J. H. McClelland) the return of 
circular on school buildings, in order that the same might 
be published. 

On behalf of the committee on sanitary legislation, 
rules and regulations. Dr. B. Lee reported that House 
bill 636, for the appropriation to the Board, had been 
amended and the sum of $6,000.00 allowed per annum for 
the next two years. A bill to prevent the drainage of 
cemeteries contaminating the water supplies of cities of 
the first class ; and a bill to prevent contamination of 
water by abandoned oil and gas wells had also been 
passed during the last session. 

Nomination and election of a president for the ensuing 
' year being in order, Dr. Lee moved and Dr. Davis sec- 
onded the nomination of Dr. J. H McClelland. The vote 



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No. i60 MnnjTEs. 

was taken by ballot and resulted unanimously in favor of 
Dr. McClelland, who was declared duly elected for the 
eQBuing year. 

New bnsinesB bein^ in order, the question whether Nswuu^ino 
landlords or their agents were to be comtDonicated with 
in case of nuisances was (:alled np. The Board decided nuiudcs w 
that DoticeB be sent in such cases to landlords. 

In the matter of a charge for burial permits at Lan- cbuie for 
caster, the secretary was directed to look into the ques- p*"°'"- 
tion and satisfy himself as to the existence of laws and 
ordinances conferring that power upon the local board, 
and to acquaint the local .bcMird with his decision. 

It was ordered that the circular on disinfection at the drenianoi 
quarantine staiitm be incorporated in the annual report. 

Accounts, vouchers numbered 488 and 140 to 463, aoouudh > 
amounting to $66.84 and $664.08, which had been audited 
by the executive committee, were submitted to and ap- 
proved by the Board. 

The matter of holding a series of local conventions in buiutj co 
place of one annual sanitary convention waa brought up ""'"■ 
by Dr. P. Dudley and discussed, but no action was takei) 
thereon. 

The Board then adjourned. AujoDrnme 

Benjakim Lee, 
Secretary. 



Special Ueetlng, August 31, 1891. 

A special meeting of the Board was held at the execu- specisi mMitng. 
tive office, at 12 o'clock on Monday, August 31, 1891. 

Present , Dr. Geoi^e G. Groff in the chair, Drs. Ed- 
wards, Dudley and Lee. 

The secretary presented accounts, vouchers numbered pr»ent*tian at 
439 and 464 to 466, amounting to $460.28, which had '**""'°"- 
been audited by the executive committee and found cor- 
rect. They were on motion approved. 

A telegram from Dr. H. T. Davis, stating that he was 
unable to be present was read by the secretary. The 
secretary stated that tiie president. Dr. J. H. McClelland, 
was absent in Europe. 

The secretary announced the death of Dr. 0. L. Gum- duuii of Dr. c. i 
mert, medical inspector for the Southern Tier District, ''"°""'"- 
and nominated Dr. J. S. Hackney, of Uniontown, 
president of the Fayette County Medical Society, to "' ^ 
fill the vacancy thus created. Dr. Dudley seconded 



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State Boabd of Health. [Off. Doc. 

the nomination, which was carried nnanitnoiialy, and 
Dr. Hackney was declared elected medical inspector for 
the Southern Tier District. 
■ A communication from a citizen of QermantowD, on the 
deleteiiouB qcalties of chemically preserved milk, aooom- 
panied by advertisements of milk preBervatires oat from 
the Gtormantown newspapers was read. After discussion, 
it was resolved that the matter be referred to the com- 
mittee on adnlterations. poisons, etc., with instructions 
to report on the same at the forthcoming meeting of the 
Board in Kovember. 

A complaint bad been received from the Delaware 
State Boud of Health that the watets of the Brandy- 
wine river were being poUated by dead hc^ and the 
drainage from two creameries at Cossart Station and 
Chadd's Ford in Chester county, Pennsylvania, where a 
lare:e number of hogs were kept. The secretary, with 
Oie medical inspector of the district, investigated the 
complaint, which was folly confirmed as regards the 
oreunery at Ohadd's Ford. Notices had been sent to the 
parties requiring them to abate these naisances forth- 
with, which notices were being duly carried out. The 
action of the secretary was approved. 

In regard to the pollution of streams in Pennsylvania, 
the secretary pointed out the advisability of asking 
congress to pass a law prohibiting the pollution of all 
streams, the waters of which fiowed from one state into 
another. This would affect a majority of the most im- 
portant streams in the United States. The Board ap- 
pointed a committee consisting of Drs. Groff, Dadley 
and Lee to investigate and report on this subject. 

The Board then adjourned. 

Benj. Leb, 
Secretary. 



Special Meeting. October 34, 189L 

A special meeting of the Board was held Saturday, 
October 24, 1891, at 2 p. m., at the office of Dr. Wilham 
B, Atkinson, medical inspector tor the Delaware district, 
to cooeider the subject of the drainage of the Devon Inn. 
Present, Dr. Samuel T. Davis, Dr. J. F. Edwards. Dr. 
George G. Groff, Mr. Howard Murphy, C. E., and Dr. 
Benjamin Lee. 



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Ho. I6.3 Minutes. 

The seraretary moved that in consequence of the al> 
senoe of the president, Dr. J. H. McClellaud. who iras 
still in Europe, Dr. Samuel T. Davis take the chair. It 
was carried. 

Mr. Howard Marpby moved that the reading of the 
minntes be dispensed with. It was carried. 

There were present by invitation Messrs. Coffin &. 
Altemus, owners of the Devon Inn; Mr. J. H. Cramp on 
behalf of the lessees ; Mr. Paist, {s^eneral manager, and 
Mr. William "Waddell, attorney ; Mr. C. Davis English, 
the principal complainant; Dr. Henry Leffmann, analyst, 
and Medical Inspector WiUiam B. Atkinson. 

In introducing the subject to the meeting, the secre- 
tary stated that the drainage of the Dev<Hi Inn was first 
oomplaiucd of in a verbal commonication by Mr. C. Davis 
English during the absence of the seoretary at Johns- 
town, where he was compelled to spend the entire sum- 
mer superintending the work of sanitary relief of that 
city. The date of this visit by Mr. C. Davis English, 
was Jane 28, 1889. He begged leave to submit the fol- 
lowing documentary history: 

1. December 6, 1889. Jjetter from Mr. Murphy to the 
secretary, enclosing the record of the regular meeting of 
the Engineer's clnb, of Philadelphia, held November 16, 
1889, at which the Bimmer oxidizer was subject to num- 
erous critical tests, and appeared to work satis&ctorily. 

2. Copy of above-mentioned record. 

3. May 2S, 1890. Letter from Mr. Howard Murphy to 
the secretary endosing a letter to Messrs. Coffin and 
Altemos, stating that they had not kept their pledge, 
that the purification system should be in full operation 
before the spring opening of the hotel, and nrging the 
immediate fulfilment of their promise. 

4. Same date. Copy of letter of Mr. Murphy to 
Messrs. Coffin ft Altemus above referred to. 

5. Jane 10, 1890. Letter from Mr. Mnrphy to the 
secretary, stating that the plant was nearly completed 
and requesting the Board to inspect it. 

6. Jane 16, 1890. Letter from General Knssel Thayer 
to secretary postponing the visit of inspection. 

7. June 27, 1890. Beport of the secretary of the in- 
spection of the plant of the Devon Inn by the Board, de- 
claring that the purification was not yet sufficient, but 
suggesting that time be given to allow the apparatus to 
be broaght into complete working order. 



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State Boabd op Health. [Oft, Doc. 

8. July 1, 1890. Xjetter from Mr. Mnrpby to the secre- 
tary! BuggeBtiag that samples of water be taken from a 
iiamber of poiots and subjected to analyBis. 

9. Jtily 2, 1890. Letter from Mr. C. Davis EnBlidi to 
the secretary, thanklnf? the Board for its intervention and 
tlio resultant benefit. 

10. July 17 and 2G, and September 19, 1890. Letters 
from Mr. Murphy to the secretary in reference to analy- 
sis. 

11. September 23, 1890. Report of analysis made by 
Dr. Henry Leffmann, showing the effluent to be im- 
pure. 

12. September 29, 1890. Letter from Mr. Murphy to 
tlie secretary stating that as the naisance has not been 
satisfactorily abated. Dr. Atkinson be instructed to make 
another inspection. 

13. October 2, 1890. Letter of Mr. Murphy to the 
secretary, on pollution of streams. 

14. October 13, 1890. Letter from Mr. Mnrphy to the 
secretary, on pollution of streams and Dr. Atkinson's in- 
si>ection. 

15. July 15, 1891. Report of inspection of plant by 
Medical Inspector Atkinson. 

16. August 4, 1891. Letter of the secretary to Messrs. 
Coffin & Altemus, stating that the purificBtion of the 
sewage is incomplete and unsatisfactory and insistingon 
aetive measures being taken to improve it. 

17. August 13, 1891. Letter from Mesarfi. Coffin & 
Altemus, stating their readiness to comply with the in- 
structions of the Board and asking the favor of a per- 
sonal interview with the secretary. 

18. August 14. 1891. Report on inspection by Dr. 
Atkinson, stating that although some improvement has 
been made, the discharge at the mouth of the effluent 
pipe is still offensive. 

19. August 29, 1891. Report of an inspection by Dr. 
Atkinson showing improved disposition of the sludge. 

20. August 19. A conference took place at the execu- 
tive office between the secretary and Medical Inspector 
Atkinson, representing the Board, and Mr. Coffin and 
Mr. Paiat representing the inn, at which it was agreed 
that the various wells should be cemented, the sludge 
composted, and the filtration perfected. 

21. August 25, 1891. Report of analysis of samples of 
water taken from twelve difierent pointe made by Dr. 



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No. 16. 1 Minutes. 

Charles M. OreBBoa, showing BoriouB pollation of the 
stream by the efiSuent. 

22. September 26, 1891. Dr. Leffmaan a^Q takes 
sample of water. 

23. September 26, 1891. Letter from Mr. C. Davis 
English, requesting that the Board take measvireF to 
close the hotel 

24. September 26, 1891. Letter from Mr. Murphy to 
the secretary, stating his donbts as to the possibility of 
purifying the drainage of the inn by the present system 
even il enlarged. 

25. September 28, 1S91. Letter to the secretary from 
Mr. Murphy enclosing report of analysis made by Dr. 
Leffinanu, showing the effluent to be very foul. 

26. October 9, 1891. Report of an inspection of the 
plant and stream made by Mr. Murphy, Medical In- 
spector Atkinson and the secretary, showing that al- 
though certain abuses have been remedied, the purifica- 
tion is very imperfect. 

27. October 17 and 19 letters from Mr. Murphy with 
regard to special meeting. 

This completed the presentation of the sobject, and 
the secretary then moved that Mr. C. Davis English, the 
principal complainant, being present, fae be allowed to 
present his views. It was carried. Mr. English then 
made a brief statement in which he claimed that the mat- 
ter had now been under consideration by the Board for 
two years, that in the meantime two deaths had taken 
place on his ]>roperty, one from typhoid fever and one 
with typhoidal symptoms, presumably due to the pollu- 
tion of this stream by the drainage from the hotel ; that 
in consequence of these facts he could neither occupy his 
residence himself nor rent it to any one else, and that he 
therefore had a right to demand that decisive action 
should be taken by the Board to abate this nuisance. 

Mr. Howard Murphy considered that the question was 
as to the right of Messrs. Coffin &. Altemus, or any 
other person or persons, to pollute a stream of this com- 
monwealth. 

Mr. Coffin being called npon, stated that the owners 
of the inn were as earnestly desirous as any one present 
to remedy the trouble, and were ready to carry out any 
suggestions which the Board would be good enough to 
make tor this purpose. The suggestions of the secretary 



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State Boabd of Health. [Off. Doo. 

of the Board as to dispoeal of sladge aad cdmeatdng of 
wells had been and were being' faithfully carried oat. 

Mr. Faist said that last year the filtration was not as 
Bucoessfnl as daring the present, in conseqaencd of the 
dishonesty of an employ^, but this abuse had now been 
corrected, 

Mr. Crump stated that as the Board ordered the own- 
ers of the inn not to allow polluted water to enter this 
stream, be fett that it was incumbent upon the Board to 
suggest what additional methods should be adopted. 

Mr. English considered that the onus was not npon the 
Board, and the secretary sustained this opinion, stating 
that he had just receiTed an opinion from the Attorney 
General of the state, which held that the Board was 
under no obligation to suggest the means for carrying 
out its orders for abatement. 

Mr. Waddell called attention to the (act that the State 
Board of Health had jurisdiction only over public nuis- 
ances, while the complaint of Mr. English was of a pri- 
vate character. 

The secretary replied that Mr. English was only one 
of ten complainants, and that the Board was careful to 
avoid receiving complaints of private nuisances which 
were often merely quarrels between neighbors. 

In answer to an inquiry from the chairman, Mr. Coffin 
stated that the proprietors of the inn had already spent 
(10,000 upon this matter, and stood ready to spend $10,- 
000 more if necessary. No effort should be spared which 
engineering skill could suggest to make the water in the 
stream as pure below the plant as above it. 

I>r. Leffmann threw oat the suggestion that the addi- 
tion of a different system of purification and filtration 
to the present ouq would give better results than the en- 
larging of the present, and farther considered it import- 
ant that all old drains, which mast be saturated with filth, 
be dug up and exterminated. 

The secretary then moved that as the subject had been 
fully discnssed, the Board now go into executive session. 
It was caiTied. 

On motion of Mr. Murphy, the following resolution 
was adopted: 

Resolved, That the secretary be instructed to notify 
Messrs. Coflin & Altemns to immediately proceed to 
take measures to ensure the complete purification of the 
effluent of the sewage and drainage system of the Devon 



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No. I6.1 MiNUTEB. 

Inn and its associated cottages, and to take ap and re- 
move the uld abandoned drain and fill in the excavations 
thos piodnced with fresh, clean earth and qaicklime; 
and that lie be further instructed, in the event of their 
failure to comply with these requirements, so that the 
improved system shall be in ^ood working order and 
ready for the inspection of the Board by April 15, 1S92, 
or one full month before the opening of the Devon Inn 
in the spring of 1892, to proceed against the said Messis. 
Coffin and Altemus according to law. 
On motion, the Board then adjourned. 

Benjauin Lee, 

Secretary, 



Becrular Meeting, November 13, 1881. 

The twentieth regularmeeting of Board was held at the iveniieu 
supreme conrt room, Harrisborg, November 12, 1891, at 4 "™"''«- 
p.m. 

Present, Dr. J. F. Edwards, Dr. Pemberton- Dudley, 
Dr. Geo. G. Gk^, Mr. Howard Murphy. C. E., and Dr. 
Benjamin Lee, secretary. 

Dr. Jjeemovedthatinconsequenceof tbeabsenceof the AbMncei 
president, who wasstill in Enrope, Dr. J. ¥. Edwards take "*"- 
the chair. The motion was carried. 

The secretary read a telegram from Dr. S. T. Davis re- 
gretting his inability to attend. 

The minutes of the nineteenth regular meeting, held at 
Harnsbui^, July 9, 1891, were read and approved. The hmS^"" 
minutes of special meetings, held at Philadelphia, August 
31, 1891, andOctober24, 1891, were also read and approved. 

1. The report of the secretary being in order, as its first BMreikrr' 
item, the secretary read his seventh annual report. It 
was accepted and approved with the thanks of the Board, pon ° 
and, in conjunction with the minutes of the Board for the 
past year, ordered to be forwarded to His Excellency, the 
Governor, as the annual report of the Board. 

The recommendations occurring in the course of the re- 
port were ordered to be brought up under the head of 
new business. 

TheBoardnowadjoomedtomeet at the supreme court lavttaMi 
room at 8 o'clock p. m. 

The Board reconvened at 8:30 o'clock the same evening. 
The report of the secretary still being in order, the fol- 
lowing items were presented: 



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St^te Boabd of Health. [Off. IXmx 

2. TliA precautions against sunstroke had been printed 
and partisly diatributed since the last regular meeting. 
Also Circular No. 33, " School Hygiene No. 2,"on constnic- 
tion, ventilation and management of schools, addressed 
to school directors, controllers and trustees. The chair- 
maa of the committee on vater supply, drainage, sewer- 
age, topography and mines had handed the secretary a 
newspaper extract from a recent report of the French 
Academy of Medicine, stating the length of time daring 
which patients recovering from contagious diseases were 
liable to communicate these diseases. The periods as- 
signed agree closely with those fixed in thiscircular, inno 
instance being longer, but in certain diseases being shorter. 

3. A report of the prevalence of diphtheria at Glen 
Riddle, Delaware county, had been made to the Board. 
After investigation Medical Inspector Atkinson reported 
cases at the railroad station. There had been several 
previous cases of sickness in this bouse, the sanitary con- 
ditions of which were found to be very impei-fect. There 
was evidence of leakage from the walls into the cellar, 
and the drainage from the roadway passed tinder the 
kitchen floor, the level of which was below that of the 
road. The general manager of therailroad company had 
written promising that no steps should be spared to 
properly disinfect the house, and rearrange its drainage. 

4. A complaint that owing to defective drainage, stag- 
nant water from a canal bed filled cellars and thus caused 
much sickness and damage to property at Weissport, 
Carbon county, bad been made by several citizens of 
that borough. A communication was addressed to the 
president of the Lehigh Coal and Navigation Company. 
This officer while considering that the nuisance was prin- 
cipally caused by parties having placed a dam aci-oss the 
Lehigh river at this point, promised to open a drain and 
thus prevent this leakage from the canal bed. 

5. At the request of the secretary. His Excellency, the 
Governor, has issned a commission appointing the pres- 
ident of the board, Dr. J. H. McClelland, a delegate from 
the Commonwealth of Pennsylvania to the International 
Congress on Hygiene and Dem<WTaphy to be held in 
London on August 7-14, 1891. The secretary has also 
issued Dr. McClelland credentials from this Board to the 
same body, and had notified Dr. John S. Billings, of 
Washington, D. C, and Prof, W. H. Corfield, honorable 
foreign secretary of the congress of such appointment. 



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Ko. 16.] Minutes. 

The action of the seoretary in tliiB matter waa refeired 
to new basiness. 

6. The attention of the Board had been drawn by Mr. J^£,','^^°'; 
R. R, Bentley, ^neral haggetge agent FennBylyania sys. "'pn'ieru. 
tern west of Pitteburgh, to the action of the Ohio State 

Board of health, whohad recently prohibited thatranspor- 
tationof bodieadeadof diphtheria. ThelowaStsteBosrd 
of health had previoasl y taken similar action. It waa for the 
Board todecide whether itshonldamend its Fegalations in 
the same way. The matter was referred to new business. 

7. An investi^tion into the cause of typhoid fever at Trrboiiiteisri 
Millville, Colombia county, had disclosed the fact that a 

spring at the bottom of a hill near the residence of a phy- 
sician, was being contaminated by cesspool matter from 
a disnsed well on his premises used as a cesspool. The 
cases of sickness had occurred among bBin hands and 
others who had drunk from this spring, which the secre- 
tary at once ordered closed, in accordance with the recom- 
mendation of Dr. Leiser, medical inspector. 

The snbject of the increasing use of disnsed wells as di.u»«i^bii. » 
cesspools throoghoatthestate, wasordered to be brought 
Qp under new business. 

8. A complaint that scarlet fever prevailed at Ship- ^?^"*V^" 
pensburg. Cumberland county, had resulted in an inspec- 
tion of that borough by Medical Inspector Sibbet. He 
reported about fifty cases of scarlet fever, also several 

cases of typhoid fever. He found the borough in a bad 
sanitary condition. He had attended a meeting of citi- 
zens and urged the necessity of abating the privy nuis- 
ance by the purchase and use of an odorless excavator, 
the free use of disinfectants, the appointment of a sani- 
tary committee, the abatement of pig pen, stable and 
slaughter house nuisances, and the closing of all wells 
within one hundred feet of any such places. He had also 
caused hand bills to be issued containing the above sug- 
gestions. The secretary had communicated vrith the 
burgess, fully endorsing all these recommendations. 

9. Diphtheria had again prevailed somewhat seriously Diphtherial 
at Bangor, Northampton county, six cases ont of eight °^' 
having terminated fatally. Circulars were sent, and sug- 
gestions made to the board of health, which were suita- 
bly acknowledged by Dr. Buzzard, the president. 

10. The board of health of Carbondale bad complained Dmin««e'i(c«i 
recently of their inability to enforce the sanitary laws of '»"'>■'"• 
that borough, especially in regard to drainage, and asked 

4-16-91 



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State Board op Health. Off. Poo. 

for advice. The secretary inBtmcted Medical Ingpoctor 
Taylor to visit CarboDdale aod confer with the board. 
He reported great prog^ss in sanitary matters since his 
visit in 1888, brick pavements having been laid io the 
center of the towo, and abont 16,000 feet of sewers havinf; 
been coostmcted. The great need of the city was a com- 
plete system of sewerage. The secretary had writteo to 
the board of health pointiufr ont that the power to order 
the sewerage of a city, and to provide the aecesaary ap- 
propriations, were vested solely in councils; also endors- 
ing the recommendations of the medical inspector. 
I 11. Information had been received from one of the phy- 
sicians of St. Clair, Schuylkill county, to the effect that a 
nuisance was bein^ created by a blocked up sewer. The 
secretary notified the borough authorities of the matter, 
and a reply was returned that the nuisance should receive 
speedy attention. 

12. A complaint that filth from a tannery and a cream- 
ery was being run into Martin's creek, at Nicholson, Wy- 
oming county, had been j«ceived, and was investigated 
by MedicallnspectorTaylor. Hefonndthatthenuisance 
had been partially abated since the report had been sent 
to the Board. He, however, siiggestedthatthepipefrom 
the creamery be lengthened and that the Uquidin which 
the hides are soaked at the tannery be emptied into 
Tunkhannock creek, about three eighths of a mile away. 
The secretary wrote advising these suggestions to the 
owners of the creamery and tannery, who promised that 
prompt attention should be given the matter. 

13. A communication from the Hon. L. B; Reefer re- 
quested an investigation into the cause of typhoid fever 
lit Cressona, Schuylkill county. Dr. W. Murray Weid- 
man had inspected Cressona, and found ground for sus- 
picion that several of tlie wells were polluted. He bad 
conferred with the committee appointed to investigate, 
and had submitted several of the suspected waters for 
analysis, advising the closing of every well the waters of 
which were found contaminatetl. An analysis of seven 
different samples was mikde under the direction of the 
Board, showing serious contamination of certain wells, 
which were ordered closed. Eventually the epidemic 
was brought under control. 

, 14. The continued obstinacy of Mr. Peter Hermes, of 
Bulger, Washington county, to abate the nuisance at his 



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No. 16.] MuiOTES. 

cheese factory had caused the secretary to threaten him 
that \egaX proceedingB irould be instituted. He bad re- 
plied deaying that any ouiBauce existed, his letter to this 
effect being- now read. In the event of his failure to com- 
ply with the Board'sorders the secretary hadadvised him 
that the district attorney would commence proceedings. 

15. The secretary's attention had been called to the lant 
tact that a portion of Camp Sherman at Deyon had been 
located on marshy ground near a contaminated water 
course. This had been pointed out to the commanding 
officer, and that portion of the camp was promptly re- 
moved to higher ground. A complaint was received 
snortly after the close of the encampment that large 
quantities of garbage and cesspool matter had been left 
exposed and were creating a serious nuisance. On in- 
spection the secretary and Dr. Atkinson found that all 
this matter had been, just before their visit, covered with 
fresh earth, and no cause for further complaint existed. 

16. At the request of Mr. Frank Smith, the secretary iie*e 
and Medical Inspector Atkinson had inspected the new ^" 
sewerage system of Wayne, Delaware county, on August 

8. They were accompanied by Col. Waring. The system, 
which might be termed one of filti-ation and aeration, 
did not appear to be working perfectly, but it was claimed 
that all impure matter was separated from the small 
amount of water which entered Itham creek, and it was 
expected thai this entrance would Boon cease entirely. 

17. An epidemic of dysentery had prevailed atthe Nor- 
ristown State Insane Asylum during the past summer. 
On request Dr. Robert H. Ohase, superintendent, made 
a report showing forty-two cases had occurred, of which 
thirty-seven had recovered, three bad died, and two Oiore 
were still under treatment. Thedisease had been confined, 
with the exception of two cases, to the insane inmates of the 
asylam. The cause of the dysentery was not definitely 
discovered, it was, however, most prevalent in the crowded 
parte of the institution. A deficiency in the water sup- 
ply bad also occnrred, interfering with the proper fluah- 
ing of the closete 

18. The members would recall thefactthat a complaint 
was received during the last meeting of the prevalence 
ot typhoid fever at Bitnerville,Laiicasteroounty,aDdthat 
an investigation was ordered. MedicallaspectorHartman 
reported that the cesspool matter bom nineteen cottages 



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State Board o? Health. Off. Doo, 

for advice. The aecretary intjtnictod Medical Inspector 
Taylor to visit Carbondale and confer with the board. 
He reported ^i^fit progress in sanitary matters since bis 
visit in 1888, brick pavements having been laid in the 
center of the town, and about lfi,000 feet of sewers havinf; 
been constructed. The threat need of the city was a com- 
plete system of sewerage. The secretary had written to 
the board of health pointing out that the power to order 
the sewera^ of a city, and to provide the necessary ap- 
propriations, were vested solely in councils; also endors- 
ing the recommendations of the medical inspector. 
! 11. Information had been reoeivedfrom one of thephy- 
sicians of St. Glair, Schuylkill county, to the effect that a 
nuisance was being created by a blocked up sewer. The 
secretary notified the borough authorities of the matter, 
and a reply was returned that the nuisance should receive 
speedy attention. 

12. A complaint that filth from a tannery and a cream- 
ery was being run into Martin's creek, at Nicholson, Wy- 
oming county, had been received, and was investigated 
by Medical Inspector Taylor. Hefoundthatthenuiaance 
had been partially abatetl since the report had been sent 
to the Board. He, however, suggested that the pipe from 
the creamery be lengthened )ind that theliquidin which 
the bides are soaked at the tauoery be emptied into 
Tunkhannock creek, about three^if^hths of a mile away. 
The secretary wrote advising these suggestions to the 
owners of the creamery and tannery, who promised that 
prompt attention should be given the matter. 

13, A communication from the Hon. L. B; Keefer re- 
quested an investigation into the cause of typhoid fever 
at Cressona, Schuylkill county. Dr. W. Murray "Weid- 
man had inspected Cressona, and found ground for sus- 
picion that several of the wells were polluted. He had 
conferred with the committee appointed to investigate, 
and had submitted several of the suspected waters for 
analysis, advising the closing of every well the waters of 
which were found contaminated. Ad analysis of seven 
different aiunplos was made under the direction of the 
Board, showing serious contamination of certain wells, 
which were ordered closed. Eventually the epidemic 
was brought under control. 

, 14. The continued obstinacy of Mr. Peter Hermes, of 
Bulger. Washington county, to abate the nuisance at bis 



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No. 16.] Minutes. 61 

eheeae factory bad caaeed the secretary to threaten him 
tbat le^ proceedmgs would be inatituted. He had re- 
plied denying that any nuisance existed, hia letter to this 
etfect being DOW read. In the event of his failure to com- 
ply with the Board'sorders the secretary had advised him 
that the district attorney would commence proceedings. 

16. The secretary's attention had been called to the muDiurr loratioD 
fact that a portion of Camp Sherman at Devon had been '"'^™'""'™™'- 
located on marshy ground near a contaminated water 
course. This had been pointed out to the commanding 
officer, and that portion of the camp was promptly re- 
moved to higher gjound. A complaint was received 
sHortly after the dose of the encampment that large 
quantities of garbage and cesspool matter had been left 
exposed and were creating a serious nuisance. On in- 
spection the secretary and Dr. Atkinson found that all 
this matter bad been, just before their visit, covered with 
fresh earth, and no cause for further complaint existed. 

16. At the request of Mr. Frank Smith, the secretary »«■•»«■ tnMa of 
and Medical Inspector Atkinson bad inspected the new '"'^ 
sewerage system of Wayne, Delaware coanty, on August 

8. They wereaccompaniedbyCol. Waring. Thesystem, 
which might be termed one of filtration and aeration, 
did not appear to be working perfectly, but it was claimed 
that all impure matter was separated from the small 
amount of water which entered Itham creek, and it was 
expected tbat this entrance would soon cease entirely. 

17. An epidemic of dysentery had prevailed at the Mor- nrHnisiT u tiw 
ristown State Insane Asylum during the past summer. aSJi™. """^ 
On request Dr. Bobert H. Chase, superintendeut, made 

a report showing forty-two cases bad occurred, of which 
thirty-seven had recovered, three bad died, and two more 
were still under treatment. The disease had been confined, 
with the exception of two cases, to the insane inmates of the 
asylum. The cause of the dysentery was not definitely 
discovered, it was, however, most prevalent in the crowded 
parts of the institution. A deficiency in the water sup- 
ply had also occarred, interfering with the proper flush- 
ing of the closets. 

18. The members would recall tbefactthatacomplaint TiptioM tsver bi 
was received during the last meeting of the prevalence »'"*"'"«■ 

(^ typhoid fever at BitDerviIle,Ijanca8tercomity,aDdthat 
an investigation wasordered. Medicallnspector^urtman 
repcnrted that the cesspool matter from nineteen cottages 



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State Boabd of Health. 



[Off. Doc. 



was carried into an open trench aboat eighty yards back, 
where it lemained, the stench from this trench being most 
offensive. He recommeuded that the owner {Or. Bitner) 
cover this trench, and provide properly coostmcted ceaa- 
pools lor these cottages, which the secretary advised Mr. 
Bitner to have done. Sabseqaently, on notice from the 
complainant, Dr. S. T. Davis made two further inspections 
of the place, and reported that the n^lected matter had 
been attended to by Mr. Bitner, and no further caose for 
investigation by the Board was needed. 

19. A nuisance caosed by a slaughter house at Tully- 
towu, Bucks county, had been investigated by Medical 
Inspector Atkinson. He reported every thing around the 
slauffhter house in a very unsatisfactory condition; pi^ 
fed on offal and blood ; no drainage whatever, and foul 
odors constantly arising from the place. He recom- 
mended the removal of the place outside Tullytown, 
which the secretary at once ordered. Subeeqaently the 
owner and tenant of the premises waited apon the secre- 
tary and agreed in a sworn affidavit to cease feeding hogs 
on offal and blood, to cement the floor, remove the pig 
pen. and clean up the entire premises if allowed to re- 
main. On these terms the secretaiy allowed the slaughter 
house to remain. 

The Board then adjourned to meet at 9:30 a. m. on the 
13tb inet. 

The Board reconvened at 9:30 a. m. on Friday the 13th 
instant; the secretary's report was continued as follows: 

20. Application had been made by prominent residents 
of Washington, Washington county, for assistance in the 
formation of a local board of health. Medical Inspector 
Thompson was instructed to visit the town and confer 
with the petitioners. He reported Washington to be 
well sewenid and supplied with ample water works. Only 
one-fourth of the people had, however, begun to use this 
water. There was much fear of contamination of wells 
from cesspools. Nine cases of typhoid fever were re- 
ported. Documents for establishing a local board were 
sent to the citizens, and the entire discontinuance of the 
use of well water was strongly urged. 

21. A complaint that diphtheria was prevalent at 
Lenni, Delaware county, was investigated by Medical In- 
spector Atkinson. He reported that little ground for 
complaint existed, diphtheria being but present in one 
instance. Two cases of typhoid fever existed. A re- 



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So. 16.] Minutes. 

ported stairoaDt pond was found to be fed by a spring: 
. iind to have two oatlets, and did not appear to be the 
uauo^ of any sickness. The teaohers and directors of the 
HchooU were seen, and all affieed that they had no caose 
for complaint. 

The nuisances at Biddie's Mills, howeyer, reported 
during Uie previoos epidemic, had not been remedied, 
and the secretary had urged the owners to give the sub- 
ject immediate attention. 

32. On request of citizens, Dr. L. H. Taylor had made i 
an iuspectioD of Forest City, Susquehanna county. He 
reported finding the city in a most deplorable condition 
as regards sanitation. The filth from the privy vaults 
and house drains in hundreds of instances ran down 
through the yards of houses situated on lower ground. 
There was no system of sewerage whatever, the drainage 
from privies running into open gntteis in the streets, in 
many places this accumulated and remained stagnant, 
producing noisome stenches. In some few instances 
where privy vaults were found they were full to over- 
flowing, and nuisances were abundant everywhere. No 
successful attempts had been made by council to abate 
these nuisances. From fifteen to twenty oases of typhoid 
fever had existed in two months. The secretary had 
strongly pointed out the dangers of this wretched condi- 
tion of affairs to the council, and endeavored to dissuade 
that body from allowing political questions to interfere 
with their duties as r^ards sanitation. 

23. The board of health of Schuylkill Haven had asked i 
tor the co-operation of the Board in removing certain ' 
dangeronsnuisancesinthatboroogh. Medical Inspectoi- 
"Weidmaa had inspected the localities complained of. 
The secretary had advised the local board in accordance 
with Dr. Weidman's recommendations, and the board 
had undertaken to carry out the suggestions. 

24. In consequence of information from the burgess of , 
l^rone, Blair county, respecting the prevalence of diph- 
theria. Dr. Oroff had visited that borough, and had con- 
ferred and advised with the bnrgess and other prominent 
citizens. The secretary had also communicated with the 
burgess recommending the ordinance requiring physi- 
cians to report all cases, the issuing of a proclamation, 
the distribution of circulars and placarding of infected 
houses. The progress of the epidemic was checked. 

26. Information had been received from Police Surgeon 



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8tatb Board of Health. [Off. Doc. 

Andrews, of Fhtladelpbia, that scarlet fever prevailed at 
Howelville, (jhester couoty, This was investif^ated by 
Medical Inspector Atkinson. He reported many Duis- 
ances, especially caused byfllthy immif^rante. The Penn- 
sylvania Railroad Company, the owner of the quarry 
works and others, were written to and urged to co-operate 
in remedying these insanitary conditions. 

26. The deposit of iaree quantities of offensive and 
putrefying: manure at Ardmore Station, Pennsylvania 
railroad, had been ui^ntly complained of by a promi- 
nent physician The secretary had communicated with 
the railroad company, advising that the transportation 
of the manure be either postponed until cold weather, or 
that some other point be selected for its deposit, with 
the result of the immediate cessation of the grievance. 
i 27. A serious condition of affairs resulting from the 
pollution of the snbsoil by drainage and sewerage had 
been reported at Wallingford, Delaware county. The in- 
spection by Dr. Atkinson revealed the fact that theground 
was saturated with sewerage matter in all directions, 
every man draining on to his neighbor's property, or into 
his neighbor's well. Owing to the action of the secretary 
the nuisance complied of (which led to the discovery 
of this condition) was being pmmptly abated, but unless 
this deplorable absence of all sanitary provisions were 
remedied in this as in other sabnrbau districts, he appre- 
hended grave results in the near future. In this case four 
inspections bad been made. By his advice the residents 
were uniting to form a sanitary protection association, 
and adopt regulations regarding drainage andother mat- 
ters affecting the health of the neighborhood. He would 
suggest the issue of a circnlar recommending the forma- 
tion of such associations throughout the state. 

Beferred to naw business. 

28. A complaint that the water supply of Lebanon was 
being polluted had been investigated by Medical Inspec- 
tor W. Murray Weidman. He found possible cause for 
contamination from the feeces of workmen who were con- 
structing the dam where it was alleged the pollution oc- 
curred. The results of the inspection were sent to the 
complainants, who were the publishers of a daily news- 
paper in Lebanon. 

29. A report of the prevalence of typhoid fever at 
Shanksville, Somerset county, asking for an inquiry into 
the cause of so much sickness resulted in Medical Inspec- 



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No. 16.] MlNDTEB. 6f 

tor J. 8. Hackney beings iiiBtracted to inspect the town. 
He reported the sickness to be malarial, and not true 
typhoid fever, due to deficient drainage and ^neral filtli, 
und Bagfrested several sanitary measnree which were re- 
commended by the secretary to the burgess. 

30. A complaint had been made of the prevalence of inipeouatiofiiiDD- 
typhoid fever in Montrose, Susquehanna comi^. Medi- 
cal Inspector Taylor, on inspection, was nnable to verify 

the complaint in the main, bat found several minor nui- 
sances. He also snf^f^ested the pressing need of a pure 
water supply for the city. The secretary had pointed 
OTtt these needed reforms to the burgess, advising that if 
a pure water snpply could not speedily be introduced, 
earth closets should be substituted for privies throughout 
the entire town, as under the present system the pollution 
(A all the wells was only a question of time. The bui^^ss 
was evidently disposed to do all in his power to promote 
sanitary measures. 

31. On the receipt of doonments and advice from the Fonnuioo Qrbwm 
secretary a local board M hetdth had been established at bnr^ * ' "'°'"' 
Oinousbnrg, Washington county. 

33. The advice of the Board had been sought with re- 
gard to diphtheria at Galeton, Potter county. Ciroulais 
and an advisory letter had been sent by the secretary, 
which had been gratefully acknowledged. 

33. The attention of the Board had been drawn by a 
physician to a badly polluted well suspected of having w«ii ■> sbeiUu- 
caused deaUis from typhoid fever at Sheridanville, Alle- 

^eny county. The complaint was accompanied by the 
anaJyst's report fully oonfirmingtheeesaBpicion8,andthe 
secretary immediately ordered the well closed. 

34. Acomplaint of theprevalenceof diphtheriaatNaz- DipbuunxtKM- 
areth, Northampton county, and a request for sssiBtance "^"'* 

had been received from a physician. The secretary at 
onoe sent a supply of circulars of the Board with insbuo- 
tions for preventing the spread of the disease. 

35. A complaint had been received from a member of Typbow feT«ru 
the board of health of Butler, Butler county, that typhoid """"- 
fever was epidemic in that borough, asking for aesistanoe. 

Medical Inspector Thompson reported the sickness to be 
caused by drinking water from contaminated wells on the 
south side pf the town, which had not yet been supplied 
with water works. Prom seventy to eighty oasra of 
fever were said to exist. He recommended the erec- 
tion of a small garbage furnace, and the estabhshment of 



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Btate Board op Health. [Off. Doc. 

a local board of health. The secretary had sent docn- 
ments for this purpose, and had or^ed the cloeiiig of 
every well suspected of being polluted. Also the exten- 
sion of water works to the southern part of the town. 

36. On receipt of a complaint that typhoid fever was 
epidemic at Beaver Meadows, Oarbon county, the secre- 
tary urged that committees be formed by the citizens, 
and a hooae-to-bouse inspection made of the town. Sur- 
vey blanks for this porpoae were sent. From the low 
rate of mortality the secretary thought the sickness wte 
rather of a malarial character than true typhoid fever. 

87. Diphtheria had prevailed at Heokeofaerville, Schuyl- 
kill county. The secretary had sent circulars and ad- 
visory letter. 

88. A complaint of typhoid fever at Boohester Mills, 
Indiana county, had been investigated by Medical In- 
spector Matthews. He attributed the disease to the use 
of water from contaminated wells, and suggested that a 
well be dug for the use of the jieople above the town 
He also advised tiiat an analysis be made. The secre- 
tary ordered three demijohns sent at once, but no reply 
had yet been received. 

39. A letter was read from an engineer of Pittsburgh, 
requesting the secretary's advice with regard to the dis- 
l»osal of the sewage of a town on the Beaver river, not 
far below which was a dam which might supply the 
drinking water for a small village. He had replied, 
stating that the parties owning the dam referred to conld 
take legal proceedings in the event of the sewage being 
emptied into the river whether it were used as a water 
supply or not. He further advised the inquirer, in any 
event, to make ample provision for the purification of 
the effluent before it entered any stream. Circular Ko. 
30 was also sent. 

Complaints of minor Duisances had bf^eu received from 

40. Fryberg, Clarion county. 

41. Bosemont, Montgomery county. 

42. Ligonier, Westmoreland county. 
48. Leechburg, Armstrong county. 

44. Troy, Bradford county. 

45. Fredonia, Mercer county. 

46. McKees Bocks, Allegheny county. 

47. Haverford College, Montgomery county. 

48. Coopersburg, Lehigh county. 

49. Wrightsville, York comity. 



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No. 16.] MiNDTBa 67 

60. Bolivar, Westmoreland county. 

61. Baukin Btatioc, Allegheny county. 

62. Port ProndeDoe, Mon^^mery connty. 

In each case the necessary namber of sig&atnrea and 
the affidavit required had not been forwarded. 

39. The financial report showed the receipts dnrinir nniaoiai rapon. 
the year to have been t3.682.20, and the disbursements 
$8,682.06, of which 11,661.28 was for incidental expenses 
oi the secretary and office, and the remainder for travel- 
ing ex[»eiiBes of members, inspections, analyses, vaccine 
vims and sanitary convention. 

64. The number of written oonunonications sent since commnniutiani 
the last aoDual meeting had been 1,777, and the number """^^ "" ••'■'■ 
received 1,791. 

65. The total number of citeolars distributed daring' arcniumdia- 
the same period had been 20,503. Namber of boxes of 
complete sets of circulars, 926. 

66. The additions to the library had been of boohs re- Additiotu w 
ooived as exchanges and donations, 92 ; purchased, 6; of "*™" 
pamphlets received, 81. 

The report of the secretary was now accepted and re- 
ferred for publication. 

Beports of standing committees being in order, Dr.Fem- rspotu of ■uikiidc 
berton Dodley, chairman of the executive committee, re- *"°°""*"' 
ported that since the last regular meeting of the Board, two 
regular meetings and one special meeting had been held. 

At the regular meeting held Aogust 31, voucher 139, B,ecnun«m- 
and vouchers nombered 151 to 166, amounting to 1696.86, °"'*™' 
were examined and approved. 

At the special meeting held September 21, vouchers 
numbered 167 to 181, amounting to 1696.35, were exam- 
ined and approved. 

At the regular meeting held November 12, voochers 
numbered 186 and 186, amounting to $308.61, were ex> 
amined and approved. 

The report was accepted. 

Dr. Benjamin Lee, <^airman of the committee on vital 
statistics, reported that the register of physioiaiia pub- 
lished by the Board, as was expected, had met with con- 
siderable ciiticism. 

It was proposed, in order to secure accuracy in the 
next register, to assign the daty of examining and tran- 
scribing the registers in the <^cea of the various pro- 
tbonotaries to the Board's medical inspectors, with 
dearly defined instractions as follows ; 



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68 State Board of Health. [Off. I>oc. 

Each inspectoi' to examine the records of the counties 
within his own district, with inBtmctions to omit from 
his retuniB the names of persons deceased, removed or 
declining practice, and to make special reference to all 
persons whose registration appears to have been in any 
way irregular. 
The report was accepted. 
p™'«n"*ie n"- Dr. J. F. Edwards, chairman, committee on preventable 

diseases and Bupervision of travel and traffic, stated that 
he had no written report to present, his committee re- 
porting every month sach matters onder its observation 
through the " Annab of Hygiene," of which he was the 
editor. 
The statement was accepted. 
wi>t«rrappij. The report of the committee on water supply, drain- 

tootmvbt Md ago, sewerage, iopoKTWphy and mines was mode by the 
chairman, Mr. Howard Mnrphy, 0. E., and was devoted 
to the question of drainage of the Devon Inn. It urged 
in the strongest manner the importance of the insistenoe 
on the part of the Board on the complete purification (A 
the effluent of the drainage of the Inn before it is per- 
mitted to enter the stream in question, considering the 
question to be one, not^imply of local or individual in- 
terest, but affecting almost every water supply in the 
commonwealth. 
The report was accepted. 
PDbUc Lomtouon. The report of the committee on public institutions and 
«.a«i.«.ih^.«. Bchool hygiene was presented by Dr. George G. Groff, 
chairman. It described the distribution of the two cir- 
culars on school hygiene, the latter of which, prepared 
for the instmotion of school trustees and controllers, had 
recently been prepared and the delivery of twenty-five 
lectures to teachers, school directors and farmers' insti- 
tutes on the-importance of better sanitary conditions in 
homes, schools, churches and public institutions. The 
report drew especial attention to the following evils in 
schools : Insufficient lighting, overwork, the spread of 
con tf^ous -diseases through carelessness in sending con- 
valescent's- from these diseases to school while still in an 
infective condition : the abolition of a recess, and the ab- 
sence of any proper medical and sanitary supervision of 
schools. Reference was also made to the lack of proper 
sanitary precautions in the establishment of new summer 
resorts, the deficient ventilation of churches, and the 
dajigeis of holding public fnnerals incases of death from 



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No. 16.] Minutes, I 

conta^onfi diseBsee. The committee felt that on the 
whole improTement was being made in the matter of the 
conatraction of schools and other public bnildings, as 
ulso in the heating, ventilation and plumbingof thesame. 

The report was accepted. 

Dr. Dadley, chairman of the committee on adnltera- AnuiwruioDs. pi 
tions, poisons, explosives, and other special sources of 
danger to life and limb, reported verbally : That an in- 
vestigation was being made by the committee into the 
subject of the nse of chemical preservatives for milk, but 
that it had not yet reached a point where it was deemed 
advisable to make any of its results public. 

In the absence of Dr. Samuel T. Davis, chairman of the santMrrieciiu- 
committee on sanitary legislation, mlee and regulations. 
Dr. Benjamin Lee reported a list of all the bills passed 
in the last session of the legislatore relating to sanitary 
matters. 

The report was accepted as the report of the committee 
with the understanding that Dr. Lee's name appear 
ti^fether with that of Dr. Davis appended to the report. 

Beports of special committees ; 

The chairman of thecommitteeonanational rivers con- Rapon> of ipeotai 
Bervancy commission (Dr. S. T, Davis) not being in at- '""™'"*~ 
tendance, no report was presented. 

Dr. Pemberton Dadley moved that with regard to the AppoiaUDent or 
appointment of standing committees for the ensuing *«». """"""^ 
year that the committees stand the same as last year, ex- 
cept that Dr. Oro£F's name be substituted for that of Dr. 
McClelland as chairman of the committee on public in- 
stitutions and school hygiene, and for that of the same 
gentleman as member of the committee on water supply, 
drainage, sewen^fe. topography and mines. 

The motion was carried and the committees therefore 
stand as follows : 

ExecuHve Committee — Pemberton Dadley,M.D.,chair- unointaaiat 
man; Howard Murphy, C. E., Joseph F. Edwards, M.D., "■"»'""• 
and Benjamin Lee, M. D., secretary. 

Committee on Registration and Vital Statistics — Dr. 
Benjamin Lee and Dr. Samuel T. Davis. 

Committee on Preventable Diseases, Dieinfection and 
Supervision of Travel and Traffic — Dr. Joseph F. Ed- 
wards and Dr. Pemberton Dudley. 

Committee on Water Supply, Drainage, Sewerage, Topo- 
graphy and Mines — Mr, Howard Murphy, C. E., and Dr. 
George G. Groff. 



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State Boabd o^ Health. [Off. Doc. 

CwamiUee on. Public InstUiUions and Scitool Hygiene- 
Dr. George G. Groff and Mr. Howard Murphy, C. E. 

Committee on Adutteratione, Poisons, Explosives and 
other Special Sources of Danger to Life and Ltmb^Dt. 
Pemberton Dudley and Dr. Joseph F. Edwards. 

Committee on Sanitary Legislation, Rules and Segula- 
fions^Dr. Somnel T. Davis and Dr. Pemberton Dudley. 

New bnsiness being in order : 

It waB ordered that the next state sanitary couven- 
tion be held at Erie, Erie county, on such date during the 
latter part of February aa the secretary may consider 
most suitable. 

The following members were appointed as a commit- 
tee of arrangements for the ooDvention, with power to 
act, viz : Dr. Groff, chairman, with Drs. Lee and Dud- 
ley. 

The secretary presented acoounte, vouchers nambered 
186 to 486, amounting to $303.64, which the executive 
committee had audited and approved. 

The accounts were approved. 

The secretary suggested that a circular on the "Sani- 
tary Management of Dairy Farms," be prepared for dis- 
tribution among farmers, dairymen, creamery proprie- 
tors, etc., and that a circular on this subject prepared 
by Dr. Bussel, of Glasgow, Scotland, be taken as a basis 
for same. 

The publication of such a circular wEts authorized. 

The secretary suggested that a circular, addressed to 
physicians and midwives, recommending measotes'for the 
prevention of blindness, as suggested in a communica- 
tion received some time since fi-om the Sydenham Medi- 
cal Coterie of Philadelphia, be issued. 

The suggestion was adopted, 
r deferring to the conditions described in the amtoal 
Report, as existing at Wallingford, the secretary pro- 
posed the publication of a paper read at the Lewisbuig 
conveation on sanitary protective associations. 

The publication of such circular was ordered. 
I "The model ordinance for the better protection of life 
and health in cities and boroughs in this commonwealth," 
originally proposed by the Board as a guide to munici- 
pal corporations in framing their sanitary ordinances, 
was, on motion, unanimously adopted as a " regulatioa^f 
the Board" to be enforced in all "cities, boroughs, dis- 
tricts and places having no board of health or healtb-offi 



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No. 16.] Minutes. 

cers, or in case the sanitary laws or regulations in places 
where boards of health or health-officers exist should be 
inoperative" in accordance with the provisions of section 
six of the act of June 3, 1885, "to establish a State Board 
of Health,V which declares that, in the places aforesaid or 
onder the circamstances aforeeaid, " The State Board of 
Health shall have power and aatbority to order nnisances 
or the cause of any special disease or mortality to be 
abated and removed, aud to enforce quarantine regula- 
tions, aa aaid Board shall direct." 

In asking for the adoption of this r^mlation, the sec- 
retary stated that it had become necessary as the basis 
for prompt and definite action on the part of the execu- 
tive officer, in the rural districts and small towns; the ex- 
pectation of the Board when it was established that the 
state legislature would at once see the expediency of es- 
tablishing local boards of health in such places, having 
beeu entdrely disappointed. 

The secretary presented a compilation of the acta buhutu-i 
passed by Uie last legislature in reference to the protec- '"' '*"■'"'' 
tion of life aud health which he had classified and anno- 
tated, and moved that it be printed as " Appendix B" to 
the " Gompendimu of the Laws relating to PublicHealth 
and Safety of theStateof Pennsylvania." It wascarned. 
In the same connection the secretary stated that " Ap- 
pendix A" to the compendium bein^ out of print, he had 
annotated it, and suggested that a new edition be issued. 
It was so ordered. 

The pamphlet containing the constitution, by-laws and 
r^ulations of the Board was also stated to be out of . 
print, and a new addition containing the regulation just 
adopted was authorized. 

On motion of Mr. Howard Murphy, it was ordered, tl^t Muum at [h< 
the new edition of the constitution, by-lawe and compen- 
dium of sanitary laws, including the two appendices, the 
names and addresses of the members and inspectors, the 
lists of committees and such other information as the 
secretary may consider pertinent, be bonnd together in 
one volume as a manual for the use of the board and its 
inspectors. It was carried. 

Dr. Dudley moved that a sufficient number of copies 
of such m*"""^! for the Board, its inspectors and heads of 
departments of the state government be bound in sheep- 
akin, and the remainder in cloth for general distribution. 
It was carried. 



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State Boabd of Health. [Off. Doc, 

On motion of Mr. Howanl Murphy, the Becretury was iu- 
stnicted to transmit the thanks of the Board to the physi- 
cians and to the citizei^B of Johottonburg, who so promptly, 
ener^tically, and generously assisted the Board in the 
emer^Dcy resulting from the outbreak erf small-pox at 
Clarion Junction, and by such asaiBtance contributed 
materially to the successful result which crowned the 
efforts of the Board. 

The subject of inadequate provision for lepers discov- 
ered iu this state, referred from the annual report of the 
secretary, was then called up. Mr. Howard Murphy moved 
that in view of the evident lack of sanitary precaution and 
humane provision in regard to cases of leprosy in this 
state and in the United States, the secretary be requested 
to inveetiKAte the subject and report as to the appropri- 
ate measures for remedying this evil at the next r^nlot 
meeting of the board ; and, further, that he be author- 
ized to commtmicate with the supervising surgeon gen- 
eral of the United States marine hospital service and 
with the President of the United States, urging the im- 
portance of bringing this matter before congress at an 
early date. 

With reference to the communication received from the 
' general baggage agent of the Pennsylvania roads west of 
Pittsburgh, and from the State Boaxds of Iowa and Ohio, 
calling attention to the fact that the boards of health of 
both of these states had considered it expedient to for- 
bid the transportation of the bodies of persons dead of 
diphtheria in public conveyances, the board ordered 
regulation iu regard to disinterment and transportation 
of dead bodies (No. i. Regulation of Travel and Traffic), 
to be amended by inserting the word " diphtheria," after 
the words "typhoid fever," in rule 1 under the heading 
"transportation of bodies, so that said rule shall read 
" the transportation of bodies of persons who shall have 
died from small-poi, Asiatic cholera, typhus fever, diph- 
theria or yellow fever is strictly forbidden." 

The chairman of the committee on water supply, 
- drainage, sewerage, topography and mines called up 
the subject of abandoned cannl beds. On motion of Dr. 
Dudley, it was resolved that the chairman of this com- 
mittee be directed to correspond with the companies or 
individuals owning or leasing the various abandoned 
canal beds or other abandoned waterways in this com- 
monwealth, in order to obtain information as to their 



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No. 16.] MlHDTBS. 

present oondition and efiFect on the pablic health, and' 
authorized to make snch inspections as be may consider 
necessary in order to obtain definite information in ad- 
dition to that received from the owners, and is further 
directed to report oii this subject at the next regular 
meeting. 

The action of the secretary in issuing credentials to Dr. 
J. H. McClelland, president of the Board, as delegate to 
the International Congress of Bygiene and Demography 
in August last, and in obtainingfrom the Oovemorof the 
state s commission lor the same gentleman to represent 
the Commonwealth of PennsylTsniaattiie samecongress, 
was approved. 

On motion of the chairman of the committee on water 
supply, drainage, sewerage, topography and mines, it was 
resolved that this Board condemns in the strongest 
terms thepractice which is now becoming a very common 
oue in the smaller towns of the state of making use of 
abandoned drinking wells as receptaclesforcesspoolfilth 
and other house drunage, and that in every iostcmce in 
which the executive officer has reason to suppose that 
snch disposition of filth and drainage is the cause of dis- 
ease be be requested to use the authority of the Board to 
forbid its continuance. 

On motion of Mr. Howard Murphy, it was resolved that 
tiie members of the Board be at liberty to invite the 
medical inspectors of the Board, the members of other 
state and local boards of health, and such other persons 
as are interested in sanitary science, or whose presence 
may be of interest or benefit to the Board, to be present 
at any meeting of the Board. 

On motion, the chairman of the several standing commit- 
tees were aatfaorized to incur such reasonable expense as 
may be necessary for the due prosecution of their work, 
and to forward vouchers for the same to the secretary. 

In view of the ni-gent need for improved moans for dis- 
p06in<; of house drainage in Forest City, as indicated by 
the leportof Medical Inspector Taylor, the secretary was 
instructed to confer with the authorities of that place, ad- 
vising that immediate steps be taken for providing the 
townwithapropersystemof drainage or sewerage as local 
circumstances appear to demand. 

On motion of the chairman of the committee on water 
supply, drainage, sewerage, topography, and mines, it 



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State Board of Health. [Off. Doc 

was reeoWed that two engineer inspectors be appointed 
one for the western, and one for the eastern part of the 
state; said engineer inspectors to receive the same com- 
pensatioD and to be invested with the same authority ea 
the medical inspectors of the Board ; and that whenever 
a report be made by an engineer inspector a copy of the 
same be transmitted to the medical inspector of the dis- 
trict in which the inspection was made as well as to the 
secretary, and when so reqaested to the chairman of any 
committee ; it being understood that the committee on 
water supply, drainage, sewerage, topograpy and mines, 
shall be<consalted in the appointment of such engineer 
inspectors, bat that nominations for these positions sball 
be made in open meeting of the Board. 

Mr. Howard Murphy moved that the secretary be in- 
structed to request Alfred Iiee, Esq., to present a bill for 
his services in preparing the full and able opinion pre- 
sented at this meeting on the subject of the pollntion of 
streams in this state, and that a sum of not less than $150 
or more than 1260 be appropriated for this purpose. 

It was carried. 

On motion, the chairman on committee on adultera- 
tions, poisons, explosives and other special sources of 
danger to life and limb was instructed to obtain speci- 
mens of butter from leading dairies with a view of deter- 
mining to what extent iujurious materials are made use 
of for the purpose of coloring the same. 

On motion of Mr. Howard Murphy the secretary was 
instructed to subscribe for the Engineering News and 
Engineering Becord. 

The secretary presented a communication from His 
Excellency the Gkivemor of the state, enclosing a pro- 
clamation calling upon all state officers to lend their as- 
sistance in making the exhibit of the State of Pennsyl- 
vania at the World's Columbian Exposition, to be held 
in Chicago, in the State of Illinois, and which is to be 
formally dedicated on the 12th day of October, A; D. 
1892, and regularly opened to the public on the 1st day 
of May, A. D. 1693, one that will be a source of pride to 
every Pennsylvaniau and a revelation to the world of 
enterprise, progress and unrivalled resources of the state, 
and requesting such officers bb may wish to take part in 
said exposition to communicate at an early date with 
Benjamin Whitman, executive commissioner of the 
Board of World's Fair Managers of Pennsylvania, at his 



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No. 16-3 MnnriEB. 

office in the city of Harrisburg, in order thai be may be 
enabled to learn their views and porposes onthesabject, 
and to aid in making Bach arrangements as to space and 
location as well as sectue the best results. 

The secretary was on motion inatruoted to confer with coniaranoe wi 
the aforesaid Benjamin Whitman, execative commis- 
sioner, with the secretaries of the boards of health of 
other states, and with the secretary of the American Pub- 
lic Health Association, in order to obtain their views as 
to the best means of illustratii^ sanitary work, and as to 
the expediency of conjoiot action between these bodies 
for this porpose ; and the secretary was further author- 
ized, in case the result of such correspondence should be 
the proposal of a conference between these bodies, to at- 
tend such couferenoe as the representatiTe of the Board. 

The secretary stated that he bad received the announce- 
ment of the opening and cooises of instruction of the 
new laboratory of hyRiene of the University of Pennsyl- 
vania, which woold be equipped and ready for use on 
February 1, 1892. 

This would be an occasion of great interest to the Board, 
and would afford an opportunity for the establishment of 
such relations between the two bodies as might accom- 
plish most beneficial results for the cause of sanitary 
science in the state. He therefore proposed the follow- 
ing resolution, which was passed: 

Beaolved. That the Botuxl has received with sincere 
satisfaction tiie formal announcement of the approat^hing 
opening of the laboratory of hygiene of the University 
of Pennsylvania, considering that it marks an era in the 
progress, not of science only, but of civilization in this 
commonwealth. 

Besolved, That the secretary be instructed to commu- 
nicate with Dr. William Pepper, provost of the nniver- 
sify, and Dr. John S. Billings, surgeon U. S. A., director 
of the laboratory, requesting a conference for the pur- 
pose of formulating a plan by which the State Board of 
Health may avail itself pr^tically of the facilities af- 
forded by the laboratcoy for the investigation of the 
causes of disease, and of the means for its prevention, 
for the analysis of foods, water and other beverages, and 
for bacteriological studies. 

Besolved, That in a definite co-operation between the 
University and the State Board of Health in the prose- 
cution of such researches, the Board recognizes an op- 
5-16-91. 



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State Boabd of Health. [Off. Doc. 

portnnity not only for mntnal profit, but for advantafre 
of the greateet moment to the entire state. 

A oommtmication was presented from the secretary of 
the Woman's Health Protective Association of Pitts- 
burgh, requesting the Board to take some action to abate 
the nuisance of promiscuous expectoration in public con- 
veyances and other places. The letter was referred to 
the secretary for reply, with an expression of the sym- 
pathy of the Board with the work of the association. 

The Board then adjoomed. 

Benjamin Lee, 



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PART ir. 



APPENDICES. 



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Official Document, 



APPENDIX A. 



BEPORTS OP STANDING COMMITTEES. 



Report or the Exocutlve Committea Pnmberton Dudley. M. D., OIulntMn. 
Report of Ifae Oommittee on Registration and Vital Statistioa. Benjamin Iiee, M. D., 

Ctaaimiaa. 
Beportof the Committee on W»Eer Supply, Drainage, Sewerage, Topography and 

Mluea. Howard Murpliy, C. E., Chairman. 
Report of the Committee on Public Inatltntlons and School Hygiene, Qeorge O. ' 

OrofT, M. D., Cb^rman. 
Report or the Committee on Sanitary Legislation, Rules and Kegulatlona. S. T. 

Davis, M. D., Cli^rman. 



RXPOBTB OF BXDOUTIVB OOMMIITIOIB. 



May, 15. 1891. 

Tonr committee begs to report that, since the regfolar meeting' of the 
Board in November last,' two regular and two special meetings of the 
executive committee have been held. 

The special meeting of the 22d of December, 1890, was for the pm:- 
pose of endorsing the vouchers and pay-rolls covermg the special ex- 
penditures made by the secretary in abating the nuisaaces caused by 
the floods of May 31, 1889, at Johnstown, the total amount of which 
was $39,928.76. The committee, on motion, approved the vouchers and 
ordered them to be so endorsed before presentation to the Gtovemor. 

At the regular meeting held March 6, 1891, vouchere Nob. '409 to 425, 
amounting to $760.82, were examined and approved. 

At the special meeting held May 1. 1891. vouchers Nob. 426 to 436, 
and voucher No 439, amounting to $460.14 and $6.16, were examined and 
approved. 

At the regular meeting held May 14, 1891. voucher No. 437, amount- 
in|r to 1288.97, was examined and approved. 

Respectfully submitted. 

Pehberton Dodley, 
Chairman. 



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70 State Boabd of Health. [Off. Doc, 

July 9, 1891 
The execative committee beg respectfully to report that one meeting' 
has been held since the last re|*iilar meeting of the Board held at Al- 
toona, May 14, at which voucher !No. 438 and voucherB Nob. 440 to 
468, amounting to 166.84 and $664.08, were audited and approved. 
Bespecttully submitted. 

Pehberton Dudley, 
Chairman. 

November 13, 1891. 

Your committee begs to report that since the laat regular meetinf? of 
the Board, two regular meetings and one special meeting of the execu- 
tive committee have been held. 

At the regular meeting, held August 31, voucher No. 489 and vouch- 
ers Nos. 463 to 466, amounting to $460.28, were examined and approved- 
The bill of Dr. J. F. Edwards, amoanting to $200.00, for expenses in- 
curred in publishing the minutes and papers of the Board in ^e Aimala 
of Hygiene, was approved and ordered to be paid as soon as there 
should be fuuds in the treasuiy to meet it 

At the special meeting held September 21, vouchers Nos. 467 to 484, 
amounting to $696.36, were examined and approved. 

At the regular meeting held November 12, vouchers Nos. 485 to 486, 
amounting to $803.64, were examined and approved. 

Bespectfnlly submitted. 

Pembebton Dodlby, 
Chairman. 



BOPOBT OF THB OOSOHTT&B ON RHO-ISTRAllON AMD VITAL 
8TATI8TI08. 



Your committee beg leave to submit the aocompanying documents 
referred to them by the secretarj', as a convincing proof of the necessity 
for the establishment of a Byst^m of registration of deaths in thia state. 
The statement made-by the coroner that he is greatly annoyed by such 
cases, indicates that, shockini? as they are, they are not of infrequent 



PrrrsBiTBGH, July 7, 1891. 
Dr. Benjamin Lee, Secretary State Board of Health : 

DejlR SeubbtabT: a week ago. Squire Owynn, of Duqnesne, of Alle- 
gheny county, called on me in reference to the enclosed verdict and con- 
tents of letter, thinking there was a law to cover the case, and not being 
informed by him, at the time, to the contrary, I told him he had better 
prosecute on some Buch charge as a misdemeanor. Ha returned a day 



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No. 16.] CoMBflTTEB ON VlTAL STATISTICS. 71 

or SO later to iuform me that he had found no law to cover the case, 
that be bad buried the child and administered a severe reprimand to the 
father and let bim go. The next day after the sqnire called the second 
time I received the enclosed verdict aud letter. I have seen the coroner 
since and suggested that we had better let the matter rest as it is, but 
that I would forward the letter and verdict to you. and that the knowl- 
edge of this case wonld be of value for future reference, in similar cases. 
The coroner says he is greatly annoyed by such casea 
Very respectfully, 

J. B. Thohpson, 

Medical Inspector. 

PllTSBUBGH, July 1, 1891. 
Dr. James R. Thompson, BeprenentativeStcUe Board of Health, OUy. 

DoAR Snt: I hand you herewith a trauBcript of record in case of male 
child. The said child had been thrown into the river by the father be- 
cause he had no money to bury it. As I think the matter should be in- 
vestigated by your Board, will you please have it presented to the 
proper ofllcials. 

Very respectfully, 

Herbert McDowell, 
Coroner. 

Allegheny county, ea: 

An inquisition indented, taken at Miffiin township, in the county of 
Allegheny, on the 26th day of June, A. D. 1891, before me, Josiah 
Gwynn, acting coroner of the county aforesaid, upon the view of the 
body of a male child then and there lying dead, upon the oaths and 
solemn affirmations of C. W. Allebrand, Thomas D. Davis, James Hun- 
ter, Wm. Thompson, Nick "Williams, August Wisser, good and lawful 
men of the county, who being sworn and affirmed, and charged to in- 
quii'e, on the part of the commonwealth, when, where und how, and after 
what manner the said male child came to its death, do say, upon their 
oaths and affirmations aforesaid, that a fully developed male child 
was found in the Mouongahela river near Duquesne, Mifflin township, 
afloat on Friday, June 26, 1891, abont 7.45 o'clock a. m., aud the identity 
nnknown, and the facts appearing suspicious aa to its death. We the 
jury find upon testimony offered that the said child was placed in said 
river at, or near said point by one A G., the father, the said being still- 
bom, and we further censure the father for his cruel and barbarous 
treatment of said male child. And bo the jurors aforesaid, upon their 
oaths or affirmations as aforesaid, say that the aforesaid male child for 
the cause aforesaid in manner and form aforesaid, came to its death, and 
not otherwise. 



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72 



State Boa%d of Health. 



[Off. IXw. 



In witness whereof, as well of the aforesaid coroner, we, the jurotB, 
have hereunto put our hands and seals on the day and year, and at the 
place above mentioned. 

JOSIAH GWYNN, J, P. [SEAL-l 

Deputy Coroner. 

C. W. Allebfakd, [seal] 

Jaheb Hunteb, [seal.] 

Nick Williams, [seal.] 

Thomas D. Davis, [seal.] 

Wm. Thompson, [seal.] 

AoaOBT WissBB. [seal.] 

State of Pennsylvania,) 
CouTity of Allegheny. ) 

J, Herbert McDowell, coroner of Allegheny county, in the state afore- 
said, do hereby certify that the above and foregoing is a true and cor- 
rect copy of the verdict in the matter of the inquest held on the body 
of a male child of A. O., deceased, which waa rendered on the 26tb day 
of June, A. D., 1891, as appears from the records of my office. 

Witness, my hand and seal at Pittsburgh, in said county, this 1st day 
of June, A. D. 1891. 

Herbert McDowell, 
Coroner. 



The prothonotary of Philadelphia has returned to the Board the 
names of three hundred and sixty-two physicians, as have registered in 
that city during the year ending July 1, 1891, and of sixteen as having 
died during the same period. The committee has prepared a blank for 
the returns of local boards of health in abstract, a copy of which is here- 
with submitted. The object of this blank is to enable the Board to get 
returns in advance of the preparation or publication of the full reports 
which are often delayed so long that they cannot appear until the re- 
port of the State Board for the following year. Many of the local 
boards have responded very promptly, and seem pleased with the plan. 

Bespectfully submitted. 

Benjamin Lee, 
CkairmaH. 



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CoMMnTEE ON VlTkL STATTHTICS. 



Anncai, Bepobt of thb Health Officer ob Secbetabi of the Boabd 
ob bcbeau of health, 

or tbe of made U 

of PennsytvftnU, for the year begtnnlDgJanuitrj' 1, I8t 
169 . 

^T'llDolude DOtblDg: outalde of tbeao date*.) 

^F'The annual report of tbe local board of health itaould bemadaasearlylD Jan- 
UMyaa possible. — Write In the blank space after each queatioQ, or if more room is 
needed, write on the acoompanying blank sheet plaolng- the appropriate figure be- 
fore each answer. 

I. Oive the name and address of each meiui>er of your board. 



, Secretary. 

. Chairman. 

Member. 



Postoffice address. 



2. How many meetings bare l>een held by the board during the year T 

3. Bave any Improvements or changes been made In your as regards 

water supply, drainage and sewerage, or in the methods employed In dispos- 
ing of excreta T 

4. Nulaancea. How many have been reported to your iioard T 

How many have been removed t 

Please report the facts In regard to any nuisances of unusual charac- 
ter, or which have given unusual trouble in respect to decisions 
regarding them, or In wbich there has been unusual difficulty In 
securing sbatemenL 





Name of 

DiBBASB. 


No. of 


No. or 

deaths. 


No. of 
outbreaks. 


No. of houses 
infected. 


No. of outbreaks 
confined to the 
first house. 































































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State Boabd of Health. [Off. Doc. 

)i of the communicable dia- 

8. Were hou»B* In which casesof amall-poz, diphtheria and scarlet fever occurred 

placarded T 

9. What diseaaes were more than us aallj prevalent during the yearT (Ueasles, 

whooplnK-cough, German measles, pneumonia, cerebro-splnal meningitis, 
dlarrbceal diseases of children, etc.) 

10. PleaaecommuDloate the facts regarding any caaee of diseaae which were inter- 

esting from a sanitary point of view. (Unusual course of epidemic preval- 
ence, unusual symptomsor want of certain 8ymptoms,obMrvatlonsaBrBgBrds 
period of Incubation, communication of diseases by contagion, spread of oon- 
tagioua diseases by public funerals, long periods of vitality of infection, con- 
current or consecutive prevalenceof diseases, eto.) 

11. Schools. Have any special cases come under jour observation In which un- 

healthy conditions existed T Have contagious diseases entered any of the 
schools T If so, what aotJon was taken T 



18. What methods can you suggest for improving the sanitary condition of your 



H. Accidents. Has sickness or death resulted Trova accidental causes ; drowning, 
flr.es, and IteroseneaccldentsT If accldentsbaveoccurred from the last cause, 
please report in full to this Board. 

15. Please communicate the facts regarding any oases of disease which have -ap- 

peared to have been caused by polluted water, ceas pool or sewer gas, defeo- 
tive ventilation, lead, arsenical, or other forms of poisoning. 

16. Have any Instances of food adulteration, or Injurious effects trom 11, come to 

your knowledge T 



21. What compensation or pay has been received by the secretary or health officer 
of your tward, or by other members T If payment has not been received, for 
what reason t 



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No. 16.] ' OOKMITTEE ON WaTEB-SuPPLY. 



BBPOBT or THB OOHMimiB ON 'WATER SUPPLY DRAINAQ-B, 
SBWBBAaB, TOPOOBAPHY AND MINES. 



Phiiadelphu, November IS, 1891. 
To the President and Members of the Stale Board of Health of Peii nsyl- 

Gentlebtbn: The chairman of your committeG on water supply, 
drainage, sewera^, topo^^raphy and mines, has the honor to report 
that he has taken a very special interest in the matter of the contamina- 
tion of a small stream in Chester county, by the drainaffe of the well- 
known Dnvon Inn. A re^ar complaint was made by residents and 
riparian owners on the banks of the stream below the Inn and the mat- 
ter was referred to this committee. The secretary has been requested 
to have with him the documents which are on file i-eferring- to this case, 
reference to these will furnish the Board with such detail information 
as they may desire and it need not therefore be included in this report. 

The facts are briefly these : 

Chemical analyses by I>rs. Leffmann and Cresson, an examination by 
Medical Inspector Atkinson, and inspection made by various membei-s 
. of the Board and others, clearly indicate that the owners and managers 
of the Devon Inn are dangerously polluting this water course. 

The parties interested in this case are above the average in business 
and personal standing, and the present indications are that it may be- 
come a celeloated case. 

It is maintained that one or more deaths, which have occurred, have 
been' occasioned by the pollution of the stream and it is stated that this 
claim is considered to be well founded by the best legal medical 
authorities. 

In view of the great importance which is attached to the rights of 
riparian owners in matters relating to water powers, etc., a great ques- 
tion is involved in this case. It is this. Has any person or corporation 
a right in any way to pollute or contaminate a water course of the Com- 
monwealth of Pennsylvania, also, if they have the right to do this to a 
limited extent, how and by what authority is the limit tobedetermined? 
If tiie throwing of a dead mouse iuto a stream is excusable under the 
law, why should it not be permissible to throw into it the carcass of an 
ox or a horse. 

The question has been raised by the secretary that it is not the busi- 
ness of the Board to take part in private quarrels between adjoining or 
contiguous owners, and the chairman of your committee heartily agrees 
with him in this view, but rights and values must necessarily enter into 
consideration of this class of sanitary questions. Ten residents on this 
stream claim to be aggrieved and there is oertainly much of justice in 



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76 State Board of Health. [Off. Doc. 

their claim. They can escape the dangers which have been created in 
this case by depriving themselves of their natural and veated risrhts. 
They can abandon their properties and live somewhere else, or they 
can continue theii present places of residence anddeprive themselves of 
keeping cows and other animals, or if they keep them, can fence off 
their stream and go to the inconvenience and expense of obtaining water 
elsewhere for their cattle and also for domestic uses, where the purity 
of the springs from which they have been obtaining their domestic 
water supply is endangered. Would it be right for the Board to take 
this position T If we should in a case of this kind why not in other 
casest Why not say to every complainant, "If the conditions around j'ou 
are unhealthful, your remedy is to move away or go to the expense and 
trouble to protect yourself." Is it not rather our duty in this case, ana 
in all cases, to have the nuisance removed, so far an we are authorized 
by law to do so t 

There is hardly a deed for a city lot recorded in this commonwealth 
which does not convey with the real estate the rights, ways, water 
courses, etc., thereunto belongingor in any way appertaining, and, as pub- 
lic officers, it seems to me that we should endeavor, in all cases which 
properly come before us, to assist in enforcing the law. 

We no doubt all agree that the milk of cows is not to be regarded as 
safe if these cows drink the water into which the drainage of a large 
hotel enters close at hand, and it is to be presumed that the milk of 
such cows is not only used in the families of the ovmers, but is sold an i 
generally distributed. One case of typhoid fever in the Devon Inn 
might thus cause hundreds of cases in the eastern-central part of the 
state, and the cause of many of these cases might never be suspected. 

There are, of course, two sides to this question. The Devon Inn rep- 
resents large capital and is a great accommodation to the public as a 
summer resort. They must necessarily create drainage and must, of 
course, dispose of it. They have made what they consider proper efforts 
to purify their drainage before it enters the stream, but these efforts 
have so far been nnsuccessful. They have shown a disposition to 
make further efforts, and the chairman of your committee does not de- 
sire to persecute them in any way, but to assist them as far aa possible 
out of this difficulty, but it cannot be considered otherwise than 
fortunate if a legal determination is reached in this case. If it 
is found that there are no laws to protect streams from contamination, 
or if these laws are not adequate, then it would seem to be the duty of 
the Board to urge proper legislation. 

This is not merely a question between the owners of the Devon Inn 
and the complainants. It is one which affects almost every water supply 
in the commonwealth, and if a decision is reached in Pennsylvania it 
would largely iufiuence decisions in similar matters in other states and 
would thus become of national importance. 



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No. 16.] COMMTTEEaB ON PDBLIC IsBTTTtrnoNa, <fec. 77 

The chairman of yoar committee woald therefore respectfoUy vage 
that the Board exercise extraordinary vigor in this mattf^ so far as the 
opportunity may offer. 

All other matters which have reqaired attention from an engineering* 
standpoint are inoladed in the secretary's report. 
Bespectfnlly submitted. 

(Signed) HoWABD Mdrpby, 

Okairman Commitiee on Water Supply, Drainage, 
Sewerage, Topography and Mines. 



RHPOBT OP OOMMTTTBH ON PUBLIC INSTITDTIGNS AHD BOHOOI. 



Dr. J. EL McClelland, President State Board of Healtk and Vital Sta- 
tistice of Pennsylvania: 

SiB: Tour committee has pleasure in reporting the following work 
aceompHshed during the past year; 

Circular No. 2, on school hygiene has been prepared for the instruc- 
tion of school trustees and controllers. Copies of this circular and also 
of circular No. I, on school hygiene, have been distributed to all county 
and city superintendents of schools in the state, and it is hoped that the 
attention of the school authorities will in this way be directed to the 
importance of giving more attention to sanitary conditions about school 
premises, and of co-operating with the State Board of Health. 

The other circulars of the Board have been circulated as far as possi- 
ble at teachers' institutes and in different schools in the state, also at 
farmers' institutes to a considerable extent, and it is believed that mnch 
good has been accomplished in this way. 

During the year there have also been delivered abont twenty-five lec- 
tures to teachers and school directors, and atfarmers' institutes, in which 
attention has been called to the importance of better sanitary conditions 
in the homes, schools, churches and Dublic institutions. 

The subjects which apparently need most attention, at the present 
time, in our schools, are : Insufficient lighting of the rooms ; through 
which the eyes of the children are impaired. This is a matter which 
can and ought to be corrected in the erection of new buildings, and to 
which the Board should constantly direct attention of school trustees 
and architects. Another evil is that arising from the overworked 
condition of the children, especially in the lower classes and among the 
girls. This overwork, your committee believes, largely arises from the 
element of competition introduced into the schools. It is certain that 
nervous disorders prevailing among school children are, to eomeconside- 



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78 State Boabd of HEiLxa. [Off. Doc. 

able extent, dae to oTerwork. Another evil which has received the at- 
tention of your committee ib the spread of contagioae diseases throoeh- 
out communities by the school children. These diseases prevail every 
year; mostly during the period when the the schools are in session, and 
among- children of school age. Theie is great carelessness throughout 
the state in sending children convalescent from these diseases to the 
schools, as also children from homes in which contagious diseases pre- 
vail. It is believed, however, that by calling the attention of school di- 
rectors and controllers to the importance of excluding all children who 
may be the means of spreading these diseases in the schools, that the 
matter will finally be arrested. 

Yoar committee would also call your attention to the fact that there is 
a tendency in the towns of the commonwealth to abolish the intermis- 
sion between sessions called "recess." 'I'his your committee feels is n 
serious error to which attention should be directed ; as also prevailing' 
tendency to reduce school hours to a single session. The first of these 
errors affects the young children most markedly; the second, the older 
children, and is especially injurious because it interferes with the regu- 
lar meal hours. 

Your committee has urged upon school directors, trustees uid control- 
lers the importance of having a health officer in every district, who 
should look after the construction, heating, ventilating and plumbing of 
the school buildings, and should also inspect the genenU health of the 
school children. A great advance will have been made when in every 
community there is such a school health officer. 

Tour committee is impressed with the feeling that some attention 
should be directed to the sanitary condition of the new and cheap health 
resorts whicharespringingup throughout the state, and in which oftenlit- 
tle attentionis paid to good sanitary conditions. These resortsgather a 
large number of people during a few weeks in the summer season, and 
in them, from bad sanitary conditions, serious diseases are liable to oc- 
cur, and to spread throughout the commonwealth. These institutions 
are also liable at the present time to contaminate the inland waters of 
the state whenever located upon the same. 

More attention should be given to the ventilation of churches, to the 
attendance of persons at the services from families in which there are 
contagious diseases, and of persons convalescent from such diseases, as 
also to the holdingof public funerals in churches in cases of deaths from 
contagious diseases. Possibly a circular addressed to the clergy on tbese 
topics might result in some reform. 

Your committee feels that, on the whole, improvement is being made 
in the matter of the construction of school and other public buildings, 
as also in the heating, ventilating and plumbing of the same. 

Geo, G. Grofp, 
OkatTmaa. 



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No. 16. 1 COHUCtTTBB OH SANITARY LeOISLATIOH. 



RBPORT OF THH OOHMITTBIB ON SAIOTART XAQISIiATIOH, 
BTTLBS AND REOUIiATIONS. S. T. DAVIS, M. D., Ohalrman. 



The committee on sanitary legislation, rules and regnlatioQB begs 
leave, respectfully to report that one mouth before meeting of the legis- 
lature it caused a copy of the last annual report of the Board to be sent 
to each new member of the legislature, and a complete set of the circu- 
lara of the Board to all members, together with the accompanying letter : 
To the SoTiorable .- 

Dkab Sib : We have taken the liberty of ordering the fourth annual 
report of our Board to be sent to your address. Shall we be intruding 
too much npou yoor valuable time, if we request you to glance at its 
contents before the opening of the legislatnre in order to acquaint your- 
self with the extent and scope of our work ! 

We also mail to you a set of our circulars, designed for the informa- 
tion of the public when their households are invaded by contagions dia- 
eaaes. 

In order that we may be able to carry out fully the intentions of the 
law estabhshing the Board, itis essential that we should have the proper 
machinery in the shape of local boards of health or health officers 
throughout the entire state. We are now like a general and stafiF with- 
out an army, and the enemy, disease, is already in the field in full force. 

The water supplies of our cities and towns are in daily increasing 
danger of pollution, thus unnecessarily sacrificing the lives, health, and 
consequently the wealth, of many of ourcitizens. An earlier knowledge 
of epidemic invasions, especially of those occurring in our rural districts 
and the interior of counties is urgently needed The difficulty of secur 
ing this knowledge, under oiu- present imperfect system, seriously re- 
tards prompt action by the Board. The utter impossibility of collecting 
and preserving our vital statistics, with our present limited appropria- 
tion, most be apparent to you, yet this is one of the chief objects for 
which the Board was created. 

We could use the full limit of our possible appropriation ($10,000.00 per 
annum) with great advantage to the pnbUc health. Many smaller states 
devote two or three times as much to this purpose. We beg you there- 
tore to consider carefully the expediency of giving your valuable aid to 
legislation having the following objects : 

First The complete sanitary organization of the state ; 

Second. The prevention of the pollution of streams ; and 



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80 State Board of Health. [Off Doo. 

Third. The appropriation to the uses of the Board of the entire amonnt 
allowed by the law. 

We have the honor to be, dear sir, 

Your obedient aervants, 

aAKtiBL T. Davis, M. D.. 
Laie Member of the House of SepreseiUaiives. 
Pehbebton Dudley, M. D., 
Professor of Saiiii<^i'y Science in the Hahnemann 

Medical College of Philadelphia. 
Benjamin Lee, M. D,, Secretary. 
Committee on Sanitary Legislation. 

Immediately after the introduction of the bill to protect the purity of 
streams, the following letter was addressed to the editors of leading 
uewspapers throughout the state: 
To the Editor of ; 

Dear Sih : Allow me to call your attention to a bill now in the House 
of Bepresentatives for the protection of water supplies throughout this 
commonwealth. The extent to which all the streams of our state are 
now polluted, and the rapid increase of such contamination within the 
last few years, can only be appreciated by those who have personally 
investigated the subject. The amount of disease and the number of 
deaths caused by the use of impure drinking water, and the increase in 
sickness of a nature attributable to this cause, is known only to boards 
of health and those who make a careful study of mortuary reports. It 
is earnestly hoped, therefore, by our Board that you will use your valua- 
ble editorial influeuce in support of the passage of this measure and in 
opposition to such amendments as would exempt all manufacturing in- 
dustries from the provisions of the act, a copy of which is herewith en- 
closed. 

Yours very truly, 

Benjamin Lee, 
Secretary. 

Later in the session the following communication was addressed to 
the officers of all water companies west of the Allegheny mountains, for 
the purpose of interesting them in the effort to obtain legislation to 
prevent the pollution of water supplies: 

Philadelphia, February 18, 1891. 

Deab Sir : The representatives of the principal water companies west 
of the Allegheny mountains have recently met in a convention in Pitts- 
burgh to discuss the subject of the pollution of water supplies. As a 
result of their deliberations, they have framed a bill for protecting the 
purity of inland waters, giving the State Board of Health a certain 
amount of supervision and control over them. They also appointed a 



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No. 16.] RePOBT on LEOIBLiTIOK. 81 

delegation to visit Harrisburg on the 26tb of the present month and ap- 
pear before the committees of both Houses to which the bill has been 
referred, ur^n^ reasons for its adoption. A delegation from the State 
Board of Health will also be present for the same purpose. Allow me 
respectfnlly to suggest &e expediency of your own company sending a 
representative to be present on that occasion. The object is one the 
importance of which must commend itself to you, and the presence of a 
body of thoroughly representative men at Earrisburg could not fail to 
make an impression io its favor upon the legislature. 

I have the honor to be dear sir, your obedient servant, 

Benjamin Lee, 
Secretary. 

The following bills in which the Board was interested passed at the 
last session of the legislature : 

1. House bill No. 636, entitled "An act to provide for the current ex- 
penses of the State Board of Health." 

The following is the history of this act: The bill passed the House 
authorizing the appropriation of $6,000 annually, and soon after passed 
the Senate in the same shape. 

At the request of the committee. Senator Showalter had the bill re- 
considered and amended, making the sum $10,000. The House refused 
to accept this amendment, and aoommitteeof conference was appointed, 
of which the following is the official record : 

Report of CojonrrEE of Conference oh Hocse Bill No. 635, 

Entitled "An act to provide for the current expenses of the State 
Board of Health and Vital Statistics." 

To the Honorable the Senate and House of Bejtreseniativen of the Com- 
monwealth of Pennsylvania : 
Oentlehbn : The committee of conference to whom wtis submitted 
the differences existing between the two Houses on House biU No. 635, 
entitled "An act to provide for the current expenses of the State Board 
of Health and Vital Statistics," respectfully recommend that the Senate 
recede in part from its amendments, and that the House recede in part 
from its non-concurrence in the Senate amendments, and that the said 
bill, as agreed upon, be made to read as follows : 

J. M, Woods, 
J, B- Showalter, 
Jakes Booney, 
Chmmittee on the part, of the Senate. 

J. K. WoODHANriEE, 

H. N. Hess, 
John Meclearv, 
Committee on the part of the House of Representatives. 
6-16-91 



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State Boabd op Health. [Off. Doc. . 



To provide for the current expenses of the Sute Bo«rd of Health and Vital Statiatics. 

Section 1. Be it enacted by tlie Senate mid House of Bepresenfaiivea of 
the Commonwealth of Peniisylvanm in General Assembly met, and it is 
hereby enacted by the anthority of the sajne. That the lollowing sums 
be and are Lereby specifically appropriated to defraying the expenses 
of the State Board of Health and Vital Statistics, for two years, namely : 
For the year commencing on the first day of June, Anno Domini one 
thousand eig:ht hundred and ninety-one, and also for the year com- 
mencing on the first day of June, Anno Domini one thousand eight 
hundred and ninety-two: 

For salary of secretary and executive officer for two years, four 
thousand dollars ; for the employment of necessary clerical aid in the 
office of the Board, for postag^e, telegrams, express charges and inci- 
dental office expenses, for traveling and other necessary expenses of tho 
members and secretary of the Board while engaged in the actual duties 
of the Board, and for sanitary inspections, control of epidemics, protec- 
tion of water supplies, and laboratory investigations and analyses for 
two years, eight thousand dollars, or so much thereof, as may be nec- 
essary. 

Tho amounts expended from the above appropriation shall be dis- 
tributed by the said board in accordance with the requirements of the 
sanitary service of the commonwealth and with reference to such 
emergencies as may arise and shall be settled with the Auditor General 
and State Treasurer in the usual manner. 



2 An act to prevent the pollution of the waters of streams supplying 
cities of the commonwealth, which reads as follows : 



To prevent the pollution of the waters of Btreatns supplying oitlea of this 
wealth. 

Sbctign 1. Be it enacted by the Senate and House of Representatives of 
the Coiiimonweilth of Pennsylvania in General Assembly met, and it is 
hereby enacted by the authority of the same. That it shall be unlawful to 
hereafter establish any cemetery upon lands located within one mile 
from any city of the first class of this commonwealth, the drainage from 
which empties or passes into any stream from which any portion of the 
water supply for such city is obtained. 

Approved— June 8, 1891. 



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Na 16.] Bepobt on Legislation. - 83 

3. Ad Act to prevent the pollution of spnngs, water wells and streams, 
by water escaping from abaadoned oil wells and gas wells, which reads 
as follows : 

AN AIT 

To prevent tbe pollution of spring water wells and itreame bj water nscaping from 

abandoned oil wells and gas wellB. 

Section 1. Be it enacted by the Senate and House of Bepreeentaitves of 
the C&mmonweaUk of Pennsylvania in General Asserrdily met, and U is 
heteby enacted by the aitihortty of the same. That upoa the abandoBtuent 
or ceasing to operate or use any well, which shall have been drilled for 
oil or Roa, it shall be the duty of the person or persons interested in 
such well to plug the same, so as to completely shnt off and prevent the 
escape of all water therefrom which may be impregnated with salt or 
other substances, which will render such water imfit for use, for domtps- 
tic, steam making or manufacturing purposes, and in such manner as to 
prevent water fromaay such well injuring or poll utinfjf any spring water, 
well or stream, which is or may be used for the purpose aforesaid. 

Sectiom 2. Any person violating the provisions of this act shall be 
deemed guilty of a misdemeanor, and shall be sentenced, upon convic- 
tion thereof to pay a fine of not more than one thousand dollars or to 
Qodetg'oan imprisonment for a period not exceeding six months, or 
both, or either, at the discretion of the court. 

Section 3. Whenever any person may be injured by neglect or refusal to 
comply with the first section of this act it shall be lawful for such person, 
after notice to the owner or lessee of the premises upon which such well 
is located, to enter upon and fill up and plug such well in themanuet di- 
rected by the first section hereof, and thereupon to recover the expense 
thereof from the person or persons whose duty it was to plug and fill 
up said well, in like manner as debts of such amount are recoverable. 

Section 4. All acts and parts of acts inconsistent herewith are hereby 
repealed. 

Appeoved— The 26th day of May, A. D., 1891, 

The following is a complete list of bills relating to public health and 
safety which were passed by the last legislature, and have since received 
the signature of the Gtovemor and become laws of tbe commonwealth, 
viz: 

1. "An act to provide for the current expenses of the State Board of 
Health and Vital Statistics." 

'Z. "Ad act providing for the ascertainment of the amount of money ex- 
pended by James A Beaver, Governor of the Commonwealth, and for 
the settlement of an account against the commonwealth for said expendi- 
ture, in removing and abatingthe nuisances caused by the floods of 3Ist 
of May and Ist of June, A. J)., 1889, at JohDstown and its vicinity, and 
in the valleys of the Conemangh and Kiskiminetas rivers of the West 



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84 ■ State Boabd op Health. [Off. Doc. 

Branch of the Susquehanna, upon the report and by the direction of 
the State Board of Health as bein^ dan^rous to the public health, and 
making an appropriation foi the payment of the amount so ascertained 
and settled, to the persons advancing the said money." 

3. "An act to prevent the pollution of the waters of streams supplying 
cities of this commonwealth." 

4. "An act to prevent the pollution of springs, water wells and streams 
by water escaping from abandoned oil wells and pas wells." 

5. "An act making an appropriation to the State Hospital for the Insane 
at Danville, for the purpose of extending the sewerage pipes of said hos- 
pital to a point about a mile below the town of Danville." 

€. "An act to authorize the burgess and council of all incorporated bor- 
oughs to widen and deepen streams and water courses running through 
said boroughs, and to erect dykes and embaukmeuts along the same, 
and to empower the burgess and councils to enter upon private property 
on and along such streams and water courses for the purpose of procur- 
ing material for such work, and to provide for the payment of the ex- 
pense thereof, and the assessment of damages sustained to private par- 
ties thereby." 

7. "Anacttorepehlsectiononeof on act approved the 10th day of April, 
A. D , 1873, entitled 'A supplement to an act entitled an "Act to regu- 
late t'lie sale of clams and oysters," approved, the 4th day of May, A. D., 
1871.'" 

8. "An act to prevent fraud in the sale of lard and providing penalties 
foi the violation thereof." 

9. "An act to provide for the ordinary expenses of the executive, judicial 
and legislative departments of the commonwealth, interest on public 
debt, and for the support of the public schools, for the years A. D., 
1891 and 1892. 

Section 28, appropriation for expenses of the commission to select a 
new location for the Philadelphia quarantine station. 

10. " Joint resolution establishing a commission to consider the ques- 
tion of selecting a suitable site for a quarantine station on the Delaware 
river." 

11. "An act to amend the fourth section of an act, entitled 'An act to regu- 
late the practice of veterinary medicine and surgery in Pennsylvania,' ap- 
proved the 11th day of April, A. D., 1889, so that practioners shall be 
admitted to register as such, and to pay registration fee at any time 
prior to the 1st day of January, 1892, but not on or after that day." 

12. "An act in relation to cremation of human bodies in this common- 
wealth." 

13. "An act to amend an act, entitled 'An act to regulate the practice of 
pharmacy and sale of poisons, and to prevent adulterationsin drugs and 
medicinal preparations in the State of Pennsylvania,' approved the 24th 
day of May. A. D., 1887." 



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No. 16.] IteposT ON Legiblation. 85 

14. An act providing for the appointment of a commission by the Gover- 
nor to revise, amend and make such changes in the mining and ventila- 
tion laws of the anthracite coal regiouB as will secure greater safety to 
human life and property, and to provide for the payment of their com- 
pensation and. their necessaiy expenses." 

15. "An act to provide for the health and safety of persons emplOj ed in 
and about the anthracite coal mines of Feniisylvania, and for the pro- 
tection and preservation of property connected therewith." 

16. "Joint resolution authorizing the appointment of a commission on 
ventilatioQ and regulation of bituminous coal mines." 

It will be seen therefore that the legislature has at least taken no step 
backward in the recognition of the necessity for more enlightened sani- 
tary legislation. It has slightly increased the appropriation for the 
Board's uses, and has adopted measures, however incomplete, which 
recognize the duty of protecting the water courses of the state from pol.- 
lution. We have therefore reason for encouragement and for renewed 
efforts in the creation of a public sentiment which shall compel increas- 
ing concessions to the demands of sanitary reform. 
Respectfully submitted. 

Samuel T. Davis, 

Chairman. 
Benjamin Lee, 



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State Board of Health. TOfp. Doo. 



APPENDIX B. 



KEPORT8 OP INSPECTIONS. 

L InspecUon at St. David'a, Delaware county. Bj WlllUm B. ACktnson, M- r>.. 
Medical Inspector. 
.2; Inspection at Parsons, Luseme oouaty. By L.. H. Taylor, H. D., Medical in- 
spector. 

3. Inspection at Scotland, Franklin county. By E. L. Stbbet, M. D., Medical In- 

4. Inapectlon at Oreenshurg, .Weetmoreland county. By W. E. Matthews, M. D., 

Medical Inspector. 

5. Inspection at Two Licks, Indiana county. By W. E. MMtbews, M. D., Medical 

Inspector. 

6. Inspection at Qettysburg. Adams county. By R. L. SIbbet, M. D., MedlcsJ In- 

T. Inspection st Sandy Lake, Mercer county. By A. A. Woods, M. D., Medical In- 

6. Inspection at Clieawlck, Alleglieny county. By J. R. Tbompson, M. D., Medical 

Inspector. 
9. Inspection at Media, Delaware county. By William B. Atkinson, M. D., Medloal 

Inspector. 

10. Inspection st Chestnut Hill, Montgomery county. By William B. Atkinson, M. 

D., Medical Inspector. 
IL Inspection at PrestonvlUe, Montgomery county. By William B. Atkinson, M. 
D., Medical Inspector. 

12. Inspection Bt Carbondale, liackawanna county. By I.. H. Taylor, M. D., Medi- 

cal Inspector. 

13. Inspection at Glen Riddle, Delaware county. By William B. Atkinson, M. O., 

Medical Inspector. 

11. Inspections at Bitner's, Lancaster county. 

(a) By P. A. Hartman, M. D., Medical Inspector. 

(b) ByaT. Davis, M. D., Member of the Board. 

(c) iSuppieinentary, by 8. T. Davla, M. D. 

(d) Analysis or water. 

15. Inspection at Mlllville, Columbia county. By Win. Lelser. M. D., Medlcul In- 

spector. 

16. Inspection at Tnllylown, Bucks county. By Win. B. Atkinson, M. D., Medical 

Inspector. 
Supplementary Inspection. 

IT. Inspection at Nicholson, Wyaniing county. By I^ H. Taylor, M. D., Medical 
Inspector. 

1& Inspection at Shippensburg, CumLierland county. By R. Ij. 8il)bet, .M. D., Medi- 
cal Inspector. 

19. Inspections at Crossona, Schuylkill county. By W. Murmy Weldman, M. I>., 

Medical Inspector. 
Second inspection. 
Tliini inspection. 

20. Inspection at Cliadd's Pord and Cossart, Delswsre county. By William B. AU 

kinson, M. D., Medical Inspector, and Benjamin Lee, M. D., .Secretary. 



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Wo. 16.] BePOBTS of iNSPECITOKa. 87 

21. InapeotlotiB at Walllngford, Delaware county. By William B. Atkinson, M. D., 

Medical Inspector. 

22. Inspection at Howellville, Chester county. By William B. Atkinson, M. D.t 

Medic«l Inspector. 

23. Inspection at Rochester Mills, Indiana county. By W. E. Matthews, M. D.. 

Medical Inspector. 

24. Inspection at Camp Sherman, near Devon, Chester county. By William B. At- 

kinson, M. D., Medical Inspector. 
26. loipection of the Drainage System at Wayne, Delaware county. By WlUlani 
B. AtklDBon, M. D., Medical Inspector. 

26. iDBpection at Schuylkill Haven, Schuylkill county. By W. Murray Weldinan, 

M. D., Medical Inspector. 

27. Inspection at Tyrone, Blair county. By Oeorge G. OrotT, M. D., Member of the 

Board. 

28. Inspection at Wasblnglon, Waahlngton county. By J. R. Thompson, M. D., 

Medical Inspector. 

W. Inspection at Butler, Butler county. By J. R. Thompson, M. D., Medical In- 
spector. • 

3a Inspection at Lennl, Delaware county. By William B. Atkinson, M. D., Medi- 
cal Inspector. 

81. Inspection at Forest City, Forest county. By I.. H. Taylor. Mi D., Medical In- ' 

32. Inspection at Shanksvllle, Somerset county. By J. S. Hackney, M. D., Medical 
Inspector. 

S3. Inspection of a Dam, Lebanon county. By W. Murray Wetdmsn, M. D., Med- 
ical Inspector. 

34. Inspection at Montrose, Susquehanna connty. By I* H. Taylor, M. D., Medical 
Inspector. 



l-mSPBOnON AT ST. DAVID-S, DBLATTTAItB OOiniTT. 
By WiLLiAV B. Atkinson, M. D., Medieal Inapeetor. 

I inspected the premises at St. David's occapied by Mre. M , 

on Norember 10. At the rear the draioa^ was so imperfect that the 
water from the kitcheo settled in the path and aroond the entrance, and 
I was informed that on some occaeions it backed up into the rooms. Id 
this room the woodwork at the edf^ of both doors was badly rotted 
and broken. The draina^ led into a lot where a temporary well had 
recently been du^ to prevent the sewage flowing over the adjacent land. 
I was informed that after rains this well overflowed and also backed up 
to the house. The draina^ from the bath room, water closets, etc., led 
down to a cesspool in the rear near the stable, where a well received it. 
The cesspool in the rear was full and in a very unclean condition. The 
water pipes leak around the sinks and wash tubs, which keeps the floor 
constantly wet The cellar is also wet from the drainage and leaks; 
there is a leak id the tank roam, and the pump there does not work. 

I would suggest that all the draiunge be made complete, and that 
connectioD be made with the sewers on the west, which can readily be 
done. 



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88 State Board of Health. [Off. Doc. 

Inside the main buildinf? there were evidences of dampnens, the paper 
beiDs: loose and ready to fall in the bed room on the first floor, and in 
one comer of the parlor. 

All of which is respectfully flnbmittied. 



a— msPBOTION AT PABSONS, LUZBBNB OOtTNTT. 

By Lbwis H. Tavi^ob, M. D., Me.tlical Jntperlor. 

"Wilkes-Bakre, Pa., NovembiT 18, 1809. 
I proceeded to-day to Parsons, aud after a careful iuvestig^iition would 
respectfully report that I do not find anything in the general sanitary 
conditions of the place constituting- a nuisance. The town is reported 
by the two physicians resident there, to be in as healthy a condition as 
usual. There is nothing approaching an epidemic of any kind. There 
have been a few cases of diphtheria ; oue physician reporting two, the 
other four ; all of them mild cases. Six cases of scarlet fever are re- 
ported in the practice of the two physicians mentioned, with one death. 
There are other physicians in adjoining towns who have some practice 
in Parsons. I will write to them and find out definitely whether any 
cases are under their charge and will report to you later. The vill^^ 
'of Miner's Mills, adjoining Parsons, about one mile distant, has had 
many cases of diphtheria, and much carelessness has prevailed, but in 
my judgment the scourge is on the decline. I will, howeTer, investi- 
gate this also, and communicate with you at my earliest convenience. 
I enclose a clipping from one of our daily papers, showing how little 
confidence can be placed in such reports. On the strength of it, I hod 
already supplied Drs. Debane and Itboads with the Board's circulars be- 
fore receiving your communication. 

Letter to the Burgess of Parsoss, Ldzerne County, by Benjamin 
Lee, M. U., Secretary. 

1532 Pine Street, Novemi>er 16, 1890. 
To the Burgess of Parxniis, I/uzerne County, Pa : 

Dear Sir.- Information has been received at this office that an epi- 
demic of malignant diphtheria, and an epidemic of scarlet fever are 
prevailing in your borough. I send you circulars with reference to 
precautions to be taken for the prevention of the spread of both of these 
diseases, as well as circulars indicating the dangers of public funerals of 
tborie who have died of contagious diseases. I also sftud a copy of the 



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No. 16.] Inspection at Scotlasd (Typhoid Fever). 89 

model OTdinance recommeDded by the State Board of Health for adop- 
tion in all boroug;hs. It would be well for yoar council to adopt this or- 
dinance, so far as it is applicable to a town the eize of Parsons. If this 
is not done, you shonld at least adopt an ordinance to take effect during 
the present epidemic, making it an offense, punishable by fine, to have 
public funerals in these cases, and also for children who have recently 
recovered from these diseases, orin whose families they exist, to attend 
church, Sunday school, day school or any other public assembly. 

I have instructed the medical inspector of your district (Dr. Taylor, 
of Wilkes-Barre), to make an inspection in Parsons, and if he finds the 
conditions alarming, I shall issue a proclamation, declaring diphtheria 
epidemic in the town. 

Trusting that you will give this matter serious and unremitting atten- 
tion, have the honor to be. 

Tours respectfully, 

Benjamin Lee, M. D., 
Secretary. 



3-INaPBOnON AT SCOTLAND. FRANKUN OOUNTT 

By R. L. SiBDETT, M. D., Mtdieat Tnsp«elar. 

Carlisle, December 19, 1890. 

I went to the village of Scotland, Franklin county, and was kindly 
received by the citizens. Dr. J. J. Co£Fman, the resident physician ac- 
companied me and he has just forwarded a sketch of the place and the 
data of fourteen cases of typhoid fever, two of which died and two are 
still ill. As will appear from the sketch, the greater part of the village 
is on elevated ground, the highest point being about sixty feet above 
the Conococheaque and a small stream of water on the east. Two 
things were remarked by the citizens — that typhoid fever cases had 
been very rare in their midst until recently, and that these were 
mostly on the highest ground of the village. 

What may be called the local facts and the history of the several 
cases admit of two theories : The first accounts for six of the fourteen 

cases referred to, Mr. and Mrs. H , of Cbamberaburg, received 

into their home (being relations), Miss B and her sister, from 

Scotland, about the first of September. They all drank the water of a 
cool spring, which Dr. Cresson, of Philadelphia, afterwards condemned. 
About two weeks from this date, Dr. Montgomery was called to attend 

the first two, Mr. H died and his wife made a slow recovery. Miss 

B and her sister returned home, and on the 12th and 14th of 



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90 State Board of Health. [Off. Doc. 

September, called Dr. Coffman to attend them. Both recovered after 
three weeks of sickneBB in bed. On the Ist of October Dr. CoSman was 
called to prescribe for a youDg man in the family of the two sisters, and 
he advised him to retnrn to his relatives in Cumberland county. Here 
he recovered, but his sister who nursed him, took the fever and died 
We have thus a group of six patients, four of whom drank of the same 
spring water and took typhoid fever ; the other two took the disease by 
infection as we may suppose. 

We cannot however connect the other cases so easily and are obliged 
to seek another solution. The cause of the disease at Scotland may 
not indeed have any connection with that at Chambersburg;. Near the 
kitchen of the home of Miss B and her sister, is a well whicTi is sus- 
pected, and the two sisters as well as the young man drank of it every 
day. Moreover, the neighbors, during the summerandatthis time were 
accustomed to pump water from tliis well for drinking and culinarypnr- 

poses. Mr. H having only a cistem at his house carried water 

from this well and drank freely of it. On the 7th of September, Dr. 
Coffman was called, and he attended him several weeks. One month 
afterwards Mrs. H , in the same bouse, took sick with the symp- 
toms of fever and is still in bed On the 28th of November Miss E , 

likewise in the same house, was attacked, but her symptoms are fortu- 
nately not serious. 

Three other cases in as many homes, are known to have drank of the 
water of this well in preference to cistem water, but it is said that two 
of them, going to school, drank also of the water of another, which is 
al9o suspected. 

But there remain two other coses, the first of the series, the cause of 
whose sickness cannot be so easily ascertained. They lived in sepa- 
rate houses on the eastern side of the village. Dr. Coffman was called 
to attend them July 26th and 29th. Of the fourteen cases two died. 

From the foregoing it is clear that the cause of the epidemic of fever 
in this village is to be found in impure drinking water. A permanga- 
nate of potash solution reveals the fact of the presence of a heavy sedi- 
ment, and a good microscope shows that it is organic. 

I have already directed the citizens of Scotland to abandon the use of 
the water of the two wells referred to, and the water of others similarly 
located, and I have likewise directed them to use cistem water or water 
taken from the bed of the creek. The ground upon which the village is 
built is like that at Chambersburg, sandy and leachy, and hence it is 
impossible to find pure well or spring water in it. Stables, pigpens, 
water-closets and chicken coops seem to be necessary attachments to 
dwelling houses, and the process of infiltration from these, as is well- 
known, goes on day and night, summer and winter, and hence the pol- 
lution of wells and springs in this kind of soil. 

All of which is respectfully submitted. 



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A Aged 17 years, oase of oontinoed fever from Jalj 26, 1891. 1 Difficult at timeel 

> Bemitteot and 
B Aged 8 years, " " " " July 29, 1891. ) bnt reeemble T 

C Aged 58 years, Mr. E. became siok September 7th. 

D The two Misaea B. became infected aod were taken sick September 

12th and l4th reepeotiTely. Here also, on September 

Mr. B., a boarder, became infected, went home to 

Cnmb. Co., from whom his sister contracted 

disease and died. 
E A school boy, N. M., took sick Sept. 28. 
F M. C. took siok Oct the family get 

water from well at B. j 

G A. B., school girl, took sick Oct. <?^ 

H I J K L Stables and hog pens and privieB above 

well of B. 
M N Gbare yards. 
O Blacksmith shop. P. Mill. 




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D,Blradb,GOO<^le 



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No 16.] iNSPRCnOK AT Qbernsbdbq. . 91 

4— nrSPBOTION AT aBBBNSBUBQ, 'W^BTMORHLAND OOUNTT. 

Bj W. E. Matthews, M. D., Medical Inspector. 

On January 20, 1891, I went to Greensbnrg and inspected (with 
Mr. Frank Cowan), the court bouse cellar, and surrounding. There 
ure a number of cells in the cellar which are used by the borough as a 
lock-up. These are in a very filthy condition. In consultation with 
the commissionerB, I was assured that orders had been issued to remove 
these cells and clean the place. An old well is on the premises, into 
which a number of pipes drain. It is full to ^ritbin a few feet of the 
surface. I su^^ested that this should be emptied, disinfected and filled 
with fresh earth, and then a drain be made into the sewer. The heaters 
are in the cellar and the air supply comes from the cellar, thuscarryinf^ 
foul air to all parts of the building. This should be remedied by taking 
the supply from outside. I urged the cleaning and disinfection of the 
entire cellar, the removal of its floor, and the covering the surface with 
an inch of lime and the white washing of the wall. All this, after a 
thorough disinfection of every part. 

LtnTEB FBOK THE SeCBETARY TO THE PBESIDEMT OF THE BoARD OF COH- 
MIBSIONERS OF WESTMOBELAND COONTY. 

ObeensbURO, Pa., January 23, 1891. 
Mb. S. G. Thompson, President Board of Gommtsaioners of iVentmore- 

land- County : 

Dear SiR: The attention of this Board having been called to the in- 
sanitary condition of the court house at Greensburg, in consequence of 
the use of its cellar as a-city jail, Dr. W. E. Matthews, medical inspector 
of the Board for the Conemaueh district, was ordered to make an in- 
spection. In his report he advises me that he has made the following 
suggestions for placing the court house in a good sanitary condition as 
soon as the cells have been removed. These suggestions comprise a 
thorough cleansing of the entire premises, the disinfection and refilling 
with clean earth of the rat holes in the floor, the conduction of all the 
drainage of the building into a public sewer, the construction of fresh 
air ducts to lead the outside air to the air chambers, the use of disinfec- 
tants to such portions of the floor as have been espiecially exposed to 
filth where there is reason to suppose that the ground underneath may 
have become sajiurated. The floor should be raised, the foul earth re- 
moved, and clean earth mixed with lime substituted. The wood work of 
the rooms above should be washed with a solution of corrosive sublimate 
of the strength of one part to a thousand, after having been welt scrubbed 
with soap and hot water. If the walls are white-washed they should have 
a fresh coat. I need not urge upon your honorable board the impor- 



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92 State Board of Health. [Off Doc. 

taDce of baviuj; oil the wells remoTed in the briefest possible time. The 
Board will always hold itself in readiuesK to aid you in any work of a 
sanitary nature in any of the boildinf^s or premiseB nnder your control. 
Yours respectfully, 

Benjawm Lee, 
Secretary. 



Letter to the Bdboesb and Council op Gbeenbbcbu by the Hecbetaby. 

January 23, 1891. 
To the Burgess and Council of Greensburg, Pa. : 

Gentleken : An inspection recently made by the medical inspector 
of this Board for the CJonemftugh district, of the cells used for the in- 
carceration of prisoners in your borougrh leads me to question whether 
they are properly provided, in re;^-d ]to ventilation and other respects, 
for the imprisonment of human beings, I will therefore request you to 
Bend me at your earliest convenience an accurate deftcription of these 
cells, giving material, inside dimensions and fomiture and position and 
size of ventilating apertures. The position of tlie latter being indicated 
by their distance from the floor, from the sides and from the top of the 
cells. I would strongly urgu that until an opportunity has been given 
to the Board for judging of this mutter the cells be not permanently 
placed in any other building. I would also call your attention to the 
fact that the sanitary authorities entirely condemn the use of cellars as 
dormitories. The board of health of the city of New York expressly 
forbids the renting and occapying of cellars as human habitations. 
I have the honor to be. 

Yours respectfully, 

Benjamin Lbe. 
Secretary. 



6-INSPBOTION AT TWO UOES, INDIANA. OOUNTY. 
Bj W. E. Matthewh, M. D., Medical Inapfctor. 

Johnstown, Pa., February 13, 1891. 
I submit the followingreport of conditions found at Two Licks, having 
made inspection to-day in company with Drs. St Clair and Keed. Two 
Licks is a small town of a population of eighty. Since last July about 
sixty have had what I believe, from description, to be typhoid fever. 
One of every eight afflicted have died, and strange to say all except one 
have been strong and healthy young men, ranging from twenty-three to 



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No. 16,] IssPEcnoN AT Gettybbdrg. 93 

forty years of a^. The town is situated on a small atream, ground low 
and marshy, subsoil very porous. Supply of driDkiiig water is from wells, 
these beiu^ rather shallow. A chemical works is situated justabove the 
town, but I cannotsee how any material from this could enter thedrink- 
ing water. I believe that Drs. St. Olair aud Beed are of the opinion that 
the source of the trouble is in the water supply, as people working in 
this place and living some little distanceoutof the town, lieuce not using 
the water, do not or have not suffered. At the present time there are 
but two or three cases, and these are convalescing. As to this being ty- 
phus fever I am not prepared to say, but as far as history of cases is 
concerned I believe the typhus is to be left oat of this question. Pr. Camp- 
bell, who has attended more of these cases than anyone else, assures me 
that all the cases he attended were cases of typhoid fever. Some not 
running a regular course. The cases at Two Licks are very similar to 
many cases we have in Johnstown, and the post mortems and hemorrhages 
from the bowels prove these cases to be typhoidfever. The remedy for the 
people of Two Licks is a new water supply. A spring juat above Two 
Licks could be utilized for this purpose with littleexpense.orannrtesion 
■well could be sunk. Hughes & Guthrie, who have large lumber inter- 
ests here, have already spoken of sinking a well. 

The chemical works are owned largely by Sutton Bros., of Indiana, 
and Wilse Taylor, of the Farmers' Bank of Indiana. 

If the question of a new water supply was placed before these lum- 
bermen and these chemical men I believe they would combine and fur- 
nish this for their employes. 



e-rETSTXtonoN at aarrYBBUBa, ad ams oounty. 

By R. Ii. SiBDET, M. D., Medical Inspector. 

Oablisle, Pa., Februry 20, 1891. 

I went to-day to Gettysburg and made an inspection of the nuisance 

complained of by Mr. H. A — D . From him and from his 

attorneys I learned that he bad prosecuted the borough council for 
maintaining a nuisance near his residence, that the court had sustained 
the plaintiff on several occasions, that twelve reputable citizens had made 
affidavit to the existence of such nuisance, and I also learned from plain- 
tiff, and other reliable sources, that the council proposed tocontinuetbe 
case in court at the expense of the borough. I called upon the burgess 
and several members of the council and was received with respectful in- 
diffisrence; nevertheless, at my suggestion, a meeting of the citizen tax- 
payers, one week later, was agreed upon. 

January H, I returned but found that the council desireda private meet- 
ing, to which I of course agreed. However, a dozen or more citizens 



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91 State Buabd of Health. [Off. Doo. 

tboug'ht it their duty to attend, amon^ whom were, Drs. Charles and 
Bobert Homer, Dr. O'Xeil aud Dr. Stahley, of Pennsylvama College. 
The discussion took the form of a running debate, in which the president 
and attorney of the council took a leading part in the defense of their 
policy. On the other hand the medical gentlemen, and other citizens 
present, concurred with me as to the importance of abating the nuisance 
referred to as well as other nuisances which were known to exist. Fail- 
ing to elicit any satisfactory information or promise from the council on 
which I might base an intelligent report, I concluded to ask for another 
meeting one week later, to which the citizen taxpayers might be freely 
admitted. 

January 13, 1 returned, and after a more thorough inspection of the 
other nuisances complained of, I met the council and about a hundred 
citizens in the grand jury room of the court house. At this meeting 
there was greater freedom of discussion, but no one of the council vol- 
unteered to give any information concerning the nuisances of which the 
people complained. A communication from Dr. Breidenbaugh, profes- 
sor of chemistry in Pennsylvania College, on tlie subject of drainage, was 
read, and a few remarks were made by Dr. Stahley, professor of physi- 
ology and hygiene in the same institution. I may add that the nuisance 
complained of by Mr. D— — — lias existed for many years, and the only 
statement that I could draw from any members of the council was this, 
that he knew of the output of this drain before he purchased the lot of 
ground and built Ms bouse. The following, which was immediately pre- 
pared and was received, may be sufficient to complete my report: 

Carlisle, Pa.. January 15, 1891. 
To the Burgess ami Council of Hie Boroiigli of Gettysburg : 

Gentlemen : After a careful inspection of the sanitary condition of 
your borough, on three separate occasions, and two meetings at which a 
variety of public health topics were discussed by members of the bar, 
medical practitioners and other citizens, I have the honor, as a represen- 
tative of the State Board of Health, to present the following for your 
consideration : 

Gettysburg is favorably situated on elevated ground, most of which 
lies between two small streams— Stephens' on the northeast, and Culpa' 
run on the southwest, both of which are dry part of the year. The rain- 
fall and small springs issuing from the sloping ground on either side, 
found their way by direct courses into these streams until interfered 
with by the hand of man. The construction of a railroad between Ste- 
phens' run and the higher parts of the town has interfered with the 
natural drainage very much. This ai-tificial work laid the foundation for 
nuisances of which the people now very frequently complain. More- 
over the town council in former years not appreciating tlie full value of 
free aud direct drainage and of sanitation in a growing population, ae- 



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No. 16.] iNsPEcnoN AT Gettysburq. 95 

sieted in layinf^ the foundation of these nuisances. The natural surface 
drain^e of Baltimore street would he down Carlisle street, under the 
railn>ad and on to Stephens' run; but it has been deflected to the ri^bt 
and left at Centre square ; first, do^vn York street, over Stratten street, 
and a^ain at a right angle between the houses and lota of ground owned 
by Stoner and Swope, and through other lots of ground to Stephens' 
ran ; second, to the left down Chambersburg street, and again at a right 
angle into the same run. What is true of Baltimore street is also true 
of Stratten and Washington streets. Their drainage being added on the 
right and left. Thus the drainage of the greater part of the town js 
turned out of its direct and natural course and thrown upon two points 
where the people complain that the water sometimes covers their pave- 
ments and enters their cellars. 

But there are several other features of this question of drainage to 
which it is important to aak your attention. On the left of Baltimore 
and Carlisle streets it became necessary for the property owners to nn- 
derdrain their cellars at their own expense. Hence ob many as fifteen 
or twenty drains have been made, all leading into a zig-zag pipe. In 
the construction of these, stone, terra cotta, tiling and wood have been 
used, and apparently without any supervision or intelligeui direction 
by the council. On account of the imperfect construction of these drains 
the contents of privies have been passing into them, and as a conse- 
quence the outpnt near the residence of Mr, D , and the opening 

in the gutter near by, have become an intolerable nuisance, twelve citi- 
zens having made oath to this effect. On the same side of town and 
along a street parallel with Washington is an open drain which has also 
been n nuisance for many years. In these parts of the town a few cases 
of fever and diphtheria are known to have existed every year. 

Passing to the other side of town, my attention was directed to two 
other drains partly closed, but for the most part open, into which all 
kinds of excrement are deposited. The first one is said to begin with 

the Globe Inn. It passes by C 's slaughter house and cattle yard 

in the alley, and takes in the fluid contents of both. It then passes be- 
tween the houses owned by I and F — ou Bailroad street, in 

which four cases of diphtheria were treated not long ago. At this point 
it receives the drainage of the gutters, and gives off at times an intoler- 
able stench. It then passes under the railroad and on down to Stevens' 
run. The other drain on this side of town has been referred to. It re- 
ceives a lai^ amount of auimal matter from Baltimore, York at Strat- 
ten streets, and is open the whole length. Privies are built close to the 
edge of it and several upon it. It likewise passes under the railroad 
near the gas works and on to Stevens' run. All of these four drains, as 
they are now kept, must be condemned as public nuisancea 

The dramage of at least four hotels i-emains to be considered. For 
the comfort and health of the crowds of people who annually visit Get- 



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96 State Board op Health. [Off Doc . 

tysbur^, as well as for the credit of the place, the draiua^ from these 
should be complete. Hotels for the accommodndoa of the poblic &re 
qnite as important as streets, and it must be apparent that the proprie- 
tors cannot make all the improvementa necu^aui'y without the assistance 
of an intelligent and liberal town council. Two of these have already 
laid terra cotta pipes at their own expense into Stevens' run. They 
have helped themselves and deserve credit for what they have done, but 
it is easily seen that these efforts may become uaisances in a short time. 
Closely connected with the foregoing are the water supply of towns, 
the privies, the stables, pig pens and slaughter houses which may easily 
become nuisances, if they are not already such. Sanitarians agree that 
all attempts to drain cities and towns by open sewers, or by closed ones, 
in which animal matter is conveyed, have been futile where there is not 
an abundance of water to flush the pipes and carry the sewage outside 
the city or borough limita In your case it seems proper to present for 
your consideration two schemes, the latter being' a modification of the 
former. 

First Scheme. 
Let every step you take be in the direction of underground drainage. 
This is the plan adopted by all our cities and larger towns. Lay a large 
pipe along the course of Stevens' run eastward until you reach the 
limits of the borough. This may be terminated in a compost pile ; and 
to neutralize the above, coal ashes and the scraping of the streets may 
be thrown into it and utilized on the land in the neighborhood. Begin 
with a pipe at the comer of Chambersburg and Washington streets and 
connect it with the pipe at Dr. Homer's. Lay a pipe also on Railroad 
street to take np the drainage at Delaps. Afterwards lay a similar 
pipe down Carlisle street from Centre square and take in all the surface 
drainage of Baltimore and Itailroad streets. In like manuer when you 
have the funds lay a pipe down Stratten street, taking in all the surface 
water of York street. If you adopt this plan the next generation will 
praise you, and I have no doubt that the citizens immediately inter- 
ested will subscribe liberally. This system provides for complete drain- 
age of four hotels and the privies of many private residences. The bor- 
ough, of course, pays only for the main pipes in the sti'eets. In this 
case the borough has nothing to do with private property, except to 
obtain permission to lay a large pipe along side of Stevens' ran. For 
several months each year a larger amount of wat«r will be required in 
the houses from the reservoir to carry away all excrement in the pipes. 

Second Scheme. 

(1) Provide for and assist in the drainage of your principal hotels by 
laying a ten or twelve inch terra cotta pipe in the ground near the edge 
of Stevens' run, so that the proprietors of these hotels and others may 



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No. 16.] Inspection at Gettysbobg. 97 

coDDect their water closets with it anA not make a nuiBance out of the 
run. The proprietors will no doubt approve of this. The public health 
makes this modification imperative. 

(2) Exclude from all other dnuDS, open or closed, the contents of 
privies, pi^ pens, stables and slaughter houseij. and improve them so 
that the rainfall and water of the springs may pass directly into Ste- 
vens' run. 

(3) Make two underground drains across Centre square so that the 
surface draina^ of Baltimore street may pass directly down Carlisle 
street and under the railroad. 

(4) Extend and impi'ove the drain which passes under the railroad 
and close by the residence of Mr. Delap, so that it may no longer be a 
public nuisance. 

(5) Bemove entirely from the center of your borough the slaughter 
house and cattle yard known as Codorus'. ' 

Whether you adopt the first or second scheme it is necessary — 

(6) That yoa'purchase for the tise of the borough an odorless excava- 
tor, to be under the exclusive control of the borough coaocil ; that you 
employ a corps of workmen who shall be under the direction of your 
sanitary committee, and whose special work shall be the removal of the 
contents of privies. 

(T) All surface privies and all others whose contents are within one 
foot of the surface of the ground, including those which allow their con- 
tents to escape into the soil, are hereby declared nuisances. 

(8) Your attention is also called to the construction of small privies 
in proportion to the size of the lot of ground and the size of the dwell- 
ing house on the same, to be made of well-burnt brick and cemented. 

(9) Connected with the proper constmctiou of privies is the use of 
disinfectants in them to prevent diseases, as chloride of lime, pulver- 
ized copperas or slacked lime. The discharges of persons sick with 
typhoid fever, diphtheria, scarlet fever and other contagious diseases 
E^onld not be thrown into a privy, but should be immediately boried 
and covered with coal ashes. 

(10) Perhaps the most difficult mattera borough council has to regu- 
late is the keeping of pigs, and we suggest the following: Require all 
persons to obtain a permit and to pay twenty-five cents for each pig 
kept, the council engaging to pay this sum of money to their corps of 
workmen for keeping the pens in a sanitary condition. 

(11) Until you receive further instructions from the State Board of 
Health, to which I urn required to report the several nuisances men- 
tioned, I beg you to make use of the means herein suggested for the 
abatement of the same without delay. 

7-16-91 



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98 State Board of Health. [Off. Doc . 

7-ih8pbotion at sahdt lakb, mbbobr ooudtt. 

By A. A, Woods. M. D., Medical Inapeetor. 

I proceeded to the town of Sandy Lake on March 11. In consaltation 
with Dr. Cooley and Mr. Bose, chairman of the town committee, I took 
a roag-b draft of the town, the lake and the enrroundingB. In company 
with several gentlemen of the town I went o^^f th^ place on foot, visited 
the lake and swampy ground between the lake and town and walked 
one mile down the creek below town on Wednesday, I also secured from 
the physicians and midertakers the number of typhoid deaths in 1690, 
toother with the deaths from all causes. 

On Thursday we drove three miles down the Big Sandy creek, wading 
the creek on foot at one or two places, and examined the submerged flats 
thoroughly. The results of the investigation are as follows. We will 
take them in the following order : 

First. Bough draft of Sandy Lake and vicinity. 

Suf'Otui. Deaths in Sandy Lake in 1890 with death rate per thousand. 

Third. Topography of town and surroundings and effect of floods. 

Fourth. Prevailing diseases learned from physicians. 

Fifth. Proposed and possible remedies. 

SecfDid. Deaths occuring in the town during the year 1890 together 
with death rate per thousand : 
Deaths of typhoid diseases, either typhoid fever or typhoid mar 

laris, 10 

Total deaths in the year 1890 from all causes, 22 

Estimated populated of the town by citizens, 800 

Estimated population by inspector arrived at by roughly count- 
ing families and multiplying by five, 660 

Bate per thousand, 34.84 

. 2'kird. The topography of Sandy Lake and vicinity together with ef- 
fects of doods ■ 

By glancing at the rough map sent herewith it will be seen that the 
main street of Sandy Lake is three feet eight inches lower than the lake 
of the same name. That theoutletfrom this lake crosses the main street 
near the middle of the town, nearly all of its fall being just where it 
leaves the lake, and it flows through the town very slaggishly, like a 
canal and has banks only four or five inches above common water level. 
It will be seen that the Big Sandy creek swings around the north end 
of the town where it joins the outlet stream and continues on down the 
valley as the Big Sandy. At this junction is where back water com- 
mencesduring all floods, and even commonly heavy rains. Both streams 
bring down a great deal of swamp debris and vegetable mould. This 
junction of the streams on the flats is almost on a level with the town, 



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No. 16.] Inspectio. 'T Sandy Lake. 99 

and is only about five hundred feet from the ceutar of the main street. 
The main street itself having been raised by repeated filling. AU cel- 
lars in this part of the town are below the creek beds at their junction. 

The soil here is a loose vegetable mould, with some clay, consequently 
when the water begins to back up from the jnnctiouitatonce percolates 
throuffh the ground and enters all cellars and tow places. When it gets 
higher it freqnently overflows this portion of the town. It does this 
every year and sometimes twice, to a greater or less es'.ent. It is al- 
leged that there have been some very severe overflows in the last two or 
three years, and the marks above the town show it. 

The only portion of the town not reached by these floods and the per- 
(xilating of the water through the ground is on the hills that wall in the 
valley on the north and south, ^veral streets run up these hillsides, 
and many fine residences are built there, but the business portion of the 
town is all on the flat. The houses on the hillside while not flooded 
seemed to be reached by the malaria as much as the others. Every cel- 
, lar that I saw iu the town had from three to four and one-half feet 
of water in it. Most all other buildings on the flat that did not 
have cellars had water standing under them. At the time of my ar- 
rival on Wednesday the water was moderately high, there having been 
a thaw but no rain. Wednesday night and Thursday a drizzling rain 
fell and the creeks rose higher. Now from the point of junction of the 
Big Sandy and the outlet stream the flats extend eastward fully three 
miles with but Uttle fall, being almost dead level, and very low. A good 
part of it is covered with timber and underbrush. The creek winds 
through these flats crooking and loopinga great deal. These flats seem 
to he overflowed nearly all the time. On Wednesday I saw hundreds of 
seres of this flat land overflowed with water from an inch to a foot deep. 

It is only for a few weeks in each year that they dry out. Abont two 
miles down the flats and east of the town the creek begins to fall over 
rocky ledges. At one place in a deep gully near a point called Smith'H 
railroad crossing, the ledges fall, at a rough guess, about ten feet in two 
or three hundred yards. From that point on eastward there seems to 
be little overflow of the valley and few flats. 

Fourth. The prevailing diseases are sufficiently indicated by the large 
number of deaths of a typhoid character. It is claimed by the physi- 
cians that malaria is almost universally prevalent. Bheumatism exists 
largely. All diseases, rheumatism especially, require quinine in large 
quantities. 

Fifth. Proposed and possible remedies: What the people suggest 
and ask for is to have the creek straightened and the fall from where it 
begins a mile and a half or two miles below and east of Sandy Lake 
carried up to at or near the junction. This would deepen the channel, 
raise the banks and give a swifter current, and any overflow would be 



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100 State Boabd op Health. [Off, Doc. 

some distance from the town. This work could be done but it would 
coBt si j^rreat deal of money. At a rougrli guess I shoold say $15,000 or 
tl6,000. 

The Saudy Lake itself is tinctured aud colored from the mineral mat- 
ter dnuned into it from the mines at Stoneboro'. All the hah have been 
killed, and this has an addition^il injurious effect upon the inhabitants. 
If possible the mine owners should be compelled to carry theirdrainage 
down beyond Sandy Lake to the creek. It could be done for about 
12,000. 

OotJCLUfllON. 

Sandy Lake is in a bad sanitary condition and needs relief. It should 
have it if can be secured, but a state appropriation would be necessary. 
A good engineer could tell better whether the proposed work upon the 
creek would be efficacious. Some means must be found to check the lia- 
bility to malarial, typhoid and rheumatic diseases at Sandy Lake, or the 
business portion of the town, which has much capital invested in store 
and business blocks, must be abandoned. 



8— INBPBOTION AT OHBSWIOK, AlAjBasmTT OOnNTY. 

By J. R. Thomi-bon, M. D., Medicnl Intpeelm: 

PnTSBOBGH, March 27, 7891. 
My report of investigation of supposed cases of cerebro-spinal fever 
at Cheswick, is as follows: There were two (2) deaths in the family of 
Samuel Bemally. The deaths were so sudden that Dr. Orr, of Ches- 
wick, had little time for diagnosis, but thinks they were cases as re- 
ported. The symptoms were vomiting, pains at back of neck, delirium 
aud fever. First child ill only four hour^; second child nine hours. 
Ages of the children five and seven years. Condition of the premises 
fair, but 1 ordered a general cleaning up of house and surroundings. 



o-atspBonas at media, dhi^tvabb cx>uirrY. 

By Wm. B. Atkinsos, M. D., Medical Inajieclor. 

Subject of complaint, the exposure of bedding from a case of diph- 
theria on the lawn of a boys' school. Also, the drainage of said school. 
The case was one of malignant diphtheria which died about one month 
prior to this inspection. The boy was removed from the main building 
immediately upon the diagnosis of his case to a cottage on the grounds 
u.sed as a hospital. Immediately after, the room occupied was emptied 
of its contents and all that part of the building was thoroughly venti- 
lated and disinfected under the supervision of an expert. Every means 



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No. 16-3 Inspection at Chestnut Hill. 101 

were employed to prevent the spi'ead of contag^iou. After the death of 
the boy all his bedding:, mattresses, etc, in both rooms were burned. 
Chloride of lime, chlorine gas and sulphur were promptly and thor- 
oughly used in all the rooms of the cottage, so that the building at the 
time of this inspection still smelled strongly of these gases The 
buildings were cleansed and scrubbed from top to bottom. There was 
no possible opportunity for any continuance of the disease. An inspec- 
tion of the school and other buildings and surroundings showed every- 
thing in admirable order. No water closets open into the building. 
All are shut off by the best plan to prevent the intrusion of sewer gas. 
The outside drain pipes are separated from the building and open to 
the air. No pipes connected with this drain, either from the kitchen, 
the dishery or the milk house. The floors in the milk house are ce- 
mented and clean. All vegetables were kept out of the house. !Barth 
closets only, are used in the cottage near the school. An open body of 
treHh water is supplied from a spring near, by means of a pipe running 
into it. A careful inspection of this showed nothing flowing into it but 
pure spring water. 

Everything connected with the school, its surroundings, etc., are emi- 
nently worthy of commendation. 



lo— nraPBcnoN at ohhstnttt hill, montgombrt oountt. 

By Wn. B. ATKIhHON, -M. D., Afedieal Ititprclor, 

pHiLADELPaiA, May £8, 189 J. 

Subject of complaint: Condition of premises as resulting in malig- 
nant illness. 

The history of this house showed two years ago a case of scarlet 
fever and a case of diphtheria. Both were moderately severe. The 

next fall the family of Mr. P. C moved into the house. They had 

no illness save influenza for eighteen months. In March, 1891, the well 
overflowed and then drained into the cellar. Although the well was 
emptied in the usual way, it soon refilled and a new well was dug to 
drain the old well. At this time Mr. C and the cook were taken quite 
ill with diphtheria, and in fear of further trouble, the children were re- 
moved and did not return until all were well But in a week or more, 
the eldest child was attacked with a very malignant form of scarlet 
fever, and died in sixty hours. 

At the time of my inspection the house was vacant, and exhibited 
strong evidence of the thorough disinfecting process to which it had 
l>eeu subjected. Hence in the house itself no odor was evident other 
than that of the chemicals employed. The cellar showed where re- 
peated overflows from the cesspool had occurred, thoroughly infecting 
the soil at tiiis place, the overflow being retained owing to the tenacious 



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102 State Boabd. of Health [Off. Doc . 

red clay acting to retaia it as in a pocket. Abont tea feet away was the 
heater with all its doors openio^ to this |x>iut, thus eDsnrtDi? the thor- 
ough disBemiDation of the g«rma of disease to all parts of tho house. 

I would therefore recommeDd that the ground in the cellar where this 
overflow had occarred be completely removed to a depth sufficient to 
ensure the removal of all the contaminated soil, the disinfection of the 
excavation, and that it then be filled with fresh earth. That all the 
plumbing likely to be infected with disease gerruB be removed, and its 
replacing \^'ith new material. That the cesspool well be made tight so 
as positively to prevent any other overflow. 

I would be extremely doubtful of the safety of any one who would !«■ 
exposed by living in these premises. 



11 INSPEOnON AT PElBSTONVILLll, HONTGOMBBT OOtJNTy. 

By Wm. B. Atkinnon, M. D., Mediral Itttprclor. 

Philadelphu, Jijy 6, 1891. 

Subject of complaint: Malignant diphtheria at Prestoaville, Mont- 
gomery county. 

Prestonville consists of about 150 houses, with a population of 760. 

The disease has prevailed about five or six weeks, the first case occur- 
riug in the family of C G~ at the southern end of the village. The 
father, mother and six children were ill one after the other, with the 
death of four of the children. The first death occurred June 8, aged 
three years and a half, illness five days. The next aged nine years, 
June 20 ; then one on June 22, aged six months, and the last on July 4, 
aged eight years. Two other children are convalescent, the elder, aged 
twelve years, a girl apparently rapidly improving ; the other, a boy 
aged six years, is still troubled with nasal discharge, and looks in a 
doubtful condition. The father had quite a severe attack but is well. 
When the disease began to show such severity, the father built a board 
shanty and all lived in that, and finally a shelter tent was placed at the 
end of the lot where the children were nursed and still sleep. 

The only other cases were in the family of Mr. D , at the upper 

end of the village, and undoubtedly were the result of contagion, the 

sick children of G having come there on an errand, and the one 

here that died, was on the porch a short time with them. This honse 
and surroundings were in an excellent condition. Disinfectants had 
been freely used, and the only thing objectionable was the well, an ordi- 
nary country privy, which was ordered to be disinfected tmd cleansed, 
lest any germs of disease might remain from its use during the illness 
that hEid occurred. 

In the honse of Mr. G the paper had been removed and the walls 

were being cleansed with the sublimate wash, and I was assured that 



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No. 16.] Inspection at Oarbondalb. 103 

the {amily would remaiu in the tent and shanty till they removed from 
the plaoe. The cellar was damp and had an unpleasant odor, and as I 
was informed that bones and other decaying matters had been allowed 
to aocomulate there, and the drainage was very bad, I am satisfied that 
this was the origin of the attack. 

I directed that the cleaning, etc., should be continued, the cellar thor- 
oughly drained, and the leakage into it of water should be prevented. 
I was assured that this should be done at once. 

The soil is brick clay covered with some six to eighteen inches of 



12— INSPBOnOH OF OABBONDALR 
B; L. H. Tavlob, M. D., Medical Inapeelor. 

Wilkes-Babbe, Pa , Augwit 8, 1891. 

I visited Carbondale yesterday for conference with the board of health 
and other citizens in reference to the sanitary condition of the city. 
Since the inspection, by order of the State Board of Health in 1888, 
much advance has been made in a sanitary way. For instance, about a 
mile of vitrified brick pavement has been laid in the center of the town, 
and adds materially to the appearance of the streets. At thattime there 
were no sewers ; now the first district is largely sewered, about 16,000 
feet having been laid. The opening of this sewer, however, is decidedly 
objectionable as it is not carried far enough into the bed of the river. 

The health officer informed me that he could have this remedied at 
once and would do so 

Plans for sewering the second district, which embraces a considerable 
portion of the city further northward, bad been prepared by the city en- 
gineer, accepted by the council and ordinance passed adopting the same, 
but it failed of being signed by the mayor, by abont twelve hours, to be- 
come a law before the passage of the so-called "Pittsburgh bill," which 
was signed by Governor FattisoD before the Carbondale ordinance. 
They consider that the passage of this bill prohibits their going- forward 
with their work until they have a petition for the same signed by a ma- 
jority of the property holders. If so, then I do not see how the State 
Board of Health can be of any assistance in the matter. 

The plan of sewering the city I consider in the main a good one, ex- 
cepting that it must leave outa portion of the Fifth ward in the north- 
ern part, which cannot be sewered at all by this scheme, on account of 
the slope of the ground being in the opposite direction to that in which 
the general extent of the city drains. This paFt of the Fifth ward is es- 
timated to contain about a hundred inhabitants, and from the nature of 
things will not be largely built up for many yeara 



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104 Statb Board or Health [Off. Doc. 

A better plan for the whole oity would be a tar^ tnink sewer laid 
along the Lackawanna river, which by means of laterals entering it would 
accommodate the whole city, but I am informed by several citizens that 
the cost of this is so far beyond their means that had they waited until 
this plan could be adopted they would have had no sewers for many 
years. This trunk eewer plan is favored by C. E. Spencer, president of 
select council. Owing, however, to the opposition to this phut ou ac- 
count of expense (otherwise it is decidedly the preferable one) I would 
recommend carrying out the plans aa at present prepared by the city 
engineer, Walter Fiick, and later on provide for the disposal of the sew- 
erage of the upper part of the Fifth ward by precipitation or some other 
method. This is suggested by Mr. Frick. 

Many of the abominations mentioned in my report of 1888, in the 
shape of shallow privy vaults, still exist, but owing to the good work 
done by the local board of health the objectionable features of these have 
been largely removed. There is still much to be done, but if the local board, 
which was reorganized in September, 1890, but receive the cordial sup- 
port of the city councils, and their su^iestions fully carried out, the city 
of Carbondale will not suffer from insanitary conditions. There are at 
present no nuisances to be abated, unconnected with the lack of sewers. 
The great need of the city is a complete system of sewers, and I would' 
recommend as most desirable the laying of a brick sewer in the bed of the 
Lackawanna river from the northern limits of the city, extending to a 
safe distance below the southern limits. If on account of expense this 
cannot be done I would recommend the carrying out of the present 
adopted plans tor sewering the main part and provide for the upper part 
of the Fifth ward in some other manner than by emptying into the Ijack- 



13— INra>BC7nON AT QLBN BIDDLB, DHLAVT ARB OOUNTT. 

By W. B. Atkinson, M. D., Medical Inaj.erlur. 

Philadelphia, July 13, 1891. 

Subject of complaint ■ Station of Pennsylvania railroad at Glen Bid- 
die, Delaware county. 

The upper part of tliis house is used as a railway station aad the rest 
as a dwelling. Its history has been bad from the outset. Seventeen 
years ago typhoid fever attacked the inmates almost immediately after 
it was built and occupied. There were three cases with two deaths. 
Again some two years ago a case occurred, and now diphtheria has at- 
tacKed the inmates. There were four cases in the early part of the 
spring, and two in June or July. Of the 1 aet, one died and another is yet 
in a doubtful condition. 



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No. 16.] Inspection at Glen Riddle. 106 

The cellar, as far aa can be known, is clean, recently white washed, no 
Tegetables, save a few freshly Aag potatoes, but there are evidences of 
leaking: into the cellar of water from the walld on two sides. This is said 
only to occnr when a heavy rain falls, and is supposed to come from the 
yard back of the house. The kitchen, which is mostly used as a living 
room, has no cellar or any form of ventilation beneath its floors. A pipe 
conducts the i-ain from the roof into the soil beneath this kitchen but no 
outlet or pipe is known to conduct this flow away, but it is thougfht to 
sink into the ground which is extremely porous. The yard back receives 
the overflow from the road at all times, and all this must pass beneath 
the kitchen floor. Some idea may be obtained of the nature of this flow 
when it is known that recently the contents of some very foul cesspools 
were hauled by here and large quantities dripped out on the way, of 
course to be carried down beneath this floor. The public road is much 
above this yard and drains into it. 

The cesspool of the premises is the ordinary country privy, not near 
the surface as to its solid contents but nndonbtedly a lai^ mass must 
have accumulated, as it has never been cleaned since the house was 
erected. It is about twenty-five feet from the drinking well and twenty 
feet from the house. 

' I am satisfied that the unsanitary condition is largely due to the drainage 
under the floor of the kitchen. Undoubtedly what flows here remains 
in a stagnant pool until it sinks into the earth beneath. As the chil- . 
dren are constantly here and close to the floor they are thus exposed to 
the emanations which pass through the ci-acks, and are thus breathing a 
sewer air. 

I would recommend that this floor be removed, the dnunage made to 
pass off by some form of dosed pipe, to a safe place beyond the house. 

That the soil thos oontaminated be thoroughly removed, disinfected, 
if necessary, and the proper measores be instituted to allow free venti- 
lation beneath the kitchen floor. As the station has been very wisely 
removed temporarily, I would urge that this place be not again used as 
a station until these measares are carried into effect, the illness entirely 
gone and the place most carefully dimnfected. 

(b) Zjetter from the Secretary of tbe Road. 

Philadelphia, Pa., July 17, 1891. 
Deab Sib: I have your favor of yesterday, with reference to the un- 
healthy condition of the station at Glen Riddle, Delaware county, and I 
have referred the same to our general manager, who will no doubt, take 
prompt steps in the matter. 

Faithfully yours, 

J. C. Sims. 
Sfrretnrjf. 
Dr. Benjamin Lee, IS-^ Pine Street, Pkiladefpkia. 



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106 State Board of Health. [Off. Doc. 

(o) Letter lyom the 0«neral Manager. 

Philadelphu, Pa., JiUy 23, 1891. 

Benjamin Lee, M. D., S'-crelary Slaie Board of Health, ISSi Five Slreei, 

Philadelphia, Pa. : 

Dear SiB: Upon receipt of yon favor of the 16th instoDt, I brought 

the matter at oace to the attention of the local officers of our Central 

Division, Philadelphia, Wilmington and Baltimore railroad, and I am 

glad to know that we were aware of the condition of Glen Eiddle station, 

audhadtakenBtepstowardsimprovementofthesame. lamsatisfiedfrom 

what I learn that no steps will be spared in the direction of thoroughly 

disinfecting the present bailding and in airaneing proper draina^, etc. 

Yours truly, 

S. M , 

For General Manager. 



14 INSFBOnON AT BITNBR'S, LANOASTBB, LAKTOASTBR 
OOTJNTY. 

(a) By P. A. HaBTHaN, M, D., Medical Inapfclor. 

Habbisbubq, July 19. 1891. 

The property against which complaint is made is on the Columbia 

pike, a suburb of Lancaster, Pa,, and belongs toaMr. B , in whose 

family have been- four cases of typhoid fever. The enclosed "rough 
sketch" will show how the property is drained of its sewers^ and how 
supplied with water. There are nineteen (19) houses, most of which are 
double, on the plot. 

The history of the fever is an old one, it having been proved that tliere 
were a number of cases a ye^ ago or more. The cases occurring now 
have a clear and distinct connection with those of the year before, and if 
ordinary precaution and common judgment had been used there would 
have been most likely no cases to report now. 

The houses have inside water closets, all of which empty into a com- 
mon sewer, which carries the sewerage back from the houses about 
eighty yards into an open trench at least seventy-five feet long, here it 
rests, except what percolates through the ground, or evaporates, or what 
runs upon other people's property. To say that this trench is offensive 
to sight and smell is to put it mildly. 

In this locality there is no sewer system, so that there is but one of 
two ways to remedy this nuisance. 

I would suggest that Mr. B , the owner, be compelled to shut 

up the " open trench" completely, and to cover it over with lime and 



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No. 16.] iNBPEonoN AT Bftner's. 107 

earth ; that be build properly constructed cesspools in the yards of the 
hoases, or that he sinks a well, common to all, properly cemented, into 
which may drain the sewerage, which can be removed at soch times as 
may be necessary. 

The drinking' water is not contaminated by the bad drainage, the well 
being higher than the trench. I am glad to saytherehavebeen no fatal 
cases among the sixteen reported. 



(b) Inspeotton hy S. T. Davla, M. D., Member of the Board. 
On the 25th instant, I made an inspectioii of the properties at Bitner- 
ville, a snborb of Lancaster, af^ainet which formal complaint was made, 
brought about isy an epidemic of typhoid fever. Inasmuch as Inspector 
Hartman, of Harrisbnrg, made an inspection on July 19, 1891, 1 deem it 
bnt necessary to note the present condition of the premises, and make, 
as it were, but an additional report. Nineteen houses in one row all 
having good water closets, and all in good order ; flush water adequate ; 
pressure good or sufficient, all empty into a common terra-cotta sewer 
eighteen inches in diameter, ^ongside of which is a twelve-inch terra- 
cotta sewer pipe. Sewer empties eighty yards from rear of houses into 
a plank trough three feet wide by sides six inches high. 



J" 



This trough is twenty-five feet long and discharges its contents over 
the top of a pit twelve feet deep by twelve feet wide covered with plank, 

and planked up on all sides, except the bottom, which Mr. B tells 

me is down to ahale rock. At the lower margin of the top of box is a 
ledge, and in the middle is a small opening for the floid contents of 
sewer to enter (marked thus *). The location of the sewer being at the 
lowest part of the surface. It is where, in case of rains, the surface water 
naturally flows, the receptacle becomes fil led and overflows, when it passes 
down to the next field (now in com) and is carried oflf by a dry run, or 
only a water course in wet weather. The object of the open sewer of 
twenty-five feet long by ijix inches high was, and is to afford, a proper 
place to utilize and disinfect the solid matter. I think the trouble was 

that Mr. B ■ neglected to do this in the early spring months. Now 

there is no odor whatever, and as far as the surface water flowing over 
the adjoining property, that cannot be prevented, as it is a natural wet 
weather water course. In my opinion if he disinfect the sewerage as 
it flows from the pipe he is doing all that he can, but this he should 
be compelled to do as often as is necessary. 



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108 State Boajid of Health, |Off.I>oc. 

(o) 8upi>l«ineiitary, by S. T. I>aTia, M. D. 

LANCA8TEB, pA., (kiober /.?, 1S91. 

Ben'jahin Lee, M. D. 

Dear Doctor: I this day visited Bitnerville a second time, and as 
there hau been no rain for several weeks, and of coarse no sorface water, 
I had a ^^ood opportunity of seeing how much sewa^ water was dis- 
charged across the line dividing the properties of Mr. B and his 

neifrhbor. From the appearance of the ground I am confident there 
has no fluid passed over the line since the last rain. There is no evi- 
dence whatever of any sewage on the top of the ground. I told Mr. 
B to open up his vat and clean it out, and suggested an auto- 
matic trap which would close as soon as a flush from a storm would 
come. 



(d) AmUysla of Water. 

Fbakklin and Marshall Colleoe, 

Lancaster, Pa.. May 30, J89t 

I examined a sample of potable water handed me by Mr. B . 

and found it free from ammonia, nitrites, nitrates, sulphuretted hydro- 
gen and organic impurities. There were microscopical traces of proto- 
COCCU8 present, such as are carried into every well water by the inflowing 
water, but not sufficient to be in any way harmful. Chlorine present in 
the proportion of 1.2 grains per imperial gallon, is due to the chlorides 
in solution, and therefore notiujurious. The permanent hardness of the 
water I find to be eight per cent, showing a considerable amonat of 
carbonate of lime. 

K C. Shiblos. 



le-nraPBonoN at millvillh, cx>LnuBiA oouhtt. 

By Wm. Leisbr, M. D., Medical Inspector. 

Lewisbdrg, Pa., JvXy $4, 189t. 

I visited Millville, Oolumbia county, July 23, 1891, to investigate the 
outbreak of typhoid fever. 

The town is a healthy villa;?e of about six hundred inhabitants. About 
two years ago there was a case of typhoid fever in the family of Dr. 

H ~. Again this last May, 1891, there was another case, a laborer, 

iu the family of Dr. H , and a few weeks after the man that came 

to take his place was attacked with the disease. Since then four or five 
railroad train bands and a depot watchman have had the disease. 

Dr. H 's house and bam are situated on a hill about one hundred 

yards from the station, which isdowu inaflat. About half-way between 



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No. Ifi.] iMBPEOnON AT MiLLVILLE. lOtI 

Dr. H 's aod the railroad station, and at the bottom of the hill, 

there is a spring: from which the train hands have been getting^ their 
drinking water. 

Dr. H is reported to be using his abandoned well for a cess- 
pool, and the bottom of the well is about on a level witb tlie spring 
above mentioned. The inference from these facts would be, vizi 

That the first case was introduced iuto Dr. H 's house from 

without; that the typhoid poison remained in the cesspool and finally 

gained admission into Dr. H 'b drinking well and into the spring 

at the bottom of the hill, and made them both infections. 

I should advise that the spriug should be made macceesibte. It has 
been abandoued by the train hands, and no new cases have occurred. 



(b) Letter to Oliaa. 8. Ely from the Secretary. 

July «7, 1891. 
Mr. Chas. S. Ely, MUlville, Pa. .- 

Deab Sib: The report of Medical Inspector Leiaershows clearly that 
the origin of the typhoid fever epidemic, with regard to which you re- 
quested the interpoeitioD of the State Board of Health, was a spring at 

the bottom of a hill near tiie residence of Dr. H , and that this 

spriug is probably infected from Dr. H 's cesspool, which is re- 
ported to be simply an abandoned drinking well. Dr. Leiser advises 
that this spring be made inaccessible, and in this recommendation the 
State Board concurs. Probably the best plan to adopt for this purpose 
would be to have it filled up with large stonea Kindly inform me what 
railroad MillvUle is situated on, as I desire to inform ^e authorities of 
-the road of the danger to their hands. 

Yours very truly, 

Bekjahin Lee, 
Secreiary. 



la-msraoTioN AT tullttown, bucks oounty. 

Br W. B. Atkinson, M. D., Medical Inspeetor. 

Subject of complaint — Slaughter House: This is a small place where 
calves, sheep and large cattle are killed on a small scale. About three 
or four of the latter a week. Although the owners of the place were ab- 
sent and the house securely fastened so as to prevent a glimpse of its in- 
side, yet everything around showed it to be in a very unsatisfactory con- 
diticm. There were a few pigs in the adjacent pen which were fed on 
offal and blood, Mid the pen was nothing but a small piece of ground 



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110 State Board of Health. [Off. Doc. 

fenced in, the soil covered with straw, etc., with no evidence of any effort 
to provide for proper cleanlineflfl. 

I was informed that there was no attempt to make the place a proper 
slaughter house, there beiii^ only a board floor, through the crevices of 
which the blood, etc., made a way to the soil beneath, where it was al- 
lowed to remain and pollute the air. A cow with calf was siauf^htered 
and the dead calf was thrown out whole to the hog^s and allowed to re- 
main until they disposed of it, Drs. Walton and Sands, Mr. Shaefer 
and Mesdames Walton, Carlin, Moon and White met me and agreed in 
the statement as to the unpleasant odors constantly arising from this 
place, and that they were often compelled to close windows and doors, 
both night and day, to avoid them, and that several of them had been 
made sick thereby. All of these lived within one hundred yards of 
the place, which was close to the office of Dr. Walton. 

In your absence, and having failed to meet the proprietors of the place, 
I wrote to them suggesting the importance of at once removing it, boclos- 
ing a copy of the provisional regulations, and asking immediate atten- 
tion to the matter. Drs. Walton and Sands have promised to inform me 
as to the action taken in the case. 

The constable is Geo. Lynn ; the squire, T. C. Ivens, Falsiugtoa P. O. 



(b) 8tii>plementary Inspection at Tollrtown, BookB Ooonty. 
By W. B. Atkinhok, M, D., MeiUeal Intpeclor- 

Philadelphia, September 24, 1891. 

Subject of complaint — Slaughter House. The slaughter house had' 
been cleaned, the pig pen removed, and a cement floor had been laid, 
and some repairs doue to the weather boarding and a roof was about to 
be put on it. 

The owner was about to build an additional room to use as a hide cur- 
ing place, this was to have also a cement floor. 

The occupants disposed of their hides and bones each week by having 
them hauled away. They had no means of getting rid of the offal, so I 
advised them to obtain the aid of a farmer who would agree to carry all 
away and bary it at a distance from any habitation, flrstcovering it with 
lime. They and the proprietor promised to carry out my instructions 
as to cleanliness, and not to allow the oSaH to be fed to pigs, and not to 
keep pigs on the premises. 



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No. 16.] Inspection at NroeoLaoN. 



17— nraPBOnON. AT NICHOLSON, ^TTOMINO COUNTY. 

By Lewis H. Tatlor, M. D., Medical Tnapectur. 

Wilkes-Barre. Pa., August 1, 1891. 
I to-day visited Nicholson, Wyoming^ county, to iospect the sanitaiy 
condition of a creamery and a tannery in that boroug^h. 

First, as Begarda the Creamery. 

I find that it is situated very close to the D. L. & W. railroad, and that 
its refuse is discharged by means of an underground sewer through Oak 
street into Martin's creek about two himdred or two hundred and fifty 
yards away. The end of this sewer pipe did not estend into the bed of 
the stream, and the discharges, rotting in the sun, were very oBfensivo to 
those living in the neigrhborhood. Since the request for an inspection 
was sent to the Board this pipe has been extended some feet further into 
the stream, and the nuisance is thus already partly abated. In my judg- 
ment it should be extended about fifty feet further into and down the 
bed of the stream, thus insuring the successful removal of the daily accu- 
mulations 

During the hot weather this drain should be flushed daily from the 
creamery. I think a letter from you to the chairman of the committee 
making this recommendation would be all that is necessary in the case. 
The creamery is owned by a stock company who rent it to New York 

parties. The managing committee consists of Messrs. F. P. S , 

C. S and G. , all of Nicholson. 

The sewer was cooBtnicted by virtue of a permit from the council, 
with restrictions that it should be so maintained as to be inoffensive to 
the community. I assured the secretary of council and citizens that 
the abatement of such nuisances belonged to the borough council, and 
was entirely within their power, without the intervention of the State 
Board of Health. I think, however, a letter from yourself will have a 
good effect. Davis G. Black is burgess 

Second, as to the Tannery. 

Martin's creek flows directly through the village of Nicholson and 
empties into the Tunkhannock. The tannery is situated dii'ectly upon 
the banks of the former, within the borough limits, and a few hundred 

yards north of the creamery. It is owned by J. B, T & Co., 87 

Gold street. New York. A. H. M is local manager at Nicholson. 

The tannery has been located in its present position between thirty and 
forty years, and no complaint has hitherto been entered against it. 

The objectionable features at present complained of are : 

1. The escape of powdered tan bark into the stream. 

2. The discharge of lime water and lime into the stream. 

3. The "soakings" from the softening process. 



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112 State Boabd of Health. [Off. Dot, 

As regards the first mentioned, that which enters the stream is simply 
the woody fibre of hemlock bark from which the active principles have 
been extracted by long process of maceration. In the winter this is all 
burned ; in the summer a portion of it enters the stream and is washed 
away. 

I cannot see that therein anythiufir in this material prejudicial to 
public health, except in so far as its accumulation in little spots along 
tite sides of the stream might sei've as a bed for the detention of other 
noxious matter. 

As to the second, the superintendent and foreman assured me that it 
contained nothiug: but dime. It is the lime water in which the hides 
have been soaked for the removal of hair. The hair and b.\\ debi-is is re- 
moved and retained before the liquid is allowed to flow into the stream. 
This is dischai^red once a week. I cannot see that it is detrimental to 
public health. The residents claim that it kills the fish in the stream. 

As to the third feature, the " soakings " so called, I can readily see the 
objection to them. This material consists of the water in which the 
hides are first soaked for the purpose of softening them. It is dis- 
charged into the stream twice daily, and no doubt contains some offen- 
sive matter, though probably not absolutely deleterious. If some plan 
could be adopted by which this could be carted away and not emptied 
into the stream, the chief objection to the tannery would be removetl. 
This could also be cariied away by building, at some expense, an un- 
derground sewer passing through the village and emptying into Tnnk- 
hannock creek some three-eighths of a mile away. All refu&e could Ix' 
thus removed without passing along the open stream through the town. 
The objection to this might be raised as to its effect on the fish of the 
larger stream which has been started by the State Commissioners of 
Fisheries. 

There is also ou the banks of the stream, just outside of the building, 
un accumulation of refuse offal, from the fiesh, etc., that is left after 
boiling the fat out. Some of this probably finds its way into the 
stream, though it is not intended to discharge it thithei*. Superintend- 
ent Moore expressed his willingness to do anything in his power to car- 
' rect any objectionable features, and stated that he liad heard of no com- 
plaints imtil within a very few days. 

I would recommend that he be requested to remove at once from the 
bank of the stream all refuse now accumulated there, and to remove 
such accumulations at such frequent intervals as to prevent any of this 
substance entering the stream. From my interview with the gentle- 
man I feel assured that a request from the Board would have all tlie 
effect of a mandatory order. He should also be recommended to devise 
some plan for the removal of the " soakings" other than by the public 
stream, either by carting away in tanks by farmers to be used as ferti- 
lizer, or by underground sewer to the Tunkbannock, which would re- 
move all discharges from the tannery. 



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No, 16,] Ineipection at Nhiholson. 113 

(»— Letter to D. O. Blaok, Burgeaa, from the Secretary. 

Avgtt^t 4, 1891. 
"Mr. Davis G. Biack, Chief Bvrgess, liicholson, Pa. : 

Dear Sir: I Beod by this mail a commimiGatioD to Mr. F. P. Stevens, 
chairman of the creamery committee, recommending that the sewer pipe 
be extended fifty feet farther into and down Martin's creek, and that the 
entire drain be flushed daily during hot weather. Also a communicar 

tion to Mr. A. It M , local manager of the taanery of J. B. T 

&, Co., 87 Gold street. New York, recommending that all refuse matter 
now accumulated on the bank of the stream be at once removed, and 
that such accumulations as may occur iu future be removed so fre- 
quently as to prevent any of these offensive substances entering the 
stream, and that the soakings be either carted away to be used as ferti- 
lizers, or be carried by an underground sewer to the Tunkhannock river. 
In both of these instances your council has all the power necessary to 
abate these nuisances, even more expeditiously than the State Board of 
Health. I believe, however, that the recommendations of our Board 
will be respected, and that it will not be necessary for you to take legal 
steps in the matter. I shonld be glad to hear from you after a reason- 
able interval, whether my expectations have been realized. 
Yours respectfully, 

Benjahin Lee, 
Seciretary. 



(o) Letter of Seoretary to J. B. T & Oo. 

August 3, 1891. 
Messrs. J. B. T & Co., 87 Gold Street, New York city, N. Y.: 

Dear Sibs: The attention of this Board having been called by a num- 
ber of residents of the village of Nicholson to certain conditions in con- 
nection with your tannery at that place, which were consider^ offensive 
andinjurions to the health of the neighborhood, an inspection was ordered 
The inspector's report indicates that the complaint is well founded in 
two respects: First, that the soakings which are discharged twice 
daily into Martin's creek contain a considerable amount of offensive mat- 
ter; second, that there is on the banks of the stream just outside the 
building: an accumulation of refuse and offal, which is offensive and some 
of which finds its way into the stream. 

To remedy the first, he suggests that the soakings be carted away iu 
tanks, to be used as fertilizers, or that a sewer be constructed to the 
Tunkhannock creek, through which all of the drainage of the tannery 
conld be carried, and thus ts passage iu the open stream through the 
town be avoided. For the second, he recommends the immediate re- 
8-16-91. 



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Ill State Board of Health. [Off. Doc. 

moval of the present sccamnlation ot refuse and ofhl, and in fatare the 
removal of such material before it has an opportunity to become offen- 
sive or to enter the waters of Martin's creek. 

I have written to Mr. Moore making these recomtnendatiouB, and tnuit 
that I shall have yonr active co-operation in securing compliance with 
them. 

Yonra very truly, 

Bekjaxi!! Les, 
Secr^ary. 



(d) Ijetter of Seoretary to F. P BtevaiiB. 

August ^ 1891. 
F. P. Stevens, Chairman Creamery Company, Nicholson, Pa. : 

Deab Sir: The report of Dr. L. H. Taylor, medical inspector, to the 
State Board of Health, of investigation made by him with rejraid to a 
noisance complained of in connection with your creamery, shows that ail 
that is necessary to be done to remedy the offensive condition complained 
of is to extend the sewer pipe which conveys the drainage from the 
creamery about fifty feet further into and down the bed of Martin's creek. 
To this it would be well to add the precautiouof flushing ^e drain daily 
through its entire length. 

I fSel assured that you are equally anxious with myself and the Board 
to prevent your establishment from being offensive, and that it is there- 
fore unnecessary for me to do more than call yonr attention to the impoi^ 
tance of these measures. 

Yours very truly, 

Benjamin Lee, 
Secretary. 

(e) Letter of Beoretar; to A. .H. Uoore. 

Aiu/ust 3, 1891. 

Mr. a. H. Moore, Manager Tanfiery of J. B. T tfe Co., Nicholson, Pa.: 

Dear Sir: Dr. L. H. Taylor, medical inspector to the State Board of 
Health, after a careful investigation of the conditions of your tannery, 
reports that the only matters which require special attention are the ac- ' 
cumulations of fleshings on the banks of the stream, and the flowing of 
the soakinga into the stream. His recommendation is that the refuse 
now accumulated be removed at once, and that in future such accumula- 
tion be removed so frequently as to prevent any of this offensive ma- 
terial entering the stream, and that the snakings be either carted away 
in tanks by farmers to be used as fertilizers, or that a sewer be constrocted 
to the Tunkhannock creek, through which the drainage could be carried. 



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No. 16 ] iNSPECnOS AT NiOHOMON. 115 

Feeling that you are equally intereated with our Board in keeping 
yoar establishment in the best possibly sanitary condition, T shall be 
glad to hear from yoa when yon have taken the necessary steps to this 
end 

I am, yours, very truly. 

Benjamin Lee, 
Secretary. 



18— mspaonoH at sbippbmsbubo, ouubheiland oouNrr. 

By R. I. SiBBBT, M. D., Medical Inspector. 

I proceeded to SfaippeDsbarg, Cumberland county, and was kindly re- 
ceived by the boron^b council and the citizens. After a careful inspec- 
tion of several nuisancee complained of and an interview with several 
physicians of the place,I learned thatabout fifty cases of scarlet fever had 
ooonrred in that town during the last six months, but only one death 
from this disease. There had also occurred several cases of typhoid fe- 
ver during tiiis time, all of which recovered. I was taken to one house 
in which the fourth case of scarlet fever was convalescing, and to a 
neig:hboring house in which the rash was fully developed in a boy of 
twelve years of age. Both appeared to have a fair chance to recover. 

The borough seemed to be in abad sanitary condition and I soggrated 
a meeting of the members of the coanoil and of ptominent citizens in 
the evening. The sentimente expressed at the meeting were in favor of 
abating the nuisuices complained of, though twoof the physicians pres- 
ent thought there was no needfor agitatingthe subject Theyappeored 
to think that fifty cases of a preventable disease in half a year would be 
better for the profession than none at alL 

In presenting orders and suggestions to the burgeHs and council I in- 
sisted, first, upon the abatement of the privy nuisance, by the purchase 
and use of an odorless excavator and the use of disinfectants. Also that 
the borough council should constitute or appoint three of their number 
a sanitary committee whose special duty it shall be to study the subject 
of hygiene, and thus place the council underthe protection and guidance 
of the State Board of Health. 

Second. That another ulass of nuisances which exists should be abated, 
namely : Badljf kept stables, pig pens and slaughter shops. I insisted 
that the council should take the reins of government in its own hands, 
and should require all persons who desire to keep any such conveniences 
to obtain a permit from the council, such permit being an agreement to 
keep such stable, pig pen or slaughter shop in a good sanitary condi- 



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IIG State Board of Health. COff. Doc. 

Third. As there exist several wells of water used by the pnblic which 
are believed to be in an insanitfury condition after heavy rains, I directed 
that all wells of water within one hundred feet of any privy, pi^-pen or 
stable should be closed. 

Fourth. That disinfectants be freely used in every case of contagious 
disease as directed by the circulars printed and distributed by the State 
Board of Health. 



(b) Letter of the Secretary to the Surffeea. 

July S8, 1891. 
To Ike Chief Burgess. Shippensfmrg, Pa. : 

Dear Sir : Dr. B. L. Sibbet, medical inspector, hag made a report to 
this Board of his recent investig^ation of the sanitary condition of your 
borough. He reports the following nuisances as &x.vAxag: Full and 
overflowing cesspools, filthy stables, pif^-pens and slaughter houses, 
driukiug wells so situated as to be liable to pollution. 

I heartily endorse all the recommendations which he made in person 
to yourself, members of the council and other prominent citizens, viz: 
First. Thai your council shall appoint a sanitary committee, with full 
power td enter upon all premises and iuvesti^te all nuisances. Sec- 
ondly. That all privies full to within two feet of the surface should be 
disinfected, emptied and aj^ain disinfected ; an odorless excavator be 
used for emptying the same. Thirdly. That all owners and proprietors 
of stables, slaughter shops and pig-pens be notified to keep their sev- 
eral establishments and premises in good sanitary condition ia accord- 
ance with a regulation of the State Board of Health, copies of which I 
send you. It would be well to have this regulation published in your 
daily papers for the information of such persons as well as of the public 
generally. Fourthly. That all wells so situated as to lead to the sus- 
picion of pollution be closed, and the use of water from them for- 
bidden. 

Trusting that by the adoption of these measures you will render your 
borough as salubrious as in former days. I am, 

. Yours very respectfully, 

Benjabun Lee, 



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No. 16.] Inspection at C&essona. 



lO— INBPHOnON AT ORBSSONA, wiHi [VI.ktt.t. OOUNTY. 
(TYPHOID FBVHB.) 

Bj W. MORBAV Weidman. M. D., HetUcat Fnapcelnr. 

July 31, 189 1. 

I visited Cressona, Sohuylkill County, yesterday &fterDOOD, am soiry 
to say Senator Keefer was not in town, and by letter I leoraed be 
would not be back before Friday. However, everybody was willing to 
show me around. I found the citizenB had oi^r&iiized (July 20) a sani- 
tary committee of five in each ward (North and South) who had made 
lioose-tohouses iospection or visits last week, notifying and urging each 
family to clean, not only the cellaa-s, but the entire premises, and to 
use diBinfectants, and that the councils, although a little slow, had 
passed an ordinance imposing a fine for neglect or refusal to obey the 
same. 

I regret that Dr. Gray was the only physician whom I was able to meet. 
Drs. DeckertjiLenker and WeisthveinSchuylkill Haven, some few miles 
am»y. The town itself is scattered over an area of ground some say one 
mile and a quarter one way auil two miles the other. 

With a few exceptions the citizens are alarmed, fully realizing that the 
"Lord will help those only who help themselves." Here are 1,400 or 
1,500 people living in about 360 to 400 houses. Some portions of the 
town closely built, especially aronnd the hall on Front street. Most trf 
the sick at present living here, although they have been and are scat- 
tered over the town pretty well. It is said there are thirty now in tbe 
town. Six of whom are in the employ of the railroad company. Of 
oonrse I could not see all the sick, as my time ivaa fully taken up finding 
people who could talk intelligently upon the subject. Dr. Jtforris, of 
the relief association, is said to have pronounced it pure and marked 
typhoid fever. 

The town depends mainly upon wells fourteen to forty feet deep, and 
pumpsnear the houses for water, for cooking and drinking, although some 
bmilies use hydrants connectod with the mains that supply Schuylkill 
Haven. The privy vaults, four to seven feet deep, are invariably and 
from necessity situated on an incline above the wells. This is particu- 
larly noticed near the hall on Front street, where all the secret societies 
in (be town hold their meetings, and get all the water used by these as- 
semblies from apiunp above which, within fifty yards, are seven cesspools. 

I found that all the necessary instructions had been given concerning 
the disposal of the excrement, soiled clothing, disinfection of body and 
premises, preparation of food, etc 



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118 State Board of Health. [Off Doc. 

The officials of the B«adiD^ railroad have been active in their o£Forts 
to find a cause. "Water has been collected by several of their aj^nts, 
especially by Mr. Doolittle, of BeadiDg, and Dr. Morris, of Philadelphia, 
which will acconnt for my teletn^m of yesterday, viz : " Has Dr. Morns, 
of the P. & R. relief, sent any water to Dr. Oesfton for analysis since 
Saturday t" 

All I have to (lUf^gest was coniinaed diligence in seeing tliai all ihe man- 
dates and instructions of the sanitary committee and physicians foerr 
carried otU, the enforcement of all penalties irrespectivr, of person for a«y 
neglect or infringement. 

Do you no t think that chloride of lime would answer their porpose as 
well as, yes better, than copperas ? then the senses would aid in discov- 
ering those who neglect to purify their premises. 

I have asked that a list of all the sick, with age, date of sickness, and 
number in each family and honse be made, as I have two theories in 
regard to the spread of the disease, viz: Impure water and impregnated 
milk. I propose to demonstrate either by a diagram, and must make 
another visit next week, which I hope will show the origin of the disease 
and mode of extension. 

I promised to request you to forward^ if yon have not d<Hie so already, 
to the committee a supply of your instructions for the care of typhoid 
fever (circnlsrs 18 and 25) having left all I had, and herewith find the 
names of the committee. 

If samples of water are desired send eight or ten bottles, as the water 
ought to be taken from various localities. Bend them to the care of 
Hon. L. R Keefer, Creflsona. 

When did you hear the outbreak bei;an ! Some say last fall, others 
speak of it in May only. I know of one case (Eby) said to be the firat 
case and a " long-road " man, followed shortly by a second and a third, none 
in close proximity. Two of these were railroad employes known as long- 
road men. 

But three deaths have occurred attributable to the present disease, the 
funeral of the last taking place during my visit: the services were held 
in the open air. 

At the railroad shops the men use water brought from a dam some 
miles distant. 

Two small creeks (Beaver and Panther) pass through the village. On 
the latter, in the North ward, are two butcher shops, both discharge 
blood, ofi^, etc., into the stream. They empty into the Little Schuylkill. 
This water is used by cattle in pasture. 

Some of the cesspools are near and over these streams. 

Oouncil has cleaned the streets and alleys. 

A. pond of water stagnant opposite the engine house of the raihroad 
company could be drained at little expense. 

The strata of rocks in the litUs and in the plain (for the town is sur- 
rounded by hills) are vertical, how far below the surface I do not know. 



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No. 16.] iNsPEcnoH AT Gbessona. 119 

In my opinion the oanse of all the trouble will be fouod in impure 
wsteror impr^nated milk, one or botii. 

Sanitary Committee at Greasona, Measra. A. F. Dubril, A. P. Burton, 
Geo. L. BnrtoD, John H. Moore, Spencer 0. Wilsou, Hon. Ij. R Keefer, 
Chas. F. Beck. Geo. Seed, A. R Stroaeh. 

Send circnlsrs to these, especially Nos. 18 and 26. 



(b) Letter to Hon L. B. Keefer trota tbe 8eoretar7. 

Jvly St, 1891. 
Hon. L. R Keefer, Creaaona, Pa.: 

Deab Sib: The report made by Dr. W. Murray Weidman, medical 
inspector for the Schuylkill district, of his investigation at CresBona af- 
fords room for the suspicion that maay of the wells may be polluted. 
I have therefore directed Dr. Chas. M. Creeson, water analyst to the 
Board, to send to your address six demijohns, which I will request yon 
to have filled from different sources, and retnmed, sealed, to him at 418 
Locust street, Philadelphia. I would su^^est that one specimen be taken 
frbm a hydrant, one from the pump near hill on Front street, and the 
remainder from wells the water tram which has been used by persons 
who have suffered from the fever. 

I cannot too strongly urge that yonr committee continue its useful 
labors with unabated energy, and that yon orge upon the conncil the 
importance of strictly enforcing penalties for neglect or infringement 
of your orders. Impress upon the people the importance of using no 
water or milk for drinking or cooking purposes which has not been 
boiled. 

Trusting that the action which you have takeu will result in the speedy 
abatement of the sickness, 

I am, yours respectfully, 

Benjamin Lee, 

Secretary. 

(o) Seoond Inaiieotlon by Dr. 'Weldmaii. 

August 10, 1891. 

On last Friday I visited Cressona again. Found that nine new cases 
had been reported. One more death had occurred. Total of four since 
the outbreak. 

Conld find nothing conclusive about milk contagion, as both Mr. 

T ■■ — and Mr. B snpply Schuylkill Haven with the same milk 

aa Cressona. Heard of no cases in the former town thus furnished. 

The sanitary committee are active and anxious to do everything in their 
power to get rid of the contagicm. 

One well wasclosedandfilled,nottheLiuderman, however, the dauger 
from which the accompanying analysis shows. The report and recom 



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I'iO State Boaiu) of Health. [Off. Dog. 

mendatioD I liave forwarded to Secretary Burton. All street ^ttera, 
ponds and yards are being tboroaghly cleaned and drained. Recom- 
mended thecommittee to use chloride of lime in cases where they auspectod 
parties werecareless. Many persoDB are cleaningtheir wells, diggiag new 
priviett, repairing drains : all appeared to carry out the rules of the State 
Board of Health. Becommended the use of hydrant water. Gave no 
directions concerning the wells until I heard from you about theanalysis. 
Have stopped the shipment of water until further advised. Dr. Gray 
has given me a list of all his cases treated to date. Mi-. L>oolittle has 
^ren me i\ copy of his report to the railroad comoany, extracts of which 
I herewith transmit. Did Dr. Morris, of the relief association, make 
or have made any analysis of water sent him other than that of Mr. 
Doolittle^ Have asked for all ordinances passed by councils on this 
subject. Have a list of places where water seut (nine in all) were col- 
lected. 

BEFOirr OF Analysis of Wateb by Dr. Doolittle on Crebsona Epidehic 
Beceived August 10, 1891. 

* * • " The majority of families use water from shallow wells, which 
from their location would at once arouse suspicion." • • • * 

" That the public water supply of Cressona furnished to the workmen 
in the P. & R. round house and shops is undoubtedly pure and of excel- 
lent quality." 

" That the well of C. H. L , Front street, should be condemned 

and closed up immediately. This water was used by Albert D , who 

died of typhoid fever, and four other persons using this well (July 27) 
are sick at the present time. The location and chemical analysis con- 
demn this water as precarious." 

"If the cases of typhoid fever continue to increase we would advise 
recommending the town authorities to close every well possible in the 
infected districts, which is within five hundred feet of any building or 
outhonse, until the water from said well has been examined and pro- 
nounced harmless by a reputable chemist, who has visited the ground 
in person." 



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"Well ol C. H. L , under kitchen floor, Bixtoeu feet deep, 

stoned up but not cemented, about one hundred feet from privy, 
groond ^Dtly sloping towards well, water very bad." 

"Well of F. J. B , about fifteen feet from house, eighteen feet deep, 

stoned up biit not cemented, about one hundred feet from privy, gronnd 
gently sloping towards well, water questionable but not positively bad." 

" Well of W. E. N , twenty-five feet ftx>m bouse, depth could not be 

obtained, said to be deep, one hundred feet from privy, ground level, 
water at present date good." 



(d) Letter to O. li. Burton from the Seoretary. 

August «/, 1891. 
Mr. G, L. Boston, Secretary Sanitary Committee, Creasona, Pa : 

Deab Sir: I have been waiting to receive Dr. Cresson's report of his 
fmalysis of the various waters sent him from Gressona before addine: to 
the recommendation mode by yon and the people of Gressona in regard 
to precautions to prevent the further spread of typhoid fever among 
them. I think it better, however, not to postpone longer my endorse- 
ment of all that Dr. Weidman has advised. It seems evident that the 
wells are the principal source of the disease. Until it can be deter- 
mined with certfunty which of them are safe, the use of all should be 

abandoned. The water from L 's is simply rank poison. That 

should be closed at once and forever. 

I cannot too heartily approve your energy in carrying out sanitary 
reforms and cleaning your town, but these will be of comparatively 
Uttle me if contaminated water is drunk. No new well should be dug 
within five hundred feet of a cesspool, and any well iiow existing within 
thatdistancefromacesspoolshouldbecondemned until itswater has been 



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122 State Boabd op Health. [Off Doc. 

analyzed. Analysee can be obtaioed tlirouf^h our Board for $5.00 each. 
The appropriation for onr use in nnfortunately too Bmall to enable us to 
furnish them free of expensa I shall be glad to learn from yon the 
present Btate of the epidemic, and at its close will ask you for a com- 
plete history of it from the beginninf;. 

Yours very truly, 

Bexj. Lek, 
Secretary. 



(e) Supjriementary Report by Dr. Weldm&n. 

Beading, Pa., September ?, 1891. 

Whilst in Schuylkill Haven I learned from Mr. Burton that the fever 
at Greaaona, in Schuylkill county, had abated to such an extent that 
everybody was happy. I ?ave him a blue print and have requested the 
following information, viz: 

Number of houses in each square. 

Number of privies in each square, and distance from well, if on a higher 
plane! 

Number of pumps in each lot and distance from privyT 

Number of cases of fever in each house, male ot female, age and date! 

Number of fatal oases in each bouse, male or female, age and date! 

How many use pump water and how many hydrant! 

Number of cases occurring in members of the societies meeting in 
town hall! 

Number of cases traced to drinking milk or eating ioe cream, and 
where obtained! 

Number and location of privies and butcher shops in Beaver and 
Panther creeks ! 

I do not think that the wells have been closed — am confident greater 
care has been taken in the use of water from wells, especially those re- 
ported dangerous or even suspicious. 

Learned that no cases of typhoid fever traced to the use of milk have 
occurred iu Schuylkill Haven. 

Will get from Dm. Dechard and Gray a description of their typhoid 



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State BoAitD of Health. [Off. Doc. 



30— INISPBOnOIT AT OHADD'S FOBD AND OOSSABT. 

(a) Preamble and Resolutions lYoni the State Board of Health of Delaware. 

(b) Laws of tbe State of Delawara 

(c) Reply of Smrretary Benjamin Lee, M, D. 

(d) Inspection at Chadd'B Ford and Cossart, by Secretary Lee and William B. At- 

kinson, M. D., Medlc&l Insperlor. 

(e) Letter to necreCary of State Board of HealtJi of Delaware by Benjamin Lee, it. 

D., Secretary. 

(D Notice to Charles D , Chadd's Ford, to remedy defects. 

ig) Notice to J. M , CoBsart's Station. 



(a) Preatnlileand Beeolutions from the State Board of Health, Delaware. 

WnjiiNGTON, Del., July SO, 1891. 
Dr. Benjamin Lee, Secretary State Board of Health, Philadelphia, Pa. : 
D£AB Sot: Eocloeed please find preambles and resolntion of the 
board of health of the State of Delaware, coacurred in by the local board 
of WilmingioD, and the board of water commissiouera of Wilmin^toD, 
Delaware. This is as you ao^gested in your letter dated Jnly 24, 1891. 
Since I wrote yon, I inspected the pig^ries referred to and found them 
situated on a small stream. One about one hundred and twenty-five 
yards, and one not more than fifty yards distant from the Brandy- 
wine river. Please accept thanks for the attention you have given the 
subject. I send you a copy of our laws on this subject. 

Truly yours, 

E. B. Frazeb, 

Secretary. 



Office op the Secbetaby of the 
Board of Health of the State of Delawabe, 

WiLMiNaTOK, Del., .My S8, 1891. 
Dr. Benjamin Lee, Secretary State Board of Health, Philadelphia, 
Pennsylvania : 
Dear Sib : The following preambles and resolutions were adopted 
by.the board of health of the State of Delaware, July 28, A. D. 1891, 
and concurred in by the board of health of the city of Wilmingiou, and. 
the board of water o 



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No. 16-1 Pollution op thb Brandtwine Biver. 126 

Preambles and Reaolution. 

Whbbbas, "It has been reported to the secretary" of the state boaid 
of health of the State of Delaware, that certain nniaances exist on the 
Brandywine river, near Chadd's Ford, ou the ground occupied by 

Charles D , also a nuisance at Cossart Station, on the Wilmin;^- 

ton and Northern railroad in Chester county, and State of Pennsylva- 
nia, ontside of the limits of the board of health of the State of Dela- 
ware,namely: Two piggeries in which are kept 134 and 135 hogs re- 
spectively, and that the offensive water which runsfrom these piggeries 
flows into the Braudywine river thas polluting the water which sup- 
plies the city of Wilmington, Delaware ; 

And whereas, The said secretary has visited these places and has 
verified the above report; 

Therefore, It is deemed proper by the president of the state board 
of health, and by the board of health of the city of Wilmington, 
and also the board of water commissioners of said city, that a represen- 
tation be made to the State Board of Health of Pennsylvania, in which 
state this nuisance exists, asking that such action be taken in the case 
as to relieve our citizens of the consequences of this very offensive 
Daisance. 

The persons having charge of the piggery at Cossart, are J. B, P , 

George N and Joseph J. M , the latter person residing in 

Philadelphia. Pa. 

(Signed) L. P. Bdsh. M. D., 

President of the State Board of Health, Wilmington, Delaware. 
Attest: 

H B. Fkazbb, Secretary. 

John P. Wales, M. D., 
President, {VilmiTigton Board of Heaiih. 
William T. Porter, 
President Board of Water Gommissiinwrs. 
Attest: 

J. A. Bond, Chief Engineer. 



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126 State Boabd of Health. [Off. Doc, 

(b) Ij&wb of the State of Delaware. 

[PweTiS, ReriMidCtHls.] 

An act to define and prevent certain nut'soMrc*. 

Seotion 1. That heTesfter no peraoo or persoDB shall cast, put, place, 
discbaree in or permit or sufTer to be cast, put, placed, di&chai^:ed in, 
or to escape into any niDnm^ stream of water within the limits of thifa 
state, from which stream the inhabitants of any borongb, town or city 
within this state are supplied wholly or in part with water for and as a 
drink or beverage, any dye stuffs, drugs, chemicals or other substance, 
or matter of any kind whatsoever, whereby and by means whereof the 
said water so supplied as for a drink of beverage as aforesaid shall be 
made and become noxious to the health or disagreeable to the sense of 
smell or taste. 

Section 2. Every person offending against the provisions of the pie- 
ceding section of this act shall be deemed guilty of committing a com- 
mon nuisance, and, npon conviction thereof by indictment in the court 
of ^neral sessions of the peace and jail delivery, shall be fined from 
one thousand to five thovisand dollars at the discretion of the court; 
and in addition to the fine aforesaid the court shall issue an order for 
the abatement of the nuisance within twenty days after the verdict of 
the jury upon the indictment aforesaid, and the sheriff of either of the 
counties of this state in which sEiid conviction shall take place shall, 
under the order aforesaid, unless the said nuisance shall, before the ex- 
piration of the time allowed for the abatement of the said nuisance have 
been abated, have full power to abate the same, and to this end shall 
enter on the premises from which the said naisanoe proceeded and ar- 
rest, stop and put an end to the business from the carrying on of which, 
or in the process of which the said nuisance was created or carried on, 
or premises from which the said uuisancea proceeded and issued. 

Sectios 3. That so person thereafter shall put or place, or permit to 
be put, placed or used, any privy, hog pen or slanghter house over, or 
so near that the excrement or offal therefrom shall escape or run into, 
any stream of running water within the limits of this state from which 
the inhabitants of any town, borough or city within the limits aforesaid 
are wholly or in ]>art furnished with water as a drink or beverage ; and 
any one offending against the provisions of this section shall be deemed 
to be guilty of committing a common nuisance, and, upon conviction 
thereof in the court aforesaid, shall be fined the sum of one hundred 
dollars, and the court -shall order the nuisance to be abated immediately 

Passed at Dover February 4, 1864. 



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No. 16-J Pollution of Br&ndywine River. 127 

(o) Reply of the Secretary. 

July Si, 1891. 
Mr. E. B. FbjIZKB, Secretary State Board of Health, State of Delaware, 
mimington, Delaware : 
Dear Sis: X have the honor to ackaowlege the receipt of a. copy of 
preambles and resolution of your board, concurred in by the local board 
of health, and the board of water comtnisafoners of the city of Wilming- 
ton, tog:ether with a copy of the laws of the State of Delaware, for the 
protection of the purity of public water snppUes. I note the fact that 
yon have made a personal inspection of the sources of pollution of the 
Brandywine river on which the preamble and resolutions are based. I 
will, however, take the liberty of ordering an additional inspection on 
the part of our Board. I need not assure you that our Board will do 
all in its power to have this Bonrce of contamination of the water supply 
of BO large a population in yonr state removed If we had a law as 
wise and as stringent as your own the matter woiild be a very simple 
ona As it is the abatement of this flagrant naisanoe may occupy a 
longer period than we could desire. 

I have the honor to be. 

Yours very respeo^sUy, 

Benjamin Lkb. 
Secretary. 

(d) Inspection. 

Pbiladelphu, Avgast 5, 1891. 

Subject of complaint — Creameries and piggeries at Chadd's Ford and 
Coesart. 

The inspection was made by Secretary Dr. Benjamin Lee and Medi- 
cal Inspector W. B. Atkinson. 

At the creamery of Charles D , at Chadd's Ford, everf part was 

found Id excellent order. So was the piggery, which contained 136 
ht^fs. The only thing to complain of was the faot of allowing all the 
waste from the creamery and all the ordure from the pigs to run directly 
into the stream, thence into the Brandywine. 

It was the uniform testimony of the owners of the piggeries, and 
others not interested, that no dead hogs had ever been thrown into the 
stream, bat were invariably buried. Perhaps an objection to the pig- 
gery was that the pigs were kept closely in the pens and were not 
iiUowed to run ont and get the air and sunshine. 

The piggery at Cossart's was not qnite so well kept, but the 
floors were cemented so that no leakage could occur. In the large 
yard attached, about half an acre, a few pigs were loose, and here the 
aoil was no doubt satnrated, and in case ofrain washing into the stream 
below coold occur. There was no other mode of drainage here. To 



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128 Statg Board of Health. [Off. Doc. 

preveot tbis it was sug&rested that a li^ ht embaukment ahoald be made 
along the stream to wholly stop any flow into it. The piggery was 
about 150 yards from the street. Au additional point here was that each 
yard or pen had a email place into which the pigs could go at will for 
air and suDBhine. 

The ordure, etc., fi-om D 'a must be in some way taken away 

so as to prevent it entering the river. 

Attention was asked to the overflow on the meadows. Thus good 
land is rendered useless with no good results in any way. This should 
be good, healthy meadow land in place of being a menace to the health 
in shape of malaria. 

It is recommended that the drains be properly opened and kept so, 
and the sluice gates be opened when a freshet ooours, and thus this land 
may again be restored to usefulness. 



(e) Letter to Secretary State Board of Health of Delaware, by Secre- 
tary Beqjamln Lee, M. D. 

Aufftist 6, 1891. 
Mb. B. Frazeb, Secretary State Board nf Health, WilmtTigtoii, Dela- 
loare: 
Dear Snt: In response to the request received from your board con- 
currently with the board of health and the l>oard of water commb 
sionera of the city of Wilmington, Delaware, I, yesterday, accompanied 
by Professor Wm. B. Atkinson, medical inspector of the Delaware dis- 
trict, made a personal inspection of the creameries of Charles D , 

at Chadd's Ford, and J. J. M , at Cossurt Station, Chester county. 

The conditions which we found at the flrst mentioned establishment 
amply sustained your complaint. The entire drainage of the piggery, 
containing 134 pigs, passes directly every day into the Brandywine 

river. At M 's establishment no drainage whatever was at the 

time of our visit entering the httle stream which flows by the end 
of the yard attached to the piggery, at a point about ISO yards from 
its entrance into the Brandywine. All of the manure deposited by 
the animals in the pens is carted off and used for fertilizing purposes 
ou the farm attached to the creamery. That of the animals which are 
allowed to run loose in the yard, which covers an area of about half an 
acre, is not, however, as carefully gathei'ed as it might be and there is a 
probability that during a. heavy rain there may be a certain amount of 
surface wash into the stream. The reported fact that dead hogs are 
thrown into this stream or the Brandywine from these establishments 
was absolutely denied by the parties interested, who assert that all such 
carcasses were at once buried, and this assertion was corroborated by 
residents in the neighborhood not connected with the establishments. 
The carcasses which have been seen floating in the stream must, there- 



by GoOglc 



Na 16]. Pollution of Brandywine River. 129 

fore, have beeo placed there by other persons. It is not at all an un- 
oommoQ things for farmere to make this dispoaition of their dead animals. 

The instructions ^ven by our Board are as follows: In the case of 

Charles D , that the dischar^ of the drainage of his piggery into 

the stream running throngh his property or into the Brandywine river, 

shall at once cease. In the case of J. J. M , that an embankmeut ten 

feet broad be made across the lower end of the yard connecting c-on- 
uected with his pens, of such height that no surface wash can reach 
the stream from the same. 

Trusting that these precautions will be sufficient to prevent uuy 
farther pollution of the river, and that they will be satisfactory to your 
honorable board, I have the honor to be. 

Yours respectfully, 

Benjamin Lee, M. D., 
Secretary. 

(f ) Nottoe of Abatement 

Avguai 6, 7S9I. 
Mil. Chables J> , Gkadcts Ford, Pa. : 

Deab Sm : After a careful coDsideratiou of the couditions existing at 
your creamery, as foond by myself and Medical Inspector Atkinson, in 
our visit of inspection yesterday, I am compelled to sustain the com- 
plaint of the state board of health of Delaware and to pronounce the 
discbarge of the drainage of your piggery into the Brandywine river 
an unquestionable nuisance, liable to pollute the stream down to the 
poini at which the city of Wilmington makes use of it aa a source of 
supply for the drinking water of its large population. I feel assured 
from my interview with you that yon are the last man to be willing 
knowingly to poison his neighbor's water supply audi have your assur- 
ance that you will abide by the decision of the Board, which is that 
you at once cease to discharge the drainage of your piggery, through 
the trough through which it now runs or through any other chan- 
nel into the Brandywine river. It is scarcely necessary to add that 
the placing of dead hogs in a stream is absolutely forbidden by our 
Board. I found at M — - 's creamery that the manure is entirely util- 
ized for fertilizing purposes and that they regard it as a fertilizer of 
great value. I cannot understand, therefore, that there should be any 
very serious difficulty in disposing of that of your establishment in a 
similar manner. I do not consider that the washings of the creamery 
itself or the milk that occasionally enters the stream are likely to 
Seriously affect the wholesomeness of the water at such a distance. 

I beg that yon will lose no time in complying with these instructions 
and I shall be glad to know what plan you adopt. 
Tours very truly, 

Benjamin Lee, M. D., 
9-16-91. Secretary. 



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ISO State Boabd of Health. [Off. Doa 

Kg) Hotioe to Abate. 

Jugust 6, 1891. 
Mb. Joseph J. M , Coeaart Station, tyUmington and Norihem Bail- 
road, Chester cotmiy. Pa. : 

Dear Sib: A. communication having been received by the State 
Board of Health of PennBylvania from the state board of health of 
Delaware, concurred in by the Board of Health and the board of 
water oommiaaionera of the city of WilminetoD, Delaware, setting 
forth the fact that the Brandywine river which is used by the city of 
Wilmington as its source of water supply, was being poUnted by the 
drainage of the piggery connected with yonr creamery at Coflsari 
Station, Chester coonty, an inspection of the same was ordered. 

This inspection was made Wednesday, Aognst 5th, by myself and 
Professor Wm. B. Atkinson, M. D., medical inspector of the Board for 
the Delaware district. We find that while at the time of onr inspection 
no drunage appeared to be passing into the little stream which, running 
by the end of yonr yard enters the Brandywine abont 1 60 yards distant, 
yet it was evident that during a heavy rain a certain amoont of polluted 
surface water would Qeceesarily reach the stream. 

The Board, therefore, recommends that an embankment ten feet broad 
be made at the lower end of the yard attached to yoor pen, erf such 
height that it will be impossible for the surface drainage of this yard to 
enter the stream. It is scarcely necessary to add that the placing of 
dead hogs in a stream is absolutely forbidden by our Board. 

The Board feels assured that yon are equally desirous with itself, 
that no industry conducted within the hmita of this state should pollute 
the waters of a neighboring state, and especially when such waters are 
used for household purposes by a population of not less than 60,000 
souls. It will, however, be pleased to receive an aaaurance from yon 
that such is the case. We learned with much satisfaction from your 

foremaq, Mr. N , that there was no foundation for the charge that 

the carcasses of hogs dying in your pens had been thrown into the 
stream, but that all such are invariably buried. It affords me pleasure 
to state that a careful inspection of the creamery showed that it is con- 
ducted with scrupulous attention to cleanliness and is supplied with all 
the modem appliances for carrying on such an establishment. 
I have the honor to be, 

Youre very truly, 

Benjaxin Lee, M. D., 
Secretary. 



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No. 16.1 IsfiPEcnoNs at Wallinofobd. 



Sl— IKSPBOnONS AT VTAlAJXaFORTi, DBLAWABB OOITKTT. 



(a) First Inspection by Wm. B. Atkinson, M. D., Medloal Inspector. 

Philadelphia, July SO, 139/. 

Subject of complaint — Drainage from premises of Georgre C— ; 

cesspools of Isaac W and W. F , Wallingrford, Delaware 

coimty. 

A careful inspection of the residence and another hoose of G. C , 

showed that his wash water and kitchen drainage flowed over his own 
ground and passed into the soil of his meadow. So, too, the same from 

1 W and'W. F — ■ entered the same drain. The cesspool of 

Worrall had been cleaned some nine weeks ago. As it is au ordinary 
well the filth can pass into the soil and thence off to the nearest low 
ground. All the drainage from the houses north of the South Media 
road mns into a small gutter by a terra^cotta pipe across the I'oad, and 
then into the meadow as above. 

At the house of P , the cesspools flow into a well a short dis- 

tauce from the house ; this is covered completely, and only pumped out 
when full, say once a year. The kitchen and wash and bath water flow 
into another well a few feet away, and from this flows through a pipe 
out to the road across by a drain beneath the road and so down to the 
meadow. But at the point where this flow crosses the road, the odor 
is very bad and much complained of by the people who are exposed to 
it. I am of the opinion that there must be some communication be- 
tween the well containing the cesspool matter and the well with the 
wash drainf^ife, which causes this unpleasant odor. Ordinary wash 
water could not give off such an odor. 

G. C informed me that he was doing all in his power to pre- 
vent any annoyance through his drains, and would shortly turn all into 
a well now used as drinking water, and use for bis house the water from 

Media. I. W had been careful to clean his well, and I found no 

other cause of complaint. 

In the case of the F drain, I would suggest that he make a 

thorough examination of the relation of the two wells and the pipes, to 
determine if any leakage is taking place. The cesswell not being oe- 
mented, would possibly allow drainage of its contents into the other. 
Hence such a well should be a cemented tank which would entirely pre- 
clude any contamination of the soil or drains in any way. 



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132 State Boabd op Health. [Off. Doc. 

Second Inepeotlon by W. B. AtklneoD, M. D,, Medioal Inspttotor. 
Philadelphia, September 14, 189/. 

Subject of complaint. — Typhoid fever at several houses. Drain of 

Mr. J. M. 8 , and condition of pi^ pen tuid suiTounding:s of tenant 

house of J. W. P . 

The drain of Mr. S 's pramises runs through the entire length 

of the fann of Mr. P into a small creek which flows into a pond 

Qsed in the winter for gathering ice, and the water of this and the creek 

is used by the cattle of Mr. P . As the drain carries the overflow 

from the entire premises of Mr. S , and as this is used to receive 

all the sewage of his premises, including dwelling house, tenant house 
and stabUng, cesspools, wash and bath water, etc., we must expect to 
find at times, especially after much usage or rains, that this outflow 
must greatly exceed the ordinary amount. In places, the ground was 
qnite full of dark masses incident to the outflow of cesspool matter. 

I would suggest an analysis of the flow as it comes from the pipe at 

the end of the drain on the groond of Mr. S . If this shows, as I 

think it will, the presence of fecal matter, etc., then this drain should no 
longer be allowed to flow in this manner. 

I foand a temporary pigpen on the premises near the tenant bouse 

of Mr. P in a bad condition, also the remains of a former pen and an 

outhouse, all of which I insisted should be put into a proper sanitary' 
state without delay. I was assured this should be dune, and have learned 
that all cause for objection is now removed. 

At the dwelling of Mr. F 1 was informed that a, daughter was 

lying ill with typhoid fever. 

I found one case at the house of Mr. H , which I was informed 

was the fourth in about eighteen months, with one death. Opposite to 

this house Mr. Isaac W was sick with typhoid. At the house of 

Mr. D there iiad been two cases, both convalescent. One was 

claimed by the family to have been brought from Wayne. Mt. H 

insisted that as he drank water at Wayne and other places, it was pro- 
bable that hia attack was not due to local causes. At each of these 
places I was not able to find any special ground for the attack. While 
here I heard so much of cases at South Media, that I extended my ex- 
amination up that far, and found two cases in the dwelling of Mr. S , 

and one in that of Mr. G opposite. Nearly all of the infected 

houses got their supply of drinking water from Media, and those that 
used their own well had no evidence of contamination from any source. 

The whole locality has cesswells uncemented (save Mr. S , who 

has been extremely careful iji all his hygienic efl'orts), sewage running 
over the ground, in short the atmospheric condition is such that an ex- 
plosion of any disease may be regarded as Imminent. The milk supply 
is nearly always from their own cows. I found all the small creeks or 
runs were receiving mora or loss foul matters in every direction. 



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No. 16.] Inspections at Wallinqbobd. ' 133 

My attention was a^n called by a number to the continaatioa of the 

very foul odors given forth by the flo* from the premises of Mr. P 

opposite the blacksmith shop on the Providence road, to which I 
called attention in my former report. While this flow is claimed to be 
only wash and bath water, there is some means by which it mu8t con- 
tain some matter of a more deleterions nature. This goes down into 
the stream jvhich passes the houses of W and H , and is re- 
garded by many as a possible source of evil. 

I was informed that thus far there had been within a year say twelve 
cases and five deaths of typhoid fever. 

In all my communications with the people I have ni^ed the great im- 
portance of care as to hygiene, and I may say that I fonnd them ready, 
indeed anxious, to co-operate in every way. 

One physician of long experience appeared to think the disease in- 
digenous to the place and not eradicable. 

As there are a number of physicians who have charge ol these cases, 
would it not be well to open correspondence with them and endeavor 
to learn exactly the gravity of the present cases, perhaps their ideas as 
to the cause f 

Dra. D. T. Laine, Media, J. H. Fronfield, Media, Mary V. Mitchell, 
Media, were those mentioned to me as at present in attendance. 



Third Inspection at WaUlnfffbrd, Delaware Oounty, by 'Wm. B. Atkin- 
son, U. D., Uedioal Inspector 

Fhiladblphu, September S8, 1891. 

Subject of Complaint — Drainage and Sewage. 

I went over the ground again very thoroughly, and am satisfied that 
quite an amount of cesspoollsewage flows from the pipe into the grounds 
of Mr, P , thence into his pond used by his cows for drinking. 

A thorough inspection of the pr^nises of Mr. P showed no 

drainage of any kind into any stream or over the surface of the soil. 
Everything had been put into the best order, and I found nothing in 
any part to be objected to. 

Inspection of the cesspool drainage of Mr. P , Sr., showed it to 

flow into a well from which it was overflowing upon the surface and 
running in a broad stream down the hill into the stream below. This 

stream runs into the pond of Mr. P ; I was informed that a man 

bad been employed to pump out this well over the ground but ceased 
because of the objectionable nature of the work. 

I called upon a number of the householders and found few who did 
not allow the sewage from their cesspools to mnintotbe nearest stream, 
some conveying it by pipes for a distance in order to reach a stream. 
Nearly every one with whom I conversed appeared to think this the 
proper method. Owing to the location of Mr. P — , his stream and 



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134' State Boabd of Health. [Off. Doc. 

pond received sewa^ in this vay from a \arge number of houses. For 
this reason I would suggest that a meeting of the hooseboldere and 
other inhabitants of this place be callei and that they be asked to ap- 
point a committee to consider what plan can be adopted to remedy this 
crying evil. 

My own opinion, after a careful consideration, is that the best, in fact, 
the only means will be to have each house connect its sewer pipes with a 
well thoroughly cemented, so that no possible sipage can occur into 
the soil, and these when full to be pumped out by the odorless excava- 
tor plan, and the contents conveyed to a distance, there to be made into 
compost. 

I feel sore that if Mr. S would have a new well made in the 

rear of his pig pen, well cemented, and not allow its contents to flow 
over the soil the whole trouble relative to the drainage from his place 
would be removed. 



33— INSPBOTION AT ROWBLLVHiLB, OHBSTBIB COUNTY. 
IJj Wm. a A.TKINBON, M. D., Medical Inspector. 

Philadelphia, August 1, 7891. 

Subject of Ck)mplaint. — Condition of certain parts of Howellville, 
Chester county. 

Mr. B has one or more children very ill with scarlet fever. The 

house to the east of his property is occupied by Hungarians, etc., and is 
in a very filthy condition. It had several rooms with bunks or beds 
and from the appearance each bed held two or more occupants. It was 
impossible to learn how majiy people occupied this house at night, but 
I was assured it was much crowded Old dirty clothing and rags were 
lying in every direction both in the rooms and around the house, andon 
every side were evidences that the inmates made little useof the privies, 
as dejections from the bowels were seen in the paths, etc. Back of this 
building were two stone vaults which once were spring houses, now the 
floors were covered with filthy rags, and I was informed that a man was 
taken from one recently in a dying condition. The cesspool was located 
on the hill above and was the ordinary privy, no well, the contents run- 
uing over the surface of the ground and down in a gutter close by Mr. 

B 's house. This house had no cellar, the fioor on the ground, and 

rags and filth of all kinds were strewed around. The next house, Mr. 
U , which, while in a clean state, was made very unsanitary by the 



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No. 16.] I»8P£CrnON AT HOWELLVILLE. 135 

odor frora this mass of filth. The next was closed, a death from diph- 
theria had occurred recently in it. The building complained of is owned 
by S. W . 

Below was an old mill in ruins with & spring house much nsed to ob- 
tain water, but its whole surroundings were extremely doubtful, as 
hiTman ordure laid all round and the water was not in any way protected. 

Another house owned by J, T. D and one. owned by the railroad 

were much in need of cleansing, and the privies were objectionable in 
the same way as the others. In fact one was so filled with mud which 
ran into the door that no one appeared to use it, but evidently squatted 
around. In front of this is an old quarry hole in which are dumped old 
shoes, filthy rags, etc. This is back of the hotel and belongs to the 
railroad. I saw a nnmberof huts built of hay aud branches, dirty and ap- 
parently used to sleep iu. All the drainage of these places goes into 
the same little run and down to a creek below. 

The whole place needs a most thorough cleauiug, properly constructed 
privies, and orderly habits on the part of the workmen enf?aged on the 
railroad and the stone works. 

Mr. S. W promised to have his houses cleaned and assured m© 

he woidd endeavor to make bis tenants do better. 

I recommend that he, Mr. J.T.D , and the railroad be notified of 

the need of attention at once to these places and if possible the whole 
should be policed. I feel sure that if the warm weather had continued, 
a la^re number of cases of filth disease would have occurred. This may 
yet happen. 

The constable is Mr. Philip Kirk, Chester Valley P. O. ; the squii-e, 
Wm. Davis, Tredyffrin P. O. 



(b) Instruotloiis to Mr. Philip Klrlc, Oonatable. 

Avgust 10, 1891. 
Mr. Phiup Kirk, (Jonstable, Cheater Valley F. O. . 

Deab Sir: In consequence of the prevalence of scarlet fever at 
HowellviUe, the Board caused an inspection of that place to be made. 
The inspector reports that scarlet fever now exists at the house of Mr. 

B of HowellviUe. The Board has instructed me to enclose to you an 

order addressed to Mr. B , which you are requested to deliver to 

him, and also to see that attention is paid to it, especially with regard 
to the house being quarantined. 

The railroad company, together with several owners of property are 
being addressed, with a view of placing HowellviUe in a better sanitary 



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136 State Boabd of Health. [Off I>oo. 

coDiIitioD, as it is feared that an epidemic might break out at any 
moment. 

Very truly yonrs, 

Behjakih Lee, 
Secretary. 



{o) NotifloaUon to Mr. B . 

Auguat 10. 1891. 

Mr. E , Hmoeliville, Pa. : 

Dear Sir ; The attention of the Board has been isailed to the insani- 
tary condition of certain houses and other property at Howellville, and 
an iuspectioQ of the place has been made by Dr. Wm. B. Atkinson, 
medical inspector of the Board. 

I am instructed to inform you that until all danger is past with regard 
to the prevalence of scarlet fever from which one or more of your chil- 
dren are sufferiof?, that your house must be quarantined, and no person be 
allowed to enter or leave such premises, except those who are absolotely 
compelled to do so daring this period. When the disease has'ceased, 
your house must also be fumigated with sulphur and scrubbed with a 
solution of corrosive sublimate. Full directions for properly carry- 
ing this out will be found in the oircnlar enclosed with this letter. Tour 
prompt attention to these instructions will greatly aid in staying the 
prepress of the disease. 

Very truly yours, 

Bbnjuiin Lee, 
Secretary. 



(d) Notifloation to Mr. 8. 'W -. 

AugrM 10, 1891. 

Mr. Samdel W , Hoioellville, Chester county. Pa. : 

Dear Sir: With reference to an inquiry into the canse of the pie- 
valence of scarlet fever now existing at Howellville, and the insanitary 
condition of that place, the medical inspector reports that in a house 
owned by you at Howellville recently occurred a death from diphtheria 
The house is now reported to be empty. I am directed to request yon 
to have this house disinfected by ftunigation with snlphut and properly 
cleansed at once, full directions for which will be found in the enclosed 
circular. I am also to ask for your kind co-operation in placing Howell' 
ville in a better sanitary condition, as the Board fears that in its present 
condition a sweeping epidemic might might occur at any moment, espe- 
cially during the present hot weather. 

Very truly yours, 

Benjaiun Lee. 



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No. 16.] ImSPEOTION AT HOWBLLTILLB. 187 

(e) Notlfloatlon to Mr. J. T. D . 

August 10, 1891. 

Mr. J. T. D , Howellville, Chester county. Pa.: 

Dea£ Sib: Iq ooDsequence of a complaint that scarlet fever prevailed 
at HowellvjUe, and that the place wae in l^ very iasaiiitary condition, the 
medical inspector of the Board has made an inspection. Among; 
other matters requiring immediate attention, be mentions that a 
hoase owned by you is much in need of cleansing, and that the privy of 
same is very objectionable, I am therefore instmcted to request you to 
have this hoase and premises put in good sanitary condition at once. 
The Board farther direct me to ask for your oo operation in having 
Howelville placed in a better sanitary condition, as it is feared that an 
epidemic might occor at any moment, especially during the prevailing 
hot vreatber. 

Very truly yours, 

Benjamin Lee, 



(f) Letter to tbe Seca:etary of Peonaylvaida Railroad. 

August IC, 1891. 
The Secretary, Pennsylvania Railroad Company, S3S South Fourth 
street, Philadelphia : 

Dbab Sib : The attention of the State Board of Health haa been 
called by tiie police sai^eon department of Philadelphia, to the insan- 
itary condition of Howellville, Chester coonty, and an inspectiou of the 
distriot has been made. The medical inspector reports many serious 
nuisances, and states that an epidemic may occur at any moment, so 
bad are the conditions at present existing. Among other nuisances, he 
mentions a house owned by your company as being much in need of 
cleansing, the privy being full to overflowing, and human excreta lying 
all around, the privy being too fnU to be used. Many Hungarian lab- 
orers occupy cottages at this place, their habits being disgustingly 
filthy. 

I b^ respectfully to suggest that your company co-operate with 

Mr. J, T. D (the owner of the quarry works at Howellville), the 

squire, Mr. Wm. Davis, Tredyfifirin P. O., and the constable, Mr. 
Philip Kirk, of Chester Valley P. O., as a sanitary committee, and en- 
deavor to have the place put in better sanitary condition. The Hun- 
garian and other laborers should have privies provided for their use, 
and should be compelled to use them. Every privy should also be 
emptied regularly every week. 



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138 State Boabd of Health. [Off. Doc. 

The preBent w&rtn weather ia all in favor of an epidemic. Already 
one fatal case of diphtheria has occurred, and two or more cases of scar- 
let fever at present exist in the honse of a Mr. Beidler. Your early 
attention to this matter will obUg:e, 

Yours very truly, 

BcNJAKiN Lee, 

Secreiarf/. 



23-INBPBOnON AT BOOHBSTBB MILLS, INDIANA OOUNTT. 
By W. E. Matthkwb, M. D., Medical Inspector. 

Indiana, Pa., Avgust SO, 1891. 

I visited Rochester Mills on the 19th and 20tb of Au^rnst, 1891. The 
postoffice of Bochester Mills is in tlie town of Richmond, Grant town- 
ship, Indiana county. The town lies in a low marshy place, the creek. 
Little Mahoning, passing through it from the northeast to the southwest, 
and hills surround the towu on every side. The sub-soil is very poroufi 
with rocks at a very slight depth. The water supply is almost entirely 
from wells. Some few of these are drilled to the depth of thirty or forty 
feet, and encased to the rock. Most, however, are dry wells, walled 
with stoue. The first case of fever in the towu developed one year 
agfo, or in July, 1890, just above the spring. The land sloped toward 
the spring:, and the water closet is located only a few rods above it. 
The stools from this patient could very readily drain into the spring. 
The water gets quite low in the summer time, and a tub is sunk in the 
ground just below the spring, and water is taken from this tnb. 

The next persons to take sick were a Miss R and Mrs. W , 

a short time after, and both, from the history, had evidently drank water 

from this spring. These cases were in the fall of 1890. Mr. W 

sickened after his wife had recovered, and died. It is very probable thar 
the stools, part of them at least, were thrown out upon the groond where 
they could reach the drain. The cases at present are below the road, 
with but one exception, and that family gets its water supply from be- 
low the road. These cases have all developed within the last eighteen 
or twenty days. About foar weeks ago there was a very heavy rain which 
oversowed all the ditches aud these lots below the road. All the cases 
have developed since this occurrence. 

As an evidence of the poroaa nature of the soil aud how easily the 
wells below the road can be contaminated, some time ago manure was 
spread upon the fields above the road, and shortly afterwards the water 
from one of the wells below the road could not be used. The drainage 
from the manure could be tasted in the water. There are several oases 



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No. 16.] Inspection at Camp Sbersiak. 139 

of fever in the sarroundiiig cotmtr;, but I ttmik ail these cases coald 
be traced to this water supply, as the people attend church in the town 
and have evidently drank from these wells. 

As the people are not in a position to help themselves to any great 
extent, the only remedy I have to suggest is that a well be dug above 
the town, and water be taken from it. I think the water should be ana- 
lyzed. Vessels for the collection of water should be sent to M. T. Work, 
Rochester Mills, Indiana, Pa. I should also state that the first case in 
the Scheesely house just above the spring, was contracted away from 
the town. It was fifennine typhoid fever. There have been altogether 
about twenty or twenty-five cases, with five deaths, and at present iu 
this little town (population about 130) there are nine cases. 



By Wm. B. Ateimbon, M. D., Medical Inapeelor. 

Philadelphu, August S4, 1891. 

Subject of complaint — Unsanitary condition in which the e:roand was 
left after the military had withdrawn. 

The secretary, Dr. Benj, Lee, in company with Medical Inspector Wm. 
B. Atkinson, made a careful inspection of tiie entire grounds, and found 
that the garba^ pits and cesspools had been quite well covered with 
fresh earth, and that no evidence existed of any want of care in this par- 
ticular. But there yet remained a large amount of pieces of old paper 
and other debris which should have been gathered and burned in order 
to give the place a cleanly appearance. 

After the inspection had been completed, it was accidentally discov- 
ered that the complaint was well founded at the time it was made, but that 
Mr. Paist, manager of the Devon property, a few days prior to this in- 
spection, had a force at work who bad filled np the latrines and gar 
b«ge pits with fresh earth, so that the nuisance was abated. The in- 
spectors suggested to Mr. P, that the debris, paper, etc., be collected 
and that the ground generally be put in a more cleanly condition. 



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110 State Board of Health. [Off. Doc. 

ZG-nssFBonati of dbainaob ststbm at WAmat, nm^- 

VAIUI OOXTNTT. 
By W. B. Atkikbom, M. D., Medical Intpeetor. 

Philadelphia, Augtut 14, 189J. 

IbspectdonB of the new system for the aewera^ of Wayne. 

AufrQSt8th,at the request of Mr. FraukSmith, Medical Inspector W.B. 
Atkinson met Col. WariDf; and others at Wayne and went over the ground 
of the new plant. The whole amount of sewage flows by iron pipes into a 
reservoir, where, by means of a powerful enf^ue, it is aerated, the sewage 
being thrown in a small stream again into the reservoir, by which pro- 
cess it is claimed that a large amoant of air is carried into the entire 
quantity, and then the sewage is forced by two duplex engines up the 
hill tbroug'ii a pipe to a well whence it is allowed to flow over the surface 
of the soil, distributed as evenly as possible, being retarded by barriers 
of earth and stone so that the soil may have full opportunity to elimin- 
ate all material which is appropriate to enrich the earth. This process 
is continued to each section of the ground, alternating so that each sec- 
tion may have time to obtain the fei-tilizing matter in turn. Itia claimed 
that before the fluid can reach the low groond so as to approach the 
creek that it will be clarified and purified, so that should it reach the 
creek it can do no harm. At this inspection the flow had not, of course, 
been regulated so as to flow evenly. 

August 14th, Secretary Lee and Medical Inspector Atkinson inspected 
the plant and met Ool. Waring, who went over the ground with them. 
The flow was much more evenly distributed and all appeared to be work- 
ing in a satisfactory manner. It is claimed that nottiing can now flow , 
into the Itham creek, and so the whole difficulty relative to the pollu- 
tion of the stream is avoided. The test must be made by an examina- 
tion of water obtained at the lowest point and should any be found 
to flow into the creek that must be tested. The inspectors were in- 
formed that arrangements are to be made to prevent the flow of rain 
water into the reservoir, which will materially lessen the amount of sew- 
age to be cared for. 



26 -mSPEXTnOH AT SUUUYLKIIX HAVBN, SOUULEIUi OOITNTT. 

By W. MUBBAV Weidmah, M. D., Uedieal Intpeetor. 

September, 7, 1891. 
In company with Mr. Goas, secretary of the board of health of 
Schuylkill Haven, I inspected the " lots in southern portion of the 

place" belonging to Loose estate, 8. B , J. G— ^ and Mrs. 

B , facing on Columbia street, running back 210 feet to an alley. 



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No. 16.J Inspection at Schuylkill Haven. 141 

West of thetM properties and almost at right anftles. Main street is con- 
tinoed on the banks of the Schuylkill river. 

Some few years ago the streets were raised by aathoriiy of the town 
council. Consequently these properties are about two feet below the 
level On the northern side of the alley there is an open gutter except 
where it crosses Main street, where there is a culvert twenty inches 
square, of stone. 

Two weeks ago, the river, after a heavy rain, backed its water through 

the culvert and covered these lots, so that to-day those of L estate 

and Mrs. B are covered with stagnant water to at least three- 
fourths, Mr G 'e one-half and R 's one-fourth, discolored (black) 

by the lai^e deposits of coal dirt in the neighborhood. 

Some of the owners are ready and willing to abate the nuisance, others 
think the town aothorities are the proper persons, and the owner of one 
does not reside in the town. 

Some one, a plumber, was willing to abate it by means of a siphon 
for $26.00. By ditching I thought it could be done more thoroughly 
and economically. 

I recommended that the board of Iiealth established by ordinance in 
1674, and their physician should inspect the same, and as soon as he de- 
clares it a nuisance, the board should notify the owners of all the sub- 
merged properties of this part, that they (the owners) must abate the 
same within days. Neglecting or refusing to act, they should em- 
ploy some one to do the work and place a lieu on each property. 

If they have ever adopted and proclaimed or published " rules, orders 
and regulations," there will be no trouble or delay. As I could find 
none, I told them to act under the direction of their attorney, and trust 
soon to hear that the nuisance has been abated, to assemble their body 
immediately and pass rules and regulations, and post them in conapicn- 
otts places. 



(a) Snpplementar? BepoH. 

September 7, 1891. 

During my visit to Schuylkhll Haven last Batnrday, the following 
cooditioDs were called to my attention : 

A. well on Dock and another on Main street have been abandoned, 
pipes so laid that the refuse from kitchen and house can be emptied 
into the well. Although not so used by present occupants, their loca- 
tion is such that they would, when made receptacles of bouse debrin 
contaminate the wells on adjoining properties which are used daOy. I 
could only recommend vigilance, and when suspicion was aroused, have 
water analyzed. 

My attention was also called to the condition of the bed of the river 
and of a meadow just outside of the borongh limits, now overflowed, 



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142 State Board op Health. |_Opf. Doc. 

throngh which Lou^ mu comes. Quantities of coal dirt have accuma- 
lated in the bed of the river, and in such qaaotitieB about the mouth of 
Long run, that its channel has been changed, which during the heavy 
rain, a few weeks ago, checked the egress of the water and caused the 
meadow to overflow. Since the abandonment of the canal no effort has 
been made to keep the bed of the river clear and free, and hence a ques- 
tion of law has arisen as to whose duty it is, viz : The borough, the pri- 
vate operator or corporation controlling the coal product. 



(b) Letter of the aeoretary to Mr. G. H. Ooas. 

Sejriember 9, 1S91. 
Mr. Chables H. GrOAS, Secretary Board of Health, Schuylkill Haven, 
Pennsylvania : 
Deak Sib : Dr. W. Murray Weidman, medical inspector, who has re- 
cently investigated the condition existing in your borough, agrees irith 
yon that they seriously threaten the health of your community. I en- 
tirely sapport bis recommendations, that your board, if it has not done 
BO, shall at once adopt such rules, orders and regulations as may be 
necessary to cover all such nuisances, or others, injurious to the public 
health, and publish the same in the newspaper having the widest circu- 
lation in your town. If you have already done so, there need be no 
delay in declaring the condition of the submerged properties a nuisance, 
and ordering the owners thereof t-o abate the same within ten days, and 
in case of their neglect or refus^ to obey your order, in proceeding to 
have the work thoroughly done, and a lien placed on such property to 
cover the expense. In order to assist yon in the formulation of roles, 
I send youcopies of our model ordinance and model rules for the or- 
ganization of a board of health. If you can persuade your council to 
adopt the ordinance in full, with such slight modifications as local con- 
ditions may demand, you will have a firmer basis of action than if you 
simply adopted the form of regulation of your own body. I observe, 
however, that the ordinance of April 2y, 1674, establishing your board 
is a very strong one, requiring borough officers to carry out your rules, 
orders or regulations under a penalty of heavy fine. In either case, 
therefore, your authority is ample, and you need not hesitate a moment 
in taking action of the most positive and authoritative nature. I will 
request you to give me a full report of all proceedings taken in regard 
to this matter, whether by council or by your board. Heartily sympa- 
thizing with you in your expressed anxiety that your borough should 
present the best possible sanitary state, I am. 

Tours respectfully, 

Benjamin Tiitir., 

Secretary. 



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No. 16.^ Inspection of Tyrone. 118 

(e) Prom O. H. Ooaa, to the Secretary. 

Schuylkill Haven, September 18, 1891. 
Benjamin Lee, M. D., Secretary State Board of Health : 

Deab Sir: Enclosed will fiudoue of Dotices served od property o\viier8. 
We had no trouble with the people, they used limo aud had it spread 
over all of the lots. Our physician. Dr. Lenker, was satisfied with it as 
a disinfectant and deodorant. We had Superintendent Smith here to 
view the Schuylkill river and canal which is filled with coal dirt, washed 
in from coal regions of Philadelphia and Reading lUilroad Company 
mines, which causes river to overflow, and think he, as superintendent 
of navigation, will have it removed. Thanking you very kindly for the 
interest yon have taken in this matter, 

I am truly yours, 

C. H. GJOAB, 

Secretary Board of Health. 

Notice to Abate. 

Yoa are hereby notified that the decaying vegetable matter and the 
stagnant water on your lot on Columbia street, is dangerous to the pub- 
lic health, and that the same must be removed or thoroughly disinfected 
within five days from this date, or the borough will proceed to remove 
the same and will lay a lien upon your property for the cost of removing 
it, together with twenty per cent, added thereto as provided by act of 
assembly in such case made and provided. If the water is not removed 
but is claimed to be disinfected, it must be disinfected in a manner 
satisfactory to the physician of the board of health. 

By order of the board of health. 
September 11, 1891. 



sn—osspaanas op ttbonb, Bi*Am oounty. 

By Gborsk O. Orofk, M. T).,Member of the Board. 

Lewisbubo, SeptcTnber 4, 1891. 

In accordance with the request of the burgeas of Tyrone, I visited that 
place on September 8d and made an inspection and gave him advice in 
reference to the management of a threatened outbreak of diphtheria. 

There is nothing in the situation or present condition of Tyrone to 
make it more liable to an epidemic of this disease than any other town 
in the state It is in a fair sanitary condition. The disease has been 



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114 State Boabd of Healah. [Off. Doc. 

recognized some ten days. There are reported to date twenty or twenty- 
foar cases with fonr or five deaths. The disease appearing largely to be 
oonfined to families using well water, the use of such water, it was reoom - 
mended, be abandoned. 

I distributed the circulars on "Goutagioos Diseases," "Diphtheria " and 
"To Funeral Directors," and urged upon the burgess that he secure the co- 
operation of the physicians, undertakers, ministers and school author- 
ities to restrict the disease to its present limits. Public funerals and 
visits iu families where members are sick of diphtheria not to be toler- 
ated. Children exposed to infection to be rigidly excluded from public 
and sabbath schools until danger is past. Disinfection, isolation of sick, 
etc., all to be governed by the directions of circulars of the Board. 

There is a great demand for our circulars, and I would urge that ten 
full sets be sent for use of burgess and town council, ten sets for physi- 
cians, eight sets for ministers. A liberal supply of circulars on diphtiieria. 
Population about 6,000. I think the burgess would put one of the 
diphtheria circulars in every house if they Were sent him, as be seems 
anxious to do all in bis power to stop the threatened epidemic. I re- 
commend that this be tried. 

I saw members of town council, members of school board, phyeiciaus 
and all seemed anxious to know what was the best to do to cut the 
epidemic short. 

I think if the circulars are accompanied by a letter from the secretary 
of the Board, addressed te physicians, undertakers, ministers andschool 
authorities that all will respond with alacrity. 



(b) Proolaniatloa. 
To the Citizejis of tiie Borough of Tyrone : 

It has been reported to us that there are a number of cases of diphtheria 
of a malignant type in our community. While we do not thinkthere is 
any occasion for general alarm we deem it advisable to take the neces- 
sary precautionary steps to prevent the spread of the disease and avoid 
a possible epidemic. To this end we call upon the citizens of the 
borough and suburban places to begin at once a general cleaning- up of 
their premises. All decaying vegetation, garbage, and filth of every 
description should be cleaned up and burned. If each householder will 
do his or her doty in this matter the disease can be confined to narrow 
limits and the health of the people preserved. The following regula- 
tions have been adopted by the sanitary committee of the borough mid 
their strict observance is enjoined upon the people: 

First. There shall be no public or church funeral of any person wlio 
has died of diphtheria, nor of any person who has died of any other disease 
in a house in which diphtheria was present at the time of such death. 



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No. 16.] iNSPBcnoif AT TntoNE. 145 

Second. The body of any person who has died of diphtheria shall not 
be exposed to view. Such body shall be immediately after death, 
wrapped in a sheet which has been soaked in a solatioQ of corrosire 
Bnblimate, in the proportion of two drachms to the gallon of water, and 
privately buried within twenty-four hours. 

Third. No person shall unnecessarily visit any house in which diph- 
theria is known to exist, or has existed within a period of six weeks. 

Fourth. No member of a family in whose house diphtheria exists 
should attend school, Sunday school, chnroh, theatre or any other pub- 
lic assembly. 

Fifth. Every school, amon^ members of which there have been cases 
of diphtheria should be dosed, tmd no child should be received into a 
nou-infected school who has been attending one among the pupils of 
which the infection is known to have existed. 

Sixth. No persons recently recoveredfrom an attack of diphtheria, or in 
whose family diphtheria exists, shall go to work in any factory or mill 
in which their work reqaiies them to be in dose contact with fellow 
workmen in confined rooms, without a certificate from their attending 
physician, stating that in his opinion they run no risk of conveying the 
contagion. 

Seventh. The period during which a person who had diphtheria is in 
danger of conveying the contagion is from four to six weeka 

Eighth. All rooms and houses in which diphtheria has occurred, and 
all dothing, bed clothing and articles of furniture which have been ex- 
posed to infection should be disinfected in accordance with the sub- 
joined instructions. 

Ninth. No dead animal, garbage, or filth of any kind shall be thrown 
into any stream, race, dam, pond or other water, or upon any pnblic road 
or place. All such material should be either burned or buried. 

Tenth. All ceUars should' be thoroughly cleaned and whitewashed, and 
all house yards and privies disinfected with copperas and kept clean. 
BlCHAItD Bbaston, 

Burgess. 
D. H. PTa Anvn 

James Wiqhaman, 
Jas, a, Crawfoed, 
John Oakwood, 

Sanitary Committee. 



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146 State Board of Health. [Off. Doa 

(o) Oirotilar Letter to the Olersy, PhyBlolans, Soliool AuthorltleB. and 
Funnel DireotoTB, by Bei^amiii Lee, M. D., Seoretaiy. 

September 9, 1891. 
To the Bevereiiii Clergy, the Phyaiciam, the Sc/iool Authoriiies, and the 
Funeral Directors of the borough of Tyrone, Blair county. Pa. : 

The State Board of Health of Pennsylvania is desiroae to do every- 
thingiD its power to cnt short the epidemic of diphtherianow prevailing 
in yoar town. To this end its late president has visited your place' 
made a careful inBi>eGtion, and personally advised yoiu- authoiitiea as to 
the proper step to be taJien. 

The Board, through its secretary and executive officer, has oommnni- 
oated with your chief bui^ess, endorsing the recommendations of Dr. 
Groff in all respects. It has reason to believe that that officer will use 
his best efforts to carry out the instrnctiouB which he has received. A 
heavy responsibility, however, rests upon the members of dach of your 
several vocations in regard to this matter. By a cheerful compliance 
with his orders you may do much for the saving of life and the preven- 
tion of disease. Your advice will be of the greatest assistance in sup- 
plementing bis instructions in individual cases ; on the other hand, in- 
terference or opposition on your part may succeed in thwarting his best 
efforts. The B<mrd, therefore, urges that you will unite in procuring 
compliance with the following instructions : 

First, that the use of well water for drinking purposes be abandoned, 
whenever possible. 

Second, that such water if used, be always previously boiled. 

Thurd, no public funeral, either in church or at the house, be allowed 
to take place. 

Fourth, that every house in which the disease exists be placarded, so 
that persons may not enter it in ignorance of the pi-esence of the infec- 
tion, 

Fifth, that all visiting to or from such houses be discouraged. 

Sixth, that the inmates of such houses, whether children or adults, be 
not permitted to attend any public assemblage. 

All precautions with regard to cleanliness of houses, yards and streets, 
admirable as they are, will be comparatively useless so long as inter- 
course is allowed between the sick and the well beyond what is abso- 
lutely essential for the care and comfort of the sufferers. 



(d) Letter to the Chief Burgees of Tyrone, by the Seoretary. 

September 9, 1891. 
Hon. BrlCiJARD Bbaston, Chief Burgess, Tyrone, Pa. : 

Deab Sik : In accordance with a request of Dr. Groff of our Board, I 
have sent yon circulars with regard to the prevention of the spread of 



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Na 16.] IS8PECTI0N OP Tyronk 147 

diphtheria and other contagious diseases. To^ay I forward you a saffi. 
cient uamber for free distribution and will send more if you will let me 
know yon can use them. Dr. Groff reports fEivorably of tUe measares 
which yon have ordered to foe taken in pnttingr the town in good sani- 
itary condition. These efforts, however, will be unavailiDg, so long aa 
free intercoaTse Ib allowed between the well and the sick, between in- 
fected houses and those in which the disease has not occurred. Unless 
the diseaae has already to a great extent abated, I would strongly urge 
you to issue a proclamation forbidding under penalty, first, public fun- 
erals of those who have died of diphtheria ; second, annecessary visit- 
ing at houses in which the disease exists ; third, visiting from euch 
booses to others; fourth, the attendance of the inmates of snch houses, 
whether adults or children, at public gatherings of any kind for pur 
poses of worship: education or amusement. I ui^ntly advise the 
placarding of every house in which a case of the disease exists until 
snch house has been disinfected in accordance with the instructions con- 
tained in the circnlar of the Board. 

I enclose a letter addressed to the clergy, the physicians, school auth- 
orities and funeral directors, which it would be well for you to have pub- 
lished in your most widely-circulated paper. 

I have the honor to be, 

Tours respectfully, 

Benjamin Lee. 

Sfcretary. 



(e) To R. Beaston, Oblef Bortreas, by the Secretary. 

Sept. 17, 1891. 
Mr. BiCHABD Beaston, Chief Burgess, Tyrone, Pa.: 

Beab Sib : I take pleasure in acknowledging the receipt of your very 
satisfactory statement withre^ard to the efforts being made by yourself, 
the borough council, school authorities and citizens generally to stamp 
out the diphtheritic infection in Tyron'^ Tour proclamation is admira- 
ble, and I have no doubt has been the means of saving many lives. I 
tmst you will not abate one jot of your precautions as long as a single 
case of the disease exists within the limits of your borough. 

Yours respectfully. 

Benjamin Lee, 
Secretary. 



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146 State Board of Health. [Off. Doc. 

^f) To tbeSame. 

Sy>teniberS9. 
Mr. UlCHABD Bkaston, Chief Biirgean, Tyrone, Pa.: 

Deab Sib : Your three commuQicationii, thu third contaiiimg the or- 
dinance of your boTOOgh with reg^artl to the reporting; of uonta^ous dis- 
eases by phyBicians, are received. I am extremely glad to hear that you 
are taking prompt steps to enforce it by the arrest of those who neglect 
it. I have no doubt whatever that this step will bring them to tfaeir 
senses. Tour powers are ample, and oven those who have refused to 
obey you in the past will respect you all the more if you are firm. 

I would suggest in regard to section two of your ordinance that it is 
scarcely fair to saddle the duty of placarding an infected house on the 
physician. This should be done by the order of the board of health, 
health officer, sanitary committee or burgess, as the case may be. Please 
let me know if you require any further advice. 

(g) Ordinance No. 0. 

Section 1. All physicians residing within the borough of Tyrone, or 
practicing in said borough, who shall have under his, her or their care and 
direction any case of smallpox, or other contagious or intectiousdisease, 
shall report the same in writing to the burgess, stating the disease, name 
of the afflicted, residence, etc , immediately after the same shall come to 
his, or her, or their knowledge. 

Sec. 2. And it shall be the further duty of any physician as aforesaid, 
having in charge any case of small-pox or other contagions disease, to 
fix or cause *to be fixed on the front door of any house or building in 
which a case of small-pox is confined, a card not less than 8x10 inches, 
with the words "Small-pos " either painted, written, or printed thereon, 
in plain letters. 

Sec. 3. That any person or persons within the limits of the boroi^h 
aforesaid, who may be afflicted with any contagious or infectious disease, 
shall be required to coufiue themselves during said affliction, closely and 
strictly within their respective dwellings, until such time as tfaey can 
produce a certificate from some regular physician, certifying that the 
person so afflicted has so far recovered from the disease as to go abroad, 
without endangering the health of the community. 

Sec. 4. That no parents or beads of families, where the small-pox or 
any other contagious disease prevails, shall permit their children, or per- 
sons under their care, to attend any school, or permit any person as 
tiforesaid to go oat from their premises during said affliction, except in 
cases of extreme necessity, under a penalty of not less than ten (10) dol- 
liiis to be collected as hereafter provided. 

J. M. Caldebwood, Burgess. 
W. Geo. Wabing, Secretary. 



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No. 16] iNSPEOnoS AT WASHIUaTON. WASHINaTON CoUNTY. 149 

TSBONE, Pa., ISO 

To the Burgess of Tyrone. Borough : 

In compliance with the requirements of the State Board of Health 
and with Boroagh Ordinaiice No. 6, 1 herewith make report of the fol- 
lowing or infections disease mider my care and direction ; 

Name of afflicted 

Disease 

Name of family with whom living 

Residence 

[Phjaiciuis are required to make this report to the bui^ess immedistely after It 
ehall come to faia, her or their knowledge that any one under their care or direction 
is afflicted with any contagious or Inf^ttoua d' 



aa. - TOSPBonoN at Washington, wAaHraoTON oouirrr. 

Hy J. R. Thompson, M. D., Medient Innpector. 

PrrrsBDEOH, September 18, 1891. 
My inve&ti^tioQ at Washingion, Washington county, developed 
the following [acts: Bamett k Finn,Rttomeys, the Journal Pablishiu^ 
Company, and others whom I met, are much in favor ol creating a local 
board of health in their town, and lurged the necessity of it as a protective 
measure. I gave Mr. Bamett a copy of the roles governing local boards 
of health. The town is well sewered and has its own water works, but 
few of the people have taken the water into their houses, about three- 
fourths of them still nse well water, and this must be contaminated by 
the number of cesspools in the town. There was. no special complaint 

made. Mr. Bamett mentioned a c^upool at Dr. B 's drug store, 

which was found to be communicating with a spring at B. A O. depot. 
The spring has since been closed up with the result that the liquid con- 
tents of the cesspool, together with the spring water, have come to the 
Bnrfaoe on Main street There are nine (9) cases of tsrphoid fever in 
West Washington at present. The burgess of the town is Samuel Haz- 
lett. 



aO.— IN£n>BOTION AT BUTLHB, EUTLBIB OOnNTY. 
By J. R. THOMrsoK, M. D., Medical Inspector. 

PiTTSBOaoH, September £S, 1891. 
The inspection at Butler, Pa., revealed the following conditions: Water- 
works in the' main portion of town not adequate to supply water to south- 
side (across the creek). Auxiliary waterworks being bullion thatsideof the 
town not yet completed. Most of the cases of typhoid fever are on the 



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160 State Boabd of Health. [Off. Doc. 

south Bide of town; the disease resolts from drinking: water from wells. 
Sewers are being extended to that part uf town as rapidly as possibla 
I recommended the erection of a email frarbage furnace to consume the 
garba^ of the town. It is estimated that (here are about seventy or 

eighty cases of the fever in the town. Dr. B had twenty-two cases 

occur in three familiea Clearly traceable to a contaminated well. The 
buiKess of the place is J. Q. A. Kennedy. 



(b) Letter— Burvees Kennedy from the Secretary. 

September S9, 1S9I. 
Mr. J. Q. A. Kennedy, Chief Burgess of Butler, Pa. : 

Deab Sib: The inspection made at yonr town by Medical Inspector 
Thompson of the Allegheny district, leaves little room to doubt that the 
epidemicof typhoidfever.from which youareat present Bnfllering,iBdueto 
the use of water from polluted wells. I cannot too strongly urge npon 
yon the duty of using the alwolute power vested in your council bylaw, 
to close up every well in regard to which iheze is the slightest apparent 
connection betwen the uae of its water and the occurrence of sickness. 
I forward to you, as well as to Mr Thomas Alexander, the necessary 
documents for the organization of a local board of health, and although 
there is no legal provision for such a step, I think your council would 
be wise in assuming the responsibility at this juncture. 
I have the honor to be. Yours, respectfully, 

Benj. Lee, 
Secretary. 

(o) Letter to Thomoii .Alexander from the Seoretary. 

September SB, 1891. 
Mr. Thohas Alexander, ZeigJer avenue, Butler Pa. : 

Dear Sir: At the suggestion of Dr. J. K Thompson, medical in- 
spector of the Allegheny district, who recently by my order visited your 
town and investigated its sanitary conditions, I send you the documents 
uecessaryfortheorganizationofalocal board of health. UudbrBtand,how- 
ever.thatthelegidatarehasnotyotaathorizedtheestablishment of boards 
of hcEdth in boroughs, and that, therefore, yon will need to get your 
council to pass a strong ordinance, and to be assured that it will back 
you up in your praiseworthy efiForts to protect the health of your people. 
The model ordinance, which I enclose, would cover the ground very 
completely. It is evident from Inspector Thompson's report that your 
present epidemic results principally from the use of well water. Tour 
first step, therefore, must be to order the immediate disuse and clostne 
of every well which has any symptoms connected with a case of fever 



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No. I6.3 IflSPEOTION AT liBNNI. 161 

It would pay your town to furnish drinking water from your water 
works to those people who are compelled to abandon their wells and 
who have not the reawvoir water within easy reach. 

Tmatiiig that your efforts to procure a permanent sanitary organiza- 
tion will be soooeesful, I am. 

Tours very truly, 

Benjauin Lee, 
Secretary. 



aO.^INBPBOnON AT LHNin, DBLATWABB OOT7NTY. 
Bj VVm. B. Atkinson, M. D., Medical Ingpeetor. 

Philadelphia, September $J, 1891. 

Subject of Complaint — Prevalence of diphtheria and typhoid fever 
pond near the B^timore Central railroad. 

I found upon inqttiry of Dr. M. P. Dickinson and Dr. Lashelle, who 
practice and live iu this village, that very few cases of either disease at 
present exist. The latter had none of either, and the former only two 
of typhoid, one being at Llewellyn, imported from Chester, the other at 
Glen Kiddle, regarded as the result of exposure, and the old unsanitary 
condition of that locality. I was assured these were all thatwere known 
to exist. Dr. D. informed me that there were some eighteen to twenty 
cases of malaiial fever in the neighborhood. 

Diphtheria was present in a few instances, bnt these are due to the 
old state of affairs in connection with the Chester creek as reported in 
the inspection of nearly one year ago. Nothing has been done by 
people at Biddle's Mills to relieve the conditions then existing. The 
pond is due to the damming across by the railroad, has been in exist- 
ence more than twenty years, and does not appear to be the cause of 
any sickness. It la some 300 or 400 feet in length, and lOOfeet in width, 
the stream doubling around an island, the water having two outlets, and 
is supplied from a spring to the north. It is five feet at its deepest, 
and shows no sign of stagnation or appears in any other way objection- 
able. I visited the school house, saw cue of the directors and the 
teachers, and all agreed that they had no complaint to make. I findno 
need of any action in the premises, but would nrge that if possible the 
proprietors of the Biddle Mills be compelled to put in sanitary condi- 
tion their property. My former report will give in detail all the needed 
I'eforms. 



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162" State Board of Health. [Ofp. Doc. 

31— msfbonon ob- forb8t ottt, fobb»t ooitnt7. 

By L. H. TaVLoB, M. D., .Vtttical rnapeclur, 

Wilkes-Babre, Pa.. October 6, 1S91, 
I to-day visited the borough of Forest City to iavesti^te its saoitaiy 
condition with reference to typhoid fever, etc. Forest City is a town of 
recent growth, having increased in ten years fFom leas than one hon- 
dred to nearly three thousand inhabitants. It is sitnated in the ex- 
treme southeastern comer of Sosquehanna comity, on the ri^kt bank of 
the Lackawanna river, aboat six miles above the city of Corbondale. 

It is situated on a side hill and consistB of a Bcries of streets ronningf 
north and south parallel with the river, rising one above another as we 
proceed toward the west. This situation is an admirable one for street 
draina^, or would be if the gutters were properly paved, but a very 
unfortunate one for the residents who reside on a lower level than their 
more fortunate neighbors. The sewage from privy vaults and house 
drains in hundreds of instances runs down through the yards and close 
to the houses of the neighbors below. 

There is no system of sewera in the town, but drainage from privy 
vaults and houses is into the open gutters of the streets, and oftentimes 
directly through private property, and owing to lack of grading and 
paving of gutters, this accumulation remains in various localities, pro- 
ducing a horrid stench offensive te the inhabitants and prejudicial to 
public health. Numerous privy vaults are full to overflowing. Nui- 
sances are abundant everywhere. As I undetstand from citizens uo 
snocessfol attempt has been made by council in any way to abate these 



Some of the property owners have prepared suiteble vaults which are 
kept in such condition as te be no cause for complaint. 

As te the existence of typhoid fever, I am informed that there have 
been from fifteen te twenty cases in all daring the past two months. 

The first case occnrred on Main street in a locality where typhoid has 
been prevalent for several years. This patient died, and his wife is now 
sick with the fever. Well water was used, and the same well has been 
used by numerous typhoid cases of the post. 

The most of the cases, however, are in a comparatively narrow strip 
running across the tewn on either side of Centre street. 

Beginning at the tep of the hill at a house between Susquehanna and 
liackawanna avenues, there are two cases, with two other cases in an 
adjoining bouse. 

The privy here is situated above the well, about thirty feet from it. 
It is used by seventeen people, and the well by the same number. The 
water now used is boiled, following the advice of the physicians. Fol- 
lowing down the hill from west te east in line of Centre street the wells 



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No. 16.1 ItJBPEonoN OF F0BB8T City. 168 

and privies are so arranged that contamination of each well can scarcely 
be avoi'ied. Neatly all of these cases are in this narrow atrip, and idl 
of them are users of well water. 

It is the old story so often repeated and so little heeded. In the ma- 
jority of these cases the wells are so placed as if especially arranged to 
receive drainings and leaohings from cesspools. 

The town is partially supplied by water pumped from the Laokar 
wanna river ; a portion of which is sent directly into the mains ; a por- 
tion forced into a reservoir a half ot three-quarters of a mile away, 
whence it Sows to supply a pai't of the town. This supply from the 
Lackawanna river is by no means an ideal one, bat in my judgment is 
much to be preferred to the well water in use. The objection to the 
city supply is that the river itself is a small stream, with a small settle- 
ment of four or five families one-and-a-half miles above the pumping 
station, and a larger town (Carbondale) some six miles above, and the 
town of Herrick one mile further. These places have no sewers running 
into the river, but all surface drainage most find its way thither and be 
a possible source of contamination. A i>urer supply could probaby be 
found a few hundred yards above the pumping station, in Brace Brook, 
bnt I am not prepared to say that it would be sufficient for the town. 

If the dam at the station were cleaned and the charcoal filter around 
the intake renewed occasionally, the present supply would be reason- 
ably safe for some time to come. Mr. L. H. May is auperintendeut. 

I did not have an opportunity of seeing him to ascertain the exact num- 
ber of houses supplied with hydrant water, though I heard it estimated 
by others that about half of the town is thus suppUed. 

The great need of the borough is a system of sewers, and this should 
earnestly be urged upon them, but as it is impossible to secure this 
desideratum at once, the borough council should be ut^ed in strong 
terms to abate the nuisances that exist in the form of overflowing cess, 
pools. By digging suitable vaults and emptying the same as often as 
they become filled, a large part of the ground for complaint woidd be 
removed. The burgess should be requested to issue a proclamation de- 
claring all wells in the infected districts as absolutely unsafe, and all 
wells in the city as liable to be dangeroas, and recommending that all 
well water should be boiled before being used for drinking or culinary 
purposes. 

At the urgent request of a number of citizens I remained until even- 
ing to attend a meeting of the town council, at which meeting I gave 
the members the substance of my recommendation, and assured them 
in plain terms that their doty lay in the line of abating these nuisances. 

There now seems to be a disposition on the part of the council to pro- 
ceed to sewer the town ; any encouragement that you can give them in 
this line will be timely and will help strengthen the resolutions already 
formed. I urged them also to look forward in the near future to secur- 



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154 State Board op Health. [Off. Doc. 

iag a better wattir Bapply. The inapection has already rraalted in 
good, for the removal of one of the most glaring of the nuisances will 
be commenced to-mortow, the owner of the property at fault having 
promised in my presence to join his neighbors at once in patting in a 
private sewer. 

The president of the town oonncil is Mr, Thomaa Brown, the burgess 
is Mr. Benjamin Maxey. 



aa-iNaPBonoN at bhanksvillb, somheisbt ootinty. 

By J. H, Haokkkv, M. D., Medical Intpeetor. 

8OMBB8BT, Pa., October S, 1891. 

I visited Shanksville, Somerset county, this day, I was very materi- 
ally assisted in my investigations by Dr. J. W. Carothers, a prominent 
physician of Somerset, Pa. 

Shanksville is an unincorporated village of about 250 inhabitants, sit- 
uated about ten miles from Somerset. The country about is princi- 
pally farming land, and is of a loose, sandy nature. 

The local physician of this place is Dr. W. L. Krissinger, who ac- 
companied Dr. Carothers and myself in our investigations. He re- 
ported to us that there had been from twelve to fifteen cases of typhoid 
fever in and about the village, and that this had been the third year that 
the disease had broken out. He reported no deaths from the disease. 
I requested to be shown some of his cases, and herewith subjoin my 
report of those I saw : 

At the house of John B two cases ; Mrs. B , aged 61 ; has 

been sick six weeks; is now very weakj began with pains in head and 
back; high fever; but slight diarrhoea at first ; no tympanites ; patient 
had been in the west until two weeks previous to her illness ; patient 
now convalescing. 

George B , sou of Mrs. B ; had typhoid fever two years 

ago, immediately after the Johnstown flood, where he had been work- 
in<^ ; has now been sick two weeks; has no diarrhoea; no tympanites; 
no rose-colored spots ; no bleeding of the nose and but slight fever. 

Inspection of the premises found them in a fairly good condition. 

At the house of E. B — '■ — , two cases— E. B^ , aged 54, sick sii 

weeks with about the same symptoms as the above two cases, as was 
also his daughter, aged 13, who had been sick four weeks and was now 



Inspection of the premises showed a bad state of a&irs, cellar damp 
and tmaired; well at the comer of the house where they emptied all 
their slops, which percolated back into the well. The privy, pig-pen 



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No. 16.] iNBPEOnON AT SHANKSVn.LE. 155 

and stable also were sitoated in snoh a way as to alford ac easy drainage 
into their water supply. In fact the whole town is so situated that the 
stables, privies, etc., have a natural and easy draina^ towards the 
dwelling houses and water supplies, and notably so is the hotel, kept by 

J. H where everytbingfromthestable, privy, pig-pen andhen-bouse 

draiuB into the kitchen door. At this place they are conveying their 
water from a spring through tile pipes underneath their stable and pig. 
pen to their house. I recommend that they convey their water through 
iron pipes, tightly screwed together. I farther reconunend a thorough 
cleaning of the town in regard to surface drainage. I also visited a 
butter factory but could not get inside. On the outside there was com- 
plete tack of drainage; sour buttermilk was allowed to stand in pools 
around the building ; also their pig-pen was in a foul condition and 
needed a thorough renovating. 

My diagnosis of the trouble is a low form of malaria and not typhoid 
fever, which can be prevented only by a thorough cleansing of the town. 



38— INSPBCrnON OP DAM, LBBANON OOUHTY. 
By W. Murray Wbidmas, M. D., Medical Intpeeior. 

Reading, Pa., October J^ 1891. 

On October 12 I visited the dam, building iu Lebanon county, seven 
miles south of the city, to investigate the sanitary condition of the banks 
of the stream or streams furnishing the water supply of the city. 

The daily number of men employed during the summer in the con- 
struction of the dam (about 400 feet long), was eighty-three ; at present 
fifty-two are thus employed, mostly residents of the vicinity. The work 
is expected to be complete in five weeks. Whose is the responsibility 
for the selection of the site of the shanties, stable, hut, pig-pen, sink, 
etc., on the eastern slope of the hill, and thirty to fifty feet upward from 
the stream I do not know ; a better mi^ht have been chosen, then no 
feais of possible or probable contamination could have arisen. They 
are too near the stream forming part of the water supply. The only 
evidence of untidiness or carelessness I saw was the contents of a chaff 
bag which had been emptied near the buildings. The common, nortb 
of the highway, along a whitewashed board fence, had been used as a 
depository of hnman excrement instead of the sink selected by the con- 
tractors. 

There had been some diarrhoea among the laborers during the sum- 
mer ; even now a few cases had been seat to the hospital with typhoid 



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IM State Boaed of Health. [Off. Doc. 

symptoms (see report from hospital and Dr. Keith, of Schsefferstowu, 
attendlDif physiciaii at the worke). An interview with a family (Mat- 
thews) living OD the western bank of the streiam. showed that diarrhcsa 
and sore throat had occurred in that family as well aa that of the family 
(Hoffinan) just above them, some just convalescing from the latter dis- 
ease, but neither coold attribute it to the water supply supposed to be 
polluted or contaminated, as they had not used the water from the 
stream. 

The shanties were tidy, the stable and pig-pen clean, the manure re- 
moved weekly by the farmers in the neighborhood. I directed that the 
chaff be collected and burnt and piles of fecal matter be covered. 



34^~INSPBOTION AT MOtTniOSB, SITSQUBHAinTA OOITHT?. 
By L. H, Tavlor, M. D., Medical Inaptetor. 

Wilkbb-Babbb, Pa., Odober 11, imi. 

I yesterday visited Montrose and spent the day in company with 
Burgess H. (.!. Jessup and Mr. James P. Taylor, member of the sanitary 
committee, in inspecting various ports of the town, looking into wells, 
outhouses, etc. 

In regard to th<« presence of typhoid fever I am somewhat at a loss 
to determine the true condition of afiEairs, as there seems to be differ- 
ence of opinion among the physicians of the place. Dr. Bichardson, 
one of the oldest physicians in the place, assured me that he had never 
seen but one case of typhoid in Montrose, &nd that occurred a number 
of years ago. He does not think there are any cases at present. 

Dr. Macky stated that in a practice of six years he had not known of 
a single case, and did not think there were at present any. Dr. Gard- 
ner, who is at present attending the only two cases of fever that I could 
hear of in the town, says he has seen but one case of typhoid, and that 
several months ago. 

He has treated the three cases of fever that have occurred on Church 
street, beside the one that died, and did not regard them as typhoid. 
He states that these were all cases of continued fever without any char- 
acteristic typhoid symptoms. He does not think there have been any 
typhoid oases in recent years. 

Dr. Baldwin, homeopathist, regards the present cases as typhoid, 
though he has not seen them. He attended Mr. Warner, who died, and 
considers that he had typhoid fever. He also considers that there have 
been several cases in recent years in the same locality (Church street). 



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No. 16.] iNSPBCmON AT MONTBOSK. 157 

I did not have auy opporfetmity of makiof personal ezamination of 
any soapeoted patieate, as all had progresBed for in convalesoence and 
were without fever. InaBmuch as I could learn of but two cases of ty- 
phoid in the present year, I do not consider that the disease has as- 
samed the proportions of an epidemic, threatening the general health 
of the borough. 

As to water supply there is none excepting private wells, nor is there 
any system of sewers. 

The disposal of excreta is by ordinary privies, many of which are the 
ordinary dangerous vaults, which too often are closer to the wells than a 
strict regard for eateiy would justify. Many citizens, however, have 
abandoned the vaults and use the box and dry earth or sifted ashes. I 
did not find nuisances at all prevalent in the town. There are a few 
privies back of South Main street, located on an open ditch, which 
serves as a drain for bouse and surface water, and perhaps for some 
sewage. 

There are a few drains throughout the city covered which were con- 
etmcted for the disposal of slop water, etc., from houses not for ex- 
crement. 

As to the complaint made in the letter which you forwarded to me I 
would say : 

Firtft. The bam adjoining the H. W plaoeis built upon the solid 

rock, which seems todipintheoppositedireotioQfrom thiswelL Thereis, 
however, a small pool of liquid which, with surface drainage might, in time 
of a storm, wash down toward the W well. lu its prerant condi- 
tion it is not seriously bad, but it should not be there at all, and inas- 
much as it trespasses in its overflow upon neighboring property, the 
council should require the owner to prevent its overflow, and also to 
prevent its accumulation. The privy on this adjoining property is not 
many yards from the well, but as it was at the time of my visit sup- 
plied with a box and dry earth, I know of no better arrangement to 
suggest in the absence of any public sewers. 

Second. The foulest kind of cesspool, some distance further up the 
hill, is not at present so situated as to contaminate the well on the 
W place, as the dip of the rock seems to be in the opposite di- 
rection, and all surface drainage at this point would flow in the opposite 
direction. This cesspool, however, on general principle, should be 
well supplied with lime and cleaned often enough to prevent ofi^ense to 
the neighborhood. The general condition of aflairs was better than I 
expected. The gutters were not oflensive. I presume that recent rains, 
together with a sharp frost the night before my visit, conspired to make 
the appearance of things more favorable than perhaps would have been 
the case had the inspection been made during the heat of summer. 

Third. The public cistern mentioned is in bad condition and should 
forthwith be emptied, cleansed and disinfected. 



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168 State Boakd op Health [Off. Doa 

There is a blind stone drain under the street in tbe neig:hborhood in 
question, the location and ootlet of which, if it have any, are uncertain. 
It should be traced up, opened and cleansed. 

I would suggest that you impress upu the council of Montrose : 

1. The liability in a town uusewered of all wells to become contami 
nated, and the importance of seeking a pure water supply at an early 
dat«. 

2. The need of removing the privies that are located on the open 
ditch mentioned in this report, and having the same supplied with boxes 
and dry earth. 

3. The importance of having all privies emptied and cleansed suffi- 
ciently often to prevent their becoming oflfenBive and sooroes of con- 
tamination to wells. 

i. I would recommend that the closed drain on Church street be 
opened and cleansed and its course ascertained, and thus settle the ques- 
tion as to whether it may have any influence in contammating ihe public 
well and public cistern ou said street I would recommend also that 
the public cistern on this street be emptied and its sediment removed. 

5. The overflow from the bam adjoining the W place should be 

so disposed of so as to prevent its flowing over to the neighboring 
property. 

6. I would also recommend that the water from the two wells exan.- 
ined by Dr. Creason be boiled before being used for drinking purposes. 

In conclusion, I would say that I met the burgess and several mem- 
bers of the borough council, and they impressed me as intelligent men, 
anxious to do all in their power to maintain the health and promote the 
welfare of their town. 

E. B. True is president of the council and H. C. Jessup is burgess. 



(b) Letter of Secretary to the Bunreae. 

October J6, 1891. 
Mr. H. C. Jessup, Chief Burgesn, Montrose, Fa. : 

Dear Sir: I have just received the report of Medical Inspector Tay- 
lor of bis investigation into the sanitary condition of your borough. 
While I am happy to say that, as compared with many towns, which his 
duties in connection with the State Board of Health have led him to 
visit, be finds Montrose exceptionally clean and well policed, and is not 
led to think that there has been any very unusual prevalence of febrile 
diseases, and especially of typhoid fever, yet he is impressed with the 
fact that certain dangers threaten you in the near future, from the fact 
that you depend entirely upon wells for your drinking water, and that 
you have no system of sewerage. Under these conditions, the pollu- 
tion of the drinking wells is a mere question of time. 



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No. I6.3 Inspection at Montbose. 169 

Two ooorses are open to you. Either to obtain an abundant supply 
of pure drinking water from aome source outside the town, or to empty 
and disinfect and fill up all privies, and substitute the dry earth closet 
system by ordinance in every instance. 

In the meantime I make the following recommendations, which I 
trunt your council will see the wisdom of endorsing and at once putting 
in force: 

First. The removal of all the privies at the back of South Main street, lo- 
cated on an open ditch which serves as a drain for house and surface 
water, and )>erhaps for some sewa^, and generally the sabstitution of 
the dry closet in place of the ordinary vault. 

Secondly. The importance of having all privies emptied and cleaned 
sufficiently often to prevent their becoming offensive and a source of 
COD tanii nation to wells. 

Thirdly. The opening and cleansing of the closed drain on Church 
street, and the ascertaining of its course with regard to the contamina- 
tion of a public well and cistern on said street. The ^ublio cistern on 
this street be emptied aud its sediments removed. 

Fourthly. The disposal of the overflow from the bam adjoining the 
place so as to prevent its flowing over the neighboring property. 

Fifthly. That the water from the two wells examined by the State 
Board of Health be boiled before being used. 
I have the honor to be, 

Yours respectfully, 

Benj. IjBE, 
Secretary. 



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State Boakd of Health. [Off, Doo. 



APPENDIX C. 



ANNUAL REP0BT8 OF dTIES AND TOWNa 



1. CarboDdkla 

2. Cbe*t«r. 

3. CoateBvllla. 

4. Julinstown. 
6. Lebanon. 

6. Headville. 

7. NorristowD. 

8. Oil City. 

9. PbiladelptalB. 
1(L tkirantoQ. 

11. TltuBvllle. 

la Well'boro'. 

13. WilliamBpon. 



Made to the State BoKrd of Health of PeDaa^lvanU, Tor Tour uionUm l>«(clni 
September 2, 1890, and ending Deoember 31, 1890. 
L Name and addreas of members of the board. 

Name. Postofflce address. 



Samuel D. Jones, nenrelary 
















John Copeland, Member. 




L. S. Brumell, Health Officer 





Z six meetinge have been held by the board dnrtng the four montha 
8. The following improvements or changes have l>een made in this city as regards 
water supply, draiqageand eewerage, or in the methods employed in dispoaingof 
excreta : Sewers have been constructed, and a public dumping ground t.s secured 
outside the city limits. 
4. Nuisances, 185; removed, 104. 



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No 16] 

5 Commu 



Repokt of Carbondale Board of Health. 

ilcable diseases. 



Name of 

DiHEASB. 


No. of 
caseg. 


No. or 

dektha. 


No. or 

outbreak!!. 


No. or houses 
infooted. 


Na of outbreaks 
contliiedioUie 
first house. 




1 






Diphtheria, . . . 


1« 


• 




13 






Typhoid Fevor, . 


5 






' 











6. Tliese diseases are reported to die hoard by the physicians iu attendanee in nc- 
cnrdance with the law, ordlnaiioe or regulation requiring such reports. 

T. When cases of tlie coiiimuuicable diseases have been reported, the aaiiilary or- 
Hoer placards the liouso and the usual precautions are taken to prevent the spread 
of the disease. 

8. Houses in which teases of sniall-pox, diphtheria and scarlet fever occurred are 
placarded. 

II. Schools. No special cases have come under oljservaUon In which unhealthy 
conditions existed. 

r2. There are particularly unhealthy localities. The cause of such unhealthrnl- 
nesa la that the soil is completely saturated with the overflow (Voui privies. 

13. More sewerage suggested for Improving the sanitary condition. 

14. No accidents; nor has sickness or death resullod from accidental causea, 
drowning, fires and kerosene accidents. 

16. No instances of food adultoriLtion or Injurious effects from it. 
IT. No cases of diseases of anlnialn which have occurred, and any cases of relation 
or apparent relation between such diseases and human diseases. 
18. The by-laws adopted by the board are not coniplete yet, 

la. No other work of Interest which has been done by the board during the year. 
21. The sanitary ollicer receives $50 per month. The secretary, (16.66. 

Sahitel S. Jonkh, 
Carbondal'-. 
.TaHitary, 1S91. 



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State Board of Health. 



[Oft. Doc. 



S-ANKUAL REPORT OF SEKJRBTART' OF THB BOARD OF 
HELAIiTH OF THB OITY OF OHBSTBR, OHBSTZIB OOONTT, 



Die to Clie State Boanl of Health or PennajlvanU, for the U 

e, lt<90, and ending December 31, 1891. 
.. The name anil address or each member of ttie board is 



Na: 



PoBtolHce addreex. 



Charles B. Ross, Secretary, . . , 
Benjamin W. Blakely, Chairman, 
George McCall, Member, , . 
E. W. Perkins, M. P., Memlwr. 
J. Frank Evans, M. D., Member, 
William D. Piatt, M. D., Member, 
John 11. Mirlcll, Health Ofliirer, . 



"News" Office, Cheater, Pt 
Chester, Pa 



2. Thirty-eeven meellngs have been hel'l by the board during the year; 34 regn- 
lar, 3 special. 

3. Noimprovenientsor clianges been maile as regards water supply, drainage and 
sewerage, or lii the inetliod employed in disposing or e. 

4. Four hundred nuisances have been reported. 

5. Three hundred and eighiy-oiie have been i-emovetl. 



Name op 

DIBHASK. 


No. of 


No. of 
deaths. 


No. of 


Sa of houses 
infected. 


confined to the 
first house. 


















9 
2 
11 


21 
21 
33 


11 
21 
23 




S(»rlet fever, 
Typlioiil fever. 




I 
t 



6. Tiiese diseases are to some extent reported by the physicians in attendance with 
the law ordinance or regulation requiring such reports. 

T. ''Vhen eases of the communicable diseases have been reported prompt action U 
taken to prevent a spread of the disease. 

8. Xo housBs in which coses of eniall-pox, diphtheria and scarlet fever occurred 
were placarded. 

n, Cliolera infantum, consumption and pneumonia were more than usually pn>- 
valent during the year. 

10. Nothing interesting from a sanitary point of view. 

11. Schoola No pupil is permitted to attend school without a permit from this 
board, and a certlticate from the attending physician, indicating that all danger ii 

12. There are one or two particularly unhealthy localities from want of sewerage 
13 Better drainage is suggested for improving the sanitary couditioii 



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Xo. 16.J Repobt of Johnstown Boabd of Health. 163 

14. Accidents. Twelve accidenuil deaths, rtulroad and drowning, have occurred. 

15. Xo cases or disease appear to liave been cauaed by polluted water, cesspool or 
sewer gaa, defective veotiiation, lead, arsenical, or other forms of poisoning. 

IB, No instances of food adulteration, or injurious effects from it. 

IT. No diseases of animals. * 

18. By-laws were adopted, copy enclosed. 

10. Annual report of councils gives an account of other work of interest which 

20. No suggestion as to the liealth laws of the state. 

21. The health officer is paid feo per month, or (720 per year. The secretary is 
allowed t2G per month, or 1300 per year. 

Charles B. RobBt 
Seeretarv. 
April 6. 1391. 



3-OBOANIZ&.TION OP THB BOABD OF HBALTH OF COATBSVILLB 

CoATEBVlLLE, Pa., Ma// S6, 189!. 

The memberB of our board of bealtLi are : 

Dr. E. T. Swing, chairman-, Mr. John Speakmau, (burgess), president; 
Dr. 8. Horace Scott, Mr. Harry BnmsoD, Mr. John Eutrikeo, Mr . O. C. 
Jackson ; Icla V. Biel, M, T>., Secretary. 



Johnstown, Pa., Janvary /3, 1891. 
Gentleicen: Iu compliance with the act of assembly appi'oved May 
23, 1889, the board of health begs leave to herewith submit its report of 
operations for that portion of the year 1890 during which it was in exis- 
tence, year closing December 31, 1690. An ordinance passed by your 
honorable bodies and approved by the mayor on the 27th of May, 1890, 
provided for the appointment of the board of health ; snbsequently the 
mayor appointed Dr. A. X. Wakefield, Dr. F. Schill, Mr. John J. Ffarr, 
Mr. Lackey Kelley and James M. Shnmaker the members of the said 
board. The board was formally organized on the 11th of June, 1890, 
by the election of Dr. A. X. "Wakefield president and Geo. J. Askers as 
secretary. On the 24th of July Mr. Jas. A. Bloan was chosen health 
officer and assumed his duties August 1, 1890. The salary of the secre- 
tary was fixed at two hundred dollars per annum, and that of the health 
officer at sixty dollars per month. On the 25th of July the councils 
passed an ordinance making an appropriation of tl,500 to defray the ex- 
penses of the board and pay the salaries of its officers. Of this appro- 
priation there has been $721.44 used, leaving a balance to the credit of 



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164 State Board of Health. [Off. Dec. 

the board of $778.56. Tlie amount expended lucludeB all necessary 
printing, ofGue furniture, sulaiies and other incidental espenaea. The 
balance in treasury the board believes will be ample for the remainder 
of the year. The direct cash receipts from the operatious of the board 
for the five months of its existence have been $5 20. This lias been paid 
into the city treasui'y. The record of vital statistics bein^ necessarily 
incomplete, owin^ to the fact that the Board has been iu existance but 
five months, no positive conclusions can be drawn. It seems safe, how- 
ever, to assume that the death rate per annum will not exceed fifteen in 
every thousand, including both adults and children. This is rc^rardedas a 
favorable condition when the circumstances are considered. A tabulated 
statement of the deaths for each month is herewith griven. 

August, 3K 

September 3f 

Outober 2S 

Nareiuber, 2S 



Of the decedents eighty -five were males and seventy were females ; 
twenty-eight were of foreipu birth and one hundredand twenty-seven of 
native birth ; of the latter numl>er eighty -three were bom in Johnstown ; 
fifty-seven were infants under one year and thirteen were children be- 
tween one and five years of age. During the five months there were 
three hundred and fifty births reported. Tlie following is a tabulated 
statement of births by months : 



August, 
SopteiiiLier, 
October, , . 
November, 
December, 

ToUl, . 



The number of conta^ous diseases reported by the physicians waa 
one hundred and five. These diseases were reported as follows : 

Scarlet fever, bl 

Typhoid fever, 38 

DIpliUieria, 10 

Measles, J 

Dipliihoritlc <;roup, I 

llerebro-spinsl meningitis, I 

Total - - . lOfi 

The largest number of contagious diseases reported in one montli wns 
ill August and the smallest number in December. There were fourteen 
death from contagious diseases, ten of typhoid fever and one each of 



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No. 16. 1 Repobt of Johnstown Board of Health. 165 

scarlet fever, diphtheria, cerebi-o-spinal meniDgitis, diphtheritic croup. 
Daring' the five moDthn of the board's operation there were abated two 
hundred aod nioety-two nuisances on written or verbal orders of the 
health officer. It may be proper to state here that tjie operations of the 
board have nd the city entirely of hog pens and their inhabitants, 
the existence of which in cities is almost incompatible with the public 
health. 

The board can readilyseemany threatening- surrounding in numerous 
localities throughout the ctty, which will necessitate vigorous measures. 
Sewers are badly needed. 

Another source of trouble is the garbage that is found almost every- 
where. The great amount of produce and fruit that is required for the 
consumption of our city, brought here by our merchants aud others and 
distributed through the various channels of buainesK to the consumer, 
necessarily results in an accumulatiou of a large quantity of matter that 
is fit only for cremation, and as there is no garbage furnace some dispo. 
sition must be made of it. Our oflicer finds it accumulating in collars, 
yards and out-houses or dumped into alleys, vacant lots, and other places. 
The material is generally placed there under cover of darkness. The at- 
mosphere becomes poisoned and the health and comfort of the entire 
community is made to suffer. When our officer serves notices on the 
parties to remove it, he is met with inquiries. What are we to do with it? 
Where shall weputit! Bealizingthefinancialconditionuf thecityandits 
inability to at present constmct a garbage furnace, we would recommend 
that councils secure a location somewhere outside the city limits, where the 
offal and refuse matter can be burned or disinfected. The board would 
also recommend that the collection of garbage be taken in control by the 
city, a small charge to be made to each citizen to defray expenses. Tliis 
would insure a systematic and complete collection of garbage, which 
under the present hap-hozard system is impossible. 
Bespectfully submitted. 

BoABO OP Health. 
A. N. Wakefield, 

President. 
Geo. J. AsEBS, 

Secretary. 
Jameh a. Sloam, 

Health O^icer. 



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HTA.TE BOABC OF He&LTH. 



[Off Doc 



e-ANNTTAL RBPORT OF TBB PBBSIDBNT OF THB BOARD OF 
HBALTH OF THB OITTOF LOBANOH, LBBANON OOUNTT, PA 



Made to the State Board of Health of Pennajlvaulk, for ttie year beginoi 
ary I, 1890, and ending December SI, 1890. 
1. The name and address of each member of the board is 



Namb. 


Postoffloe Addresi. 




















.. « 




„ „ 




„ ,. 







2. Eight meetings have been held b; the board during the jear. 

3. No Improvemenla or cbangea have been made as regarde water supply, drain- 
age and sewerage, or in ttie methods employed in disposing of excreta T 

4. Nuisances. Twenty-two nuisances hare been reported. All tiave been re- 
moved. At the weBt«rn end of the city Is an obstruction by a Isrge ciuder banli 
damming water back on western end of city. 

6. Communicable diseases : 



Name OF 

DlBKASE. 


Naof 
cases. 


Naof 
deaths. 


No. of 

outbreaks. 


No. of houses 
infected. 


confined to the 
first house. 


Small-pox, . . . 



























































No report from physicians. 
S. No diseases are reported by the physicians in attendance In accordance with the 
w, ordinance or regulation requiring such reportsT 

1. No communicable diseases have been reported. 

i. No houses in which cases of small-pox, dtptitberia and scarlet fever occurred 

jre placarded. 

X No diseases were more than usually prevalent during the year. 

IX Nothing to report. 

L Schools. No cases under observation in which unhealthy conditions existed. 

2. Yes. Western end of city. Cause: Cinder bank, above alluded to f 

). We surest for improving the sanitary condition of city, a law that will give 
B Board of Health the power to impose penalties. 



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No. 16J 



Befort of Lebanon Boars of Health. 



167 



14. No accidents. 

15. Notbing reported. 

16. No inatancss or food adulteration, or iojurloua efTeots from it, 

17. No diseases of Milmals. 

18. No report. 

19. Tlie board of health of this city is powerless to eoforce obedieDoe to Its ordera 
owing- to the fac*; that the city solicitor construes Uieactof 1889, relating to the auth- 
ority of the board of health to enforce Its demands by Imposing penalties Is not 
speci&cally stated In the act. 

20. Tlie wording of the act of 1889, In no tnlstoken terms as to the imposition of 
ptinaltles. This oonatruction of the law by our city's solicitor, makes the board of 
liealth a Jibe for all persons committing uiilsaaces, they abate them If they cboose, 
if not we are penniless to force tbem. 

31. The secretary has received four dollars per month for live montbs, and the san- 
itary policeman ten dollars per month for Ave montbs, for the reason that the appro- 
priation of councils baa not been sufflcient to pay more. The balance of the year 
tbej have received Dotbing . 

8. T, LiNBAWBAVER, lYetidtnt, 
Lebanon, Pa. 
April 4, IS9L 



O— ANNUAL BHPOBT OF THB SBOREITABT OF THE BOABD OF 
HEALTH, OF THB OITT OF UOADVUiLB, PA. 



Made to the Slate Board of Health of Pennsylvania, for the year beginning Janu- 
ary 1, 1890, and ending December 31, 1890, 
1- Name and address of each member of the board, Is 



XASE. 


Postoffice Address. 












» 




» tt 




» « 


Chuk P. Woodrlng, Health Officer, 






2. Four meetings have been held by the board during the year. 

3. No Improvements or changes have been made, as regards wat 
■ge and sewerage, or in the methods employed in disposing of ex< 

4. Three hundred nuisances have been reported. All have been 



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State Boabd of Health. 



[0?F. Doc. 



b. Conitniinicable 



Disl 



Small-pox, . . 
Diphtheria, 
Scarlet fever, . 
Typhoid fever, 



No. of outbreaks 
couAoed to the 
I A rat house. 



6. These diseasee are reported to the board by the phjaiciane in att«adance in ac- 
cordance with the law, ordinance or regillntion requiring such reports. 

T. The causes were looked for and, when found, removed. 

& Soiile houses in which oases of small-pox, diphtheriaand scarlet fever o<viirred 
wore placarded. 

0. There was not an unusual amount of sickness of any kind. 

10. There was not much sickness, and what there was was easily handled and con- 
trolled. 

11. ScboolfL There were special eases in which unhealthy conditions existed. 

12. There are not any particularly unhealthy localitiea, 

13. The sanitary condition la above the average. 

14. No accidents. 

15. There are no facta regarding any cases of disease which appeared to have bean 
caused by polluted water, cesspool or aewergas, defective ventilation, lead, arseni- 
cal, (ir other forms of poisoning. 

16. No instances of food adulteration, or injuriouaeH'ectB from IL 

17. No diseases of animals. 

I!i No by-laws adopted In 1891. 

19. No work of interest done by the board during the year. 

2a The experience of the board does not suf^est any changes which ought to be 
made in the health laws of the state. 

21. No pay received by any member of board ol health except health officer, whose 
salary is$20l). No pay has ever been received by any other member of board, nor 
bad any been expected. 

CBAS. p. WoODRlNd, 

MeadvilU, Pa. 
March ts, ISBL 



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Xa 16.] 



Report of Nobeistown Board op Health. 



Made to the Slate Board ot Health of Paiinsylvania, for the year beginning Jar 
ai7 1, 1K90, and ending December 31, 1H90. 
1. Th« name and address nf each member ia 



Name. 


Postofllce address. 


Dr. Harry H. Whiwomti, Hecretary, 


622 DeKalb 


street, Norrlstown. 


WlUlfcin A. Bvanu, Esq., Chairinu 


Norrlstown 


Pa. 












„ 




„ 




" 


„ 




„ 


Dr. Cliarles Bradley, Meml>er. 


« 


E. M. Daniels, Esq.. Member. 


" 


" 


Dr. H. H. Whiuomb, Health OIBcer, 







i Twenty meetings have been held by the board duringthe year. 

3. No improvements or changes tiave been made in the borough as regards water 
supply, drainage and sewerage, or In the methods employed In dispoalng ol ex- 
creta. The water basin has been cleaned and are gradually doing away with wells. 

4. Ten hundred and seventy-one nuisanceshavebeenreported to the board. Two 
hundred and eleven have been removed. Two hundred and sixteen complaints 
declared to be nuisancea. Ten hundred and seventy-one comptttints made in a 
year— of this numberonly two hundred and sixl«en were such as the board could 
intjUlre Into and declare to be nuisances, mostly of trivial or a personal nature for 
private abatement. Five only wu were unable to abate, which our solicitors said 
wo had un power to correct Tlieso being the drainage of cellars, closing of wells 
and removing of cesspools from near street. 

J. Communicable diseases : 



Naxb or ■ 

DiHKABE. 


No. of 


No. of ■ No of 
deaths. 1 outbreaks. 


No. of houses 
Infected. 


No. of outbreaks 
confined to the 

first house. 


Small 






Diphtheria, . . 


12 1 5 1 1 


, 


1 


Typhoid fever. 


21 















•These » 
fVery mi 

(I am su: 



e Isolated cases and kept pretty close. 

y more than reported ; the disease, beinn un mild many employed i 

more eiiste<l but were not reported. 



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170 State Board op Health. LOff. Doc. 

U. Some report very promptly, othei-B do aot, and keep m 
about tlieui. Our ordiniuice requires, but our solicitor eays' 
have Hvoided Ihw. 

7. Wiien (aufesofthe communicable diseases have been reported, ive keep tlie 
cbildren from school and keep them away from otber children, as much as pos- 
sible. Fumigltion. 

8. No houses in which oases of smoU-pox, diphtheria and scarlet fever occurniL 
wore placarded. 

9. The diseases more than usually prevalent during the yoar were iiiAa>tl(.«. la 
grippe, dyBentery and typhoid fever. 

10. Nothing to communicate. 

11. No special cases have come under observation in which unhealthy eondition^ 
existed. Wu send children liotuo at once. 

li. There are particularly unhealthy localitios the cause of which is low, flat 
drainagi) and well water. 

l.'t. Wusagfcost for Improving the sanitary (tonditloii. jiower to enforoe the ordi- 
naneea wc have by some general law. 

14, Accidents. Drowning lias occurred. 

IE. Nothing to couimunlcete regarding any c 
have been caused by polluted water, cesspool c 
lead, arsenical, or other forms of poisoning. 

III. Instances of food adulteration have come to our knowledge. Adulterated milk. 
No HI eifect traced ; shall try to corn^ct the present year. 

17. No diseases of animals. 

18. No report 

19. The board during thyyunrhave been trying to give our people a pure water 
supply. 

20. We need power. We have no power whatever to comi)el a compliance with 
our ordinances, 4f ust depend simply upon the good wishes and fear of the peopla 

1^1. We pay (240 a year for Health Officer. 

Uarrv H. Whitcuhb, 
SM DeKalb slreel, Not 
Ma^fhso, 1391. 



8— ANNnAL BBPORT OF THE BOABD OF HBAIjTH OF OIL OITT. 

On. Cm, Pa., January 24, 1891. 

GENTLgHEM: lu acoordoiice with the act of assembly requiring us to 
submit amiually, in January, a report of our work for the preceding 
year, would say we have abated twelve hundred and fifty nuisances. 

We are inclined to believe thie a favorable showing, and the amount 
of work accomplished in excess of that of the year previous proves, we 
think, the wisdom of employing a health ofiicer, whose full time can be 
given to the growing work of the board. 

During the 2'ear there were reported to the board one hundred and 
five deaths, one hundred and thirty-nine births, fifty-four marriages, 
one hundred and ninety-two cases of infectious and coutagious diseases. 

Unquestionably great sanitary benefit will accrue from the five thou- 
sand eight hundred and ninety-three feet of sewer built on Butler alley. 
Pearl avenue, Duucomb street and Elm street, and the six thousand five 
hundred and sixty feet arranged to build on Plummer road. Pine, 



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No. 16.] ■ Kefobt of On. Cm Board of Health. 171 

Center and Second streets. But the city is growiiigr rapidly, and con- 
tinued favorable action in the way of liberally eupplying further sewer- 
age, as well as- the paving of as many streets as possible, is, therefore, 
most earnestly recommended 

Attention is called to the insufficient supply of city water to the in- 
habitantfi of Palace Hill, thereby compelling the use of water from the 
spriogs in that section, breeding much sicknesB in consequence, and ae 
we are closing the springe on account of the bad condition of the water, 
a proper supply of city water should be fumished as soon as possible, 
to take the place of these springB. 

We wonld again call attention to the dangerous condition of some of 
the railroad crossings in the city that have not as yet been provided 
with safety ^ates, and we would also recommend the passage of an or- 
dinance requiring horses, when standing on the street, to be properly 
tied, or left directly in charge of acompetent person. 

In regard to the pest house, situated on Clark's Summit, the matter 
of ownership and right of occupancy thereof is not in a clear or satis- 
factoiy condition. We would recommend that the title to the property 
be examined and properly vested in the city, and if it is desirable to 
allow the present occupant to continue there, that it be done with the 
understanding that should an exigency arise, requiring the use of the 
same by the board of health, it be immediately vacated for that par- 
pose. 

We submit the following statement of the health fund for the year: 

Balancetocredit of fund January 1,1890 1189 63 

Appropriation April 1,1890 760 00 

$939 63 

Against which warrants were drawn as follows : 

S. H. Gray, secretary $120 00 

H M. Good, health ofiBcer, 480 OO 

Stationery, printing, etc. 156 25 

Sundry expenses, burying dead animals, burning 

mbbisb, analyzing water, etc 75 95 

Total. $832 20 

Leaving balaance $107 43 

as unexpended, which will be insufficient to carry ns through to the first 
of April 1891. 
Bespeotfully submitted by order of the Board of Health. 

B. F. Brundbed, President. 
Attest: 

8. H, Gbax, SecT^'ary. 



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State Board of Healtb, 



EXTRACTS FBOM THB AHKUAI. REPORT OF THB BOARD OP 
HEALTH OF P TTTT. A ru BT.P WT A FOR 18QO. 



Preparetl l>7 William H. Atkinson, M. D. 

The death rate for the year -w&i 20.75 per thousand, a slight excess 
over the two previous years. 

The number of deaths returned was twenty-one thousand seven hun- 
dred and thirty-two (21,732), an increase of eleven hundred and ninety- 
six (1,196) over the previous year. 

The number of births reported was twenty-seven thousand and 
eighty (27,080). 

Tlie number of marriages was seventy-one hundred (7,100). In this 
connection it must be remembered that owing to the absence of a mar- 
riage law in New Jersey, a large number of marriages take place out- 
side of the city to avoid the law requiring a permit, hence these are not 
recorded in the city. 

The record of deaths is complete, while that of births falls short of 
the actual number very considerably. It is believed that at least ten 
thousand each year are never recorded. 

The increase in the number of deaths is accounted for by the epidemic 
of indueaza, which was first felt in this city in the latter part of De- 
cember, 1889, continuing with great virulence until the second week of 
February, 1890, It is believed that about 1,300 deaths were caused by 
this epidemic in a period of seven weeks, perhaps the highest death 
rate ever experienced in this city, except the epidemic of yellow fever 
of 1793, which continued during the warm weather and of which 4,041 
are known to have died out of a population of nearly 45,000 persons. 

The most striking increases were in the diseases of the circulatory 
and respiratory systems; 

Cholera Infantum — There were 918 deaths, an increase of eighty over 
tlie previous year. 

Consumption of Ikt Lungs — The deaths amounted to two thousand 
seven hundred and sixty (2,760), an increase of two hundred and twenty- 
eight (228). 

Diphtheria — Deaths, five hundred and twenty-eight (628); increase, 
one hundred and fifty-three (153). 

Scarlet Fever — Deaths, one hundred and eighty-nine (189); increase, 
one hundred and nine (109). 

Typhoid Fever — Deaths, six hundred and sixty-six (6661; decrease of 
seventy (70). 

Injlummation of Lungs — Deaths, two thousand and twenty-six (2,026); 
increase, four hundred and forty-four (444). 



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No. 16.j EEPOBT of pHILiDELPHU BOARD OF HEALTH. 173 

The following table sliows the ratio of deaths, with populatiou, for 
the past thirty years : 



Populalion. I DeatliH. 











liviag. 


ODc deatli. 






13,040 
13,864 
14,220 
15,875 
16,633 
15,362 
12,660 
13,391 
13,428 
15,317 
16,485 
181987 
15,224 
16,238 
17,805 
18,882 
16,004 
16,743 
15,473 
17,711 
19,516 
20,059 
20,076 
19,999 
21,392 
20,005 
21,719 
20,372 

2o;58e 

21.732 


23.49 

1-73 
28.10 
25.26 
22.80 
19.76 
20.39 
20.27 
22.72 
22.12 
26.19 
20.29 
19.60 
22.26 
22.88 
18.81 
17.97 
17.17 
20.91 
22.48 
22.62 
22.13 
21.55 
22.63 
20.59 
21.85 
■20.04 
19.74 
20.78 




iwa, . . ■. 


587 
598 
fl08 

tiU 

ttsi 
e62 

•674 
700 
725 
750 
775 

eoo 

826 
650 
976 
•Wl 
"849 
868 
886 
907 
927 

m 

971 

99S 

1,011 

1,«0 


166 
046 
924 
803 
6Vi 
681 
440 
022 
000 
000 
000 
000 
•AXt 
594 
856 
118 
380 
980 
000 
539 
041 
995 
432 
S6S 
801 
768 
246 


42.36 


















1868, 


43.65 






































1S79, 

itwo, 


58.2J 
47.82 




















48.55 
45.75 




50.65 















The followinE comparative table shows the namber of deaths from 
diphtheria and scarlet fever for the past twenty-three years: 




-the iiiMrvealng yesrs popuUtlou 



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State Board of Health. 



[Off. Doc. 



The uuinbet of births durin;^ the year amounted to tweuty-aeveu thou- 
sand eight handled and fifty-eight (27,858), an increase of three handred 
and sixty-aeven (367) over the previous year; the ratio of births to popu. 
latioD being 26.60 per thousand, or 1 in each 37.6 persons. 

The number of male children amounted to fourteen thousand five hun- 
dred and fifty-two (11,552); the number of females to thirteen thousand 
thice hundred and six (13,306). 

The number of illegitimate births amounted to five hundred and 
seventy-three (578). 



1890. 




Total. 


BIRTBS. 


Black. 


B,..™.». 


i 

I 


1 


1 
1 






M. 


F. 


M. 


F. 


M. 


F. 


JaaDory 

Februar 

March, 

April, 

MSy,'. 

June, . 

July,' . 

August, 

Septemb 
October. 
Nov em b 
Decern b« 


ar. 




2 
2 
2 
2 
2 
2 
2 
2 
2 
2 
2 
2 


2ff7 
087 
188 
041 
13a 
309 
i«i 
4SJ 
186 
366 
486 
884 


1,177 
1,073 
1,133 
1,043 
1,129 
1,202 
1,319 
1,253 
1,154 
1,2-16 
1,316 
1,S08 


1,000 

•'998 
1,006 
1,107 
1,163 
1,184 
1,032 
1,110 
1,171 
1,37B 


33 

35 
20 
28 
26 
31 

37 
36 
40 
BI 
31 


36 

36 
38 
23 
26 
44 
22 
36 
26 
21 
36 
24 


73 
47 
57 
46 

76 
60 
75 
ft 
56 
58 

61 


47 
38 
43 
37 
52 
88 
50 
33 
27 
56 
42 
89 


28 
18 
30 
18 
17 
22 
26 
26 
22 
17 
M 
20 


2 


49 
54 

34 
58 
68 
33 
58 
68 
46 

47 
3S 


To 


'I. 




2T,8&8 


14,&62 


13,306 1 40B 


364 


701 


501 


264 


' 


573 



The number of births in each quarter of the year was as follows: 

First quarter, eudiug Marcb 31, 1S90, 6,542 

Second qoarter; ending June 30, 1890, 6,436 

Third quarter, ending September 30, 1800, 7,106 

FouTtii quarter, ending December 31, 1800^ 7,736 



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Nc. 16-1 Report op Philadelphia Boabd of Health. 175 

Marbuoeb. 
The number of marriEtges registered duriiig the year was seven thous- 
aad one hundred and ninety-six (7,196), or about one person married in 
72.74 — an increase ol two hundred and ninety-six (296) over the previ 
oas year. 

First quarter, en<lin|; March 31, 1890, 1,6S2 

Second quarter, ending June BO, 1890, 1,930 

Third quarter, ending September 30, 1890, 1,4»7 

Fourth qu&rt«r, eodtng December 31, 1890, 2,197 

7,198 

The following table gives the birth place of those married : 
Nativities of the Parties. 





BiBTHPi-ACE ov Brides. 




Nativities 


United 
Slates. 


Foreign. 


Unknown. 


Total or 
groomB. 


Birth place of grooms— 


3,490 
743 

29 


616 
2,107 


28 

2 

173 
















Total of brides, 


4,271 


2,724 


201 


7,198 



The number of marriages in which both parties were natives of the 
Unitetl States was three thousand four hundred and ninety-nine (3,499) ; 
those in which the parties were foreign bom amounted to two thousand 
one hundred and seven (2,107) ; in one hundred and seventy-three (173) 
cases tbo nativities of both parties were not given. 

The number of native grooms was four thousand one hundred and 
forty-one (4,141); the numberof native brides was four thousand two 
hundred and seventy-one (4,271). 

The number of foreign grooms was two thousand eight hundred and 
fifty-two (2,852) ; the number of foreign brides was two thousand seven 
hundred and twenty-four (2,724). 



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176 State Board OP Health. [Off. Doc. 

Tlie following table giveB the apes of the partiea married : 

Atjes of ike. Parties. 









A,....> 


,H» 


Won 


.». 






i 


isBa 


^ 


A 


SE 


s 


s 


s?,;^ 


. 


1 






^ 


s 


2 


s 


s 


sis 


2 


5 


■x 






s 


•A 


s 


s 


s 


S 


;? 


z 


i: 


Ages of the men— 












































20 to 25, 


«T 


1,620 


21! 


21 


I 








11 


2,281 




164 






102 


10 


1 






23 


2.»il 




56 


iH 


553 


417 


24 


4 






15 


1,49S 


40 to 50, 


5 






162 














SO to 60, ... 




1 


10 


42 


47 


M 


1 




1 


I2H 








3 


12 

e 

2 




6 


■3 




2 
JEM 










N.-.t Riven, . , , . 


6 


1 


329 


Total of women, . . 


722 


3,39tj 


1,705 


764 


17. 


53 


7 




376 


7,198 



The iiumber of men married under twenty years of age was thirty 
(30) ; the number of women amounted to seven hundred and twenty-two 
(722). The number of men married between twenty and twenty-five 
was two thousand two hundred and thirty-one (2,231) 1 the number of 
women, three thousand three hundred and ninety-ei^ht (3,398). Be- 
tween seventy and eighty years of age fourteen (14) men and no women 
were married. There were three hundred and twenty-nine (329) men and 
three hundred and seventy-six (376) wonjen whose ages were not given. 

The foUowiag table gives tlie ages of those married under twenty-one 
years of age: 



ITniier 20. 


Wo„.. 


IINDKB 20 






IS. 


14. 


15. 


16. 

1 
4 

21 

B 

■ 


17. 


la 


19. 


^ 


Men under 20- 






■3 

6 


'. 60' 


9 
6 

166 
40 

16 


S 

220 
S6 
26 
6 




















2oto2&,' :;::::::;::::: : 


8 


fi 


.467 






























3 


5 


10 


39 


102 


226 


33K 









Three (3) females were married at thirteen (13) years, five (5j at four- 
teen and ten (10) at fifteen. Eleven (11) men were married at eigliteeu 
(18), nineteen (19) at nineteen (19) ; in all, thirty (30) men under twenty- 
one (21) years of age. 



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No. 16. Bepobt of Philadelphu. Boabd of Health. 177 



Masruoes. 
The foUowuig table will show the number of each sex in each division 



of age married dur 


lag the year 
















igao. 


1 


^ 


^ 


S? 


g 


n 


^ 


u 
? 




^ ! 2 


3 


a 


s 


2 


2 


2 


« 




- 


8 


& 


s 


s 


SS 


s 


S 


•< 


M.le^ 

Keuuaea, 


30 

723 


l:iJ 


2,664 


1,406 
764 


361 
171 


126 
63 


46 

7 


14 


329 
378 


Total. 


752 


.m 


*.ae9 


2,260 


- 


1T» 62 


14 


705 



Whit«, 20*671 




Actual deaths in the city: 

D«aUia from apeclflc dlseaws, 20,163 

DflMhB from old age, . . 817 

Deaths from vtoienoe (accident), homlcfde and suicide, 752 



In the above fi^rures the still-born and premature births and bodies 
brong'ht to the city are not included, thus showing the actual moitality. 

The number of native bom was sixteen thousand three hundred and 
seveuty-seven (16,377); of foreign, four thoasand eight hundred and 
two (1,802) ; while there were five hundred and fifty-three (553) wliuse 
nationality was unknown. 

Abecexn. — The numberof deaths from this cause amounted to one haa- 
dred and nineteen (119). 
1216 91. 



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178 



State Boakd of Health. 



[Off Doa 



Cancer. — The deathtj from this cause amoonted to two buDdred and 
fifteen (216). 

Cerebro-Spini'- Meni/fjifts. — Tlie number of deaths so reported 
amounted to twenty-five (25), n decrease of twelve (12) from the previ- 
ous year. 

Consumption of the Lungs. — The deaths from this cause amoimted to • 
two thouBand seven hundred uud sixty-four (2,764) an increase of two 
hundred and thirty two (232) during the year. Of these, two thousand 
four hundred and thirty-three (2,433) were adults, and three hundred and 
eleven (311) minors ; one thousand nine hundred and twenty-six (1,926) 
were natives of the United States, seven hundred and nineteen (719) 
were foreig^n bom and one hundred and nineteen (119) whose nationality 
was unknown. 

The deaths in each month of the year from this cause were asfollows: 



January, 
February, 

April, . . , 



July. . . 

August, . 
Septeiiibe 
October, 



December, 



The largest number of deaths occurred in the month of January, four 
hundred and twenty-nine (429), while the influenza epidemic prevailed, 
and the smallest in the month of June, one hundred and seventy-six (176.) 

Tbe average deathB from thii disease ill each month 2S0.3 

The average deaths from this disease in eacJi week &3.I 

Tbeaverage deathsfrorn this disease In each day 7.6 

The number of deaths from consumption, of both sexes, for the past 
thirty years were as follows: 



Years. 


Males. 


Feiualea. 


Total. 


Yearb. , 


Males. 


Females. 


Tot»l- 


1861, . . . 


910 


907 


1,817 


1876, .. . 


1,288 


1,388 


•2.67r, 












1.949 


187T. 






1,142 


L207 










96« 


989 




1878. 






1,IM 


1,337 


2,491 
































1,020 


1,006 




1880, 






1.335 


1,367 


2.hll:; 


1868, 






99* 


960 
















1«67, 






012 




1,947 










1,427 


































9H2 


993 


1.97& 


ism. 






1.395 


1,406 




1H70, 






1,118 


1,990 




1885, 


















1,(190 


1,138 










1,168 


1,366 


■^sn 


1872. 






1.167 


1,163 


2,3.-«) 












2,8i'l) 








1,093 






1888, 






1,404 


1,291 




IS7J, 






1,133 


1,171 




188a 










2.53;; 


1875, 






1,185 


1,174 


2,359 


1S90. 






1,467 


1,307 


2,761 



Cholera Infantum.— Tiie number of deaths so reported amounted to 
nine hundred and eighteen (918), an increase of eighty (80) over the pre- 
vious year. 



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No. 16.] Repobt of Philadelphia Boabd of Health. 179 

Diphtheria. — The number of deaths from this cause amounted to five 
hundred and twenty-eight (526), an increase of one hundred and fifty- 
three (153) over the previousyear. 



1808. 
1800, 

UTO, . 

1871, . 

1872, . 

1873, . 
1874, 
1875, . 
187«, . 
1877, , 
1878, 
1879, . 

isao, . 

1851, . 

1852, . 

1883, . 

1884, . 
1885, 

1886, . 

1887, . 
13SH, . 

itisa, . 

1890^ . 



















i 




i 


2 

2 


Dka 


rnaiN KA.r 


H CiUA 
































■3 


1 


1 


1 


l8U 


2.1. 


3<l. 


4ti>. 


2 




51 


S3 


w 


24 


17 


52 












48 


37 


56 


4 






96 


33 


26 


31 








71 


68 


48 


32 


39 


36 


5 






79 


52 


28 






1 




56 


51 


45 


25 


17 


23 


1 






04 


30 








6 




314 




116 


158 


142 


236 


10 




330 


360 


21» 


192 


103 


194 


6 




182 


263 


120 


97 


84 


167 


















6 




141 


109 


ISO 


57 


46 












99 


72 


51 


101 


3 




214 


332 


84 
















187 




20a 


381 






511 


485 


267 


218 


230 


291 


5 


6 




8:ta 


196 




114 


258 


3 


10 


282 


305 


204 


120 


111 


165 


a 


4 


159 


342 


136 


84 


Ot 


100 


5 


6 






67 




94 


167 




S 


lee 


170 


108 


72 


52 


118 




3 


190 




100 


85 


82 


12fi 


5 




347 


270 


155 


95 


86 


192 



Scarlet Fever. — The number of deaths from this cause amounted to 
one hondred and eighty-nine (189), a decrease from thfi previous year of 
one hundred and nine (109). 

The deaths in each month amounted to : 



February, 
March, . . 
April, . . . 



14 July, . . , 
8 August, 

G , September, 

15 ' October, . . 

November, 



June. 12 I Deceml'e 



Typhoid Fever. — The number of deaths from this cause amounted to 
six buodred and sixty-six (666), a decrease of seventy (70) from the pre- 
vious year. 

Hydrophobia. — Tlie following table shows the deaths from this cause 
since 1660- 



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State Board of Health. 



Inflammation of Lungs. — The total namber of deatlis from this caase 
amouDted to two thousatid and fifteen (2,015), an increase of fonr hun- 
dred aud thirty-three (433). 

Inftuema.—Dxinag the epidemic of this disease that prevailed durinfir 
the month of January, one hundred and forty-seven (147) deaths were 
attributed to this cause. 

Old Age. — The iinmber of deaths under this heading amounted to 
eight hundred and seventeen (817). 

Poiaonijtg. — The number of deaths from tliis cause amounted to thirty- 
four (34), as follows : 



Poiaonlng, 1 l 

ArseDic, !> I 

AinmonlBi, 1 . 

r«rbollc acid, I i 

Chloral, 4 I 



CorroBive subliu»te. 
Cyanide of potash, . 

Opium 

Stminonliim, .... 



Suicide. — The number of deaths from suicide amounted to eigrhty (80), 
a decrease of twenty- four (24) from the previous year. Of these, seventy- 
seven (77) were adults and three (3) minors; sixty (60) were males, aud 
twenty (20) fem lies ; of the latter, three (3) were between fifteeu and 
twenty years of ^e. The following table gives the means employed : 



Aconite, 

Arsftnic, 

Carbolic ncid, 

Coalgaa, 

Corrosive BuUlimatc, .... 

Cutting ttiroHt, 

DrowninB. 

Hanging, 

Jumping ftom window, 
Jumping from rsilmnd train, 



; Oxalic ucid, 1 

; Paria green, i 

. Prussicacid, , l 

i Bough on rata, I 

. Shooting, 2(i 

Straagululion, i 

Strycimine, 2 

Wounds, 1 



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No. 16.] Report of Philadelphia Board of Health. 181 

Smallpox.— There wereuo deaths nor cases occurring iu the city dur- 
ing the year. 

Sunstroke. —The deaths from this cause amouuted to eight (8), an in- 
crease of two (2) over the previous year. 

Tamors. — The uomber of deaths from this cause amounted to one 
hundred and five (106), distributed as follows: 



Tumor uf BlfuldeT. 

" BrafD, . 

Cbest, . 



Groin, . . 
KIdnej'B, . 
Leg, . .' . . 



Tumor of Liver, . 



Spleen, 1 

Stomacb, 2 

Throat, 8 

Uterus, 18 



OvaileB, . 



Whooping Covgh. — The number of deaths from this cause amounted 
to two hundred and five (205), an increase of fifty-nine (59) over the pre- 
vious year. 

This table shows the percental of deaths (to total mortality) during: 
specified periods of life, compared with a similar statement of the mor- 
tality in the year 1889 : 





1S8S; 












1890 










26.66 




5,287 


BeiDK 


24.38 


Per.;eiit. 












1,305 






fl 


(HI 




1,167 




ft 






1,320 






«l 


(r? 




663 




.H 


•a 




654 






H 


IN) 




307 




1 


40 




322 






1 


4H 




613 




■/ 


m 




5B7 






•f 






l,9£7 




« 


HH 




2,0B5 






« 


6fi 




1,824 




f 


KK 




2,018 






V 


W 


























1,661 




7 


tH) 




1,717 






7 


v\ 








(1 


«» 




1,068 






f 


flfl 




1,491 




7 


W 




1,604 






7 






817 




fl 


m 




860 






H 


Ml 




116 






Ml 




158 








78 




6 


" 


•oa 




8 





























,Google 



State Board op Health 



[Off. Doc. 



Made to tlie Stats Board of Health of PennBylvania, Tor the year beginning Janu- 
ary 1, 1890, atid ending December 31, 1890. 

1. Tbe name and aduresa or eaob member of tbe board la 



Namc. 



PostDff)i:e address. 



Samuel Edgar, Secretary, . . 
Hon. EL H. Ripple, Chairman, 
W. A. Paine, M. D., Member, 
J. K. Bentley, M. !>., Member, 
Henry Zeigler, Member, . . . 
Micliael J. Kelley, Memlter, . 
W. E. Alien, Healtli Officer, 



SIT Spraoe street, Scranton. 
613 Webster avenue, " 
149 N. Main street, ■' 
ITI3C)lncharenue, -' 
605 Cedar avenue, ■> 
1031 Capouseavenud, ■' 
206 Wyoming ave., ■' 



2. Twelve regular monthly and seven special meeilng have been held during the 
year, 

3. No improvementa or changes have been made as regards water supply, drain- 
age and sewerage, or in the method employed' tu disposing of excreta. 

4. Two hundred and tblrty-eigbt nuisances have been reported. About ail tliat 
were reported have been removed. 

5. Communicable d 



NajbkoI' 

DlSEASK. 


No. or 
cases. 


No. of 
deaths. 


No. of out- 
breaks. 


ND.orhoaBes 
inrect«d. 


No. of outbreaks 
confined to the 
first house. 














Diphtheria. .... 


131 
124 

57 


71 
15 

18 














Typhoid lever, . . 















& These diseases are reported to the board by the physicians in attendance In ao- 
oordance with the law, ordinance or regulation requiring sucb reports. 

7. They are recorded. Notice sent to the superintendent of the schools, and a 
placard placed upon the house by an officer. 

8. Houses In which caaea of anull-pox, diphtheria and scarlet fever occurred were 
placarded. 

9v The diseases more than usually prevalent during the year were meaalos. Two 
hundred and forty-two cases reported. Fourteen deaths from the same. 

10. Nothing to cotuinunlcate. 

11. Schools. No special cases have come under observation in which unhealthy 
conditions existed. 

12. No particularly unhealthy localities. 



,y Google 



No. I6.3 Repobt of the Titdbtilij: Board of Health. 183 

13. We auggest for improving the Hanitary coDditloti a uremalor for dUpoaing or 
our garbage and night noil. Also more Bewera. 

14. Accidenta: Rumlng, 5; drowning, 5. 

15. Nothing regarding any cases of diBeaae which appeared to have been oaused 
by polluted water, cesspool or sewer gas, derectlve ventilation, lead, arsenical or 
other forma of polaoning. 

16. No inatances of food ad ii iteration, or Injurious effects from iL 

17. Diseases of animals: One case glandered horse. 

18. The same rules tlist were adopted under the law of 1887, wet* re^adopted under 
1889, a copy of which waa sent to Stale Secretary Benj. Lee. 

19. Have inveatlgaled the best means to dispose of the city's garbage and night 
HOil, and have determined that cremation was the best, and have requested the coun- 
cils for an appropriation for a cremator. 

20. Nothing to suggest. 

21. The health officer receives 1800 per annum, paid monthly; secretary, $500 per 
annum, paid monthly ; food and milk inspector, |I7C per month, paid monthly ; san- 
itary policeman, fT5 per month, paid monthly. 

Secretary. 
March tl, 1891. 



Hade to the State Board ol Health of Pennaylvanla, for the year beginning Janu- 
uary I, 1890, and ending December 31, 1890. 
L The name and address of each member ot the board is 



Nahb. 


PostolQce address. 






TituavUie, Fa. 












Charles L-aibbs, Member, 













Z Five meetings have been held bj the board during the year. 

3. The vratersupply and aewers are extended every year. 

1. Twenty nulaanuea have been reported. Twenty have traen removed. Nothing 



,y Google 



State Board of Health. 



[Off. Doo. 



5. Corotnunlocble 



Sinall-poz, . . . 
Diptberia, . . . 
Scarlet favor, . 
Typhoid TovM, . 



^ INo. of outbreaka 
coafiaed to tbe 
tVrst houscL 



a. These disaasea are reported bj the physlcianB In attendance In accordance 
wiUi tbe ordinance or regulation requiring such reporta. 

7. The health officer placards Che building ; children not allowed to att«nd achoot 
trom tbe bm II J. 

e. Hoiiaeain which caaeaof amall-pox, dtpbtheria and acsarlet fever occurred were 
always p1ac«rdea. 

9. The dlMaoea more than usually prevalent daring the year were, 4 cases diph- 
theria, 1 measles, 86 scarlet fever, 1 cerebro-splnal meningitis. 4 whooping cough, 6 
cholera infantum, t pneumonia, 2 brain fever, 4 convulsions. 

ta Scarlet fever was of a mild type prevailed largely in March, April and May; 
Children not allowed to attend public funerals ; funerals conlined to relatives and a 
few neighbors. Heard of no cases spread from funerals, 

11. Schools. No special cases have come under observation in which unhealthy 
conditions existed. 

12. There are no particularly unhealthy localities. 

13. Nothing to suggest for Improving tbe sanitary condition. 

14. No accidents. 

IG. No cases of disease which appeared to have been caused by polluted water 
cesspool or sewer gas, defective ventilation, lead, arsenical or other forms of poison- 
ing, 

I& No Instances of food adulteration, or injurious effects from It. 

IT. No diseases of animals. 

18. No by-laws adopted In 189a 

IP. Nothing of consequence done by the board during the year. 

20. Our board think there should be some law authorizing them lo employ a phy- 
sician, when a contagious disease la reported, and it Is doubtful whether it is as re- 

21. Secretary receives, per annum, 1130 ; health officer per annum, 76 ; no other sal- 

Thos. Ii. MoHART, tleerelars. 



ly Google 



No, 16] Bepobt of Wkllseobo' Board of Health. 



12— AHHUAL BBPORT OF THB HBALTH OFFIOHB OF TEB BOARD 
Off HBALTH OF THB BOBOUOH OF WBU.8BOBO', PA. 



Made to the State Board of HMtltb of Pennaylvaaia, for tho year beginning Jan- 
uary I, 1890, and ending December 31, 1S9IX 
1. The name and addresB of each member of the Iraard ti 



Name. 




U. li. Klo<-k, Member 


Wellaboro', Pa. 











2. Four meetings have been held by the board during tbe year t 

3. One thousand feet additional sewer have been put in. 

t. N uieances : Several minor ones have been reported. Ail have been removed. 
b. Communicable d 



Name OP 
Diss ASK. 


Naof 


No. of 
deaths. 


No. of 
outbreaks. 


No. of houses 


No. of outbreaks 
confined to tho 
first bouse. 


Sniall-po«, . . . 
Diphtheria, . . 
Scarlet fever, . 
Typhoid fever, . 




126 

1 

1 










27 



1 


•40 

1 

1 




1 
I 



& These dieeases are reported to the bo«rd by the physicians In attendance in ac- 
cordance with the law, ordinance or regulation requiring such reports. 

T. Only active -meBaures have been taken in diphtheria, which oases have \>een 
quarantined and houses disinfected. 

B. HouMB in which cases of diphtheria occurred were placarded. 

9. DlptberU was more than usuaiiy prevalent during tlie year, 
la Dlphtberl* broke out in Ave houses in one week, January 16, 1890, in four dif- 
ferent parts of town. The cause of infection obscure. 

11. Schools. One case not reported as diphtheria, out of school only a few days, re- 
lumed, told tbe teacher he came near having diphtheria, two nearest pupils to him 
contracted dtpfatbeiia, one died, the other had a mlid form, but gave dutease to 
brother and two sisters, one of whom died m four days. 

12. No particularly unhealthy localitiecT 

13. No suggestion improving tbe sanitary condlUon. 

14. Aocldents. t'hree deaths from scoident 

16. Nothing to communicate. 

1& Nolnstances of lood adulteration. 

17. No serious diseases of animals, 
la No by-laws were adopted In IseoT 

* Successive from January 15th to Noveml>er ITth about. 



,y Google 



State Board of Health, 



[Off. Doc. 



19^ If o other work nf tntereit bsa been done by the board during the .vear. 

20. Thlak the physicisnB Bhould be made to be prompt In reporting cases. 

21. The hesllh officer receives 950 aye«r, whiob rorcoiiilDgyearbaslioen cut down 



March io, Idul. 



Made to the 8tat« Board of Health of PeniiHjlv.uiiii, 
AuguBt I'l, 1690, and ending Decemtier 31, iwa 
1. Tbu uMne and address of each member oTthe iHMtrd it 



PoslofHco addn-SH. 











PoBlofDce. 


C. W. Younginan, M. D., Men 


ber, 


No. 342 Pine street. 












H. H. Feasler, M. D., Member, 






er 











2. Monthly meetings have been held by the boards during the year. 

5. No improvements or changes been made as regards wrater supply, drainage and 
sewerage, or In the methods employed in disposing of excreta. 

4. No report. 

6. Communicable < 



Name OF 


Ma of 


No. of 
deaths. 


No. of 
outbreaks. 


No. of houses 
infected. 


No. of outbreaks 
confined to the 
Hrat taoiise. 


Small-pox, , . . 
Diphtheria, . . 


DOtkno'n 
notkno'n 
□otkno'n 
notkno'n 


























Typhoid fever, 



















s of infectious diseases has there h 



iny spreading from house to 



,y Google 



No. 16.] Beport of the WiLLiAMapoKT Board of Health. 187 

& Some few caaea aie reported, but not all. 

7. When iaiM3 of communicable diseanes bave been reported, the hcaltli olBccr lii- 
spt^ts tlH- locality aad glvea directions wLen required. 

8 No liouBCBiu which casoB of amall-pox, diphtheria and scarlet fuvor occurred 
were plai-arded. 

9. Tli<! illBeaseB more than usually prevalent during the year were, In BumDier, 
diarrii(i*al diseases of L-hildrcQ, imd in wiat«r poeumoaia. 

10. The annual report ofdisoaiea In Williamsport has shown nothing of an epi. 
(Iciaii; whatever, not even influenza; whatever appeared was atrlctlj sporadic. 

11. Schools. No special cases have come under observation in which unhealthy 
conditions existed. 

12. Ko particularly unhealthy localities. 

13. Nothing lo surest for improvinK the sauitary condition. 
i4. No accidents. 

15. Nothing to oommuuicate. 

16. No Instances of food adulteration, or injurious effects from it. 

17. No diseases of animals. 

18. By-laws were adopted by the board in 189a 

19. Noother workof interest has been done by the board during tlie year. 
2a Nothing to suggest. 

21 The cleaning of privies has paid to the board, or rather into the treasury of our 
city, Ave dollars and twenty-flve cents. The secretary receives ten dollars per 
month, the health officer iteventy dollars per month. 

J. J. Galbraitfi, St<vretary. 

April >l, isui. 



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State Board op Health. [0pp. Doc. 



APPENDIX n. 



METEOROLOGICAL OBSERVATIONS — PENN8TLVASIA 
STATE WEATHER SERVICE. 



ABSTRACT FROU UONTULT WBATHSIB EUTVlflW. 



For January, 189L 

I'emperature. 

The mean temperature of fifty-four stations for Jaunary, 1891, was 
30''.6, wliich ia over 4°.0 above the normal, and 7°. 1 below thecorreapond- 
in^ month of 1890 

The mean of the daily maxima and minima temperatores S?".? and 
23°.3 ^ive an average duly range of 14°.4, and a monthly mean of 30°.6. 

Highest monthly mean, 36°. 1 at Philadelphia. 

Lowest monthly mean, 23°.8 at Eagle's Mere, 

Highest temperature recorded during the month, 64°. on the 29th at 
Union town. 

Lowest temperature, minus 4°.0on the 4th at Eagle's Mere and Lewis- 
burg, on the 8th at Columbus, and on the 9th at Wellsboro'. 

Greatest local monthly range, 20°. 2 at Lancaster. 

Least local monthly range, 10°.l at Pittsburgh and Grampian HiUa 

Greatest daily range, 43° at Smethport on the 26th. 

Least daily range, 2° at Grampian Hills on the 11th. 

From January 1, 1891, to January 31, 1891, the excess in temperature 
at Philadelphia was 122°, at Erie 137°, and at Pittabargh 164°. 

Barometer. 
The mean pressure for the month, 80.06, is about .04 below the nor- 
mal. At the United States signal service stations, the highest ob- 
served was 30.67, at Pittsburgh on the 8th, and the lowest, 29.22, at 
Philadelphia on the 12th. 

Precipitcdion. 
The average precipitation, 3.64 inches for the month, is nearly normal. 
The largest totals in inches (including melted snow) were Girardville, 
8.74; Cooperaburg, 7.29, and Pottstown, 7. 



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No. Ifl,] Meteobolooical Observatioks. 189 

The least were Oreenvitle, 1.22; Cbambersbur^, 2.27; Altoont^ 2.35, 
and Erie, 2.43. 

The snowfall average fur tlie st&le was about 9 iuches. 

The largest totals in inches were titomeiset, 40.5; Blue Knob, 33.5; 
Dyberry, 20; Eagle's Mere, 19, and Gharlesville, 15. 

Only elevated dtetrictB report snow on the ground at the end of the 
month. 

WiW and Weather. 

The prevailing wind was from the northwest. The wind and snow 
storm of the 25th cansed great damage to telegraph and telephone wires. 

Average number: Rainy days, 12; cleardays, €-. fairdays,10; cloudy 
dayB, 15. 



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State Board op Health. 



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'S 'i lis s 



3 ■ *-■ 



g£53S . ;= 



l|i«||Hl II fill f !ll|lll ill 



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Meteorouhcal Obbervations. 







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State Boaud of Health. 



[Off Doc. 



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-»«3ui inoj. ' 58a8.';pe=R5Ba =ss82s 



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No. 16.] 



Meteobolooical Obbbrvations. 



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: : 8- 


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No. 16.] Meteoroloaical Observationh. 197 

For February, 1891. 

Temperature. 

The mean temperature of fifty-five stations for February, 1891, was 
34°.9, which is nearly 6°.0 above the normal, and 2°.2 below the corree- 
poudinff month of 1800. 

The mean of the daily masima and minima temperatures 42°. 8 and 
26°. 7 give an average daily r&n^e of 16°. 1, and a monthly mean of 34°. 7. 

ffi^hest monthly mean, 40°. 5 nt Philadelphia. 

Lowest monthly mean, 26°.6 at Eagle's Mere. 

Highest temperature recorded durin<:r the month, 70° on the 18th at 
Philadelphia. 

Lowest temperature, minus 7° on the 5th at Dyberry. 

Greatest local monthly range, 63° at Somerset. 

Least local monthly range, 46° at Kennett ^nare, Nisbet and Green- 
ville. 

Greatest daily range, 43° at Erie on the 6th. 

Least daily range, 2° at State College and Grampian Hills on the 8th, 
Pottstown on the 7th, and Lock Haven on tlie 4th. 

From January 1, 1891, to February 28, 1891, the excess in tempera- 
ture at Philadelphia was 244°, at Erie 274°, and at Pittsburgh 313°. 

The warment days of the month were the l?th, 18th and 25th. The 
coldest, the 4th and 6th. 

Barometer. 

The mean pressure for the month, 30.07, is about .03 below the nor- 
mal. At the United States signal service stations, thehigbestobserred 
was 30.71, at Philadelphia, on the 16th, and the lowest, 29.26, at Erie, on 
the 26th. 

Predpitaiion. 

The average precipitation, 4.61 inches for the month, is slightly above 
the normal. Thelargest totals in inches (including melted snow) were Lig- 
onier, 8.29 ; Johnstown, 7.99 ; Grampian Hills, 7.01 ; Columbns, 6.67 ; 
Meadville, 6.65 -, Uniontown, 6.64, and Pittsburgh, 6.09. 

The least were Blue Knob, 2.13 , Greenville, 2.50 \ Chambersburg, 
2.54i Wysox, 2.71, and Drifton, 2.90. 

The snowfall was light outside of the more elevated sections. Dy- 
berry reports 17.6 inches; Blue Knob, 16.0; Nisbet, 16.0; Grampian 
Hills, 13.6 ; Eagle's Mere, 12.6 ; and Le Boy, 12.3. Several stations re- 
port snow on the ground at the end of the month. Heavy rains oc- 
corred on the 16th and 17th, which caused heavy freshets in many parts 
of the state. 

Witui and Weather. 
The prevailing wind was from the northwest. 

Average number : Bainy days, 12 ; clear days, 6 ; fair days, 8 ; cloudy 
(lays, 14. 

CoBBEcnoN. — For January. Greatest monthly range, 66.0 at Somer- 
set. Least local monthly range 34.0 at Chambersburg. 



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No. 16.1 MBTEOBOLOOICAL OfiSEBYATIONB. 



For Uaroh, 1891. 



Teinperaturf. 

The mean temperature of fifty-tliree stations for March, 1891, was 
34°.l, which is nearly 2''.0 below the normal, and 0°.7 above the corres- 
ponding month of 1890. 

The mean of the daily maxima and minima tempemtures 42°.0 and 
25°.7 grive an average daily i-ange of IB^.S, and a monthly mean of 33° .8. 

Highest monthly mean, 38°.i at Philadelphia. 

Lowest monthly mean, 29°. 1 at Eagle's Mere. 

Highest temperatnre recorded during the month, 60''.0 on the 18th 
at Pittsburgh and Uniontown. 

Lowest temperature, minus 14° on the 2d at Dyberry and Columbus. 

Greatest local monthly range, 70" at Smethport and Dyberry. 

Least local monthly range, 43°, at Harrisbnrg. 

Greatest daily range, 42° at Emporium on the 30th. 

Least daily range, 1° at Pottstown on the 27th. 

From January 1, 1891, to March 31, 1891, the excess in temperature 
at Philadelphia was 185°. at Erie 261°, and at Pittsburgh 258°. 

The warmest days of the month were the 18th, 23d and 80th. The 
coldest were the 1st and 2d. 

BaromefeT. 

The mean pressure for the month, 30.10, is about .08 above the nor- 
luid. At the United States signal service stations, the highest observed 
was 30i63, at Pittsburgh, oa the Ist, and the lowest, 29.36, at Pittsburgh 
on the 13th. 

Prccipilalion. 

The average precipitation, 5.10 inches for the month, is ao excess of 
about 2.00 inches. The largest totals in inches (including melted snow) 
were Selinsgrove, 8.39; Wost Chester, 8.33: Kennett Square, 8.04; 
Charlesville, 7.89; McOonnellsburg, 7.45, and Phcenixville, 7.42. 

The least were Erie, 2.44, and Columbus, 2.72. 

The largest monthly snowfall totals in inches were Charlesville, 39; 
Blue Knob, 34; Carlisle, 33, and Grampian Hills, 31. 

The snow storm of the 27th was very severe in the Schuylkill and 
LsbanoQ valleys. Heavy drifts occurred and caused delay to traffic. 
The snow soon melted and very little was left on the ground at the end 
of the month. 

Wind and Weaiher. 

The prevailing wind was from the northeast. The month was cold, 
wet, and generally unpleasant and unhealthy. Vegetation is backward. 
The prospects for grain and fruit are favorable. 

Average number: Kainy days, 14; clear days. 7; fair days, 8; cloudy 
days, 16. 



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No. 16.] Meteoroiogical Obsekvatiosh. 



For April, 1891. 

Temperature. 

The mesD temperature of fifty Btations for April, 1891, vraa iS^.S, 
which is about 3° above the normal, and l°.l above the corresponding 
month of 1890. 

The mean of the daily maxima and minima temperatures 61° and 
3S°.B give an average daily range of 22°. 5, and a monthly mean of 49°. 7. 

Highest monthly mean, 54°. 2 at Philadelphia 8. O. 

Lowest monthly mean, 44".* at Dyberry. 

Highest temperature recorded during the month, 87° on the 30th at 
Carlisle, and ou the 27th at Lewisburg. 

Lowest temperature 11°. 4 on the 6th at Greenville. 

Greatest local monthly range, 68° at Uniontown and Greenville. 

Least local monthly range, 53° at Philadelphia. 

Greatest daily range, 55° at Columbus on the I7th. 

Least daily range, 1° at Le Boy on the 4th. 

Prom January 1, 1831, to April 30, 1891, the excess in temperature at 
Philadelphia was 286°, at Erie 347°, and at Pittsb«rgh 332°. 

The warmest days of the month were the 18th, 19th, 20th, 2lBt, 22d, 
27th and 30th. The coldest were the 4th. 5th, 6th, 7th and 6th. 
Barometer. 

The mean pressure for the month, 30.02, is about .02 above the nor- 
mal. At the United States signal service stations, the highest observed 
was 30.54, at Philadelphia, on the 10th, and the lowest, 29.48, at Phila- 
delphia, on the 3d. 

Precipitcdion . 

The average precipitation, 2.08 inches for the month, is a deficiency of 
about three-quarters of an inch. The largest totals in inches (including 
melted snow) were Girardville, 3.54; Eagle's Mere, 3.1G) Philadelphia, 
2.82; Quakertown, 2.74, and Johnstown, 2.73. 

The least were Wellsboro', 1.12 ; Somerset, 1.13 -. Carlisle, 1.18, and 
Pitteborgh, 1.18. 

The largest monthly snowfall totals in inches were Blue Knob. 16; 
Pyberry, 10 ; Eagle's Mere, 5, and Le Eoy, 5. 

No snow reported on ground at the end of the month. 
Wind and Weaiher. 

The prevailing wind was from the northwest. The month was season- 
able, with a slight excess of temperature, and a deficiency of rainfall. 
The proBi>ect6 for grain, grass and fruit continue favorable. 

Average number rainy days, 8 i clear days, 13 ; fair days, 9 ; cloudy 
days, 8. 



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No 16.] Meteobologioal Observations. 



For May, 1891. 
Temperature. 

The meua temperature of fifty-two stations for May, 1891, was 67° .fi, 
which is about 2''.6 below the normal, and 1°.3 below the conesponding' 
month of 1890. 

The mean of the daily maxima and minima temperatures 69". 2 and 
i5°A give an averaf^ daily range of 28''.8, and a monthly mean of 57°.3, 

Highest monthly mean, 61°.0 at Philadelphia S. O. 

Lowest monthly mean, ei^.O at Wellsboro'. 

Highest temperature recorded during the month, 93°. on the 10th at 
CarliBle and McCounellsbnre, 

Lowest temperature 20°. on the 4th at Dyberry. 

Greatest local monthly range, 64° at Hollidaysburg and Dyberry. 

Ijeast local monthly range, 48° at Erie 8, O, 

Greatest daily range, 53° at Hollidayeburg on the 10th. 

Least daily range, 2° at Wellsboro' on the 18th. 

From January 1, 1891, to May 31, 1891, the excess in temperature at 
Philadelphia waa 268°, at Erie 250°, and at Pittsburgh 222°. 

The warmest days of the month were the 10th and 11th.' The coldest 
were the 4th, &th, 6th, 7th and 17th. 

Baromeier. 

The mean pressure for the iponth, 30.07, is about .07 above the nor- 
mal. At the United States signal service stations, the highest observed 
was 30.42, at Philadelphia, on the 20th, and the lowest 29.76 at Phila- 
delphia, on the 16th. 

Pre/iimtation. 

The average precipitation, 2.12 inches for the month, is a deficiency 
of about one and a quarter inches. The largest totals in inches (includ- 
ing melted snow) were Ligonier, 4.41, and Somerset, 4.16. 

The least were Blue Knob, 0.31 ; WysoJt, 0.49, and Lewisburg, 0.67. 

The largest monthly snowfall totals in inches were Columbus, 2.00 ; 
Wellsboro', 1.60, and Meadville, 1.60. 

Wind and Weaiher. 

The prevailing wind was from the northwest. 

Average number : Bainydays,8; clear days, 10 : fairday8,10, cloudy 
days, 11. 



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Na 16.] MbTEOBOLOOIOAL OseBBTATtONS. 



Por June, 189L 
Temperature. 

The mean temper&tareof fifty stationsfor June, 1891, was 68°.T,wliich 
ia aboat normal, and 1°,6 below the corresponding month of last year. 

The meaD of the daily mftTimft and minima temperatures, 80°. 1 and 
56°. 3 ^ves an average daily rang^ of 23°. 8, and a monthly mean of 
68°.2. 

Highest monthly mean, 72°.8 at New Castle. 

Ijowest monthly mean, 63°. 7 at Dyberry. 

Highest temperature recorded daring the month, 100° on the 7th, at 
Hamborg. 

Lowest temperature, 30° on the 7th, at SslinsgroTe. 

Greatest local monthly range, 69°.0 at Selinsgrove. 

Ijeast local monthly range, 34° at Eennett Sqoara 

Greatest daily range, 52" at Selinsgrove on the 3d. 

Least daily range, 3° at Dyberry and Soath Eaton on the 2lBt. 

From January 1, 1891, to June 30, 1891, the excess in temperature at 
Philadelphia was 270°. at Erie, 254°, and at Pittsburgh. 274°. 

The warmest days of the month were the 16th and 16th. The coldest 
were the 7th, 8th and 9th. 

Barometer. 

The mean preasnre for the month, 29.97, is about .03 below thenormul. 

At the United States weather bureau stations, the highest observed 
was 30.26, at Harrisburg on the 8th, and the lowest 29.60 at Ene on the 
18th. 

Precipitation. 

The average rainfall, 4.60 for the month, is an excess of about one-half 
inch. 

The largest totals in inches were Swartbmore, 9.30, and Johnstown, 
9.22. 

The least were Erie, 1.22 ; Honeadale, 1.46 and Dyberry, 1.86. 

Wind and Weaiker. 

The prevailing wind was from the west. 

Average number : Bainy days, 11 i clear days, 14 ; fair days, 6 ; cloudy 
days, 8. 



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No. 16.] MerEOROLOGICAL OBSESVATIONa. 



For July, 1891. 
Temperature. 

The mean temper&ture of forty-Biz statiuuB for July, 1891, was 67''.9, 
which is about l°.l below the normal, and 2° .9 below the correspondiuf; 
month in 1890. 

The mean of the daily maximum aud mioimam temperatures, 78°.6 
and 66°.6, gives an average daily ran^ of 22°.0 and a montlily mean of 
67°. 8. 

Highest monthly mean, 72°. 4 at Philadelphia (Centennial Avenue). 

Lowest monthly mean, BS^.O at Dyberry. 

Highest temperature Teoorded daring the month, 97° on the 14th at 
HuntiagdoQ and on the 15th at Wilkes-Barre. 

Lowest temperature, 84° on the 10th at Wellsboro' and <»u the 27th at 
ColiunbuB. 

Greatest local monthly ran^^e, 68° at Huntin^on. 

Least local monthly range, 32° at Swarthmore. 

Greatest daily range, 48° at Hollidaysburg on the 18th. 

Least daily range, 3° at Philadelphia on the 8th. 

From January 1, 1891, to July SI, 1891, the excess in temperature at 
Philadelphia was 143°, at Erie 74°, and at Pittsburgh 116°. 

Barometer. 

The mean pressure for the month, 30.03, is about .07 above the nor- 
maL At the United States weather bureau stations the highest ob- 
served was 30.36 at Philadelphia on the 22d, and the lowest 29.73 at 
Harrisborg on the 3d. 

Frecipitaiion. 

The average rainfall, 6.32 for the mouth, is an excetis of about two 
inches. 

The fall was particularly excessive in the southeastern portion of the 
state. 

The laigest monthly totals in inches were Ooatesville, 11.61 ; York, 
10.77 ; Kennett Square, 10.21, and West Chester, 10.11. 

The least werp Wysoi, 2.63. and Erie, 2.66. 
Wind and Weather. 

The prevailing direction of the wind was from the west. The month 
was characterized by extremes of heat and cold. 

Average number: Rainy days, 13) dear days, II; fair days, 10 ; 
cloudy days, lO. 



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No. 16.] 



Meteobolouical Observations. 



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Na 16.] Meteorological Obsebvationh. 246 

For Autniat, 1891. 

Temperature. 

The mean temperature of forty-six. statioQB for August, 1891, was 
&i°.l, which ia about O'T. below the normal, aud 1°.8 above the corres- 
ponding' month of 1890. 

The mean of the daily maximum and minimum temperatures 80°.l and 
59°. 2 give an avera^ daily range of 29°. 9, and a monthly mean of 89°. 6. 

Highest monthly mean, 74°. 5 at Philadelphia (Centennial avenue). 

Lowest monthly mean, 65°.0 at Wellaboro'. 

Highest temperature recorded during: the month, 99°. on the 9th, 
at Gharlesville, and on the 10th at Philadelphia, (Centennial avenue). 

Lowest temperature, 35° on the 30tb at Somerset. 

Greatest loc^ monthly range, 59° at Charlesville. 

Least local monthly range, 29*^ at Kennett Square. 

Greatest daily range, 17° at Qirardville on the 14th. 

Least daily range, i," at Grampian Hills on the 23d, and at Coopers- 
burg on the 5th. 

From January 1, 1891, to August 81, 1891, the excess in temperature 
at Philadelphia was 171°, at Erie 75° and nt Pittsburgh 107°. 

The warmest period of the montli was from the 9th to the 11th, in- 
clusive. The coldest were the 29th and 30th, 

Light frosts were i-eported in several of the elevated districts. 

Barometer. 

The mean pressure for the month, 30.00, is about .02 above the noi^ 
mal. 

At the United Statm weather bureau stations, the highest observed was 
was 30.24 at Harrisborg on the 6th, and at Philadelphia on the 26th. 
The lowest observed was 29.53 at Erie on the 21st. 

Precipitation. 

The averse rainfall, 5.09 for the month, is an excess of about three- 
quarters of an inch. 

Thu largest monthly totals were, in inches. Beading, 11.77; Smith's 
Corner, 10.18; Point Pleasant, 9.56; Qirardville, 9.47; Lewisbui^, 9.42, 
and West Chester, 8.85. 

The smallest were New Castle, 1.43; Pittsburgh, 1.60, and Erie, 
1.96. 

Rains were of almost daily oocurrenue in some parts of the state. 
The heaviest occurred on the 23d and 24th. 

Wiiidand Weather. 
The prevailing wind was from the southwest. 

Average number: Bainy days, 12; clear days, 8, fair days, 12; cloudy 
days, 11. 



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D,Bi,z,db,Goo<^le 



No. 16.] MSIEOBOLOOICAL Obsebtations. 



Tor September, 1861. 



Temperature. 

The mean temperature of forty-five st&tious for September, 1891, was 
66°.4, which is about 5° A above the normal, and 4°. 4 above the cocrea- 
poudinj; month of 1890. 

The mean of the daily maximum and minimum temperatures, 78°.! 
&nd 64°.8, irives an average daily range of 23°.6 and a monthly mean 

of ee'.e. 

Highest monthly mean, 1\°.& at Philadelphia. 

Lowest monthly mean, 60°. 8 at Wellsboro', Dyberry and Smetbport. 

Highest temperature recorded during the month, 94° on the 26th at 
Coatesville and ou the 17tb at Somerset. 

Lowest temperature, 32° oo the 30th at Wellsboro' and Columbus. 

Greatest local monthly range, 61° at Somerset. 

Least local monthly range, 37° at Erie. 

Greatest daily range, 52° at Selinsgrove on the IStb. 

Least daily range, 4° at Erie on the 6tb and at Dyberry on the Stb. . 

From January 1, 1891, to September 30, 1891, the excess in tempera- 
ture at Philadelphia was 303", at Erie 158°, and at Pittsbursh. 203°. 

A series of dry and cloudless days occurred from the 9th to the 28th 
iuclosive ; the last eleven days of the series being phenomenally warm. 
Cool nights, however, gave relief from the oppressive heat of the days. 
This has been the hottest September on record excepting' Septem- 
ber, 1881. 

The coldest days were the 9th, 10th and 30th. 

Frosts were reported on the 9th, 10th, llih and 30th in the high dis- 
tricts. 

liqromeier. 

The mean pressure for the mouth, 30.164, is about .07 inch above the 
normal. At the United States weather bureau stations the highest 
observed was 30.43 at Harrisbnrg on the lOtb, and the lowest, 29.88, at 
Philadelphia on thd 17th. 

Pri-cipit-aiion. 

The average rainfall, 2.39 iuches for the month, is a deficiency of 1.18 
inches. 

The largest totals wereKeunett Square, 5.00 , Charlesvllle, 4.55 , West 
Chester, 4.30 



,y Google 



261 State Boabd of Health. [Off. Doc. 

The least were Carlisle, 1.05; Lebanon, 1.07; Emporium, 1.17; Qiuk- 
ertown, 1.17. 

IVind atid Weather. 
The prevailiDfir wiud was from the southwest. The weather was tery 
favorable for harveBting &ad ouriti^ orops and for fall seeding. 

Average number; Bainy da.ys, 7 ; clear days, 17 ; fair, 8 ; cfoudy, 5. 



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State Board of Health. 



For Ootober, 1891. 



Temperature. 

The mean temperature of forty-six stations for October, 1891, was 
61°. 4, which is about 1°.5 below the normal, and 0°.6 below the corres 
ponding month of 1890. 

The mean of the daily mazimum and minimum temperature, 61°. 2 and 
40°.l, gives an averaee daily range ol 2I°.l and a monthly mean of 50°.7. 

Highest monthly mean, 55°.7 at Philadelphia (Centennial avenue). 

Lowest monthly mean, 44°. 1 at Dyberry. 

Highest temperature recorded during the month, 91° on the 3d at 
GarUele. 

Liowest temperature, 16° on the 29th at Dybeny. 

Greatest local monthly range, 69° at Coatesville and Dyberry. 

Least local monthly range, 47° at Altoona. 

Greatest daily range, 49° at Hollidaysbnrg on the 2d, and at Colum- 
bus on the 18th. 

Least daily range, 1° at Colnmbns on the 27th. 

From January 1, 1891, to October 31, 1891, the excess in temperature 
at Philadelphia was 240°, at Erie, 137°, and at Pittsburgh, 145°. 

The warmest days of the month were the 3d and 4tb. The coldest 
were the 28th and 29th. 

Barometer. 

The mean pressure for the month, 80.11, is about .04 inch above the 
normal. At the United States weather bureau stations, the highest 
observed was 80.69 at Harrisbnrg on the 12th, and the lowest, 29.68 at 
Philadelphia on the 6th. 

Preciintaiion. 

The average rainfall, 3.06 inches for the month, is a deficiency of one- 
toorth of an inch. 

Thelaz^estmonthly totals were, Belinsgrove, 4.46; Wysox, 4.43; State 
College, 4.38. 

The least were. New Castle, 0.84; Ligonier, 0.88; Pittbnrgh, 1.53. 

Flurries of snow occurred in several places on the 27th. During 
October, 1890, over 5.00 inches of snow was recorded at some stations. . 
iliis October the amount was inap'preciable. 

Wind and Weather. 
The prevailing direction of the wind was from the northwest. 
Average number: Rainy days, 8; clear days, 11 ; fairdays,9; clondy 
days, 11. 



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270 State Board op Health. [Off. Doc. 

For November, ISOL 

7'emiieralure. 

The mean temperatare for November, 1891, was 39°.6, whicli is about 
the normal, and 1°.9 below the correepondiug month of last year. 

The mean of the d&ily maxima and minima temperatures, 49°.l and 
30°. 3, gives an average daily range of 18°. 8, and a monthly mean of 
39°.7. 

Highest monthly mean, 44°. 9, at Altoona. 

Lowest monthly mean, 33°.l, at Bluo Knob. 

Highest temperature recorded during the month, 76° .0, on the 9th, at 
Pittsburgh. 

Lowest temperature reconled during the month, 0°.0, uii the 30th, at 
Dy berry. 

Greatest local monthly range, 66°.0, at Ligonier. 

Least local monthly range, 37°. 0, at Selins^jrove. 

Greatest daily range, 46°. 0, at Coatesville, on the 9th; Lebanuo, on 
the 22d and Dyberry on the 8th. 

Least daily range, 0°.O, at Columbus, on the I7th. 

From January 1, 1891, to November 30, 1891, the exoess in tempera- 
tui-e at Philadelphia was 180°, at Erie, 73° and at Pittsburgh. 79". 

Baromiifer. 

The mean pressure for the mouth, 30.15, is about .1,0 inch above the 
normal. 

At the United States weather bureau stations, the highest observed 
was 30.84, at Philadelphia, on the 16th, and the lowest 39.82, at Erie, on 
the 23d. 

PrKcipUalioH, 

The average rainfall, 2.65 fur the month, is a deficiency of nearly one 
inch. 

The lai^est monthly totals in iuclieH were, Columbus, 6.70 -. Girard- 
ville, 5.12 and Drifton, 4.08. 

The least were, Lancaster, 1.09 ; Reading, 1.38 ; Westtown, 1.41, ' 

The heaviest rainfall occurred on the 11th, 17th and 23d. 

The snowfall was light and at most stations too small for measure- 
ment. 

The largest totals were Blue Knob, 11.0 inches ; Grampian Hills, 
6,0 inches ; Wellsboro', 5.5 inches and New Castle, 4.0 inches. 

Wind and Weather. 
The pi'evailing direction of the wind was from the northwest. 
Average number : Kaiuy days, 9 ; clear days, 9 ; fair days, 8 ; ch >udy 
days, J 3 



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No. 16.] 



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State Board of Health. [Off, Doc. 



For December, 18S1. 
General RemarkK. 

The uuDth just closed, has been one of the wurmest ou i-ecord. and is 
in marked contrast with th© correst>ondiufT month of 1890. The mean 
temperature of this December beiiig eleven de^i«es higher than latit 
December. 

Following ia a tabulated &tatemeut of the mean temperatures for De- 
cember since the Peimsylvania state servict^ has been in operation ; 

December, 1887, mean temperature 31°. 5. 

December, 1888, mean temperature 32°. 6. 

December, 1889, mean temperature 89°. 3. 

December, 1890, mean temperature 27°.6. 

December, 1891, mean temperature 38°. 6, 

It will be noticed that Deceml>er, 1889 was sliglitly warmer than in 
1891. 

The month was almost entirely without the low temperatures that 
usually occur, and the maximum temperatures were decidedly higher 

Another marked feature of the past month was the almost entire al^ 
sence of snowfall. The largest total was 3.00 inches, while in December, 
1890, 96.00 inches, 65.00 iachea, 60.00 inches and 57.00 inches for the 
month were reported at different stations. 

Owing to the continued waim weather the crops wei-enot injured, and 
they are reported as generally in good condition. 

Tevif/fratiin: 

The mean temperature for December, 1891, was 38".{i, which is ovi.r 
8°. above the normal, andll°.l above the corresponding month of 1890. 

The mean of the daily maxima and minima temperatures 47"''. 9 and 
28°. 9 give an average daily i-ange of 19°.0, and a monthly mean ot 38°. 1. 

Highest monthly mean, 44°.0 at Altoona. 

Lowest monthly mean, 33°.6 at Kane. 

Highest temperature i-ecorded during the month, 68". on the 5th 
at Meadville. 

Lowest temperature, minus 3°.0 on the 18th at Somerset. 

Greatest local monthly range, fi6°,0 at Somerset. 

Least local monthly range, 38°, at Kane. 

Greatest daily range, 49° at Ligonier on the 18th. 

Least daily range, 2°. 2 at Hulme\'ille, Westtown and Dyberrj- on the 
25th, at Gi-ampian Hills on the 2{ith, Erie on the 30th, and Oolumbus 
on the 7tli. 

From January 1, 1891, to DeeembtT 31, 1891, the excess in temperature 
at Philadelphia was 362". at Erie 207", and at Pittsburgh 275°. 



,y Google 



No. 16.] Meteoroloqioal Observations. 279 

Barometer. 
The DieaB pressure for the month, 30.18, is about 12 above the uor- 
nial. At the Uuited States weather bureau statious the highest ob- 
served was 30.69 at Pittsburgh on the 18th. and the lowest 29.55 at Pliil- 
ad^phia on the 16th and at Erie on tlie 16th. 

Prtcipitation. 

The avera$^ precipitatiou, 4.09 inches for the month, is au excess of 
1 12 inches. 

The larf^est totals in inches were Drifton, 6,53 ; Girardville, 6.23 ; Mc- 
Connellsburg, 5.62, and Quakertown, 6.14. 

The least were Blue Knob, 2.00 : New Castle, 2.58 ; Wysox, 2.83, and 
Altoona, 2.96. 

The following are the largest totals of snowfall reported : Blue Knob, 
3.50; Kane, 8.00, aud Emporium, 2.75 inches. 

Wind and Weather. 

The prevailing wind was from the southwest. 

Average number: Rainy days, 10; eleardays, 12 ; fair days, 8; cloudy 
days, 11, 



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No. 16.] CONTEEBNCE OF StaTE BoABDB. 



APPENDIX K 



REPORTS OF CONFERENCES AND CONVENTIONS. 



1. Pnweedingsof the l^sllonal Conrerenue ofStatd Boards of Heallli, IfV 

2. KeportortbeSeorelarj ax Delegate to the Meeting ofUte Public Health A 

lion, 1S90. 

3. Report of the Secrelai7 as Srcretar; of the Section cm State Medicine of tlie 

Aineri<»n Medical Association, 1891. 

4. Proceedings of the Fifth State Sanitary Convention, May, ItiSL 



1. PBOOBHDINaS OP THB NATIONAL OONFHRBNOB OP STATE 
BOARDS OF HBAIiTH, "^ASHINOTON, t>. O., MAY 2 ANX> 4, 
1881. 



States represented. 

QuaiAntine requisites. 

Sources of our yellow fever epidemics. By J. < 

Principles of diBiDfeotlon 

Quarantine outfits. 

Discussion. 

Should state boards control the sanilary a 

How consumption Is spread and tneasur 
M. D 

History. 

Prevalence. 

Predisposing causes. 

Discussion. 

Would the appointment of medical liealtli officers for counUen, and paid for de- 
voting thoir time to public health work, in place of township officers be advantageous 
and practicable T By C. A. Lindsley, M. D 

The advHntages of organization ot rivers conservancy commissions, composed nf 
slate and municipal heaitii Ixiards, for the proteclion of streams against deforesting 
and pollution at tbetr sources and along tlieir courses. By Dr Saluuion. 

DiscoBKion. 

What change, if any, nhonld be made in the present plan for providing il pro- 
fcrsmtne for meetings of the (conference. 

Officers elected for 1S92. 

What recent derolopmenta have beeu made In laboratory work of value to beallh 
boardsf B.v V. A. Vaughan, M. D. 

Report on c-ou sumption. 



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288 Statk Boabd of Health. [Off, Doo. 

The seventh amiual meetiag' of the Natiooal Uonferenoe of State 
Boaids of Health was held at the Ebbitt House, Waebi&?to&, D. C, May 
2 and 4, 1891. 

The meeting was called to onler at 10 a. ni., Saturday, May 2, by Dr. 
J. N. McConnack, President. 

The following states were repreeented: 

Alabama— Dr. Jerome Cochran. 

Connecticut — Dr. C. A. Lindsley. 

Illinoia^ — Dr. John H. Bauoh. 

Indiana— Dr. C. N. Metcalf. 
Dr S. S. Boots. 

Iowa — Dr. J. C. Shrader. 

Kentucky — Dr. J. N. McCormack, 
Dr. George Boeler. 

Louisiana — Dr. S. 11. Olliphant, 
Dr. L. F. Salomon. 

Maryland— Dr. C. W. ChanceUor. 

Michigan — Dr. John Avery, 

Dr. Victor C. Yan^han. 

Minnesota— Dr. P. H. Millard. 

Missoori- Dr. George Roman 

New Hampshire — Dr. Irving A. Watson. 

New York^Dr. Leftia Balch, 
Dr. O. Donohue. 

Ohio— Dr. C. O. Probst. 

Pennsylvania — Dr. Benjamin Lee. 

Rhode Island — Dr. Albert G. Sprague. 

South Carolina— Dr. H. D. Frazer. 

Tennessee — Dr. J. Berrien Lindsley 

Vermont — Dr. J. H. Hamilton. 

West Virginia— Dr. N. D. Baker, 

Wisconsin — Dr. J. T. Keeve 

Province of Ontario — Dr. P. H. Bryee. 

The Pbebident: Gentlemen of the Conference, I have the pleasure of 
introdncing to you Mr. Douglass, president of the board of commission- 
ers of the District of Columbia. 

Mr. Douglass made a pleasant address of welcome to the del^ates, 
in which he referred to boards of health as boards of happiness, for their 
efforts are to promote the health of the community in order that every 
man may live out the full measure. 

Washington, said he, is rapidly getting to be quite a scientific city Dy 
attrition and contact witli the many scientific Indies that are making it 
their custom to meet in conventions here. This city has a new health 
ordinance compelling the placarding of houses where certain dist 
are known to be. 



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KO. 16.] COMTEREMCE OF StATE BoARDB. 28!* 

At firdt this had almoet cansed a riot, but more recently a, man had 
4X>mplamed bitterly because liiB house was not placarded. This shows 
the progress of Banitary intelligence here. Feeling sure that their con- 
ference would resnlt in the greatest good to the society and to the coun- 
try at large Mr. Doaglass agEtin bade them welcome to the city. 

The Pbesident. I have heard with pleasure the kind things Mr. Doug- 
lass has said. This is one of a Dumber of meetings we have held in this 
city. We represent the official state organizations in our respective 
states. The growth of state board of health work has been Tery rapid. 
As you know, the first board was organized in 1869 ; now there are thirty- 
two state boards of health in the union, and measures are pending look- 
ing to the establishment of similar organizations in the other states. 

The Secretabi. I have an e^cpl&nation andapology to make in regard 
to announcing the local committee of arrangements, to whom we are 
very much indebted. Dr. Townahend, the district health officer, very 
kindly consented to arrange for this committee, but on account of the 
doctor's illness, the matter was delayed until after our programme was 
istmed. The local committee are Dr. Philip S. Wales, Dr. C. H. Deme- 
rest, Dr. Poole and J. C, McGinn, 'the deputy health officer. 

The PiiEbV>ENT. Dr. Brice, of Toronto, telegraphs asking me to an- 
Doancethat it is impossible for him to get here until this afternoon, and 
requesting the postponement of the discussion of the first and second 
questions in which he is interested 

The first question for discussion will be the one proposed by the 
State Boanl of Health of Louisiana: 

1. What are the requisites for a thorough system of quarantine and 
maritime sanitation in the light of present scientific attainment f 

2. What are the beat methods tor tho self-protection of individual 
states from tho introduction of pestilence through states which have no 
adequate quarantine T 

And in connection with this, the question proposed by the State 
Board of Health of Alabama: 

1. Given a vessel with cargo from Central or South America, or the 
West India Islands, can such vessel and cargo be disinfected without 
discharging the cargot 

2. Can such cargo be disinfected thoroughly, and without damage, 
after it has been discharged? 

The discussion of these questions will be opened by Dr. Jerome Coch- 
ran of Alabama. 



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290 State Board op Health. COff. Doc. 

Quamntine Keports. 
By'Dr. Jbhumk Cuuhran, State Health Vjjieer ^/ Alabama. 

I have oudertakeQ to open the discussioii on one of the qaestions sub- 
mitted by tbn Louisiana State Board of Health, namely: What are the 
requisites for a thorough system of quarantine and maritime sanitation 
in the light of present scientific attainment T In accordance with the 
limitations of my own personal and experimental knowledge, I shall 
confine the discussion to a consideration of the best means for the pro- 
tection of onr gnlf ports from invasion by yellow fever by way of the 

The SonBOEs of Oub Yellow Fevek Epidemicb 

Tellow fever epidemics have prevailed within the territorial hmits of 
the United States since the Columbian discovery of America, in ninety- 
three different years. In eighty-one of these years we have had some 
evidence as to the sources whenoe it waa'derived, namely: From 
the West Indies, seventy-five (7S) times ^ from Mexico, four (4) times; 
from Demerara, twice (2); from Honduras, once (1), and from Kio de 
Janeiro, once (I). 

From these statements it follows that the great sources of danger to 
us are the West India Islands; and amongst these islands, the single 
island of Cuba, and the single city of Havana, have furnished ns with 
the immense majority of our epidemics. I conld give you the reasons 
why Havana is so exceptionally dangerous, but it would take too much 
time to undertake to do so on the present occasion. 

The yellow fever which is brought ns from Havana and other foreign 
ports is necessarily brought to us in water crafts of various kinds, all of 
which we may speak of for convenience as shi]>s, and as an incidental 
consequence of our foreign commerce 

If we could prevent the infection of ships at the foreign port, say for 
example, at Havana, that would be the best possible solution of the 
problem of protection. We cannot always do this with certainty ; but 
we can do it even now to a considerable extent; and it is to be hoped 
that we will be able to accomplish more in this direction in the near fu- 
ture. It is certainly true, and I desire to call very emphatic attention 
to the statement, that the immense majority of the ships coining to ns 
from Havana during the season of the year when yellow fever is 
most prevalent there, are entirely free from infection, and hence, also, 
entirely free from danger. While this is a fact of great practical im- 
portance, it is one that seems to have attracted very little discussion, 
and it is therefore difficult to indicate what prupoi'tion of the whole 
number this majority actually is. From such data as I liave been able 
myself to collect, I am well satisfied that of ships coming into the Gulf 



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No. 16.1 CoNTERBNCE OF State Boahds. 291 

of Mexico from the West India ports ia epidemic seasoiis, not more 
than one in twenty at the most is really infected, while in non-epideuio 
aeaaoos the proportion is leas than one to the hondred. I suppose that 
to maDy who have had much ezperieuce in quarantine work, this etate- 
meut will seem altogether incredible. It Lb, nevertheleas, beyond all 
questitm, Bubstantially tme ; and it is very easy to see that its thorough- 
goioi? recognition will materially influenoe the current practice of quar- 
antine. 

This comparative immunity of ships from Havana from the infection 
oi yellow fever has been obtained for many years, and in the absence of 
any special effort to secure it Of late years, however, we have had 
agents in Havana, and some other ports, whcee ofScial dnty it has been 
to inspect and certify to the sanitary condition and sanitary history of 
ships coming to this ooontry. I r^;ard this system of sanitary super- 
vision of ships at the port of departure as extremely important, and as 
admitting of large development. Indeed, I do not think that it is alto- 
gfether visionary to forecast the time when the principal quarantine 
station for the protection of our gulf ports will be not at Kew Orleans 
or Mobile, but in the harbor of Havana. 

As we have seen the chances are many to one that any designated 
ahip in the harbor of Havana will escape infection anyhow, without any 
special care being taken to that end. But it is possible to take a groat 
deal of care to secure this immonity from infection, and with very great 
probability that soch case will be rewarded with a very lai^ie measure 
of success. 

The plan, in this regard, pursued for several years by the Plant line 
of steamers, running between Havana and Pampa, may be taken as a 
sample of this sort of work. These steamers are of iron, they have no 
bilges, and it is easy to keep them scrupulously clean. They go into 
ihe harbor of Havana after sun up in the morning, and leave it before 
sunset in the evening They do not lie along side of the wharf, but tie 
up to a buoy out in the bay. Only a single acclimated officer is allowed 
to go ashore, and only into the business part of the city, where yellow 
fever is not apt to be found. And no sospicious passengers or freight 
are allowed to be shipped. 

I do not undertake to say that these preoantions guarantee complete 
immunity against infection. I know of no precantions of which that cau 
be said. But I believe such precautions are of very great practical 
Talue, and more likely to keep a ship free from infection than the usual 
fa«atment at our quarantine stations is to make an infected ship safe 

Principles op Disinfbction. 
Disinfectants, for tJie purposes of this argument, may be briefly de- 
0ned as agents which destroy, or render innocuous, the zymotic poisons 
which generate epidemic diseases. 



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392 State Boabd of Health. [Off. Doa 

Or, inaamuoh as these zymotic poisons are aniverBally held to be as- 
sociated with the action of living germs, disinfectants, from another 
point of view, are each agents as destroy the vitality of disease ^rma. 

It is extremely probable that the real toxic agent in the production 
of yellow fever is either a ptomaine or a toialbomin. But it is also 
extremely probable that hiimaa creatures very rarely reoeive this 
ptomaine or toxslbamin in sufficient doses to produce an outbreak (4 
the fever, except when it is generated within the system itself by the 
action of the living germ ou some of the tissues or fluids of the body. 
At any rate, the practice of disinfection is based on the assamption that 
tuiy agent which will kill the germs which generate the disease poisons 
will i>revent the generation of the disease itself. Hence we may say, 
very briefly, that disinfectants are germieideB 

The principal agentsofdisiofectionare. (I) extreme cold; (2) extreme 
heat; (S) various chemical reagents; (4) cleanliness and ventilation. 

The influence of heat and cold upon living creatures, and especially 
upon microscopic organisms and disease germs, is not at all uniform. 
Fritsch has shown that certain bacteridia in the micrococcus stage retain 
their vitality after congelation with carbon dioxide, that is to say, at a 
temperature of 70° below the zero of Fahrenheit's scale, or 102" below 
the frcGziiig point of water. On the other hand, Dallinger and Drys- 
dale have shown that the germs of certain monads are able to survive s 
temperature of 300° above Fahrenheit's zero, or 88° above the boiling 
point of water. In the meantime, fully developed bacteria and fully de- 
veloped monads are destroyed, as a. rule, at a temperature far below the 
boiling of water, iiamely, at 110° Fahrenheit. 

Of the morbid poisons which generate human pestilences very few 
have been subjected to direct experimental observation in i-egard to 
their capacity to withstand elevations and depressions of temperaturei 
but it is generally accepted as well established that the heat of boiling 
water is sufficient to destroy the malignant energy of most of the septic 
germs generated in the human body, such as the poisons of pytemia, 
septicaemia, gonorrhoea, syphilis, etc. The contagium of vaccina and 
the contagium of small-pox are also destroyed at the temperature of 
boiling water, and this temperature seems to be destructive of the germs 
of cholera and of typhoid fever. The limits cf the resistance of the 
zymotic poisons to cold have not been much studied, and our knowledge 
in this direction is still very defective. It is known, however, that vac- 
cina and small-pox survive very great reductions of temperature. !Small- 
pox, indeed, seems to be specially a disease of cold climates and of cold 
seasons of the year; and is hardly able to maintain itself at all against 
the protracted summers of our gulf ports. On the other hand, yellow 
fever is notoriously a disease of warm climates and warm seasons of the 
year; and the most dreadful t-.pidemica are promptly checked by tho 
advent of frost and wiuter weather. lu the face of this broad fact. 



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No. 160 CONFEBENOE OF StATE BoABDS. 293 

wbioh is sustained by the imauimous testimony of many hundrede of 
epidemics, it is hardly possible not to believe that the yellow fever 
poisoD, or the yellow fever germ, can be destroyed by cold ; and if it can 
be destroyed by the natural cold of very mild wintei's, it would seem to 
follow that it can bo desti-oyed, also, by cold artificially produced. The 
cases, so much disooBsed, of the Susquehanna and the Plymouth, have 
thrown some shadows of doubt acros» the minda of many sanitarians as 
to the Bonnduess sod universality of this conclusion. It seema to me, 
however, that it is more reasonable to believe that there is some undis- 
covered ^lacy in these cases, than it is to believe that the uniform ex- 
perience of centuries has in this matter led the whole world astray. 

While the yellow fever poison is thus sensitive to cold and intolerant 
of frost, and while it flonriahes most in tropical countries and in summer 
weather, experience warrants the statement that very high temperatures 
are just as fatal to it as very low ones. It is very Bafe to say that it is 
not able to withstand either wet heat or dry heat at 250° Fahrenheit; 
and the heat of boiling water, 212°, is probably quite sufficient for its 
destruction. 

The list of chemical disinfectants is quite a long one, but for quaran- 
tine purposes it is only necessary to mention two of them, namely, sul- 
phur dioxide and mercury bichloride 

Sulphur fumigation is one of the most ancient methods of disinfection. 
It was employed by the much planning divine Ulysses, a thousand years 
before the beginning of our Christian era, to purify the hall of his pal 
ace, at Ithaca, which had been made foul by the carcasses of the slain 
suitors of the prudent Penelope. The disinfecting power of sulphur 
fumes has been called in question of late years, but the range and limits 
of its application are now, thanks to the labors of the committee on dis- 
infectants of the American Public Health Association, quite accurately 
defined. Mixed with atmospheric air to the extent of one or two vol- 
umes per centum it destroys the vitality of vaccine virus. 1 think there 
can be no doubt of its efficacy against the poisons of measles, small-pox 
and scarlet fever ; but I would like to use it in atmospheric mixtures of 
much greater strength than one or two per centum^ — say from five to fif- 
teen volumes per centum. In brief, it is probably fatal, when properly 
used against all non-spore-bearing bacilli, while it cannot be depended 
upon for the destruction of the spores of the pathogenic bacilli, such as 
those of anthrax and malignant cedema. The presumption is that the 
f^rm of yellow fever . does not produce spores, and that the sulphur 
dioxide iB competent to effect its destruction. The sulphur strength of 
the atmospheric admixture, and.tbe length of exposure necessary to this 
end we do not know; and in the absence of such knowledge prudence 
dictates that the sulphur dioxide should be used in abundant quantities, 
and that the exposure should be protracted. 



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294 State Boabd of Health. [Off. Doc. 

Of mercary bichloride I need say very little. Ite K^nnioidal power 
is very energetic, except in the presence of albameo, and its use is not 
attended vith any special difficulty. 

The importance of cleanliness and Tentilation is so f^nerally recof;- 
nized that I need do no more than to mention them. 

Quarantine Odtptts. 

In order to determine what sort of a quarantine establishmeot ia 
needed for the protection of any of oar gait ports it is necessary that we 
should know approximately a good deal about the commerce of the port 
in question ; such details, for example, as these that follow : 

(1) The number of vessels coming into the port during the quaran- 
tine season from ports infected >vith yellow fever and especially from 
Cuban porta so infected, 

(2) The Dumber of Buch vessels constracted of wood, and the number 
ounstructed of iron, and whether sailers or steamers. 

(3) How many come with cargoes, and the nature of such carf^oes. 

(4) How many come in ballast, aod the nature of such ballast, whether 
rock ballast, or sand ballatit, or water ballast, or ballast of some other 
sort, 

(5) How many of the ships briuff passengers { and how many pa£< 
seiigers, and what sort of passengers; whether acclimated or unac- 
climated, and whether cabin or steerage passengers. 

The sort of information here indicated can be always easily obtained; 
and it is easy to see that the quarantine requirements of a port in which 
the arrivals of ships during the quarantine seaeoa amount to several 
hundred would need to be projected on a very different scale from the 
quarantine requirements of a port in which the arrivals number only a 
few dozen, AVooden ships, under sail, in ballast, without cargoes, with 
acclimated crews, and without passengers, such as frequent so many of 
our gulf ports to take away lumber and naval stores, require very differ- 
ent treatment from iron steamers, with valuable cargoes, and uumeiona 
tmacclimated passengers. 

From another point of view, ships may be divided for quarantine pur- 
poses into those coming from infected ports, indeed, but with clean bills 
of health and no history of infection, and in regard to which the pre- 
sumption is that they are not dangerous; and those without clean bills 
of health, or with a history of epidemic disease during the voyage, or 
which for some reason are vehemently suspected of infection; and these 
two classes of ships require very different treatment 

In regard to ships of the first class there is twenty, thirty, forty to 
one, that they are free from danger. Nevertheless it is considered to be 
expedient to disinfect them with more or less care, with the hope of pro- 
\'iding against'all contingencies and of rendering safe the very small 
percentage that in spite of appearances may, perchance, be the carriers 



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No. 16.] CONFEBENCB OF StATB BOARDB 295 

of infection. The lar^e majority of oar quiirantine stations are intended 
to deal exclosively with this class of -vessels. 

Ships of the second class, those that are known to be infected, or that 
are vehemently suspected to be infected, are treated with mnch more 
rigor, and for them separate stations have been constructed, where an 
abundance of time is taken, and all the resources of disinfection are ex- 
hausted in the effort to make them safe again before they are restored 
to commerce. 

There ia only one port on the ^If coast where this dangerous class 
of vessels is treated by the local quarantine authorities, and that is New 
Orleans, which city has two separate quarantine stations near the month 
of the Mississippi river, one for the treatment of vessels belonging to 
the first class, and one for the treatment of vessels of the second class. 
Pensocola, Mobile and other smaller frulf ports send ships of the second 
class to the national quarantine station at Chandeleur. 

For convenience we call these two classes of quarantine stations, re- 
spectively, inspection stations and refuere Btations. I may be pardoned 
here for recalling attention to the fact that the eatablishment of refuge 
stations grew out of a recommendation made by me to the National 
Board of Health in I S79. The outfit of a refuge station need not differ 
much from the outfit of an inspection station, except in the provision of 
hospitals and warehouses; but it would astonish any one but a quaran- 
tine expert to know bow very small is the extent of hospital and ware- 
house accommodation that is needed at a gulf refuge station. At an in- 
spection station, of course, the need is still less, and most inspection 
stations in the gulf can get along very well without any provision in the 
way of hospitals or warehouses cither. 

The inspection station takes charge of ships that are presumed not to 
be duigerous, and the aim of such stations is to treat these ships in 
snch a way as not to occasion any considerable delay, and as not to in- 
volve any very great cost in such a way ; in other words, as not to throw 
too mnch embarrassment in the way of commerce. I do not hesitate to 
assert that a quanuitine detention of ten days at any gulf port woold 
act as an absolute embargo on the commerce of snch port with all 
tropical countries subject to yellow fever; and I will assert further that 
a detention of five days at quarantine is more than our West India com- 
merce and travel can very well bear. For Havana steamers any deten- 
tion of more than a few hours is found to be burdensome. The disin- 
fecting work at our inspection station must t>c done speedily. At the 
refuge stations the period of detention may be as extended as you please; 
in the case of the sick, until their recovery ; in the case of the ship and 
its cargo, whatever time may be considered necessary for their purifica- 
tion. If the ship is empty, all that is possible in the way of disinfec- 
tion can be accomplished in a few days. If there is a cargo to be treated 
then tbe character of the cargo has to be taken into account. In the 



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296 State Board of Hbaivth. [Off. Doo. 

meantiime there is do theoretical reason why a ship should not be dis- 
iulected as speedily at a refuge station as at an inspection station. If 
the methods employed at the inspection station ^arantee the sabse- 
quent immunity of the ship from danger, why should not the same meth- 
ods secure such immunity under all circumstances T Htill the practice 
ie as I have stated it to be. 

In projecting a scheme of quarantine, the first problem to be settled 
is whether the disinfecting apparatus shall be carried to the ship nt some 
convenient anchorage, or whether the ship shall be brought to some 
wharf where the disinfecting apparatus is stationed. A few years ago 
the rule was to treat the ship at the quanwtine anchorage. The rule 
now is, since the introduction of what is commonly called the improved 
quarantine system, to bring the ship to the quarantine wharf. 

The agents of disinfection are the same in both systems, namely : (1) 
Ventilation. (2) Cleanliness. (3) Sulphur fumigation. (4) Flooding 
with mercury bi-chloride solution. (5) The application of dry and wet 
heat. These agents are applied to the disinfection of the ship, to the 
disinfection of the ballast, to the disinfection of the cargoes, and to the 
disinfection of the baggage and bedding of the passengeru and crews. 
It is necessary to make a few remarks under each of these heads. 

(1) The disinfection of an iron steamer, without bilges and without 
cargo, can probably be accomplished with tolerable certainty by sulphur 
fumigation and flooding with the mercury bichloride solution. If we 
have to deal with a wooden ship with two skins, foul bilges and sodden 
timbers, the problem is much more difficult, and it has been generally 
believed the foul bilgea themselves are apt to become infected, we ore 
warranted in doubting whether the disinfection can be snccessfally ac- 
complished at ail, unless the inner skin is removed and the accumula- 
tions of filth in the bilges removed by scraping. I have known yellow 
fever to break out again in a few days in a ship of this sort whero great 
labor hail been expended in the effoii to make her safe. 

(2) Very few outbreaks of yellow fever have been traced to infected 
ballast; but cases enough have occurred to render the ballast sus- 
picious. Clean rock ballast might, perhaps, admit of disinfection 
without removal from the hold of the vessel. But when dirt ballast is 
encountered, packed hard for a depth of several feet, prudence would re- 
quire its removal. This is not always so simple a thing as many might 
imagine. Tlio ballast is necessary to preserve tho stability of tho ship 
in the water. It cannot be removed safely while the ship is at anchor, 
and if foul ballast is removed other ballast must be put in its place. 
"With water ballast the problem is, of course, easy. 

(3) I think in the large majority of the cases wo have to deal with, the 
disinfection of cargoes without removal from the ship is impracticablo. 
For any effort in this direction wo would have to depend almost exclu- 
sively on the sulphur fumigation, and I doubt if it could be efficiently 



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No. 16. ) COHFEBENOE OF STA.TE BOABDfi. 297 

applied. It is hardly worth while to inquire whether cargoes can be 
saccessfully difiiofeoted after removal from the ship, because any sach 
practice as this would require bo much time and so much expense that 
oommeroe would not submit to it. Fortunately cargoes are very rarely 
infected. 

(4) Baggage and bedding are the most dangerous of all fomites that 
come to us in abips. It is therefore fortunate that their disinfection is 
comparatively easy. The rough baggage of crews can be boiled in 
simple water, or in bi-chloride solution, and subjected to fumigation. 
The finer fabrics, belonging to the better class of passengers, are a Utile 
more difficult to deal with, because they are liable to suffer serious damage 
if subjected to any of the methods suggested. It is in regard to this 
class of goods that the use of dry heat in the steam cyhnder may be em- 
ployed. But even this method sometimes does considerable damage. 
Resides, when lai^e quantities of baggage iu piles and bundles are 
treated in the cylinder, the heat is not always sufficient to guarantee the 
destractiuti of all the disease germs. I cuppose a good many of those 
who hear me have been surprised that all I have so far said about the 
improved Quarantine methods, so much talked about of late years, has 
been au incidental allusion. I have not cared to discuss at length these 
improved methods*becauBe I believe their value as compared with the 
older methods has beoa greatly exaggerated. The same identical agents 
of disinfection are employed in the old system that are employed in the 
new, and the only important consideration is that their application shall 
be »8 thorough as possible. I am sure that the atmosphere of a ship's 
hold can ha impregnated with just as large a percentage of sulphur 
dioxide by the old method of burning the sulphur in pans, as by the 
uew method of burning it in the furnaces outside of the ship, and it does 
not take any more time. I am sui-e that the holds and decks of ships 
can be just as thoroughly deluged with the mercury bi-chloride solution 
by the use of tubs and buckets as by the use of an elevated cistern and 
& hose pipe. And I am snre that all rough textile fabrics can be as com- 
pletely disinfected by thorough boiling in common water, or after soak- 
ing in the solution of the mercury bi-chloride, as in the steam cylinder. 
It is only iu the treatment of the finer fabrics, as already explained, that 
the steam cylinder plays a port of special importance. 

Ne%'ertheless, I would favor the adoption of the newer method by all 
X>orts that are able to bear the expense. They are more elegant, more 
convenient, and impress to a much greater extent than the old ones the 
imagination of everybody concerned. 

The President. The discussion will be continued by Dr. UUiphant, 
president of the State Board of Health of Louisiana. 

Dr. Ollifhamt. Mr. Pi-esident and Gentlemen: The discussion which 
I liave been selected to open is on the interesting question proposed by 
the State Board of Health of Alabama. 



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298 State Boabd of Health. [Off. Doc, 

First. Given a vessel with cargo from Oentral or Soath American 
ports, or the West India Islands: Can such a vessel and cargo be dis- 
infected withont discbari^g the cargo 1 

Second. Can suchcargobedisinfected thoroughly, and without damaf^, 
after it baa been discharged ! 

The subject matter of these questions is so intimately connected with 
the first question submitted by the State Board of Health of Lonisiaua, 
that in discnssiug the former, it is impossible to avoid entering very 
fully into a description of what the board of health of Looiaiana believes 
to be at least part of the "requisites for a thorough system of quaran- 
tine and maritime sanitation in the light of present scientific attain- 
ment." The gentlemen who have been so happily chosen to open the 
discussion of the questions submitted by the board of health I have the 
honor to represent, will certainly appreciate this necessity, and under- 
stand that there was no intention to attempt to create prejudice for or 
against their views on the subject. 

New Orleans may, without presumption, be said to be the port in this 
country that has afibrded the greatest practical experience in the disin- 
fection of vessels and cargoes from dangerous points in the countries 
named in the first question, and it was doubtless, with the intention of 
eliciting information as to the results of this experience, that one of the 
representatives of the state of Louisiana was chosen to open the discus- 
sion. 

It is almost superfluous to state that I am here to sustain the afSrma- 
tive side of the discussion ; at any rate as far as the first question goes. 
It is a matter of almost daily occurrence every summer for \essels with 
cargoes from the countries named to be disinfected at the quarantine 
station on the Mississippi river without discharging any part of the car- 
goes, and without damage to the vessels or the goods they carry. 

It is true that when the State Board of Health of Louisiana, under 
the able lead of my predecessor. Dr. Joseph Holt, undertook to replace 
by % system of scientific and efficient disinfection the old, brutal and 
haphazard quarantine methods that still prevail even to-day in many al- 
leged civilized countries and communities, mistakes were mode that re- 
sulted in more or less damage to the vessels and cargoes, but this was 
almost inevitable under the circumstances, and in few cases did the dam- 
age reach important proportions. 

The danger of damage being done in the process of disinfection is 
uow practically «i7, and does not need to be considered in connection 
with the system under which we operate. 

Of course a certain cla^ of cargoes cannot be disinfected by any 
known process whatever without utter destruction to the articles handled, 
but the only cargoes of this nature that we find coming from the coun- 
tries under discussion u.re bananas, pineapples, oranges, limes, etc., and 
it seems to be conceded that while the vessels carrying these fruits may 



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No. 16.1 CONFEBENCE OF STATE BOARDB. 399 

bring in diBease, the fraits themselves are not to be dreaded aa possible 
germ conveyers. 

The cai^oes from the countries named in the questions, that are looked 
on as probAble f^erm carriers, and that can be thoroughly dlBinfected on 
board of ship irithout damage, coDSiBt of oofTee, sugar, tobacco, woods, 
mbber, hides, bone, etc., and in some cases the vessels have baled, 
Ijozed and other goods loaded in Europe and carried around by way of 
the West Indies and Central America, that naturally come in contact, 
more or less, with the articles taken on board at the dangerous points 
visited on the way. 

This is the class of cargo that is presnmably referred to in the ques- 
tions propounded, and I state, as a fact, that we cui and do disinfect 
vessels and cargoes of this description at the Mississippi river quaran- 
tine station without discharging any of the goods, and without damage 
to ship or cargo. 

It is true that we land the clothing and bedding of the crews and pas- 
tiengers, and all the movable textile fabrics on board the ships, and treat 
these articles on shore, but they cannot properly be classed with the 
cargo, and the handling of them is accomplished with very little extra 
expense and probably no extra delay. In fact, with proper appliances 
and thorough system, the disinfection of the articles so landed c&u 
be carried on simultaneously with the treatment of the vessel and cargo. 

W© have every reason to believe that onr disinfection now is thorough 
in every detail, bnt it is not possible to make this assertion with abso- 
lute certainty. 

It will donbtlesB be conceded that the clothing and bedding of the 
crews and passengers are the most dangerous character of fomites. It 
will therefore be appropriate to consider in the first place the process of 
disinfection which these articles are subjected to. 

Heat e£Bciently applied is universally recognized as the disinfectant 
par excellence. 

It is to this agent that we have recourse in treating the clothing and 
bedding, etc., from vessels that come within the scope of the questions 
nnder discussion. 

The articles to be disinfected are hung on racks suspended inside 
large iron cylinders, through which run numerous coils of pipes which 
convey from a steel boiler the heat necessury to raise the temperature 
in the cylinders to 210° F. of dry heat, when steam is allowed to rush 
direct into the cylinders, rapidly raising the temperature to 230° F, of 
moist heat, at which figure it is kept for at least half an hour with pres- 
sure on the cylinders of about seven pounds to the square inch 

I call special attention to this statement because Dr. Oochran doubted 
very much whether or not the heat permeated thoroughly the articles 
sal^ected to it. 

Ih*. CoCHBAN. I bad in mind especially the experiments made by Dr. 



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800 State Board of Health. ' [Off, Doc. 

Ki&youn. You say Beven pounds to the squuv inch. Do you mean 
seven pounds nbove the fifteen ponndsT 

Dr. Ollipuant. We have valves connected with this cylinder that 
blow off ut seven pounds pressure in eicess of the fifteen pounds nor- 
mal air pressure. 

The articles ore thus subjected to a heat of from 210° to 230° F. for 
a total period of nearly one hour, and it is found by actual esperiment 
tbat under this pressure thermometers imbedded in the center of pil- 
lows and mattresseB indicate ihe same temperature as that of the cylin- 
ders, proving conclusively that the beat penetrates thoroughly all arti- 
cles exposed to its action. 

Some years a^o the United States Marine Hospital Service, upon in- 
vitation of the Louisiana State Board of Health, commiBsioned Dr. Ein- 
youn to investi^te and report upon the efficiency of maritime eanita- 
tiou as practiced at the Mississippi station at that time. Although the 
means of application were then far inferior to the present arrangements. 
Dr. Einyouu's report showed that this step in our methods of disinfec- 
tion was very certain in a(,tiou, apd deatraotiTe to most germs that were 
submitted to this test. 

If then it was so very effective at that time, we are justified, with our 
improved appliances, in claiming to-day absolute efGciency, and believe, 
were Dr. Kinyouii's experiments now repeated, the result would justify 
the claim. 

pn support, see page 267, Beports and Papers of the American Pub- 
lic Health Association, Vol. 11, in which Dr. Sternberg states that steam 
at a temj^crature of 230° F. maintained for a period of one or two min- 
utes, or of 222° F. maintained for ten minutes, will infallibly destroy the 
spores of bacilli which constitute the most difficult test of disinfecting 
power, kuowu.] 

At tim same time that this heat disinfection is being applied a force of 
men is I'ngaged with mercuric chloride solution in washing down decks 
and cabins, and sprinkling all ai'ticles that would be damaged by heat 
disinfection. This solution is made of a strength of 1 to 1,000. There 
18 no special skill requireil in its application, care as to thoroughness 
being the main point to bo considered. This solution is contained in a 
tank of about 7,000 or 8,000 gallons capacity, placed at an elevation of 
about fuity-fivo feet. The tank is connected with pipes leading along 
the whai-f. By means of a rubber hose mth nozzle and spray attach- 
ments, a stream of the solution can be conducted and thoroughly applied 
to any and all parts of a ship 

A? this process of disinfection is clahned to be efficient, we will now 
consider the lost step, t. e., the fumigation of a ship's hold and cai^^ 
witli sulphur dioxide 

It is apparent, if reference is made to the report of Dr. Einyoun, that 
bis Bxpevimeiits were not very flattering to this process as practiced at 



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170. 160 CoNli^RENCB OF HTATB BoAUDS. 301 

that time. But with the improv«ments made since then, we believe this 
portion of our service has been made to equal if not excel the efficacy 
of oar other methods. 

Formerly the SO, (^Derated was obtained by the combination result- 
ing from the volontary combustion of the eolphur in a furnace to which 
oxygen was admitted in unlimited quantity. 

Dr. Cochran in bis paper made the statement that the old methods — 
X do not refer specially to methods immediately preceding the present 
system — suffice for the purpose of saturating the hold of a ship with 
SO, gas OS well as any that have been devised since. 

It is a well-knowQ fact that combustion cannot take place in on at- 
mosphere with one-half its oxygen replaced by 80 j — such an atmosphere 
would extinguish combustion. That being the case, it can readily be 
seen that by former methods a ten per cent, gas was the highest possi- 
ble attainment. As a, matter of fact, testa showed from four to eight 
per cent, in our former system which is claimed to hf> superior to the 
pot system. With this weak gas introduced into thd large volume of 
air contained in tho hold of a ship, it can readily be imagined to what 
degree of dilation it would bo subjected, and what length of time would 
be required to replace or saturate the ship's air by pouring this weak 
gas into it. 

I am asked by nat authority I make the statement that on atmoa- 
phero containing ten per cent, of SO-, will extinguish combustion. 

It the doctor will allow me, probably I would as well make the state- 
ment now as on the completion of this paper— I give Br. Albrecht as 
my authority and tho following test in corroboration; 

Oa tho completion of our new fumuco I was naturally solicitous, con- 
sidering the short lead of pipe to hold of ship, as to vfhetfaer or not we 
Tan risk of setting fire to a vessel. Dr. Albrecht assured me of tlje im- 
possibility of combustion in an atmosphere with one-half its oxygen re- 
placedbySO, gas. Havingtestedthogasandknowingittobostronger 
than ten per cent., we made the following experiment: A hogshead filled 
with shavingd saturated with coal oil was set on fire ami the gas played 
on it. The volnminous flames were almost instantly extinguished. On 
esamiiiation afterwards it was found that even the oil on the shavings 
had not been consumed. This proved conclusively to my mind the 
statement mode by Dr. Albrecht. 

With the improved apparatus now in use, we consume almost all the 
oxygen in the air supplied to the furnace, and generate a gas of from 
fifteen to twenty per cent, strengtli. We also favor the displacement of 
the air contained in a ship's hold by introducing this gas, twice as 
heavy as the atmosphere, into tho bottom of the ship and at the same 
timo exhausting the foul air contained in the ship through a pipe con- 
necting with and tapping the ship's hold almost flush with the deck. 
Sy this means we lessen the dilution of our SO, gas and favor the dis- 



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802 State Boabd of HealtiI. [Off. Doa 

placement of the atmosphere ; nt the same time we are pnssing this Bup- 
poBed infected air over our heated sulphm: in the furnace at a tempera- 
ture of about 600° F., literally cHinsuming ^1 organic matter, and con- 
verting almost the entire oxygen into sulphur dioxide. Certainly the 
atmosphere passed through tho furnace is mo6t thoroughly disinfected, 
both by heat and SO^, and we believe by the length of time devoted to 
ft ship's hold, that most, if not all the air contained therein, has passed 
throunfh this ordeal 

Any particles of contaminated air that may possibly have sscaped the 
force of our suction current from the ship we believe will be relieved of 
all living organisms by its oxygen being materially diminished and re- 
placed with the deadly HOj gas; practically an atmosphere permeated 
with SOg to the extent of ten per cent, is considered germicidal. With 
our present apparatus we are confident we easily obiain that degree and 
even stron^r 

Our apparatus consists of a boiler-like cylinder containing one or 
more pans, arranged one above the other with air spaces connecting 
them alternately at the front and back, whereby the air is made to paw 
over the contents of all the pans. Underneath the cylinder is a furnace 
arranged in the same manner as for steam boilers, with ash pan, etc., 
which furnace serves to keep the sulphur in the first pan in a molten 
state and the heat from this pan melts the sulphur in the pan above. 
An air-tight pipe from the hold of the verael to be famigated, is con- 
nected with the furnace immediately over the surface of the bottom pan 
to supply oxygen for the generation of the sulphur di-oxide. This pipe 
is provided with a cock for obtaining samples of the air, and a valve for 
regulating its supply to the furnace. 'An eleven-inch discbarge-pipe 
taps the furnace at the top, curving over, leads down into and within six 
inches of the bottom of a reservoir. From the reservoir tho gas is drawn 
by a "Sturtevant fan" through an eight-inch pipe, issuing from the side 
of the reservoir, but having a curved section on the inside reaching 
nearly to the top, and is forced thi'ough a lead of pipe, extending 
through the roof of the tug to the pilot-house, and thence to the bottom 
of the ship's hold. It will thus be seen that, as the gas entering the 
reservoir is lead nearly to the bottom of the reservoir and having to 
leave again through the curved section of pipe near the top, the direct 
current is broken and any particles of burning sulphur that may enter 
are apt to be lodged at the bottom. The difference of size of pipe of 
entrance and exit is made with a view of having a slow current in and 
from the furnace to tho reservoir through tho fan; this result natorally 
following as the same amount of gas must necessarily leave the reaer. 
voir through tlie small pipe as comes iu through the largo pipe, thereby 
allowing louger contact of the air with the surface of the sulphur. 

You will observe we now have a connection between the compartment 
to be disinfected and the furnace, by which we can keep up aoontinuotui 



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No, 160 CkmiEBENOE OP State Boards. 303 

current without theadmiBsion of any air from the ontaide world. After 
charf^n^ the pans with sulphur, the furnace iti closed and the fire started 
in the box underneath. In a few minutes the sulphur is in amolten state 
— not burning, because it has no oxyg«n supply ; then the fan is started 
driving a current from the reservoir into the hold and prodacin^ a re- 
turn current in second pipe from the hold to the furnace. We now have 
the apparatus in fall operation, drawing the foul and infected air from 
the ship's hold into the furnace, literally burning it and converting its 
oxygen into SO,, and sending this deadly gas to the bottom of the ship. 

I believe with the above appliances ships with the ordinary cargoes 
can be and have been thoroughly disinfected without dischai^ng oar- 
goes. Cargoes thus disinfected in the hold of a ship can be simila.iy 
treated when removed to a compartment speoially prepared for the pur- 
pose, bnt this procedure would entail extra time, labor and expense, and 
not render the service any more e£Scieut. 

From a practioable standpoint one can conceive of particular kinds of 
cargoes, rags, baled goods, etc., that would not be thoroughly disin- 
fected by the methods mentioned. Even these could be disinfected by 
proper exposure to our agents, but as such exposure would not be prao- 
ticable, this class of goods is not brought to our port in quarantine 
season from the countries named ia the questions under discussion. 

I think Dr. Cochran did not understand one or two statements in my 
paper — one of which is in i-egard to the generation of the sulphur gas. 
The doctor makes a statement that according to my own paper I would 
have to admit that we could only generate a gas of ten per cent. 

I>r. CocHBAM. Undoubtedly if you draw the air out from the hold of 
the ship. 

Dr. Oluphant. If the doctor will understand, my original statement 
-was that an 80^ gas cannot be made stronger than ten per cent, by 
bnming anlphur in the atmosphere. We do not claita to generate this 
gas in that manner. The sulphnr is kept in a molten state by a fire 
underneath the pan, and oxygen Or air is supplied simply for chemical 
combination. 

Surely, sulphur in a molten state la in the most favorable condition 
for chemical union with oxygen, and it is beUeved that a supply of air 
properly regulated will he deprived of nearly all its oxygen, which latter 
is converted into 80^ gas. As a matter of fact, we have by actual test 
obtained a gas of eighteen per cent. 

Dr. Cochran also expresses his doubts, in the absence of lacts, as to 
vhether this gas, let down into the ship at one point, would permeate 
the whole ship. 

All large ships are cUvided into compartments, and each compartment 
is fumigated. 

Dr. Holt, vith a view to removing just sucn doubts, placed vessels 
containing water at the most remote point from the entrance of the 



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304 Stai-e Board of Health. [Off. Dog. 

gas in the hold of a ship loaded with coffee, coyenag these vessels with 
sacks of coffee, and after the completion of the famigation this water, 
on examination, proved to be strongfly impregnated with solphar. I 
propose making other experiments the coming sammer. 

As to the impracticability of thoroaghly disinfecting baled goods, I 
agree with the doctor f nlly, but it is to be remembered, as I stated in my 
paper, no such goods are shipped from intertropical ports to our port 
during qtiarantine season. 

As to the damage done to textile fabrics in heat disinfection I will 
state, that the most delicate silks and laces have been subjected to this 
process withoat being injured in the least. 

Regarding the question of ballast I will state that our board, recog- 
nizing the impossibility of disinfecting earth-ballast, has prohibited the 
bringinjT of such ballast from infected ports. 

Dr. Salomon. Mr. President and members of the conference: I have 
been requested by Dr. Olliphant to continue the discussion of this sub- 
ject, and will ask your attention for a few moments: 

The question as to what constitutes a thoronghly efficient system of 
quarautino, offering the greatest assurance to seaports subject to inva- 
sion of epidemic disease through their commercial relations with in- 
fected foreign ports, having been discussed, and it being admitted that 
the methotls in operation in Louisiana meet the requirements and guar- 
antee a reasonably certain protection, it necessarily follows without ar- 
gament, that seaport towns not pursuing such methods while allowing 
intercourso with infected places, not only do not protect themselves, but 
expose other and adjoining states to the liability of invasion by disease. 

The liability may bo remote, it is true, still it exists, and existing, it 
becomes a matter of serious consideration what measures should be 
adopted by the several states tu protect themselves without causing 
conflict and disagreement, which never results in good. 

It is to be regretted tliat no succcssfnl effort has yet been made to 
solve this problem of self -protection; and it is with this object in 
view that the question has been iiropounded, in the hope that this con- 
fereneo will be able to arrivo tt a conclusion whereby all intci-cstcd 
states will bo nblo, thitiugli tlieir duly constituted health authoriticit, to 
act in harmony, by means of a common understanding 0.-3 to tlio i:eeds 
of each. 

It is not our intention to reflect upon the good faith oi- jiropci- »igi- 
laucu of any particular state; and while granting to each the i;ght to 
act ns it sees £t in the matter of quamntino x^'otcction, and the adop- 
tion of whatever measures may bo selected, and by it considered ade- 
quate to meet the needs of proper sanitary protection, wq still claim 
the same right of refusing to rLcognizo such methods as offering a 
guarantee of protection if the system iu voguo does not meet all the 
conditions considered essential to a thorough, efficient and modem 



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No, 16,] Conference of State Boards. 305 

qasnmtme service, or system of maritime sanitation at porta of arrival. 
In the exercise of that lifirht, therefore, it necessarily follows that we 
seek for the beet means of preventinf; the introduction of pestilential 
disease throng h other ports, when omr own ports are provided with 
what we deem adequate methods of protection, and while so doing:, 
leave without question to each state to provide its own methods of quar- 
antine; but say that others should not be the means of afflicting' as. 

We of the State of Looisiana, foremost in the matter of quarantine im- 
provement, believe, vrith onr complete methods of fumigation and dis- 
infection of vessels, cargoes, baggage and ships' effects, coupled with a 
reasonable period of detention of passengers and crews after the work of 
sanitation is completed, that we provide all that can be done in the way of 
keeping out pestilence; and i^ the health authorities of other states do 
not deem this sufficient for their protection from invasion through Lou- 
isiana it is their doty to protest; and, failing to secure a better guaran- 
tee of safety, to adopt such measures as become necessary to defend 
themselves. 

We claim the same privilege. 

For several years after the epidemic of 1878, which scourged the Mis- 
sissippi valley and which found its way to this country through New 
Orleans, the other states exposed to the direct danger of another visita- 
tion expressed their want of confidence in the efficacy of the methods 
then in vogne in Ijouisiana, and adopted such measures as they thought 
best for self-protection. 

This vant of confidence and a desire for greater assurance of safety 
gave rise to the National Board of Health through whose officers and in- 
spectors such measures were instituted as satisfied the doubts of com- 
plaining states, and through traffic went on uninterruptedly. 

Bat for reasons which it is unnecessary to mention at this date, con- 
gress deemed it wise to take away the powers of said board and leave to 
each state its own methods of protection. 

I refer to this, not for the purpose of reviving any of the former argu- 
ments either for or against the National Board, but only to direct atten- 
tion to the fact that, Louisiana at one time showing itself derelict, other 
stat^ sought and fonnd means which at the time satisfied them to a 
reasonable extent. 

The same conditions as then existed at all the gulf ports, exist to-day 
as to some of the ports on the Atlantic and the Qulf of Mexico. A few havp, 
at an enormous expenditiu'e of money and incessant effort at improve- 
ment, provided themselves with quarantine disinfecting plants of mod- 
ern construction ; some, durisg the danger period, maintain strict non- 
intercourse, while others offer no protection at all or their methods are 
inadequate; and it is as to our relations with these two latter that we 
are particularly interested and ask the deliberations of this conference 
a8 to what is the best course to pursue. 
20-16-91. 



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306 State Boabd op Health. [Off. Doc. 

We claim that such ports should not be allowed to give free entrance 
to either freight, baggage or persons whereby the least risk of infection 
IB incurred, as it is iu auch through traffic that great danger lies, and 
against which we protest. 

While Looisiana with its efficient quarantine system and untiring vig- 
ilance is seeking to protect itself throueh its own ports of entry, it is 
ever anxious lest through other ports it may be visited with yellow fever 
from Havana or small-pox from Mexico. And if we are to be exposed in 
such manner, where, I may ask, is the necessity of our own methods with 
their delay and consequent cost to commerce. 

While imposing a detention on shipping after thorough disinfection, 
said detention being for observation, and thus providing a time for al- 
lowing the development of disease before giving a vessel praliqve, we 
seriously and emphatically protest against a person being allowed to 
come to New Orleans from Havana in less time than that occupied in 
undergoing surveillance at our quarantine station when coming direct. 

It is with the greatest gratification that we team of the recent im- 
provements iu the quarantine service at Tampa, Fla., but Tampa is one 
of the many ports of entry in the vast peninsula of Florida and through 
many of these ports, passengers with their baggage, can and do come fo 
New Orleans within three or four days of the time of leaving Havana; 
and it should be the duty of the board of health of that state to provide 
the necessary safeguards against the introduction of disease. 

True, an effort is being made in this direction. A boat has been put 
in service to patrol the coast, and this will, to some extent, prevent il- 
licit intercourse, but not entirely so, and therein lies oar source of danger. 

Another, and what we consider a more serious source of danger, and 
one against which Louisiana has protested, is the inadequate system at 
Tampa, It is a matter of history that persons, for the purpose of evad- 
ing detention at the Mississippi river quarantine station, have taken 
ship ot Havana, landed at Tampa, and come through to Kew Orleans in 
three days or a little over. True, they were admitted upon oeriificates 
from the health officer at Havana and their baggage disinfected, but we 
claim that there is not only a possibility, but a probability, that the 
health officer can be deceived as to the acclimatization of such persons, 
with the risk of attending results. 

Again, persons destined for points north of latitude 38° 64', can go 
from Havana to Tampa without further question than as to their ap- 
parent destination, and with their baggage coming from a probably in- 
fected quarter, go through without detention or disinfection, and pro- 
ceed, it they so will, to Mobile, Memphis, New Orleans, or other points, 
open such baggage in some boarding house, hotel or private residence, 
and thus expose the community to the liability of infection of yellow 
fever. 



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Na 16.] CoNFEREMCE OF State Bo&rds. 307 

During what is cousidered with us the danger period of last year, the 
board of health of the State of Louisiana protested against being thus 
sabjected to the danger of epidemic which we were using our means 
and energies to keep away, and this protest failing of securing any 
change, we adopted measures which we thought best for oui: protection. 
The health authorities of Florida were notified that we would not allow 
any persons coming under the above mentioned conditions, to enter 
Louisiana without disinfection of their baggage, or if baggage had been 
disinfected at Tampa, without undergoing a detention for observation 
such length of time as would assure safety to the community. 

Bailroada were notified not to carry such passengers into Louisiana, 
and that if such were found they would be taken from the trains and 
sent to the nearest quanuttine station. 

Plorida took umbrage at this action, and it was charged that Louisiana 
had proclaimed quarantine against Florida. Ifot so. LouiBiana was 
simply endeavoring to enforce its own regulations against passengers 
and ba^^age from Havana. It is a difference of small import whether 
passengers come to New Orleans via the Mississippi river or via Tampa. 
Tbe resulting danger is the same, and we proclaim the right to prevent 
such travel without proper and necessary sanitary precautions, by what- 
ever route it may come. 

Therefore, I repeat, we did not quarantine persons or freight from 
Florida, but we did say, that through the assistance of Florida's regula- 
tions, persons should not violate oar own quarantine regulations against 
Havana. 

It was and is still far from the intention of Louisiana to provoke con- 
troversy with Florida. Wo simply ask that she shall not expose ns 
through a lax system. If the State of Florida alone were to receive such 
passengers and retain them within her borders, we should enter no word 
of protest, but be ever vigilant for the first spark of danger. But when 
they can come to us without having undergone what we consider proper 
and efficient sanitary treatment, we protest and endeavor to prevent. 

In view of all the foregoing we come to this conference asking the 
qaestion propounded, seeking advice or suggestion if our views are not 
concurred iu, and requesting an expression through resolution or other- 
wise whereby this vexing problem may be solved in the interest of har- 
mony between state health authorities, and for the better protection of 
the people with whose safety from pestilential disease we are chargetL 

The President. The next subject for discussion will be the question 
proposed by the State Board of Health of Ohio : 

1. Should state boards of health have control of the sanitary ar- 
rangements of all school buildings to be erected within their boundary i 

2 What is the best plan to secure such control 'i 

Diacossion opened hy Dr. Louis Balcli, of Albtiny, N. Y. 



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308 State Boabd of Health. [Off. Doc . 

Dr. Balch took the position that local boards of health, and not state 
boards, ohotild control and look after the sanitary airan^ments of school 
buildings. He gave many esamples to show the difficulties a state board 
would meet with in attempting to remedy the many evils connected 
with school boildings. 

Dr. Probst. Dr. Balch has mistaken the drift of the question pro- 
posed by Ohio. He has confined his remarks to school buildings al- 
ready erected, and to the various nuisances arising in school life. It is 
the school buildings to be erected that we would urge ehould be under 
the control of some central authority. This need not necessarily be the 
state board of health, although it is to be supposed that this board will 
better understand the sanitary requirements of school buildings than 
any other. In our state the matter of erecting pchool buildings, and the 
ventilation, heating and hghting of the same, is left entirely in the hands 
of school boards or school directors — men often guiltless of any knowl- 
edge of sanitation or the sanitary requirements of school buildings. 
Especially is this true of the smaller towns and country districts. It 
has seemed to us that it would be advisable to require the plans of all 
school buildings to be submitted to the state board of health, or to 
some other state authority, and to have its approval before allowing the 
buildings to be erected. 

As for the inspection of school buildings already erected, our laws re- 
quire our local boards of health to do this semi-annually, and we would 
not wish to have this changed. 

The question was further discussed by Dr. McOormack, Dr. Balch and 
othere. 

Adjourned until ten o'clock Monday. 



SECOND SESSION. 

The president announced as the first order of business for the second 

day the discussion of the question proposed by the State Board of Health 

of Kentucky. "What should state and local boards of health teach, and 

what should they do prevent consumption! Dr. Bryce opened the dis- 

a by reading the following- paper: 



How Oonsumptlon la Spread, and Measurea for its Prevention. 

Dr. P. H. Dbvce, M. D., Seenrtary Provincial Biiur<l u/ HeaUh of Ontario. 

In view not only of the fact of consumption being of all causes the one 
producing the greatest number of deaths in temperate climates, wherever 
iiettlement is advanced, but also because of public attention having- re- 
cently been specially directed to the experiments whereby it was hoped 
Dr. Koch had obtained a sovereign remedy for the disease spread over 
the known world, it is proper that we should anew point out the par&- 



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No. 16.1 Conference of State Boards. 309 

mooQt imoortanoe of the public realizing the Dature of the oonditioDB 
ontier which, ia every-day life, the disease gains a foothold La the indi- 
vidnal, and of how people generally can do much to lessen the dangers 
to which they are exposed. 

1. History of the Disease. — CkjnBumptiou means a wasting or consum- 
ing of the physical organism, and owing to this, received the Oreek 
d^gnation, phthisis (a wasting). Owing to little nodules, or tubers 
appearing in the longs and other tissues of the body, it has been called 
tubercle, and ia now scientifically designated tuberculosis. The real 
nature of the disease baa been vainly sought by physicians from the 
time of Hippocrates, who believed it to be a pus disease originating in 
the brain, down to within the last twenty years, when biological stndies 
began to throw some light upon its probable cause. 

So long ago as 1761, Morgagni and his school believed in the contagion 
of consumption, but this view has not been generally held till the 
present day, when, through direct experiments, Villemin, in 1866, showed, 
by inoculating rabbits with tuberculous matter, that the disease could 
be artificially produced, has its infectious character been established. 

He concluded : 

1. "Tuberctilosis is a specific disease. 

2. "It is an inoGulable disease. 

3. "It may be successfully inoculated in rabbits from man. 

4. "It belongs, therefore, among the virulent affections, and takes its 
place in classification with small-pox, scarlet fever, and more especially 
with glanders." 

He declared that the disease arises by germs suspended in the air, or 
contained in the peculiar tuberculous matter. The development of the 
science of micto-biology or bacteriology has only served to confirm 
Villemin's couclusiona 

"By these investigations of the pest the stage had been quietly set 
for the final scene in the history of tuberculosis." Koch had solved the 
problem of separating or isolating individual micro-organisms, and in 
1882 gave to the world his memorable work on "The etiology of 
Tuberculosis." In it he described the cause of consumption or tubercu- 
losis as being a germ or microscopic plant in the shape of a slender 
microbe rod, five times as long as broad, generally curved in shape, with 
rounded ends, and provided with spores (seeds) which represent its per- 
manent form. These were found by him in the tubercles or nodules, 
from the lungs and the brain of man, from inflamed scrofulous glands, 
joint inflammations from the chalky nodules of the lungs of animals, tho 
hog, ape, guinea-pig, rabbit and other animals. Ten years have served 
only to confirm Dr.Koch'sfirstconclusions.andhavegreatly extended our 
knowledge regarding the susceptibility of animals to the disease, and 
of many conditions under which the disease is propagated and dissemi- 
nated. Dogs, oatUe, chickens and other fowls have all been found sub- 



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810 



State Boasd of Health. 



[Off. Doc. 



ject to taberculosis ; while ite disseminatioii by meaoB of the flesh aod 
milk of animals baa recently been proven by indubitable evidence. 

2. Prevalence of fite Disease. — It will not be wondered at that a dis- 
ease with a history so auoieut, should, during so many centuries, have 
found its way into every portiou of the habitable globe, wherever the 
conditions were sach aa to make its existence possible. That it has 
spread amongst all civilized races, through favoring conditions, will be 
shown later on ; that there are few families in all Europe whose anoesfors 
have not at some time or other suffered from it, will probably be ad- 
mitted, though that there are many existing families who have no his. 
tory of ancestral taint for several generations, abundant evidence would 
seem to prove. This being admitted, and the affinities of the disease 
with glanders and leprosy bein? assumed, the comforting conclusion is 
forced npon us, that aa compulsory destruction of glandered horses has 
eradicated this disease from many communities, and as segr^atiou or 
isolation of lepers has practically cast this opprobrious disease out from 
amongst Anglo-Saxon races, so consumption, in some perhaps far off 
and ideal condition of human society, may similarly become a matter of 
only historical interest to the physician and statistician. 

As the causes and contagiousness of consumption have become known, 
BO its hereditary nature becomes less insisted upon, and the possibility 
of the disease being induced, becomes proportionately prominent. 

To illustrate, however, the task society has before it, the following 
figures are given : 

During the twenty-five years ending 1886, the average total deaths 
from phthisis have been 60,000 yearly, iu England, and those from other 
tubercular affections, 17,700; in all, neeurly 68,000. 

That however great this may be, it means a notable reduction, is gath- 
ered from the following tables: 

Table 1 — Mortality per Million. Persons of All Ages. 



I tS&7-60. 1861-70. 1 1871-80. 188L 1882. 



I 1861. ISSo. I 1886. I 18S7. 



1,762 I 1,718' l.Sel 
054 727 ^8 



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No. 16.] CONTEBENOB OF StATE BoABDS. 

Table 2— OntoWo, .1.881. Phthisis in PerBona Over One Year. 





Number. 


Per oent. of 

deaths of per- 


Ratio to 




464 
218 

1,730 


14.6 
17.0 
13.0 




In towns, 













RftUo of consumption loall causes: 

Iq cities, 14.07 per cent. 

In towns, 17.00 per cent. 

In country IS. 00 per cant 

Table 3 — General Death Rate from Phthisis in 100,000 Population- 
England. 





A, A0S10UI.TU 


HAI. PUBBUITS. 


B, iNHUaTRIAI, PuBSDi-ni. 




Men. 


Women. 


Men. 


Women. 


186S-1S67, 

1868-1877, 

1878-1886, 


200 
190 

168 


253 

306 
166 


243 

191 


275 
224 
179 





Table ir—Beatk Bate from Phthisis—England. 








MBit. 


WOMBW. 




A. R 


A. B. 




100 










79 

s; 

l<9 


B2 


87 










72 


56 









Id the above English tables are found maoy interesting facts; of 
these one is notable, viz., the fact as seen in Table 3, that in fLgricultural 
commiuiities the proportion of deaths from phthisis thirty years ago was 
almost equal to that of those engaged in industrial pursuits. While this 
serves to especially illustrate the insanitary condition of the farm labor- 
ing class m those years, it points similarly to the fact that even with the 



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312 State Board of Health. - [Off. Doc. 

many nicxlerii iniprovenieats in the aaoitary couditiou of workshops, 
yet the overcrowding which is induced by increased mannfactoring in- 
dastries, has failed to equal the improTements which have marked the 
habits of life of the English working classes. The great difference be- 
tween the class in England and in Ontario is gathered from the sub- 
joined figures (see Table 2). 

While the reduction of the death-rate from phthisis in those countries 
where modem sanitation has gained a sure foothold, is most satisf actor}-, 
yet the scientific investigations of recent years have shown that the ex- 
istence of phthisis is by no means limited to the human race. As long 
ago as 1816 Elencke nrged the probability of the milk of tubercular 
cows being capable of spreading the infection. And in France and Ger- 
many rigid inspection of dairy cows is required. That such inspection 
is required will be gathered from the following statements: 

Id Edinburgh, of 660 cows, thirty-seven had mammitis (or six per 
cent, probably, tubercular). 

Dr. Oruikshank, in 1889, iu the report of Qie agricultural department 
of the privy council, states from his own observations and experiments 
that: 

(1) Cows with tuberculosis of the udder are to be found iu dairies iu 
this country. 

(2) The milk of these cows is, as a rule, mixed with the general sup- 
ply. 

(3) The milk, in cases of udder tuberculosis, contains tubercle bacilli. 

(4) Babbits inoculated with or fed upon milk containing tubercle bacilli 
contract tuberculosis. 

From these facta it is i-easonable to conclude that there may be dag- 
ger from using the milk of cows with tuberculous uddero, and therefore 
strict inspection of dairies should be enforced. 

That, however, this may not be sufBcient to ward off all danger, is 
gathered from the statement of Prof. Nocard, at the Paris congress of 
1888, to the effect that it is almost impossible to tell when the udder 
has become involved, until towards the last stage of the infection. 

The recent very complete experiments reported by Dr. Ernst, of Har- 
vard University, give some idea of how great this danger from milk 
may become. 

In February last he appeared before the committee on public health 
of the Massachusetts le^slature, and gave evidence on the results of 
some experiments made at the instance of the society for promoting 
agriculture, aud conducted by Dr. A. K. Stone. He stated that of 1,200 
to 1,300 answers to a circular all but two expressed their belief in the 
possibility of transmitting tuberculosis by milk. He has records of 
probably infection of children from the milk of tuberculous mothers, aud 
cases of infection from a tuberculous cow. Yeterinarians give instances of 
infectionof calves from tuberculous cows, and he has in his experiments ta 



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Wo. 16.] CONFEBBSCE OP StATE BOARDS. 813 

the most positive way, proved the extreme infeotiouBuess of milk in 
oases of tuberculous cows. 

Dr. Ernst started out with the intentioD of determiDtng, if possible, 
the infectjoiisness of the milk of cows where the udder dia not appear 
diseased. One hundred and twenty-six distinct and separate examinar 
tioQS of the railk from different cattle were made — each examination 
meaning three or four days' work. As the result of careful examination. 
oat of 126 series of cover glasses, the bacillus tuberculosis in milk 
oominir from cows having no tuberculous udders at all (shown by post 
mortem) was found in sixteen cases, or in thirteen per cent. 

"By inoculation of the same milk in rabbits and guinea-pi^, in sev- 
enty-four inocnlations we produced six cases of tuberculosis, the inocu- 
lation being horn only one to three drops of milk. This means in over 
eight per cent, in rabbits, and in over thirteen per cent, guinea-pigs. 

"From feeding experiments with twelve pi^s, nearly fifty per cent be- 
came tuberculous, and of twenty-three calves, eight or thirty-three per 
cent, became tuberculous." 

Examination made of samples of milk collected from the city supply 
of Boston similarly showed, both by inoculation and microscope, even 
in the mixed milk taken from a number of cows, the presence of the 
Tims of tuberculosis. 

That this is possible may be judged from the recent experiments of 
Forster, who has found that bacilli of tuberculosis live in milk at least 
ten days. 

But not only is tubercle prevalent in milch cows since the inspection 
of carcasses intended for food, carried on especially in France and Ger- 
many, also shows a very notable percentage of tuberculous animals. 

Toussaint in the Oongres a Tuberculose, held in Paris, 1888, gives the 
percentage of tuberculous cattle at six per cent., while more recent Ger- 
man statistics taken from the report of the royal health officer, Berlin, 
for 1889, give the following results: 



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State Board of Health. 



[0pp. Doc. 





1 

• 

1 


1 


1 






906 
1,110 
344 
543 
403 
1,022 

338 










RotMnUm, ISSS, 


14,136 
U,9IS 

28,000 
17,766 

6,421 


2.6 
8.2 


Munlcb, 18SB, 

Grand Duchr Baden for lliree- 
fourthB or year 1888, 


6.7 
5.2 




84,9T!i 

18,193 


3,066 

612 
CowB alone 


from l.I to 15.9 per 
oenl. 






!t 



It was found Id Saxony that tuberculosis increased tvith a^e in oattie, 
nearly half the cases being: in cattle over six years of »ge. 

Another fact of extreme importance has been proved by Bayard, who, 
in 1889, found that the ratio of frequency of occurrence of tuberculosis 
in men and animals in different districts was almost parallel in both 
cases. 

The absolute necessity for enforcing saritary inspection and improve- 
ments is seen from the investigations of Hirchbei^er, who injected 
guinea-pig^ with the milk of tubercular cows. While fifty-five per cent, 
of these died of tuberculosis, he waa able to find the bacilli of taberoa- 
losis in the milk in only one instance. 

Poultry, as has been pointed out, are very subject to the disease. 

8. Predisposing Causes. — While much has been said and written on 
this subject, daily evidences go to show that unsanitary conditions under 
all circumstances, and understood as applying to every state and 
stage of human existence, are the largest factor in the causation of con- 
sumption. 

(a) Influences of HereiUiy. — Popular aud professional opinion have 
both accorded to heredity the principal exciting cause; but the most 
scientific teachings of the present day are that all that is inherited is a 
tendency due to imperfect development, not of organism in its gross or 
composite form, but in the structural or cell elements of its tissues. It 
will be manifest that if the delicate mother lias a child weak at birth, it 
is probable iu the very nature of things that it will be imperfectly nour- 
iabed by her, and the innate tendency will be rather developed than 



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No. 16.] 



Conference of State Boards. 



316 



That this Ib true Beems to be bome out by the fact of the 
I numbers of children dying' within the first year or two of 
birth from tuberculosis of the intestinal tract and neighboring glands. 

Condi has shown that the bacilli are taken into the Bystem without 
any necessary abrasion of the mucous membrane, and that the intestinal 
tract should be the commoo avenue of infection in children, will be ac- 
cepted without discuBsion 

The ur^nt necessity for increased attention to this period of danger 
is illoBtrated by statistics. Thus the Begistrar General of England has 
shown that while the death rate per million from phthisis and tnberca- 
lar brain disease since 1861-70 had decreased, that from tabes mesen- 
ierica and scrofula has increased, thus: 







■L 








$ 








H 


I 






5? 


S 








i 
























* 












TOT 


1.800 









To the malnutrition which plays so fatal a part in those with a ten- 
dency, aa infants, we can see that the tendency is by no meaoB at an 
end with the teething period. 

Everywhere, but especially in the dwellings of the poor is seen crowd- 
ing vith uncleanliness, and food, poor both in amonut and quality, and 
its preparation. 

The following from the local government's board report for 1889 
shows the necessity for attention to this source of disease: "Milk con- 
tinues to be the chief subject of analysia; out of 26,344 samples of vari- 
ous article of food, drink and drugs, no less than 10,859 were of what 
professed to be milk, of which 11. T per cent, were condemned." "While 
in one of the London districts, St. Pancras, out of 129 samples, no less 
than fifty-five, or nearly forty-three per cent, were condemned." 

The following inBtance illustrates the enormity of the crime of adultera- 
tion, and the inadequacy of the fine to prevent adulterating: 

"In another case in which the milk vender stated that he rarely sold 
more than a farthing's worth at a time, the sample taken was found 
diluted with fifteen per cent, of water, but the magistrate considered 
that one shilling was an adequate fine. On this decision the public 
analyst commeats as follows: 'It is these small portions of milk which 



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316 State Boabd op Health. [Off. Doc. 

are OBed to fill the bottles of yonn^ cbildreo, aod are often diluted by 
tke parentB after the purchase, and thus it is impossible to say how 
weak the milk becomes before the same is used, but it is not difGcult to 
onderstand why the mortality amouffst the children of the poor is so 
great.'" 

As might be inferred, the dangers minimized by the small amount of 
milk used by the poorer classes, are ou the other hand increased from 
their milk supply, of the poorest quality, being more likely to come from 
diuries inferior both as regards the healthfulness of the cows, and t^e 
cleanliness of their surroimdings. The high mortality amongst the 
children of the poor may fairly be charged in a large part to the maras- 
mus arising from mal-natrition due to insufficient and unwholesome 
food. 

Under these circumstances it is plain that whatever inherited weak- 
ness there may be, the subsequent conditions result in a lessening of 
the natural resistance of the system to the disease. 

Councilman well illustrates the difference in the resisting power (rf 
different individuals by the amount of connective tissue formation 
thrown around infected points, eis a cantery or miliary tabercle. He 
says: 

"In some cases (in autopsies) almost nothing of this is seen and the 
disease posses rapidly into inflammation and caseation. These differ- 
ences show themselves in different organs of the body and indurated and 
healed apices of lymph and bronchial glands are common." 

Beferring to the assumed predisposition in combating hereditary 
tuberculosis, he further says: "All conditions of life which produce alow 
state of vitality in the system, predispose to consumption." 

Turning then to some of these, in addition to what has been said 
re improper and deficient food, we would place first : 

(6) Overcrotoding. — The following statistics re Increase of general 
mortality according to the population per acre, is of interest. 

James T. Hammach, F. S. S., assistant superintendent of statistics. 
Begistrar General's office, says, speaking of therelation between density 
of population and mortality from consumption : "The facts about to be 
adduced will show that density of population, so far as being an unim- 
portant element with regard to the mortality from consumption, is in 
fact a very potent agent in producing that fearful and destructive 
malady. 

"Overcrowding is of two kinds, (1) On the superficial area, (2) in cubic 
space; and either may exist independently of the other. In the country 
where there is no overcrowding, a laborer's cottage may be so crowded 
by its inmates that disease may break out; while in the caae of modtl 
lodging houses and many well -constructed public institutions, it is quite 
possible, by a suitable construction of buildings, to have a dense popu- 
lation living healthily because occupying a large cubical space. 



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No. 16] 



CONFEBENOE OF STATE BOAKDS. 



317 



"Thus in the districts with the least density, the deaths from con- 
somptioQ were 375, and in those of most density, 485 to 100,000 living; 
while other lung- diseases caused 911 deaths in the densest, against 659 
in the least dense districts oat of the same numbers living — the deaths 
out of the living, not the proportion they bear to the mortality from 
all causes, being the true index to the fatality of particular diseases." 

In the Begistrar General's report the mortality from different diseases 
in London and twenty-four other city districts with an aggregate popu- 
lation of 3,769,000, was contrasted with the mortality from the same dis- 
eases in counties containing a population of 3,669,000, chiefly engaged 
in agriculture. 

Table 5. 







Anmcal rate ok mor- 




Dbhsitv. 


tality PER 100,000 




^ 
































"E 


1 


if 












g-S. 


£ 




ISO 
119 

35 


375 

405 
4S5 








No. 8, 


914 



The tendency to consumption. Dr. Farr remarks, was increased twenty- 
fonr per cent, to typhus fifty-five per cent, in the town districts; but as 
the absolute mortality from consumption is three times as great as from 
typhus ia towns, and nearly four times as great in the country, the 
Axcess of deaths from consumption, caused by the insalubrity of towns, 
is greater than the excess of deaths by typhus, a fact which has been 
hitherto overlooked. The deaths from phthisis were 437 in the towns 
and 351 in the country districts, to 100,000 living. 

That this increased mortality has its relations to the directly increased 
dangers of infection may be seen from the following investigations on 
the relative number of germs, and amount of organic impurities in 
houses with different number of rooms, by Prof. Camelley, of Dundee : 



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State Board op Health. 



[Off. Doc. 



One-rootneii house- 
Dirty , 

Dirtier, 

Very dlrtf, , 

Clean, , 

Twivroomed houses — 

Very clean, 

Clean , 

Dlny, , 

Naturally ventilated boarding school a — 

Average cleanliness, 

Mechanically ventilated schools— 

Cleanest, 

Clean, 

Less clean, 




The statistics already quoted in Table 3, showing the number of 
deaths amount the women of the agricultural class in England, as com- 
pared with men, show the malign inflnences of in-door life, the ratio be- 
ing 230 women to 205 men ; and of the greater mortality of industrial 
operations, the ratio being 467 to 664, fully illustrates two points, that 
with the decreased resistance of the sj'Btem due to industrial piursuitg is 
associated the increased danger due to greater exposure in an atmos- 
phere impure and containing the bacilli of tuberculosis. 

"Mager, from Bavarian statistics, estimates the proportion of deaths 
from phthisis between town and coimtry at 100 to 61." (Hirsch.) 

This increase of the phthisical amongst the industrial classes is due 
uot alone to the increased dangers of infection, but to the nature of the 
occupation. "Dusty trades," says "Wynter Blythe, "are specially liabla 
to produce tubercular disease." 

Dr. C. Lombard states that of 1,000 deaths of adults from consump 
tion, they could be classed as follows: 

Occupations with mineral einanatioii, ITI! 

Occupations with various tlusts, Ub 

Sedentary lire, MO 

Workshop, 138 

Hot and dry air, 13T 

Stooping posture, 12i 

Sudden movomenis of arms, 116 

Muscular exercise liy active life, 80 



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No. 16.] Conference of State Boards. 319 

Gzerciee of voice, 75 

Working In open air, 73 

Animal emaniition, 60 

Oooapntlons In 'wfalch watery vapor 1b breathed 63 

Similarly, accordingr to Hirscb, "Smith lias ascertaiaed for one tliou- 
eand persona treated for coDSamption at the Bromptoa hospital, that 
seventy per cent, of them had been in the habit of spending: their time 
in overcrowded, hot and dusty places indoors." 

"The same cironmstances seem to account for the strikiug'ly common 
occarrence of phthisiB in nnnneries, seminaries and such institntions, 
in evidence whereof a number of observations have been brought for- 
ward by Foucanlt." 

Finally, I may state, that in the 1890 report of the inspector of prisons 
and public charities in Ontario, where the public institutions have by 
all observers received high commendation, the ag'gregation of popula- 
tion would seem to produce similar results. Thus, of a total population 
of insane asylums, amounting to 3,600, having 231 deaths, or sixty-aix 
per 1,000, there were twenty-nine due to phthisis, t. c, forty-four per 
cent. 

Of the total number who died, 153 or sixty-six per cent, had been in 
the asylum over eighteen months, but no data are given showing what 
proportions of those who died from phthisis, died within that period. 

Influence of Soil and CTiJiwric.— Says Hirsch re pneumonia: "Eleva- 
tion and configuiation, situation on the coast or in the interior, geolog- 
ical character and the like, are all irrelevant in themselves; they have a 
significance for the pathogenesis only in so far as they determine the 
climate or the sort of weather in any locality ; and it is to be keeping 
that fact in mind that we may explain the contradictory conclusions 
which have been arrived at throngh attending too rigidly to each of the 
factors named, as if it could be an element in the c&usation by itself." 

This must be similarly stated with regard to their influence on the 
prevalence of phthisis; while this writer very properly states, after a 
statistical study of mortality tables of different countries, "that circum- 
stances of climate are on the whole, of merely subordinate importance 
for the limits of that distribution;" "that the disease occurs cceterus 
part6u«inallgeo£rraphical zones with uniform frequency — that in many 
regions the number of cases has gone up considerably without auy cor- 
responding changes in the climat«, but under circumstances of another 
kind." The mean level of the temperature therefore, has no signifi- 
cance, bat it exercises a very decided influence on the course of the dis- 
ease; for — it runs a much more rapid and pernicious course in tropical 
countries than in higher latitudes. 

Hirsch further affirms that "severe and sudden changes of tempera- 
ture from day to day have little influence on their own account." "No 
doubt we have to take into account a fact of importance for the question 
before as, viz., that all those regions have an absolutely dry climate. The 



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State Board op Health. 



[OfyDoc, 



circamstances are naturally different in the case of a damp climate snb- 
ject to ^reat variation of the temperature — circumstauceB which come out 
most decidedly in equatorial and sub-tropical redone.'' 

Begsrding the influence of ground water upon the prevalence of cod- 
sumption, while it is very difficult to separate the influence of dififerent 
factors, stilt evidence seems sufficient to make ua conclude that this is an 
important factor in the prevalence of consumption. 

Bowditch and Buchanan, after extended researches, especially by the 
latter, have affirmed this influence ; and Buchanan remains of the opin- 
ion that the exceptions to the rule worked out by him, simply indicate 
that other setiological factors besides the influence of soil come into the 
account under the given circumstances— and seem to neutralize the bene- 
fits even of the most favorable condition of soil. 

An interesting point seems to have been determined from the Ontario 
statistics. Thus the health districts 6 and 7 present two very decided 
differences of physical surface conditions. East district 6 is a cential 
plateau averaging nearly 1,000 feet above the sea, fifty or more miles from 
the Oreat Lakes, and having a soil largely gravelly loam ; while District 
7 is the Niagara peninsula between Lakes Erie and Ontario, about 700 
feet above the sea, flat, and having a soil largely of post-glacial cla3%. 
The latter has been till recent years very malarious, while the former has 
practically never had intermittent fevers. 

An analysis of the deaths from phthisis, in 1881 gave the following re- 
sult: 





i 


i 

i 
i 

















These latter figures are to me very convincing, for the reason that in 
neither district .are there any large towns, while the great bulk of the 
population in both is engaged in agricultural pursuits, is of the same 
race, and equally industrious and intelligent. 

Setting forth, therefore, in brief form the conclusions based upon this 
Htatistical study, I would say— 

1. That we must recognize the disease phthisis as beyond' question a 
contagious disease, belonging to the category wherein are placed glan- 
ders and leprosy. 

2. That assnming this to be true beyond question, the attitude we 
must as officers of health assume, is to treat it us such, and hence mnBt 



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Ko. 16.] CoNFEBENOE OF StATE BoARDS. 321 

examine into what practical measures are to be taken by as for prevent- 
in;; it. and as far as possible, limiting its dissemination from those cen- 
ters where we find it existing. 

3. Ar^oing by inferences fairly drawn from the nomei-ous statistics 
already presented, I conclude that we must primarily regard the ques- 
tion of dealing practically with the problem as being one having in an 
especial sense the qualities of a sanitary crusade. 

4. This I infer means that the extinction of phthisis must l>e looke<l 
for by OUT urging that to deal with it successfully, means as with diph- 
theria and other diseases of its class, we must endeavor: 

(a) Tt> prevent it by removing the canses which promote it. 

(b) By BO regulating the habits and lives of those affected with it as to 
prevent them from becoming sources of infection to the healthy. 

(c) By the establishment of hospitals and sanitaria, where those in- 
fected may have the best possible opportunities of being cured of the 
disease. 

5. Beferring to these points in their order I would say as regards the 
prevention of the disease, we must look to the private or family home of 
the people. 

Here the matters specially to be inquired into are: 

1. The removal of dampness both under and aronnd honsea, as also the 
removal of all woodor other organic matter tending to decay or promote 
fangoid growth. 

2. The establishing of efficient and complete plumbing and drainage. 

3. The introduction of a pure water supply. 

i. The maintenance of parity of the atmosphere of the house by clean- 
liness, ventilation, and the abundance of sunlight. 

5. Proper and equable heating of the living rooms. 

6. Attention to the clothing of people whether in the honse or out of 
it. It must be clean, non-conducting and snfBcient. 

7. The use of nutritious and wholesome food, notably of animal foods, 
as meat, milk, etc, 

6. This means that we must follow the people to; 
(1> The school, and see that those desiderata required for the healthy 
home be had in the school. 

(2) The work-room and shop where there is the constant difficulty oi 
over-crowding and uncleanliness. 

(3) The trade or occupation, notably into our woolen factories where 
animal materials are handled, to the works where stone-cutting, grind- 
ing etc., are carried on ; and to those where effluvia and poisonoos par- 
ticles are given off, as in painting, card-glazing, arsenical manufacturing. 
In this direction indeed our labors must be simply never-ceasing, for the 
(langerH to health are almost as multifarious as the different industries 
carried on. 

21-16-91. 



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322 State Boafd of Health. [Off. Doo. 

(4) The muuicipal lioine. 

Here we h&ve to deal with the }arf^ problem of municipal sanltatioD. 
This means, (a) town draina^; {b) town sewera^i (c) town paving; id) 
public water works ; (e) inspection of filth nniaances; (/) compulsory do- 
tification of cases of consumptioa. 

B. This means the removal of consomptives from diuly contact with 
others in public institutions, in work-shops, etc., (g) sanitary and medi- 
cal education of the people ia the homes of snch, as to the danfi^rs of 
personal contact. 

The numerous details on this point must naturally be effective to the 
degree that public sanitation acquires an influence over the person and 
in the home, and to the dogree that the medical profession in their pri- 
vate practice insist on the danger of infection and on the carrying ont 
in the homes of measures to limit this. 

The last point is one whicb specially belongs to our work, viz., the man- 
agement of municipal hospitals for consumptives, and of sanitaria. 

In ceutnries past lazarettos were numerous in Europe, the coafinement 
of lepers was compulsory, and as a result leprosy can scarcely be said to 
belong to the category of disease amongst civilized people. There oan 
be no logical reason why municipal and state government aid should not 
be given to hospitals specially appointed for treating consumption. L 
do not think that it is either practical or advisable that we should teach 
or urge that segregation of consumptives in such should be made eom- 
pulsory, hut there are abundant reasons why the existence of such homes 
where the poorer classes can live and be ti«ated, should everywhere be 
made available. 

The question of how far these views can be carried into practice will 
depend directly upon the appreciation which the public has of thedangers 
to be apprehended and of the means to be taken to avoid such. 

It is within the scope, but not witbin the time allotted, to discuss on 
what basis such can be carried out; but it must sufSce to say that cura- 
tive institutions for consumption must bo essentially sanitaria, where 
equable climate, dry air, pure air, sunlight, out-door work and exercise, 
gymnastics, and indeed every measure going to increase the resisting 
power of the system may be had to the greatest extent, which any cli 
mate makes possible. 

Dr. Vaughan said he agreed with the views of Dr. Bryoe in nearly 
every particular. There can be no doubt but that the disease is conta- 
gions, and caused by the bacillus tuberculosis; but another element must 
enter into its production, for t^ithout Joubt the germs of the disease ore 
widespread, and all of as must at times receive these germs into the sys- 
tem. The germs are most frequently disseminated by means of the sputa, 
but when the bowels become affected, as they so often do, they are also 
present in the bowel discharges. State and local boards of health coold 



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No. 16.] Conference of State Boards. 323 

accomplish great good by teachiug the people the (liiQ^r cunnected with 
the aputa and fecal diBchargea of consumptives, and how properly to dis- 
infect them. Dr. Ytiti^haa was in favor of consumptive hospitals, and 
thought thorough isolatiou of cases would eradicate the disease. 

He saidthat while he recognized a possible danger in tuberculous meat 
and milk, he was inclined to believe their importance, as a means vi 
spreading the disease, have been greatly overestimated. 

I>r. Balch spoke in favor of all efforts to secme impt-uved sanitatiuu, 
as a means of combating consumption. It was an undoubted fact that 
improyements in drainage, aDd in the ventilation of houses and work- 
shops, had done much to lessen the prevalence of the disease. " Isola- 
tioa of diseased persons is all very pretty in theory, ond would probably 
be very effective in practice, but it cannot possibly be done." He told 
of the difficulty he had encountered in causing the removal to liospitals 
of persoDS snffei-Ing with small-pox, a disease all dreaded, and said this 
indicated the impracticability of removing consumptives to hospitals. 
If consumptives were allowed at large, and he saw no way of pre- 
venting this he thought it would not be possible to secure disinfection 
of their sputa. 

Dr. Salomon related a case showing the infectious character of con- 
sumption, and the length of time the germs may retain their vitality. 
The case was related to him by an intelligent man in New Orleans, and 
while the doctor had not verified the facts, he considered them to be true. 
A family moved into a house in which there had been a death from con- 
sumption. The father occupied the room in which the first case liad died. 
He contracted the disease and died within two years. Oue of the sons 
then occupied the room, and he also contracted consumption and died. 
The room was not used for some time when the second son moved into 
it, and he also contracted the disease and died. The house was then shut 
up and offered for stde, but was not disposed of for several years. It was 
finally sold, and the person who occupied the room in which the other 
cases occnred, took consumption and died. The room was then thor- 
onghly cleaned and disinfected, the walls scraped, and I'e-kalsomined, and 
from that time on no other cases occurred in the house. 

Dr. HoHAN said that at a recent visit to a certain health resort he was 
struck withthennmberof cases of consumption reported among the resi- 
dents. The rooms were fitted up with heavy carpets and thick curtains, 
well calculated to receive and retain the infection of the disease, while 
disinfection, apparently, was not practiced. 

He thought more attention should be given to these matters at the 
various health resorts. He suggested that consumptives could provide 
themselves with cloths for receiving sputa, to be burned as soon after 
using as possible. This is the best means of disposiug of infectious 
sputa; and the people would understand us better if we use the term 
''deetmotion of sputa," instead of disinfection. 



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831 State Board op Health. [Off. Doc. 

Dr. Beexer said that constun p tioa was undoubtedly uow mucU more pre- 
valeot BmOD^ the negroes than it vas before the war. He attributed 
this to the over-crowded and jlly-ventilated dwellings in which the ne- 
groes, especially those liviiif? in cities, now dwell. The race is ondoabt- 
edly mach more suticepti ble to the disease than formerly, and their habits 
of life are such that the germs of consumption are indefinitely preserred 
in their dwellings when once introduced. 

Dr. Brxce, in closing the discussion, said he was pleased to observe 
that the majority of the conclusions of his paper had been so well sus. 
tained by the members of the conference. He did not contemplate the 
compulsory isolation of consumptiveR, but to provide hospitals where 
the poor would gladly go to be treated. 

A large number of our work-shops are, from tack of proper venttlaticm, 
and other causes, conducive to consumption. Public authorities shotdd 
be able to regulate such places ; and when on© of the workmen shows evi- 
dence of the disease, in the interest of his fellow-workmen, and for his 
own sake, he should be removed. 

Every city could afford to have at its outskirts a place where such per- 
Bons could go, and by proper arrangements for treatment, fresh air, and 
good food, many ofthese might recover. Physicians, house-holders and 
employers should be required to report all cases of the disease, and 
health authorities could then inquire into the sanitary conditions of 
dwellings and work-shops, which, possibly, were responsible for the dis- 
ease. 

On motion of Dr. Bryoe, it was voted to appoint a committee of three 
to report upon the measures to be recommended for the prevention of 
consumption. 

The chair appointed as members of this committee, Dr. P. H. Bryce, 
Dr. L. F. Salomon, Dr. Victor C. Yaughan. Dr. Irving A. Watson and 
I>r Henry B. Baker were subsequently added to this committee. 

The nest question taken up was: 

"Would the Appointment of Medical Etealth Officers for OoucUea, In 
Place of Township Offloera, and Paid fOr Devoting their ^me Itz- 
cluaively to Public Health "Worlt, be Advantatreous and PraoUoable?" 

Dr. C. A. Lindaley opene<l the discussion by reading the following 
paper: 

The first thought this question aupfjestB is, that Buch a practice would 
develop a, body of sanitarians much superior to any which the township 
system could possibly producii. lu that oim result would be found a 
large measure of advantage. 

The administration of public hygieuti in these days is not any longer 
to be successfully undertaken by any good citizen, however much he 
may be esteemed by his fellow townsmen for his skill as a blocksmitb. 
his honesty as a grocer or banker, his fair mindedness as a justice of the 



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No. 16.] Conference of State Boahdb. 325 

peace, or even for bis jad^meot as the family doctor. Public hygiene is 
not now a matter of diet and flaQnel, and of taking cold. 

Fablic sanitation is taking on a scientific character. Its administra- 
tion is based oa principles, which are more or less settled aad fixed. 
The spread of infectious and conti^ous diseases is governed by recog- 
nized natural laws. It follows, therefore, that the control of those dis- 
eases, and the promotion and conservation of the public health, is only 
to be undertaken auccessfully with a fall knowled^ of these laws and of 
the means suggested by aach knowledge. 

The above statement reduced to its simplest terms, reads — a health 
officer reqnirea a special education and training. 

The special education and training implies a business, an occupation, 
a means of earning a living, an object worthy of such preparation. 

The ideal health officer is one who has had a good medical education, 
as an indispensable foundation fur hia special work. It ia almoat equally 
important that he ahotdd have the experience of some years of general 
practice, as a further basis of preparation, because he should be qualified 
to be an authority in the diagnosis of thoso contagious and infectious 
diseases which are dangerons to the public; and also becaose such ez- 
perienGe,.and the matured age which it implies, will be an additional in- 
tioence in winning the confidence of the people whom he serves. 

Supplementary to auch acquired qualifications he should be a man 
with the natural gifts of a sound judgment, of high integrity of char- 
acter, of clear and quick perceptions, and especially of auch ready tact 
in managing affairs as to command the respectful consideration of the 
pcblic. These are qualifications of no mean order. They represent a 
higher standard of acquired and natural ability than the average man 
possesses. But the sort of man so described, corresponds well with the 
duties and responsibilities of the high functions of his office. 

To him tae entrusted the highest interests of man in the social state. 
He is the appointed guardian and custodian of the public health, and in 
that capacity one of the chief factors in the promotion of pablic pros- 
perity and general happiness. For there is nothing so disastrous to the 
public welfare, nothing so productive of personal misery and suffering 
as disease and death. 

A nation whose people are physically feeble, or which is subject to 
frequent epidemics, cannot be said to be prosperous in any true sense. 

Looking then at the question from a stand-point which takes in view 
the rare qualifications necessary for a good health officer, the prepara- 
tion for its duties, and the magnitude and importance of the interests 
involved, it seems self-evident that it ia for the best public good, that 
the tine health officer should find full occupation in the exercise of 
his official functions; that one qualified as he should be for sucb high 
and grave responsibilitiea shonld not have hia attention diverted from 



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826 State Board of Health. [Off. Doc. 

his serioua obligatioiis to the public by being obliged to earn a subsist- 
ence in other ptirauite. 

It seems right and fitting that the man who has been eda<;ate(l und 
trained for the office should be utilized to the best advantage in the pub- 
lic interest. 

Thus the question presents itself to my mind in a speculative way. 

It remains to notice the practical application of these reflections. 

I assume that in the interests of the public health, a health officer 
should be nothing else in a business or professioual way. 

All experience teaches that it i» incompatible with the public interest 
that he should be a practitioner of me<:Uci&e; or else, that it is incom- 
patible with his own intei'est that he should be a health officer in the 
same community in vhich he practices. 

A long experience in the administration of public hygiene has im- 
pressed me with the immovable conviction that a health officer who is 
never criticised and found fault with, who makes no enemies, who is not 
heartily cursed and sworn at by bis profane neighbors, is of no practical 
use as a health officer. And on the other hand, a health officer who is 
faithful to his public duties, impartial and resolute in his official acts, 
will gradually, steadily and surely surrender a large share of his patients 
to the care of his professional competitors. 

The two pursuits cannot be harmoniously joined in the same town. 

Here, then, is a serious practical difficulty with town health officers. 
In the first place, every town does not possess an available and compe- 
tent man. He should be chosen always from the medical profession ; 
no others are fully qualified for the office. But if it be attempted to 
unite in one person the special duties of medical practitioner and health 
officer, it soon inevitably happens that there is a conflict between pnbhc 
duty and personal interest, and one must be betrayed or the other will 
surely suffer 

The wealthy landlord will not meekly receive an order from his family 
physician to overhaul the plumbing in his tenement houses, to drain the 
cellars, to remove offensive cesspools, etc., etc., and so make the dwell- 
ings of his tenants safer habitations. After receiving such orders that 
wealthy landlord will call upon Dr. Smith to attend bis family, or i^er- 
haps Dr. Health Officer foreseeing that resiilt, will prudently omit to 
send the order and the tenants will continue to endure their wrongs, be- 
cause it is not the personal interest of the only party who can nrotect 
them to do so. 

But imder the town system that combination of the general pmcti- 
tioner and town health officer is the only practicable method 

Tiie town is not only too narrow a field for a man of the required ca- 
pacity, but it is also too limited for the best use of such service and for 
the best results. 

Public hygiene deals not alone with local conditions. It has to do 



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No. 16.] Conference op State Boabdu. 327 

with the welfare of pupolatioos, settled over wide areas of territory, 
and aader snch varyiug conditioas, that the common good of the whole 
can not be attained withont a comprehensive acquaintance with the 
mutual relations and interest which the separate towns or communities 
within those areas may bear to each other. 

There are undertakings essential to the promotion of the general pub- 
lic health which require concert of action on the part of several more or 
lesu aeparated communities. It is hard to behave that the wisest meas- 
ures will be proposed by health officers whose official duties are limited 
to the narrow confines of their own towns, and whose conceptions of 
such duties are generally even more limited. It is not reasonable to ex- 
pect that men whose services to the public in this line are usually gra- 
tuitous, or very badly paid, will or can give snch studions and careful 
attention to the sanitary wants not only of their own towns, but of their 
B&nitary relations to othertowns, as to be competent and wise connselors 
for the best good of the whole. On the other hand, it often happens 
that a town board of health, seeking only the selfish interests of its own 
citizeus, and regardless of others, proceeds to do thintf s which are di- 
rectly iujorious to the health and welfare of adjoining towns. 

From the uatnre of the existing facts, and from a knowledge of the 
principles and laws which should govern in the general administration 
of public hygiene, it is self-evident that the greatest good to the greatest 
number will never be realized from separate, nnsystematized and inde- 
pendent town boards of health. Town boards and town officials have 
their uses and proper functions, which are of great value, and in any 
plan of operations will be fonnd to be essential to the beet success. But 
the work of town boards needs direction and unification. 

Wherever the common interest of several towns are involved, that in 
terest will be best subserved, if the efforts undertaken be under the di- 
rection of one mind which has intelligent and comprehensive knowledge 
of their mutual relations and needs. 

The general must command the operations of the army. The col- 
onels and majors, the captains and lieutenants, most act in concert to 
accomplish his plans, or the army becomes a mob. 

It may be urged in this connection that the state boards of health 
should be the directing power, the commanding general. That, I be- 
lieve, is tme. Although they are not all constituted with such powers. 
Seveml of them are like that of Connecticnt being only an advisory body 
and having no mandatory powers at all. But even if the state board is 
authorized to be commander-in-chief, there is a long space between the 
state board tindeach little town board. There is no possibility of bring-, 
lug them into such close relations, that its authority can be exercised in 
the most practical and nsefnl way. It requires the intermediate grades 
of officials to make a useful connection between them. And here the 
county health officers would form the connecting hnk. The territory 



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328 State Boabd of Hkalth. [Off. Doc 

uuder the jurisdiction of the county health officer would not be so ex- 
tensive that he could not, in a reasonable time, become perBonally ac- 
quainted with its topography in matters affecting: health. He could, in 
many instances, by personal inv estimation, discover and expcffio the 
origin of primary cases of communicable diseases, and by such forcible 
illustration persuade and instruct the public mind. His practical ex- 
perience would bebf great value in arresting and controlllDg epidemics, 
if they occurred, but of still greater value in preventing them. 

The time has fully arrived when communities and populations should 
accept the fact that the proper protection and care of the public health 
is a most important public duty. That its due performance is so de- 
pendent upon a scientific knowledge of methods, that it can only be 
successfully accomplished by trained and qualified officials and that 
there is great economy in providing for this service in the best and most 
efficient manner. 

Another and great advantage which would be difficult to estimate, 
because it is one of growth and development and would be eahanced 
with every year's experience, is that which would come to the state botn 
possessing a body of educated sanitarians, equal in number to its county 
divisions, and each familiar with the hygienic conditions and sanitary 
needs of his own jurisdiction. 

Such men, selected for their special fitness, holding their office by ap- 
pointment, and not subject to the caprice of [Kipular elections, but con- 
fident of their position, unless by removal for cause, devoting their time 
and best energies to their duties, would form a bureau of information 
which might be of the highest benefit to the state board, and through 
it, to the people's health. 

If now we review the points which have been presented, to-wit : The 
nature of the work to be done, the qualifications required of those who 
do it, the impracticability of associating it with other pursuits depend- 
ing upon public patronage, the hindrances and difficultiesreeulting from 
limiting independent sanitary jurisdictions within town boundaries, and 
the positive advantages of broader territorial supervision, and finally 
the immeasurable benefit which such a body of educated sanitarians, de- 
voted to their work and familiar with every portion of the state could 
confer upon it, leaves no doubt in the mind of the speaker that the ques- 
tion should be answered in the affirmative. 

Thepaperwas discussed by Drs. Batch, Cochran, Ohanoellorandotbera. 

Adjourned to 3:30 p. m. 



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No. I6.3 Conference ,of State Boabiw. 



THIRD SESSION. 



The committee on the preventioii of coneamptioii was requested to 
present a preliminary report at the night session, the completed report 
to be made at the next meeting of the conference. 

The qnesfcion proposed by the Provincial Board of Health of Ontario, — 

"The advantages of the organization of rivers conservancy commis- 
sions, composed of state and mnnicipal health boards, for the protection 
of streams against deforesting and pollution at their sources and along 
their conrses"— 

Was taken up for discussion. 

Dr. Salomon, of Iiomsiana, in opening the discussion, read the follow- 
ing paper: 

Mr. President and gentlemen -. In the opening of the discossion 
proposed by the Province of Ontario, it is not my intention to occupy 
your time with an array of statistics and statement of facts with which 
yon are all familiar. 

The question submitted permits of division into two heads for discus- 
sion, each, however, somewhat dependent upon the other. 

The question as to the deforesting of rivers along their courses was 
met to a large extent by the discussions before this conference at its 
last meeting, and in regard to the views then expressed and the resolu- 
tion adopted by the conference, I have little further to add than to say 
that by the preservation of the forests along water courses, thus secur- 
ing a slower percolation and filtration through the soil, the pollution of 
streams may be and undoubtedly is, to a large extent prevented 

Streams near their origins, as a rule, furnish good sources of water 
supply, but the furthei- away we get from the springs and mountain 
streams which furnish the initial supply, the less fit do we find the water 
for drinking purposes. 

Without entering into deteuls it will be sufficient to say in regard to 
the first division oi the question that the deforesting of lands adjacent 
to streams, which permits of a more rapid surface drainage of rain 
waters directly into such streams, necessarily implies the carrying into 
them of the organic matters always to be found in regions in which the 
ground is under cultivation, more particularly so in regard to manured 
lands and other attendant conditions of the soil which it is unnecessary 
to enumerate. 

As to the consequent floods from deforestry, nothing need be said in 
addition to what is already a too familiar fact. 

It is however, with the pollution of streams through other than 



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330 State Board of Health. CO^'- l^o"- 

uatnral catieee that we are most coDcenied, and each Bnoceedinfif year is 
adding and will continue to add to the evil, and the ooDsequeut difficulty 
of providinjf a remedy therefor. 

Sewerage, and the discharf^ of refuse of all kinds into streams and 
riTers from the towns along their banks, is the most potent factor iu the 
pollution of water courses, and following this, the discharge from fac- 
tories, often of such a nature as to be destructive to all animal life for 
miles from the points of dischai^e. 

Pilution by large supply of water in the larger streams may and 
probably does to some extent mitigate the evil, but we must bear in 
mind that the smaller streams are not capable of this method of self- 
purification, owing to limited dilution of the contaminating matteis, 
and in the case of the larger streams it is found that the towns along 
their courses are so numerous that the continual succession of soorcee 
of pollution allows small chance of purification through dilution or 
oxidation. Organic and inorganic matters in a state of solution or sus- 
pension are thus being constantly added to streams already cbaiged 
with the some matters, often in a state of putrescence, and with each - 
succeeding town along a water course the evil is multiplied, and the 
danger from water-pollution keeps constantly increasing in relative ratio 
to the places of contamination, the next lower town to a manofactorin^ 
city being subjected to all the evils while it may itself be putting forth 
every effort to keep pure the stream from which its water supply is 
derived. 

Infusoria and other animalculse may in a large degree aid in purifying 
the water in such streams, but we are not certain as to the extent of 
such purification, and should not depend upon these natural agencies 
alone to accomplish the work; besides, it is very questionable as to the 
work in this direction that may be thus accomplished, when it is re- 
membered that repeated dischargees of sewage and kindred matters will 
destroy these purifying agents, with the accompanying inevitable result 
of decomposition and the production of offensive gases. 

Sewage, as is well known, often contains the specific poisons of dis- 
ease, and numerous instances are on record in which towns and cities 
along water-courses have been afflicted with disease thus brought down 
to them from adjacent towns. 

It would only be trying your patience and occupying the valuable 
time of the conference to elaborate upon this subject with which all 
saniterians are familiar, and to which I can add notliing new, and in re- 
gard to which facts have been so often repeated. 

The question before us simply resolves itself into what is best to be 
done to stop the constantly increasing evil. 

I am therefore pleased that the subject has been presented iu the way 
it has by the Province of Onterio, because I believe that in the organ- 
ization of conservancy commissions as outlined in the question, a prac- 



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No. 16.] CONFEBEHCE OF StATE BoARDS. 331 

tical Bolation of the question is foreshadowed, and that at the least 
macli good nan be accomplished. 

Legislation withoat cooperation would be futile, for while one state 
mi^ht make and enforce laws to prevent the pollution of streiEtmB within 
its own territory, its laws would accomplish little good unless contiguous 
states should do likewise -, and I believe that through the co-operative 
action of state and municipal boards of health the proper legislation 
may be secured in all states and municipalities, and with united action 
the good work be carried on. 

The import-anoe of this much needed legislation has always engaged 
the attention of sanitarians, and it may be emphasized by recalling that 
the first sanitary act upon the English statute books is an act passed in 
1388, which act prohibited the pollution of streams and provided a pen- 
alty for its violation. 

If then such an act was deemed necessary at a time when the needs 
of sanitation were little understood, and when the population was very 
sparse, and manufacturing industries so feebly developed, how much 
more urgent is the need now tot such legislation when our cities and 
towns are filled with factories discharging their refuse into the rivers, 
and the teeming thousands of inhabitants along their courses are con- 
stantly adding to their pollution and rendering them unfit for drinkable 
or other potposes — not only offending the senses, but producing disease 
and death through the ever-continuiiig contamination. 

True, the interests involved are such that the question of prevention 
at this day is one of immense magnitude, surrounded vrith many obsta- 
cles, and perhaps difficolt of accomplishment. No legislation, as yet, 
has been able to secore the much desired end, but I am of the opinion 
that with concerted action on the part of health boards, and the secur- 
ing of local regulations rather than general legislation upon this sub- 
ject, much can be accomplished: and with each local authority, under 
the guidance of commissions as contemplated, supervising the streams 
over which it has jurisdiction, their poUution can be largely controlled 
or altc^z^ether terminated. 

Such action, however, necessarily requires concerted luid uniform 
methods of procedure, and it is probably through commissions com- 
posed of health officials of contiguous states that the work can be best 
accomplished. Therefore, Mr. President, I beg to submit the following 
resolutions: 

Resolved, That it is the sense of this conference that the poliatiou of 
streams is attaining such magnitude that early action should be taken 
by state and local boards of health looking to its prevention. 

Sesolved, That a committee of three be appointed to consider the 
best means of securing the formation of rivers conservancy commis- 
sions, composed of state and local boards of health, and to recommend 
Bcch legislation as may be necessary to secure the desired result. 



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382 State Boabd of Health. [Off. Doc. 

Remlved, Tbat said committee report at the next meetiofi^of this con- 
ferenoe. 

Dr. Chancellor said there was Rreat need of state orgsmzation, or 
national aid in preventing the pollation of streams. Rivera in msay 
instanceB formed the boundaries of states, in which case it was impoasi- 
ble to protect the streams without state cooperation. The Potomac 
river was given as an illustration. The laws of Maryland for proteci- 
ing streams are fairly satisfactory ; but he had recently endeavored, nn- 
saccessfnlly, to secure the aid of West Virginia in preventing: the pol- 
lution of the Potomac river. He said that Cumberland, Md., Lad been 
suffering with an epidemic of typhoid fever for the past two years, 
some six hundxedcaseshaving occurred. In looking for the causeof tile 
epidemic it was apparently traceable to the water supply taken from the 
Potomac, which was polluted with the sewage from Keyser, W. Va., 
where typhoid fever was prevailing. National aid would probably be 
needed to control such cases. 

Dr. Watson snpported Dr. Chancellor's remarks. He said Massachn- 
setts, which has the most comprehensive laws, and a special board to 
protect its streams, was suffering greatly from the pollation of the Mer^ 
rimac river by cities in New Hampshire. It was simply impossible for 
the present to prevent the large cities along the Merrimac from empty- 
ing their sewage into it; it would cost millions of dollars to dispose of 
their sewage otherwise. 

Dr. Metcalf, of Indiana, said they were bavisg trouble iu their state 
from the pollution of streams by the waste from straw-board works. One 
of the lai^at works in the United States was only about tweoty milee 
from Indianapolis, and this question of pollution of rivers would soon 
have to be met in their state. 

Dr. Reeve said the pollation of streams to some extent was unavtnd- 
able, and a question the conference should consider was whether it was 
possible, by filtration or otherwise, to so purify a oolluted water that it 
could be safely used for domestic purposes. 

Dr. Reynolds thought it would be difficult to secure the cooperattou 
of states needed in many instances to control the pollution of streams, 
and favored asking for the national law. 

Dr. Bryce said in Ontario the question is the protection of one town 
against another higher up on the same stream. He thou^t we should 
settle such state questions before calling on the national government 
In most European countries they have compelled cities to respect the 
rights of their neighbors lower down the stream. 

Dr. Lee said that action must begin in thu state before it reaches the 
national government. Philadelphia had the distinction of having the 
highest typhoid fever death-rate of probably any other American city. 
They were now having an epidemic of the disease traceable to their water 
supply. It had been noted that wards supplied with water from storage 



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No. 16.] CoNFEBENCE OP State BoiJtDS. 333 

bafiins suffered with the disease much less thau those supplied direct. 
Recently complaint had come to their board of the pollution of streams 
by salt coming: from abandoned wells. The board had made answer that 
salt was antiseptic, and could not be considered as polluting material. 
The reply was that the salt in Beaver river interfered with the public 
water supply for Beaver city, thus compelling them to return to the use 
of wells, leading- to an increase of typhoid fever in their city. The board 
had introduced a bill in legislature for the prevention of the pollution of 
streams. The bill, by implication, included salt. The bill, however, was 
killed by amendments, and now only excludes wastes from slaughter- 
houses, dead animals, etc., from streams. 

Dr. C, A. Lindsley said they were urging upon towns the necessity of 
disposing of their sewa^ in some other manner than by emptying it 
into streams^-such as broad irrigation, iutermittentfiltratioa, etc. Their 
board had been engaged for some time in investigating: the pollution of 
the streams of Connecticut. In only one instance had leg:i8latare for- 
bidden the emptying of sewage into streamsi this was at Meriden. 

Dr. Keeve presented the following as snpplemental to the resolution: 

Resolved, That this committee be requested to consider and report 
upon the sanitary value, especially to municipalities, of the purification 
of water in polluted streams, either by the distance which such polluted 
water bae traveled, or by means of filters or storage beds, or by any other 
artificial methods. 

This was accepted by Dr. Salomon, and the resolution was adopted. 

Dr. Watson called attention to the work the Massachusetts Board of 
Health was doing in this direction, as set f orth« in their last report on 
water supplies; also to the ezperimente in sewage filtration, which for 
the first time definitely settled important questions relating to water fil- 
tration and sewage disposal. 

The president said that he would announce the committee called for 
in the reedation at the next session. 

Dr. Lee said that a bill was then pending in the legislature of his state, 
relating to water pollution, and moved that the secretary be instructed 
to forward a copy of the resolution to the President of the Senate and 
Chairman of the House of Bepresentatives of Pennsylvania. 

The motion was seconded and carried. 

The question proposed by Michigan — 

"What change, if any, should be made in the present plan for provid- 
ing a programme for meetings of the conference T" 

Was taken up for discussion. 

Dr. McCormack said there had always been difficulty in arranging a 
programme for meetings of the conference, due to some extent to the 
neglect of the various secretaries of state boards of health to send 
questions for discussion. 

It had suggested itself that it would be well to have the programme 



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334 State Boabd of Health. [Off. Doc. 

mapped out on the first day of the meeting for the next aucceeding 
meetinff. This might be done by a committee whooe report could be 
acted upon by the confereace. 

Dr. Cochran thinks Dr. McGormack's method not a good one. If a 
committee were appointed at all, he would simply have it act on the 
questions proposed by the various states. 

Dr. 0. A. Lindflley said he favored the plan proposed by Dr. McCor- 
mack. This committee could receive questious from any state and de 
cidc upon their appropriateness for discussion by the conference. He 
knew, under the present plan, that it was almost impossible to satisfac- 
torily arrange a programme. 

While on the floor he took occasion to say that he thought the con- 
fei-ence was now in a position to stand alone, and need not bold its meet- 
ings in connection with any other body. He was opposed to calling 
meetings on Saturday, as it tended to lessen the attendance. 

Dr. Bryce thought the president and secretary should fix the time of 
- meeting, and that the secretary should ask for propositions for discus- 
sion six months before the time of meeting. If the prc^n^mme was not 
completed within three months of time, the president and secretary 
should fill it. 

Dr. Olliphant suggested that delegates could submit questions a year 
in advance. 

The president suggested that the question should go over for another 
year. 

A motion to table the question was made by Dr. Lee. 

Dr. Cochran said we are running too much into committee work. The 
usefutneBs of our organization depends upon its simplicity and flexi- 
bility; without care we will be getting reports too bulky to publish. 
There is no necessity to publish mere compilations.- What we want is 
the benpfit of each individual's work and experience. What he hunes, 
and knows so well that he can come here and talk on the subject with- 
out cramming for the discussion. 

The motion to table the question proposed by Michigan was put and 
carried. 

Dr. Olliphant extended a cordial invitation for the conference to hold 
its next meeting in New Orleans. 

The secretary made a statement of the financial condition of the con- 
ference. 

On motion of Dr. Salomon it was voted to assess each state and pro- 
vincial board of health ten dollars, to be forwarded to the treasiuer. 

The president announced that the election of officers, and a paper by 
Dr. Yaughan, would be the order of business for the evening session. 

Adjourned to 8 p. m. 



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No. 16.] COSFERENCE OP STATE BOABDS. 335 

FOURTH SESSION. 

The President. I would suggest that the conference should now dis- 
pose of the question of time and place for its next meeting. 

Dr. Metcalf moved that the next meeting be held in Washington. 

Dr. Watson offered as a substitute that it be held in >lew Orleans, on 
the third Tuesday in March, 1892. 

Dr. Metcalf invited the conference to meet in Indianapolis. 

Dr. Watson withdrew his motion, and a motion by Dr. Reeve to allow 
the officers of the conference to select a time and place for next meet- 
ing prevailed. 

Dr. Bryce moved to proceed to the election of officers. Carried. 

I>r. Metcalf nominated Dr. J. K. McCormack for president, and moved 
that the secretary be instructed to cast a ballot for the conference for 
Di*. McOormack. Carried. 

The secretary reported the ballot cast, and Dr. McConnack elected 
president. 

On motion, Dr. C. O. Probst was elected secretary by acclamation. 

On motion. Dr. Henry B. Baker was elected treasurer by acclamation. 

Dr. Yanghan, of Michigan, gave an entertaining talk on "Wha,t recent 
developments have been made in laboratory work of practical value to 
health boards." 

Dr. Vaughan said if a health officer wants a sample of water examined 
he sends him from the laboratory a sterilized bottle. Determinations 
hardnesa, ammonias, nitrates, nitrites and chlorides are made. Plate 
coltures are also made. At first he endeavored to study each germ 
present, but found that this took too long— weeks and months. Kow, 
when the water comes in he immediately makes a plate cultore and in- 
oculates a tube of beet tea with a drop of the water. In twenty-four 
hours he injects some of the beef tea into the abdominal cavity of a 
white rat. If toxicogenic germs are present, the rat will likely die in 
twelve to twenty-four hours. Cultures are then made of the spleen, liver 
and kidney of the cat, and compared with the plate cultures of the water. 
Corresponding germs are given further study. In this manner he was 
able to make a report on the water within seventy-two hours. It was 
not altogether satisfactory, but more so than chemical analysis. He 
conld not say that the germs which killed his rats would kill man, but 
people will not want to drink water that will kill rats. Bats eub hard to 
kill, and the ordinary water gei-ms will not do it. One hundred and 
nineteen official reports have been made so far, and in thirty-two in- 
stances toxicogenic germs have been found. They are usually found in 
water which has apparently caused typhoid fever. Duluth has just had 
about 1,500 cases of typhoid fever. We found a sewer within 500 feet of the 



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336 State Boabd of Health. [Of. Doc. 

mtske pipe of their water works. An examiiiatioD of their drinking' 
water showed it to contain poiaonous ^rms. Pr. Vaughan said he bad 
also been working on poisonous cheeBe. He had not in throe years 
found cheese containing tyrotoxicon. Many contained a poison which 
kills cats, but has no effect on man. Public sentiment, he said, was in 
favor of the laboratory. 

Dr. Bryce stated that they' had secured some funds tor lalioratory 
work. Hydrophobiaintheprovincelast summer had created a sentiment 
iu favor of such work. He had leuned of a case where a d(^, suffering 
with hydrophobia, had bitten some cows and some pigs, and finaUy his 
master. The animals showed sig:nB of paralysis of the muscles of the 
pharynx and lamyx. He secured the head of a pit; that was bitten, 
and endeavored to inoculate rabbits with the cord. He had failed, pro- 
ducing only septicaemia. The same experience was repeated with the 
head of one of the cows. 

They had lately had an outbreak in hogs of a disease attended with 
gan^rrene in the joint just above the hoof. The disease was commuiii- 
cable and acted somewhat like charbon. They had found what seemed 
to be the germ of the disease. He said they would try Dr. Vaughao's 
method of water analysis. 

Dr. Vaughan, in answer to a question, said he did not believe that 
typhoid fever only cornea from a pre-existing case of the same disease. 
He thought water contaminated with the excretions of healthy persons 
may cause typhoid fever. He said sewage may ffow long distances in 
streams without mixing with the stream. Little cities ten miles below 
Detroit have had typhoid fever, which he attributed to pollution of the 
water supply by sewage of Detroit. Dr. Vaughan said he thought we 
had many kinds of typhoid fever due to different germs. He had failed 
to find Eberth's germ in water that had caused typhoid He said he did 
believe that one case of typhoid fever will produce another, but not that 
every case must have a preceding case. He considered it a dangerous 
theory to teach that water must be specially contaminated to produce 
typhoid fever. We should teach that filth in itself is dangerous. 

The committee on consumption presented the following preliminary 
report: 
To the Presidatt attd Members of the Confererice of State Boards : 

Oe^ntlehem: Your committee begs leave to report the following res- 
olutions: 

1. That it is the opinion of this conference that tuberculosis is a 
zymotic disease ; that its germs are developed within the blood and tis- 
sues of man and vaiious animals, and that these germs are capable of 
an existence external to the body for a number of months, especially in 
dried sputum, and in places where least exposed to the free action of 
the atmosphere and sunlight. 



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No. 16.] CONFERENOE OF StaTE B0ARD8. 337 

2. That the germs of tuberculoBis are conveyed in various ways to 
persons and animals, the principal media of these being: 

(a) Dost containing dried sputum. 

(b) Food, either contuninated with infected particles, or the flesh of 
tuberculous animals. 

(c) Milk from phthisical mothers and tuberculous cows. 

3. That unsanitary conditions are the prime factors tending to the 
development and dissemiuiition of the disease, such aa: 

(a) House and soil dampness. 

(&) Lack of sunlight and bad ventilation. 

(c) Bad plumbing and house drainage. 

id) Overcrowding in living rooms, in schools, in workshops, in public 
institutions, etc. 

i. That the diseases undoubtedly disseminated through the neglect to 
destroy or disinfect the sputa of the phthisical, distributed as this infec- 
tions matter is. 

(a) On infectedlinen (dangerous to washerwomen), clothing, carpets, etc. 

(i) On the floors and walls of houses, workshops, hospitals and hotels, 
especially of health resorts. 

6. That to limit the spread of tuberculosis it is necessary that notifica' 
tion by physicians and householders of its existence be made compul- 
sory, thereby enabling health authorities to examine into the sanitary 
surroundings of those affected, and to make provision for the adoption 
of the necessary precautions against infection to the healthy. 

6. That municipal inspection of dressed meat and of dairy cattle be 
systematically carried out, and that the notification of the health author- 
ities by owners of infected animals be made compulsory. 

7. That municipal and state governments ought to aid in the work of 
limiting the disease by the establishment of institutions especially de- 
signed for the reception and treatment of the phthisical, and so situated 
that while minimizing the danger to the general community, they may 
likewise supply out-door work and exercise, suited to the condition of 
different patients. 

Peteb H. Bbyce, M. D., Gkairman. 
LuciEN F. Salomon, M. D. 

V. c. vaughan, m: D. 

The president announced that the committee on the pollution of 
rivers, would be constituted as follows: Dr. L. F.Salomon, of Louisiana; 
Dr. C. A- Lindsley, of Connecticut; Dr. 0. N. Metcalf, of Lidlana; Dr. 
John H. Ranch, of Illinoie, and Dr. Henry P. Walcott, of Massachusetts. 

Dr. Bryce, as a delegate of the conference to the International Coa- 
gresB of Forestry, held at Montreal, Quebec, submitted a report. 

It was voted to continue all standing committees, and request them 
to report at the next meeting. 

Adjourned sine die. 
22-16-91. 



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Utate Board op Health. [Oft Doo. 



a. BHPORT OF THB SHOimTABT AS DBLBGATH TO THB MHHTINa 
OF THB AMERIOAM FUBUO BOAJ/ra ABSOOIATION, IBOO. 

ProgrBoiine. 

OIBc«rsof tbe Assoclntlon. 

Vigilaoce agaiaet Cbolern. 

VlBit to Quarantine. 

Hygienic value of Habits of Living. 

Imported Dlaaaaea. 

VkscI nation. 

Tidal D»I& System at Charleston. 

Qarbage and Refuse. 

Maritime Sanitation. 

Centennial of Vaccination. 

Diphtheria. 

Tuberciiloats. 

Beport of Committee on Sanllarj' and Medical Service on Kmif^ntnt Shlpa. 



In accordance vith his appointment the secretary attended the meet- 
ing of the American Public Health Aesociation at Charleston, S. C, 
December 16, 17, 18, 19, 1890. 

The Bubjects cousidered by the aasociatiou were as lollows: 

1. " Sanitary Constniction in Houne Architecture." 

(a) " Heating." 

(b) "L^hting." 

(c) "Drainage." 
(d) " Ventilation." 

2. "Sewage Disposal." 

3. "Maritime Sanitation at Ports of Arrival." 

1. " The Preventiou and Bestriction of Tuberculosis." 

6. "Isolation Hospitals for Infectious and Contagious Diseases." 

6. "Establishments in Favorable Climates for Persons having' Tuber 
cular Predispositions." 

(a) "Schools for Children and Adolescents." 

(b) "Sanatoria." 

(c) "Permanent Eesidence." 

7. "Papers on Miscellaneous Sanitary and Hygienic Snbjecta." 
The officers were: President, Dr. Henry B. Baker, Lansing, Miob.; 

First Vice President, Dr. Frederick Montizambeti, Quebec, Canada; 
Second Vice President, Dr. Joseph H. Baymond, Brooklyn, N. Y.; Sec- 
retary, Dr. Irving A. Watson, Concord, N. H.; Treasurer, Dr. J. Berrien 
Lindsley, Nashville, Tenn. 

Dr. Plnnkett introduced a resolution which intended to impress upon 
the quarantine officers of the country the necessity of increased vigi- 



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No. 16.] American Pdblio Health Assocuxion. 839 ' 

lance agaiuBt cholera, which is said to be now ragii^ in forei^D porte. 
Befeired to the executive committee. 

Dr. Liee, of Philadelphia, introduced a resolution which requested 
quarantine officers to be careful and, if possible, restrict the importation 
of rags from foreign ports. Referred t-o the executive committee. 

Upon motion a standing committee on car sanitation was appointed, 
and Dr. Daniels of Wisconsin was named as chairman of the committee. 

An opportunity was afforded the members of the association to visit 
the quarantine station ' of the port on the eastern end of James island* 
nea-r the site of Fort Johnson. A very complete plant, closely modeled 
on the Holt system at New Orleans, has just been introduced at this 
station, a description of which is submitted with illustrations, and the 
recommeudatioQ that it be published as a portion of the annual report 
if the plates can be obtained from the Charleston board of health. 

The session was opened by the reading of the excellent paper of Dr. 
James F. Hibberd, of Hichmond, Tndmnft^ on the hygienic value of ra- 
tional itregnlarities in the habits of living. Dr. Hibberd dealt with 
this important question in an extremely practical and intelligible 
manner. 

The next essay was on the relation of land monopoly to. population 
health, by George Homan, M. D., secretary of State Board of Health of 
Missouri, St. Ix>uis, Mo. 

The authors of the following papers ndi being present, npon motion 
their reading was postponed until next day: 

Paper on climate in phthisis, by W. H. Geddings, M. D., of Aiken, 
8.C. 

' Paper on house drainage, by Albert L. Webster, sanitary engineer. 
New York. 

Paper on trap siphonage, by Prof. James R Denton, Stevens Insti- 
tute of Technology, Hoboken, N. J 

Report from the State Board of Health, of South Carolina, by J. B. 
Bratton, M. D,, president of the state board of health. 

Among the important reports of committees were those on the sanita- 
tion of foreign ships, by Dr. Durgin, of Boston, and on diphtheria, by 
G. C. Ashman, of Cleveland, Ohio. 

luPOBTED Diseases. 

Dr. Durgin, of Boston, of the committee on sanitation of foreign ships, 
submitted an excellent report. The fact that during the past ten years 
over 5,000,000 emigrants came to America ought to give the question 
a considerable interest. Statistics showed that of the population of 1880 
there was one pauper to every 985 native-bom Americans, and one 
pauper to every 285 foreign-bom inhabitants. 

The ventilation of emigrant vessels, he said, was very defective. 
The unclean habits of most emigrants, the poor accommodations and 



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340 State Boaiid of Health. [Off. Doc. 

miserable Tentilatioii of our steamers are very likely to produce diseasa 
There is a great lack of necessary infoTmation on hyf^ene amon^ tbe 
officers of vessels. The law giving the master entire control of tbe ves- 
sel is not desirable. The health oflScer should have more authority 
Better protection to the country requires a revision of the present laws. 
There should be requirements that all persons leaving or coming into 
the country should be subject to a thorough medical examination, and 
DO one suffering: with au inciuable or contagious disease should be per- 
mitted to come into the country. 

Vaccination should be required. 

Proper ventilation of emigrant vessels should be required. 

Every vessel should have one credited health officer to every €00 pas- 
sengers or less. 

The medical inspector should be required to inspect vessel daily and 
report to master. 

The master shoald be required to answer all demands of the vessel's 



VACCrNATION. 

The paper of Dr. Montizambert was a clear and practical demand for 
the enforcement of laws requiring vaccination of all persons coming into 
the country. The nation demanded such protection and he hoped that 
the association would do its best to secure tlte necessary legislation. 
Small-poz, wherever found in America, had its origin on foreign vessels. 
It is never native bom. There was absolute need for imperative laws 
upon vaccination, and he was very sorry that America did not have any 
laws requiring general vaccination for all immigrants. 

The report of the committee and the paper of Dr. Montizambert will 
be a great acquisition to the matter to be used in ui^ng strict enforce- 
ment of quarantine laws and the passage of stricter laws. 

The two papers will be published and copies sent to the members of 
the American and Mexican congresses and the Canadian gtarliament 

The Tidai. Drain System op Chablestos. 

Mr. L. J. Barbot presented a most interesting and valuable paper on 
the tidal drain system of Charleston. 

Dr. Conn, of New Hampshire, submitted an elaborate report upon the 
disposal of garbage and refuse. The report was read by title and will 
be published and distributed. The work of the committee consists of 
an examination of the processes now in use for the disposal of garbage, 
and the best metho<ls for its destruction. 

Dr. liindsley, of Iowa, moved that the committee on vital statistics W 
continued. Carried. 

Dr. Gihon, of the United States navy, who was one of the delegates to 
the international convention in Berlin, submitted a brief verbal report. 



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No. 16.J AicEKioAN PuBuo Hbalth AaSOOI&TION. 341 

Mabihice Sanitation. 

The last paper read before the departure for the qnarantiue station at 
Fort JohoBOD was maritime sanitation at port of arrival, by H. B. Horl- 
beck, M. ]>., quarantine officer of the port of Charleston. The paper 
was one of the most admirable presented to the convention. It was 
dear, concise and well framed, and gave to the members of the associa- 
tion a full insight into the workings of the station at Fort Johnson. 

He grave an elaborate and detailed account of the quarantine laws of 
CharleBtoD, and showed how rigorously the health of Charleston was 
guarded in colonial days against the importation of dlseflse. Tellow 
fever, its origin and how it became prevalent in Charleston, were thor- 
oughly discussed by Dr. Horlbeck. Be gave a graphic account of the 
places of Charleston and the Miseissippi valley. The plague of 1861 
was introduced by intercourse with the West Indies at tli&t time. 

Dr. Horlbeck gave a complete and detailed account of the workings 
of the quarantine station over which he has direction. 

The more important resolutions were adopted as follows: 

By X>r. Wood. That a committee of this association be appointed to 
confer with a similar committee of the American Medical Association to 
observe in some appropriate way the oenteuoial of tiie discovery of vac- 
cination. 

By Dr. Bohs. That the report of the committee on the cause and pre- 
vention of diphtheria be printed in pamphlet form as soon as practica- 
ble and that copies be furnished to each state board of health. 

Dr. GmoN. That a standing committee of five members be appointed 
by the president to formulate practical prophylactic measures for the 
prevention of the spread of tuberculosis, especially looking to the pro- 
tection of the healthy members of the community from tuberculosis in- 



The rep>ori of the committee on sanitary and medical service on emi- 
finrani ships is appended. 



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342 State Board of Health. [Off. Doc. 

Report of Oommlttea on Sanitary and Uedloal Serrioe on Bmigraat 
StalpB. 

By S. H. DuROiN, M. D., Chairman of lh« Committee, Boston, Matt. 

The immigtation of people from foreigrn coantries to the United 
States daring the last ten years has been much larger than for any simi- 
lar period in the history of our country, the number landed for the ten 
years ending- June 80, 1889, exclnaive of those from the British North 
American possessions and Mexico, bein^ 5,246,568 as against 2,742,137 
for the previous ten years. The eflfect of this rapid increase of our for- 
eign population upon the industrial and sanitary interests of our country 
is a problem which has already excited discussion in the halls of congress ; 
while the importation of physical and mental ailments, frequently a^ra- 
vat«d or induced by unnatural and unsanitary conditions on shipboard, 
has been recognized and deplored by medical and sanitary organizations. 
In considering this question, we are led to inquire, first. What proportion 
or number of these people are landed in this country in an unsound men- 
tal or physical condition, more or less dangerous to the communities in 
which they move, or who fall, sooner or later, upon the support of oor 
charitable or correctional institutions T There are no statistical data, 
to our knowledge, by which we could make definite statements upon 
these points, but the observations of medical officers long in the service of 
immigrant inspection at our ports of entry, and those doing medical ser- 
vice in our departments for public chanty and correction, warrant us in 
saying that the numbers are sufficiently large to attract serious atten- 
tion, and that they point to a very disproportionate number of diseased 
and dependent persons among the foreign as compared with the native 
population. According to the statements of trustworthy dermatolo- 
gists, supported by sufficient data, many of the skin diseases, particn- 
larly scabies, tinea favosa, leprosy, prurigo, lupus and melanosis are 
rarely found in this country except as direct or indirect importations 
from foreign countries, and their increase among us is mainly if not 
wholly due to this cause. Dr. James C. White, of Boston, says: "Unless 
some more stringent laws are made to keep out of our country the pau- 
per and dirty populations of Europe, the direct importation of the dis- 
eases we have been conridering (referred to above), and those which may 
arise as well as from the . Ithy habits they bring with them and trans- 
mit to their children, must follow with increasing magnituda" 

In 1880 our native-bom population numbered 43,475,840, and our for- 
ei^-bom 6,679,943. The native-bom paupers numbered 44,106, and 
the foreign-bom paupers numbered 22,991, or one pauper in 986 of the 
native-bom and one in 290 of the foreign-bom — a proportion of three 
and one-half times as large in the latter as in the former; and yet it 



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No I6.3 Ahehioan Pubuo Health Asbooution. 843 

it will be fotmd, wheu the oensos data for 1890 are completed, that the 
lai^ proportion of paapers in our foreigm population of 1880 will be 
oonsiderably increased on account of the poorer quality of immiffrants 
which we have received from the poorest parts of Europe in the last ten 
years. This large influx of foreign people, the importation and increase 
of infectiooB and exotic diseases, and the consequent vast increase of 
oar dependent class, lead us to the second and principal part of our in- 
quiry. 

We find that the medical inspection of emigrants at the foreign porta 
of departure, for the ostensible purpose of euluding unfit persons fi'om 
emigration, with but two unimportant e^Lceptions, is done by officers in 
the interest and employment of the country which is being abandoned 
by the emigrant, and not by an officer in the interest of the country 
where the emigrant seeks his new home. A single case, which occurred 
at Boston quarantine last summer, will serve to illustrate how this in- 
spection service, as now performed in foreign ports, may fail to detect 
or arrest cases which we are unwilling to receive: It was a middle-a^ed 
woman who left her home in Sweden to join her family (who had pre- 
ceded her) in their new home in America. She passed the medical in 
spectioQ at laverpool, and on reaching Boston quarantine placed her 
self in line with six hundred others for inspection; was easily appre- 
hended as a leper, removed to tlie hospital, photographed, and after a 
few days returned to Sweden under authority of act of congress, 
August 3, 1882 The case was one of tubercular type, far advanced, 
with ulcerations on limbs and face, and with beginning neorosis of fingers 
and toes. I pass the photograph for your inspection. 

The occasional exposure of passengers to small-pox, shortly before 
embarking, renders early vaccination, at least before the expiration of 
the foarth day, .extremely important. This act, however, is never per- 
formed until after embarkation, and generally too late to prevent an at- 
tack of small-pox among the passengers. 

The allowance of room for each passenger in the steerage must be 
regarded as inadeqoate for the healthful needs of the occupant, even 
when better means for ventilation are furnished than are now generally 
fonnd, or which our laws demand. 

The means of ventilation as called for, and as generally found, are in- 
sufficient, ill-adapted, and for the most part inoperative. 

The small amonnt of fresh air now provided is delivered with a dan- 
gerous draft directly upon one or two persons, while the atmosphere of 
other parts of the same compartment, where ventilation is most needed, 
remains practically stagnant. An ample supply of fresh air conld easily 
and safely be provided through larger shafts terminating near the floor 
in the open spaces in the center of the ship between the compartment 
partitions. From this point the air would pass over the top of the par- 
titions into the spaces occupied by the passengers, be well distributed. 



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344 State Board of Health. [Off. Doc. 

and then exhausted through the iron fitter in the floor at the Bide of 
the ship; the iron gntter to be connected with a shaft leading npward 
in the side of the ship to the floor above, and thence across to the center of 
the ship terminating above the hnrricane deck at a proper distance from 
the inlet shaft, and provided with an ample ezhanst fan at the top to se- 
cure the carrent at all times in the right direction. 

The unclean personal habits of the average emigrant, with the nn- 
elean and unaired bedding and clothine, added to the ills and confine- 
ment incident to a rough passage in these overcrowded and ill-ventil- 
ated quarters, are sufllcient causes for the sickening odors which have 
often been described. 

The hospitals, when used for ordinary diseases, are fairly vreO 
located and arranged, except in the matter of ventilation, bat when used 
for contagions diseases, with their present lack of any means for ventila- 
tion, the location is very bad. 

The means for ordinary bathing are inadeqnate, inconvenient, and but 
little used. 

The latrines are generally filthy and oftentimes extremely repulsive 
for want of necessary care. 

The quarters in the forecastle for the crew are well arranged, bat 
tacking in means for ventilation. 

One of the most noticeable features met with in the exunination c4 
emigrant ships is the general lack of information among the officers as 
to the location, use, care or existence of any sanitary rules, means or ap- 
pliances, and the ready excuses given for their absence or poor condition 
when found. 

All matters pertaining to the hygienic oonditious of the ship are by 
law left in the hands of the master. This is wrong in principle, and a 
failure in practice. The master of the vessel is required to make, post 
and enforce sanitary rules but he has neither the training nor the adapta- 
bility for such duties. 

The laws concerning all points of sanitary constmction and govern- 
ment on shipboard should be explicit, and should be enforced and sup- 
plemented by an officer whose education and professional trainiiig have 
qualified him for the work. 

It is therefore oar judgment that the sanitary care of the vessel be- 
longs wholly to the ship's surgeon, who may reasonably be expected to 
possess the necessary qualifications. Experience and inquiry have 
shown that greater care shonld be used in the selection of the medical 
ofGcere of the ship, and that snch officers shonld be provided with bet- 
ter rank, pay and assistance, to the end that all parts of the ship and 
every passenger may have intelligent daily inspections, that the earliest 
symptoms of disease may be detected and t^at a wholesome condition 
of the ship may be preserved at all times. 

The most recent laws for the regulation of emigration and emigrant 



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No. 16.] Ahsricam Public Health Absooutfon. 815 

ships were enacted Id 1882, and sucli parts of these as pertain to the sub- 
ject mider discussion are herewith given. 

In the opinion of yonr committee, the better protection of our conn- 
try ag^ninst the importation of coota^oas and infectious diseases, as 
well as the sanitary welfare of the emigrant while on shipboard, requires 
that these laws be revised and extended to meet the present standard 
views of the sanitarian. 

We therefore recommend — 

That there should be allowed on all emigrant vessels such clear cnbic 
space to each passenger, and that such means for ventilation be pro- 
vided in all parts of the vessel used by the passengers, inclading hos- 
pitals, as shall secure to each one at least twelve hundred cubic feet of 
fresh air per honr continuously. 

Tba,t there should be provided and carried on every passenger ship 
brinfrioK immigrants to this country, not less than one graduated and 
competent medical officer to each six hundred passengers, or part thereof, 
and it should be the duty of the principal medical officer of the ship to 
make and enforce regrdations concerning the healA of the passengers 
and the sanitary condition of the ship, and to post copies of said regn- 
lations and of the United States laws pertaining to emigrant passen- 
gers in accessible parts of the ship ; that it should be the duty of 
the medical officer to make daily inspections of all passengers and their 
quarters, and of all sanitary appliances, note their several conditions, 
and report the same to the master of the ship each day ; and he should 
make such requisitions for nmterial and aid upon the master of the ves- 
sel as he may deem necessary for the promotion of health among the 
passengers and the cleanliness of the vessel. 

That it should be the duty of the master of the vessel to provide all 
neoesear? aid to the medical officer in the performance of his duties. 

Be it enacted by the Senate and House of Bepresentativee of (he United 
Stales of America, in Congress assembled, That it shall not be lawful 
for the master of a steamship or other vessel, whereon emigrant passen- 
gers, or passengers other than cabin passengers, have been taken at any 
port or place in a foreign country or dominion (ports and places in for- 
eign territory contiguous to the United States excepted), to bring such 
vessel and passengers to any port or place in the United States unless 
the compartments, spaces and accommodations hereinafter mentioned 
have been provided, allotted, maintained and used for and by such pas- 
sengers during the entire voyage; that is to say: In a steamship, the 
compartments or spaces, unobstructed by cargo, stores or goods, shall 
be of sofficient dimensions to allow for each and every passenger car 
ried or brought therein, one hundred cubic feet, if the compartment or 
space is located on the main deck or on the first deck next below the 
mwn deck of the vessel, and one hundred and twenty feet for each pas- 
senger carried or brought therein if the compartment or space is 



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3*6 State Boabi) of Health. [Off. Doc. 

located on the Becood deck beiov the main deck of the veasel; and 
it shall uot be lawful to carry or bring passengers on any deck 
other than the decks above mentioned. And in sailing vessels sach 
passengers shall be carried or brought only on the deck (not being 
an orlop deck) that is next below the main deck of the vessel, or in 
a poop or deck-house constructed on the main deck; and the com- 
partment or space, unobstructed by cargo, stores or goods, ahall 
be of sufficient dimensions to allow one hundred and ten cubic feot 
for each and every passenger brought therein. And such passeu. 
gers shall not be carried or brought in any betweeu-decks, nor in any 
compartment, space, poop or deck house, the height of which from 
deck to deck is less than six feet. In computing the number of sucli 
piisseugers carried or brought in any vessel, children under one year of 
age shall not be included, and two children between one and eight years 
of age shall be counted as one passenger ; and any person brought in 
such vessel who shall have been during the voyage taken from any other 
vessel wrecked or in distress on the high seas, or have been picked up 
at sea from any boat, raft or otherwise, shall not be included in such 
computation. The master of a vessel coming to a port or place in the 
United States in violation of either of the provisions of this section shall 
be deemed guilty of a misdemeanor; and if the number of passengers 
other than cabin passengers, carried or brought in the vessel or in any 
compartment, space, poop or deck-house thereof, is greater than the 
number allowed to be carried or brought therein, respectively, ae herein- 
before prescribed, the said master shall be fined fifty dollars for each 
and eveiy passenger in excess of the proper number, and may also be 
imprisoned not exceeding six months. 

Section 2. That in every such steamship or other vessel there ^all 
be a sufBcient number of berths for the proj>er accommodation, as here- 
inafter provided, of all such passengers. There shall not be on any 
deck nor in any compartment or space occupied by such passenger more 
than two tiers of berths. The berths shall be properly constructed, and 
be separated from each other by partition^, as berths ordinarily are sep- 
arated, and each berth shall be at least two feet in width and six feet in 
length; and the interval between the floor or lowest part of the lower 
tier of berths and the deck beneath them shall not be less than six inches, 
nor the interval between each tier of berths, and the interval between 
the uppermost tier and the deck above it, less than two feet six inches ; 
and each berth shall be occupied by not more than one passenger over 
eight years of agej but double berths of twice the above mentioned 
width may be provided, each double berth to be occupied by no more 
and by none other than two women, or by one woman and two children 
under the age of eight years, or by husband and wife, or by a man and 
two of his own children under the age of eight years or, by two men 
personally acquainted with each other. All the male i 



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No. 16.] Ahebican Fublio Health Association. 317 

wards of foorteen years of age, who do not occupy berths with their 
wives, shall be berthed in the fore part of the vessel, in a compartment 
divided off from the space or spaces appropriated to the other pasaen- 
gera by a substantial and well secured bulkhead; and unmarried female 
pas8eng<ers shall be berthed in a compartment separated from the spaces 
occupied by other passengers by a substantial and well constructed 
bulkhead, the opening or communication from which to an adjoining 
passenger space shall be so constructed that it can be closed and secured. 
Families, however, shall not be separated except with their consent. 
£ach berth shall be numbered serially, on the outside berth-board, ac- 
cording- to the number of passengers that may lawfully occupy the 
berth ; and the berths occupied by such passengers shall not be removed 
or taken down until the expiration of twelve hours from the time of entry 
nnless previously inspected within a shorter period. For any violation 
of either of the provisions of this section the master of the vessel shall 
be liable to a fine of five dollars for each passenger carried or brought 
on the vessel. 

SfiCnoH 3. That every such steamsfaip or other vessel shall have ade- 
quate provision for affording light and air to the passenger decks and to 
the compartments and spaces occupied by such passengers, and with 
adequate means and appliances for ventilating the said compartments 
and spaces. To compartments having sufficient space for fifty or more 
of Boch passengers, at least two ventilators, each not less than twelve 
inches in diameter, shall be provided, one of which ventilators shall be 
inserted in the forward part of the compartment and the other in the 
after-part thereof, and shall be so constructed as to ventilate the com. 
partment ; and additional ventilators shall be provided for each compart, 
ment in the proportion of two ventilators for each additional fifty of such 
passengers carried or brought in the compartment. All ventilators shall 
be carried at least six feet above the uppermost deck of the vessel, and 
shall be of the most approved form and construction. In any steamship, 
the ventilating apparatus provided, or any method of ventilation 
adopted thereon, which has been approved by the proper emigration 
officers at the port or place from which said vessel was cleared, shall be 
deemed s compliance with the foregoing provisions, and in all vessels 
carrying or bringing such passengers there shall be properly constructed 
hatchways over the compartments or spaces occupied by Such> passen- 
gers, which hatchways shall be properly covered with houses or booby 
hatches, and the combings or sills of which shall rise at least six inches 
above the deck ; and there shall be proper companiou-ways or ladders 
from each hatchway leading to the compartments or spaces occupied by 
each passengers; and the said companion-ways or ladders shall be se- 
cnrely constructed, and be provided with band-rails or strong rope, and, 
when the weather will permit, such passengers shall have the use of each 
hatchway situated over the compartments or spaces* appropriated to their 



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348 State Board of Health, [^Off. Doc. 

ase; and every vessel oturyin^ or bringing such psaeengers eball have 
a properly located and constmcted caboose and cooking range, or other 
cookinf^ apparatus, the dimension and capacity of which shall be sofS- 
cient to provide for properly cooking and preparing the food of all such 
passengers. la every vessel carrying orbringingsuchpaasengers there 
shall be at least two water-closets or privies, and an ndditiooal wat«r 
closet or privy lor every one hundred male passengers on board, for the 
exclusive use of such male passengers, and an additional water-closet or 
privy for every fifty female passengers on board, for the excluaiTe use of 
the female passengers and young children on board. The afordaaid 
water-closets aaid privies shall be properly enclosed and located on each 
side of the vessel, and shall be separated from paeseugers' spaces by 
substantial and properly constructed bulkheads or partitions ^ and the 
water-closets and privies shall be kept and maintained in a ser\-iceablo 
and cleanly condition throughout the voyage. For any violation of 
either of the provisions of this section, or for any neglect to conform to 
the requirements thereof, the master of the vessel shall be liable to a 
penalty not exceeding two hundred and fifty dollars. 

Section 4. An alloira.nce of good, wholesome and proper food, with a 
reasonable quantity of fresh provisions, which food shall be equal in 
value to one and a half navy rations of the United States, and of fr^h 
\vater not less than four quarts per day, shall be furnished each of such 
passengers. Three meals shall be servecl daily, at regular and stated 
hours, of which hours sufficient notice shall be given. If any such pas- 
sengers shall at any time during the voyage be put on short allowance 
for food and water, the master of the vessel shall pay to each passenger 
three dollars for each and every day the passenger may have been put 
on short allowance, except in case of accidents, where the captain is 
obUged to put the passengers on short allowance. Mothers with in&ots 
and young children shall be furnished the necessary quantity of whole- 
some milk or condensed milk for the sustenanoe of the latter. Tables 
and seats shall be provided for the use of the passengers at regular 
meals. And for ever>' wilful violation of any of the provisions of this 
section the master of the vessel shall be deemed guilty of a misdemeanor, 
and shall be fined not more than five hundred dollars and be imprisoned 
for a term not exceeding six months. The enforcement of this penalty, 
however, shall not affect the civil responsibility of the master and 
owners of the vessel to such passengers as may have sufiered from any 
negligence, breach of contract or default on the part of such master and 
owners. 

Section 6. That in every such steamship or other vessel there shal) 
be properiy built and secured, or divided off from other spaces, two 
compartments or spaces, to be used exclusively as hospitals for soch 
passengers, one for men and the other for women. The hospitals shall 
be located in a space not below the deck next below the main deck <A 



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No. 16.] Amebioan Public Health Abbociation. H49 

the vessel. The hospital spaces shall in no case be less than in the pro- 
portion of eighteen clear saperficial feet for every fifty such paasengfers 
who are carried or brought on the vessel, and snch hospitals shall be 
supplied with proper beds, bedding and utensils, and be kept so sup- 
plied throoghout the voyage. And every steamship or other vessel car- 
rying or bringing emigrant passengers, or passengers other than cabin 
psasengers, exceeding fifty in number, shall carry a duly qualified and 
competent surgeon or medical practitioner, who shall be rated as such in 
tbe ship's articles, and who shall be provided with surgical instruments, 
medical comforts and medicines proper and necessary for diseases and 
accidents incident to sea voyages, and for the proper medical treatment 
of sDch pafisengers during the voyage, and with such articles of food 
and nourishment as may be proper and necessary for preserving the 
health of infants and young children ; and the services of such sni^reon 
or medical practitioner shall be promptly given, in any case of sickness 
or disease, to any of the paesengerB, or to any infant or young child of 
any such passengers who may need his services. For a violation of 
either of tbe provisions of this section the master of the vessel shall be 
liable to a penalty not exceeding two hundred and fifty dollars. 

Section 6. That the master of every such steamship or other vessel 
is authorized to maintain good discipline and such habits of cleanliness 
among such passengers as vrill tend to the preservation and promotion 
of health, and to that end he shall cause snch regulations as he may 
adopt for such purpose to be posted up on board the vessel, in a place 
or places accessible to snch passengers, and shall keep the same so 
posted up during the voyage. Tbe said master shall cause the com- 
partments and spaces provided for, or occupied by, such passengers to 
be kept at all times in a clean and healthy condition, and to be, as often 
as may be necessary, disinfected with chloride of hme, or by some other 
equally efficient disinfectant. Whenever the state of the weather will 
permit, such passengers and their bedding shall be mastered on deck, 
and a clear and sufficient space on the main or any upper deck of the 
vessel shall be set apart and so kept for the use and exercise of such 
passengers during tho voyage. For each neglect or violation of any 
of the provisions of this section, the master'of the vessel shall be liable 
to a penalty not exceeding two hundred and fifty dollars. 

Section H. That the collector of customs of the collection district 
within which, or the surveyor of the port at which, any such steamship 
or other vessel arrives, shall direct an inspector or other officer of the 
customs to make an examination of the vessel, and to admeasiu^ the 
compartments or spaces occupied by the emigrant passengers, or pas- 
sengers other than cabin passengers, during the voyage; and such 
measurement shall be made in the manner provided by law for admeas- 
uring vessels for tonnage ; and to compare the number of such passen- 
gers found on board with the list of such passengers f umishe<l by the 



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360 State Board of Health. [Off. Doc. 

maeter to the ciiBtoins officer; and the said inspector or other officer 
shall make a report to the aforesaid collector or anrveyor, stating' the port 
of departure, the time of sailing, the leng^ of the voya^, the ventila- 
lion, the number of such passengers on board the vessel and their native 
country, respectively; the cubic quantity of each compartment of space, 
and the number of berths and passengers in each space; the kind and 
quality of the food furnished to such passengers on the voyage; the 
number of deaths, and the age and sex of those who died during the 
voyage, and of what disease; and in case there was any unusual sick- 
ness or mortality daring the voyage, to report whether the same was 
caused by any neglect or violation of the provisions of this act, or by 
the want of proper care against disease by the master or owners of the 
vessel i and the said reports shall be forwarded to the Secretary of the 
Treasury at such times and in such manner as he shall direct. 



The Vaooinal Protection of Pnnnengnm from Borope, 



In considering the subject of the vaccinal protection of passengers 
from Europe to this continent, one of the first questions that naturally 
present themselves is, what is the principal object of the quarantine 
laws and regulations on this subject! 

There are no general compalsory vaccination or revaccination laws in 
America. Under all quarantine regulations the alternative of a quar- 
antine of observation may be chosen. It would seem evident, therefore, 
that the prevention of the introduction into America of vaccinally unpro- 
tected persons (who may contract small-pox after arrival), however de- 
sirable it may be in itself, is not the main object of the quarantine laws 
as to vaccination. 

The regulations requiring vaccination, or a qaarsDtine of observation, 
have evidently for their main object the prevention of the entrance 
into this country of any vaccinally unprotected person who may have 
been exposed to the infection of small-pox shortly before sailing, or 
upon shipboard during the voyage — in other words, who may have 
small-pox incubating in his system. They are, I presume, fonnded 
upon some such considerations as the following: 

(a) The period between the contracting of small-pox and the falling 
ill with the disease — the period of incubation — ^is, as a rule, about twelve 
to fourteen days. That is longer by some days than the average steam- 
ship voyage from Europe to this country. A passenger may, therefore, 
take the small-pox at his home, on the continent or in Great Britain, on 
his way to the port of departure, or whilst there waiting to embark, and 
yet remain apparently well during the voyage, and wlien passing at 



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No. 16.] AUERICAN FUBUC HEALTH AsSOCUTION. 351 

qoaraQtiDt}, and only fall ill with the developed disease after he hae 
reached his inland destination on this side. 

(6) The period of incnbation of the protective vaocination is less than 
that of small-pox. A vaccination usually "tabes" on the third or fourth 
day. By the eighth day the vaccine vesicle is completely developed, 
with its areola, the "zone of safety." 

(c) When this stage of the vaccine vesicle is reached before the actual 
appearance of the eruption of small-pox, the attack of that disease, 
otherwise about to disclose itself, may be averted. 

((f) Sven when this stft;^ of the vaccine vesicle ia only reached after 
the actual appearance of the ernption of small-pox, the attack of that 
disease may be modified or aborted. 

It is evident, therefore, that the earlier we can secure the vaccination 
of passengers, the more complete will be the protection for them and for 
this conntry. Vaccination during the voyage cannot be depended upon 
to prevent the development of small-pox from reception of its infection 
shortly before embarkation, unless it can be performed the first day or 
two after sailing. If postponed by the ship's surgeon on account of 
other daties, or to allow the passengers to get over their sea-sickness, if 
only done late in the voyage just to enable the ship's surgeon to make 
oath trnthfnlly that it has been done, or, still ivorse, if only done at qttar- 
antine at the port of arrival, it may possibly modify the severity of the 
attack, bnt it cannot be counted upon to prevent its occurrence. 

My experience at the St. Lawrence quarantines has proved the well- 
nigh invariable usage of the ships' surgeous to be the postponement of 
the examination, and of such vaccination as they may do, until the vessel 
is in the comparatively quiet waters of the Gulf; that is to say, until a 
day or two before the vessel is due at the qnarantine inspecting point. 
The excuse nsnally given is, that the recovery of the passengers from 
their sea-sickness had to be awaited. Personal observation has shown 
me that a very similEir usage obtains on some, at least, of the principid 
steamships running to New York, and I am told by ships' surgeous gen- 
erally that it is practically the rule for all vessels bringing passengers 
from Europe to all ports on this side. The exx>erience of Dr. Smith, 
health officer at the port of New York, seems to be very similar to my 
own. Thus he writes in one of his reports: 

"The success in securing the examination and vaccination of immi- 
grants within the first twenty-four hours after leaving port has not been 
commensurate with the effort made. The sea-siokuess, which very gen- 
erally prostrates a great portion of the passengers soon after the voy- 
age is commenced, continues several days, making it next to impossible 
for the surgeon in some cases to give the desired attention to this duty, 
and in others, and in many instances, affords a good escuse for neglecting 
it." 

The difficulty of examining and vaccinating a number of passengers 



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852 State Board of Health. [Opt. Doc. 

auffermg from searsickueas with all ita attendant disturbance of mind and 
body needs only to be mentioned to be believed in ; but it can scarcely 
be even approximately realized without having been ezperieoced. It 
may be assumed, then, that this cause of the tardy examination makes 
the carrying ont of the vaccinal protection during the first day or two of 
the voyttge practically beyond the power of the ship's surgeon, and, as 
before stated, when postponed until later, the vaccination cannot be de- 
pended upon to prevent the development of small-pox contracted before 
embarkation. When smallpox occurs during the voyage, and is ire- 
ported or detected at quarantine, the danger to this country is not really 
great. The cases of sickness are strained out at quarantine; there is 
full opportunity for the disinfection of the vessel, clothing, etc, and all 
persons on board are, at most ports, vaccinated. Under such circom- 
stances the exposure is recent, and the vaccination, even at quarantine, 
will usually be in time to prevent tiie spread of the disease. It is, 
therefore, not so often passengers from such vessels that communicate 
smoll-pox to interior communities. A greater source of danger is in 
those who have been infected at or previous to departure from the port 
on the other side, and who reach this country and pass the quarantine 
barriers prior to the development of the disease. And if there be a 
constant source of a grave danger to the interior commniiities of 
this country from the tardy revaccination on shipboard where a time 
limit for such revaccination is enforced, as in the St. Lawrence, how macb 
greater is the danger from some of the principal United States ports 
where practically any old vaccination mark is t^en as evidence of saffi- 
cient protection 1 Thus of the port of New York, Pr. Smith writes: 

"The law in relation to the vaccination of immigrants, which provides 
that 'those who are insufficiently protected from small-pox by vaccina- 
tion shall be vaccinated,' leaves so much to the judgment of the surgeon 
of the steamer, that in some instances the vaccinations are so few that it is 
of little benefit in preventing the infection and development of the 
disease when passengers are exposed to the contagion during the voy- 
age. The medical officer not infrequently accepts the slightest evidence 
of vaccination as a sufficient protection. The Qerman surgeons revacci- 
nate pretty thoroughly, but 'the English surgeons, as a rule, have vacci- 
nated only those who have no evidence of previous protection, or in 
whom it is very obscure.'" 

The period during which a successful vaccination or aa attack of 
small-pox ensures protection from small-pox varies to a certain extent 
under different circumstances, but no one who has had any experience 
with the disease will maintain that infant vaccination is a certain protec- 
tion throughout adult life. In some, it is possible that the regular phe- 
nomena of vaccination can be produced but once in a lifetime, but this 
is never to be depended upon. There can be no doubt that the protec- 
tive power of vaccination decreases in proportion to the length of time 



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No. 16.] Amebioan Public Health Association. 858 

that has elapaed since its perfonuaaoe ; and that, too, without any 
noceflsai; dependence npon the scar npon the arm, which may be car- 
ried Qnoblitersted to the grave, for it has been demonstrated over and 
over again that the condition of the cicatriceB does not furnish reliable 
evidence as to whetiier the subject is or is not protected. 

lu the armies of Eorope, where revaccination is now general, the per- 
centage of snccessfnl revaccinations has varied from fifty to seventy-five 
per cent. In the report of the committee to the American Medical As- 
sociation, 1886, 1 find the following amongst other conolnsions : 

That oat of any number of adnlt persons who have good marks of 
vaccination, forty and one-half per cent, are perfectly protected, while 
fifty-nine and one-hidf per cent, are susceptible to varioloid. 

That oat of any number of adult persons with imperfect marks of 
vaccination, twenty-three per cent, only are protected, while seventy- 
seven per cent, are liable to small-poz or varioloid. 

B^rnlations which only require steerage passengers to be vaccinated 
who are not "sufficiently protected," are maniiestly insufficient. Ships' 
sui^^eons are prone, as we have seen, to accept the slightest evidence of 
any vaccination mark as " sufficient protection." In any passenger vessel 
those without any marks are but as units compared to the hundreds 
with old marks but almost equally unprotected. At the best these few 
units may be vaccinated a day or two before the vessel reaches port on 
this aide, and they, and all the unprotected or ouly partially protected 
hundreds, are given "Protected" cards. Of what practical use is such 
a lawt It might be comprehensible if compulsory vaccination were a 
universal law throughout America. It may tend to lessen the importa- 
tion of unvaccinated persons; it may serve to lull the public into a fan- 
cied state of security; but it certainly cannot be expected or depended 
npon to protect interior communities from the introduction and devel- 
opment of small-poz contracted before sailing. And that, and that only, 
as we have seen, is the evident intention of and reason for the vaccina- 
tion regulations that apply to vessels where no small-pox hae occnrred 
daring the voyage. 

To secnra the protection nominally sought by the vaccination regula- 
tions, every proposed passenger should be required to produce evidence 
of protection by vaccination, or revaccination, within a fixed time-limit 
prior to admission to the vessel, or before it leaves the calm waters of 
the port of departure. 

For such a time-limit seven years might well be adopted. That is the 
period in force in some of the great continental armies, and it recom- 
mends itself to the popular belief in a complete change of the body 
within each recurring interval. 

It may be difficult to secure this at the ports on the continent, hut it 
would be a great deal gained if we could even secure it at the ports of 
departure In Great Britain. 
28-16-91 



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364 State Boasdof Health. [Off. Doc. 

Tbe f^vernment of Ea^land i-«cognizes a duty to pasHengdrs leaviug 
her ehores, aDd to the coantrieu for which they are so leaving her. In 
paragraphs ii and 45 of the imperial "Act to amend the law relating 
to the carriage of passengers by sea," it is enacted that 

No passenger ship, except as hereinafter provided (l^at is, where no 
medical man can be obtained), shall clear out or proceed to sea until 
some medical practitioner, to be appointed by the emigration officer, 
shall be satisfied that none of the passengers or crew appear by reason 
of any bodily or mental disease, unfit to proceed or likely to endanger 
the health or safety of the otter persons about to proceed in such ves- 
sel. Such medical inspectiou of the passeugers shall take place either 
on board the vessel, or, at the discretion of saifl emigration officer, at 
such convenient place on shore before embarkation as he may appoint; 
and tbe master, owner, or charterer of the ship shall pay to such emi- 
gration officer a sum at the rate of twenty shillings for every hundred 
persons so examined. 

If the emigration officer at any port shall be satisfied that any person 
on board, or about to proceed in any such passenger ship, is. for that or 
any other reason, likely to endanger the health or safety of the other 
persons on board, the said emigration officer shall prohibit the embarka- 
tion of snch person, or, if embarked, shall require him to be relanded. 

A person in the stage of incubation of small-pox is certainly " likely 
to endanger the health or safety of the persons on board." Every vac- 
cinally unprotected person embarking may be in that stage from recent 
exposure, consciously or unconsciously, to the infection, yet there being 
nothing in his appearance to betray his condition, it would uot be dis- 
covered by this medical inspection. 

It may be urged that a similar statement would also apply to the 
other infectious diseaaes. So, doubtless, it would ; but we have in ^-ac- 
cination a ready means of protection against small-pox, which, unfor- 
tunately, we have, uot as yet at least, against other diseases which like- 
wise have a stage of incut, ation. 

The enlargement of this medicinal inspection to include the examina- 
tion as to the vaccinal protection of intende<:l passengers, and the vac- 
cination lit that time by the government medical officer, by medical 
men employed for the purpose, or by the ship's surgeon, of all passen- 
gers who may uot demonstrate previous protection within the required 
limit, would be the best means—and indeed the only possible and 
effectual means that I can see — of protecting this country from the de- 
velopment, subsequent to landing here, of small-pox contracted before 
sailing. 

An occasional case might still occur on shipboard, wheitj the person 
only embarked at a late stage of the period of incubation, but even 
here the vaccination, if performed before sailing, might modify or abort 
the attack. And from the protection of all others having been already 



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No. 16.] American Public Health Association. 365 

secured there would be no danger of the disease spresdittg oa the ves- 
sel ; whilst, by thus making: sure of the TsociDal protection of all per- 
sons before sailing, the great majority of the cases of small-pox now 
occorring on shipboard, and all those occurring on or just after arrival 
at this side, would be prevented. 

I have said that to secure the protection presumably sought by vac- 
cination regnlationa every proposed passenger should be required to 
produce evidence of protection within a fixed time-limit From the less 
general regard of the laws of health among' the class from which steer- 
a^ passengeTS are, as a rule, drawn, and from their greater danger of 
exposure to infection in the inferior class of lodging-house they occupy, 
as n rule, on their way to and at the point of departure, there is, to a 
certain extent, more risk from them than from passengers of a hif^her 
class. No class, however, is entirely free from the risk. And all of you 
who have paid any attention to this subject must be familiar with cases 
of small-pox introduced into our sea ports and interior communities by 
intermediate and cabin passengers. 

I am of the opinion that the difficulty of including cabin passengers 
in the vaccination regnlations has been much over-estimated. People 
uow crossing the Atlantic to this side understand that, as a general 
thing, no qaestions are asked of cabin passengers, and so they take no 
special precautions. In most instances no trouble ensues, but every 
now and then a case of small-pox occurs on the voyage, perhaps among 
the nomerouit steerage passengers. Then thd cabin passengers, ladies and 
all, may find themselves suddenly and unexpectedly confronted with the 
ivqniremeut that they must show their arms to and possibly submit to voc- 
cioation by a ship's surgeon or a quarantine officer, about whom they know 
nothing, and in whom, and in the parity of whose vaccine, they may 
have no confidence. Hence, very naturally, a great deal of trouble, vexa- 
tion and opposition. For this is unquestionably an intolerable annoy- 
ance to which to subject people of that class. But once it were generally 
known that all passengers, cabin as well as other, would be required to 
fomiah evidence of recent vaccination, first-class passengei-s going from 
this side for a trip to Europe, and those coming from Europe here, 
would, before leaving their homes, send for their family physician, be 
vaccinated by him if need be, and in any case provide themselves with 
vaccination certificates. This they would do as regularly, and as much 
as a matter of course, as they would provide themselves with steamship 
tickets, or with passports if about to travel where they are exacted. 
And steamship ticket-agents would remiud those purchasing tickets, or 
othermse taking their passage, o! the obligation. On the voyage the 
ship's surgeon could quietly satisfy himself that all the cabin passengt^rs 
possessed satisfactory certificates, and would certify that fact under oath 
to the quarantine officer at the port of arrival. Andsocabin passengers 
would be saved from annoyance, without the present risk to the public 



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856 State Board or Health. [Off Doc, 

health, even if stnall-pox slioald oconr on the vesBel i and the distressingr 
scenes alluded to, instead of increasini? in frequency, would altog«ther 
cease to recur, 

I am qnite aware that during- the late Montreal epidemic of small-pox 
the inland quarantine officers of Ontario, and of the United States Ma- 
rine Hospital Service, found it necessary utterly to refuse to take writ- 
ten certihoates; but the cases are not parallel. On the trains crossing 
the frontiers, hundreds of persons of all classes passed daily, and it was 
impossible to identify the holders of certificates. These certificates 
themselves might have borne the signatures of fictitions medical men, 
or, even if in every way correct, mig^ht be mailed back and used over and 
over again. But in steamships, daring an ocean voyage, the surgeon 
could readily identify each passenger, if only by the names on the pas- 
senger-list. In the class of which cabin passen^rs are composed, it is 
indifference or carelessness as to revaccination, rather than deliberate 
fraud, that needs to be provided against. It is' unlikely that any pas- 
senger of that class would procure or manufacture a bogus signature, or 
that he would cross the Atlantic under a false name merely for the sake 
of availing himself of some one else's vaccination certificate. 

This association has already, at a former meeting, passed a resolution 
recommending concerted and simultaneous action by the executive quar- 
antine authorities of American and Canadian ports as to regulations to 
be enforced on this side. 

In the hope of obtaining the approval and support of this association 
towards the further effort to secure the vaccinal protection of passengers 
while it would be of real practical value, that is to saj;, before sailing, I 
beg now to present the following resolation: 

Whebeas, At the seaports and in the interior communities of this con- 
tinent, an outbreak of small-pox is started from time to time by persons 
who have passed the quarantines of the American or Canadian ports . 
appai'ently perfectly well, but in the stage of incubation of smali-pox con- 
tracted before sailing, and who develop the disease subsequently to land- 
ing; and 

Whereas, Nothing can prevent this but vaccination or revaccination 
within a time-limit, before or within the first day or two after sailing; 

Be it resolved. That, in the opinion of this association, it is desirabld 
that every effort be made to secure the enforcement of such protection by 
the inspecting government medical officers at the ports of departure. 



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Kb. 16.] Akbrioan Medical Association. 



3. BBtPOBT OF THB SBOBEITABT AS SBOBBTAB7 OF THE SBG- 
TION ON STATE MHDIOINB OF THB AUBBIOAN MBOIOAL AS- 
aOOIATEON WHIOH METT AT 'WASHINOTON. D. O., MAY 6, 6 
AND 7. 

Section of Stats Madlaine. Secretary's Report. 

Relations of Meteorolf^oat Conditions to the Origin anil Prevalence of Acute Dll- 
eaaes. Davla. 

Hygiene in the Rural Districts. Jenkins. 

The Duty of the Government In Iho Prevention ofTilliercnlosis. Flick. 

The DlHlnfecUoa of Excreta. Sternberg. 

The Sanitary and Unsanitary Relations of Uadergrouml Waters. Bryce. 

Simple Methods of Sewage Disposal. Chancellor. 

Original Investigations on the Heatingand Ventilation of School Buildings. Reed. 

The Construction of School Bulldini^ Lincoln, 



Secretary's Report. 

Cbairmau, J. D. Pluukett, Nashville, TeQD. Secretary, Benj, Lee, 
Philadelphia, Pa. 

First Day. 

The section met at the ColiuDbian University, Washington, D. C, at 
3 p. m. There were present and registered dnrinp the session forty- 
two delegates from all parts of the country. 

In the absence of the chaii'man. Dr. J. D. Plankett, Dr. John H. 
Baach was, on motion of Dr. J, Berrien Lindsley, called to the chair. 

The address of the chairman being necessarily passed over, the re- 
port of the committee on school hygiene was read by Dr. D. F. Lin- 
coln, chairman of the committee. Dr. Lincoln prefaced his i-eport by 
the statement that it was mainly synoptic:d and presented only such 
resnlts as all the members had been ablo to agree npon. Several of the 
members of the committee had prepared papers ou the special subdi- 
visions of the general subject which had been assigned them respec- 
tively, and were present to read them as supplementary to the report. 

At the conclusion of the reading of the report Dr Lincoln preseuted 
a paper entitled "Remarks on the Conatmctioa of School Houses." 

Tho report and paper were declared open for discussion. 

Dr. Gihou assented to the propositions laid down by Dr. Lincoln in 
the main. He considered the reference of the speaker to .the hygienic 
defects of the hall in which the meeting was in session especially well- 
timed. This was a building of modem construction, erected at a lavish 
expense for the express purpose of a class or school room, and yet as 
had been pointed out, its lighting was execrable, and as he had discov- 



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358 State Board of Health. [Off. Doc. 

ered duriu^ the reading of the paper, its acoustic properties were still 
worse. ^S'ith reference to the Btrictores passed upon natural ventila- 
tioD, 1. e., by means of wiadows, he was not bo thorotighly convinced. 
He had, when in charge of a naval school, adopted the expedient of 
placing a four-inch board under the edge of the lower sash, thus allow- 
ing an upward current of air to enter at the junction of the npper and 
lower sashea, and had found that ventilation could be quite satisfactorily 
secured in this way without creating daugerous drafts. It was objected 
to this that it only furnishod a means for introducing fresh air, and did 
not provide for the escape of the foul air. 

Dr. B. Harvey Keed replied that actual observation of an opening 
created in this way showed that there was an alternation of inward and 
outward currents. The air would enter for a few moments and then 
pass out for a similar length of time. 

He considered that the foul odor noticed on entering an ill-ventilated 
school room wtis not in any sense dependent upon or to be takeu as a 
measure of the amount of carbon dioxide in the air of the room. It de- 
pended on sulphuretted hydrogen, carburetted hydrogen and oi^anic 
filth resulting from perspiration and respiration. 

Dr. IJL. G. Matter, of Lancaster, Fa., suggested that in the same way 
that ventilation could be obtained by the four-inch board under the 
sash, it coidd also be obtained by having two panes of glass so ad- 
justed on ou ordinary sash that the air could pass freely in and out be- 
tween them. He inquired whether inspection of schools was not a 
proper function of the health commissioner of a city. 

Dr. 0. A. liindsley held that even though the air from a window 
raised with the four-inch board entered with au upward direction, its 
density compelled it to fall upon the heads of those near the window 
before admixture with the general air of the room. 

Dr. Mclntire agreed with Dr. Keed that the odor of the room in no 
way depended upon the presence of carbon dioxide, but upon the or- 
ganic impurities, and that on the other hand the amount of carbon diox- 
ide present could not be accepted as a test of the impurity of the air. 

Dr. Lincoln remarked, in reply, that undoubtedly emanations of \~ari- 
ous kinds and of all kinds from the human body contributed to the 
foulness of the atmosphere of a school room, but that where carbon 
dioxide was found iu excess, as a product of respiration, it indicated 
necessarily the presence of other impurities, also products of respiratiou 
and other excretory processes which arc extremely difficult to detect 
and to determine. The valuo of the determination of the percentage of 
carbon of dioxide, therefore, was that of a general indicator of impurity. 

Dr. Chancellor considered it of quite as much importance to provide 
special means for the expulsion or esliaustion of the foul air, as for the 
introduction of the fresh. Two bodies cannot occupy the same space at 
the same time. Unless the foul air is first removed, the fresh air cannot 



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No. Ifi.] Ahsbicak Medical Association. 369 

eoter. In cold weather the piijre air shonld be introduced warm : the 
outer air at a freezing temperature Bbonld not be brought in. 

The difficulty of obtainiti^ a pare outer air in cr iwdod centers of x>op- 
ulation is not sufficiently appreciated. Li these days of rapid transit 
why should we not establieh our pubUc schools iu suburban districts, 
where there is an abundance of pai-e air, and furnish proper facilities 
fo-.' the pupils to reach them. 

Dr. Lincoln pointed ont the extensive character of the work assigned 
the committee, stated that it did not by any means consider that it had 
yet accomplished this work, and in the name of the committee re- 
quested its continuance. 

On Aaotion this t«quest was unanimously acceded to. 

Tlie committee thereupon continues as follows, to report next year: 

Committee on School Hyijiene. — D. F. Lincoln, Geneva, N. T., chair- 
mar ; George H. Boh^, Baltimore, Md.; J. G. Pinfcham, Lynn, Mass.; 
W. L. Schenck, Osage City, Kansas; "S,. Harvey Reed, Mansfield, Ohio. 

Dr. Bauch requesting to be excnsed from the duties of the chair. Dr. 
A. L. Gihon was, on motion, called to its occnpancy. 

Dr. Gihon inquired whether the roll of the committee on state medi- 
ciue bad been called, and stated that it had been customary to do so. 
Tlio roll was therefore called, and it was found that but five members 
out of forty-two (two of the committee being deceased) had registered 
iu this section. Further discussion of the subject was deferred until 
after tho reading of the papers. 

Dr. B. Harvey Bead, of Ohio, then read his paper entitled "Original 
Investigations on the Heating and Yentilation of School Buildinga" 
This paper was accompanied by the exhibition of a large number of 
charta illustrating the following points from actual and accurate obser- 
vation : 

1. Date and time of day inspection. 

2. Name of building and room. 

3. Number of cubic feet of air in room. 
■4. Number of pupils present. 

5. Outside temperature. 

,6. Temperature of room at levels of head, feet and ceiling. 

7. Humidity outside. 

8. Humidity in room at levels of head, ieet and ceiling. 
!). Kind of heating apparatus in use. 

10. Bystem of ventilation employed. 

11. Number of cubic feet of fresh air supplied and of foul air dis- 
chai^^ per hour. 

12. Estimation of amount of carbon monoxide present iu the air of 
the room. 

13. Estimation of the amouut of carbon dioxide present iu the air of 
the room. 



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860 State Boabd of Health. [Off. 'Doo. 

14. CoD&ideratioD of tbe amount of organic matter present in the air 
of the room. 

15. Bacteriologfical examination of the air of Uie room. 
1(J. Miscellaueoas remarks and sngffreations. 

IT. Conclusions. 

The paper of Dr. George H. Rohe, member of the committee on 
Bcbool hygiene, was then read by the author, the title being "The 
School Sanitary Inspector; His Qualifications, His Duties and His 
Powers," 

The paper of Dr W. L. Schenck, a member of the same committee, 
on "The Personal Hygiene of School Children," vas next in order. In 
the absenco of the author the secretary read an abstract of the paper 
whicli Lad been prepared by the chairman of the committee. Dr. D. F. 
Jjincoln. The subjects embraced were physical training, study, time 
and amount, recess and location, instruction in hygiene, by whom and 
how to be taught, and the prevention of contagious diseases. 

The secretary read a telegram from Dr. Octavius A. White, who had 
been announced to open the discussion on this subject, stating that ill- 
ness prevented his presence. Dr. Oihon therefore called upon Dr. N. S. 
Davis, as the oldest member of the section, to take his place. 

Dr. Davis spoke in terms of high commendation of the industry dis- 
played in the preparation of the report and the various supplementary 
papers, especially the tabular work of Dr. Beed's paper. 

Tho period of childhood was certainly that in which the greatest re- 
sults could be accomplished by proper hygienic inflnences. Could we 
have such influences in active operation in school as well as at home, it 
is not too much to hope that nearly all of the defects which wo call 
hereditary could be eliminated from our people iq the course of a few 
generations. It should be the especial duty ofthe physicians to iuKtract 
the heads of families in which he is the medical adviser in the laws of 
health, especially as regards growing children. 

Dr. Cochran being called upou, said that he had listened with amase- 
ment to the proposed qualifications for school inspectors. Certunly it 
would be a long time before it would be possible to inaugurate such a 
system in his part of the country. He could only express his gratifica- 
tion at what had already been accomplished by the gentlemen who had 
read the papers. 

Dr. Bibberd described the condition of the country school house of 
his early days, in which lack of suffici^it introduction of fresh air was 
not a noticeable feature. 

Dr. Lyster, of the Michigan State Board of Health, spoke with regaid 
to that portion of Dr. Beed's paper which referred to the Smead system 
approvingly. His board had been deeply interested in the study of that 
system in numerous educational buildings in their state. So far as it 
was a-^ociuted with a process for dessicatiug fieoes, they had been com- 



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No. 16. ) Ahbbioan Medical Asbocutiom. 361 

pelled to report adversely upoD It. When discomieoted with auy such 
proceB8, and used simply for the iDtroduotion of pure warm air and the 
exbaostion of impure air it certainly worked admirably. 

Dr. McConnadi, secretary of the 8tate Board of Health of Kentucky, 
while deeply interested in so mucli of the papers oa he had been fortu- 
nate enough to hear, and commendluK' their purpose, coming: bs he did 
from a western state, felt that the Bug^stious were many of them such 
as could only be successfully carried out in the land which we name 
TJtopia. 

He moved that the reports and papers be referred to the association 
and (he committee continued. It was carried. 

Dr. McGormack stated that a resolution was passed in the association 
at the momingf's session, calling: upon each section to appoint a com- 
mittee to confer with similar committees from the other sections to con- 
sider the subject of perfectinf; the organization and improving the work 
of the Bections. 

He therefore moved that the chair appoint a committee of three for 
this purpose. 

The motion was carried and the chair appointed Drs. H. Harvey Beed, 
A. N. Bell and J. T. Seeve as such committee. 

The section then, on motion, adjourned to meet at the same place on 
Wednesday, May 6, at 3 p. m. 

Second Day. 

The section convened at 3 p. m., May 6, 1891, pursuant to adjourn- 
ment. 

Dr. J. Berrien Lindsley, of KaehviUe, Tenn., the oldest ex-chairman 
present, was, on motion, called to the chair. 

Dr. N. B. Davis, of Chicago, 111., then presented his report as chair- 
man of the committee ou "Meteorological Conditions of the Atmosphere 
and their Belations to Coincident Prevalence of Disease." The i-eport 
was founded on an immense number of careful meteorological observa- 
tions, and sanitary and mortuary returns, showine- much faithful and 
persevering labor. It drew attention to the apparent influence of the 
presence of ozone and peroxide of hydrogen in the atmosphere in dimin- 
ishing the amount of albuminoid impurities. The alternate prevalence 
of typhoid fever and pneumonia was adduced in favor of this theory. 
A considerable portion of the report was devoted to the consideration of 
the influence of the presence of epidemic influenza, in increasing the fre- 
quency of many other diseases, such especially as pneumonia, acute 
bronchitis, typhoid fever and diarrhoeal affections. 

The report was listened to with deep interest. Discussion being 
called for. Dr. Flick, of Pennsylvania, considered that a serious source 
of error existed in all our statistics of influenza, from the fact that many 
cases of pneumonic complications were reported as pneumonia, which. 



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362 State Board of Health. LOff. Doa 

when the symptoms were carefully sifted, could not be Maintained to be 
so. It was a special conditiou peculiai* to in&ueaza, in which localized 
foci of iuflammattou were found distribnted throughout the long' tissue. 
The same might be said of the diarrhceal complications. Strictly, all of 
these cases should have been returned as influenza. 

Dr. Faningtoc, of Ireland, who was present by invitation, drew atten- 
tion to th» somewhat i-emarkable fact, that th€ Btatistics of influeuza in 
his country showed that this disease made its appeafanoe with them at 
about the same time that the earlier cases were reported in America. 

Dr. Davis was fully aware of the errors liable to creep in from false 
diagnosis, as referred to by Dr. Flick. These liabilities, however, existed 
at all timet) and in all places. They were not confined to times of epi- 
demic or to certain cities. His owu impression was very strong that, 
during the prevalence of an epidemic, and especially one of such an af- 
fection as influenza, which manifested itself in so many different ways, 
the danger was ratlier that other affections should be falsely designated 
as cases of the prevaiUng disease which was uppermost in every mind, 
than the reverse. The same remai-kable simultaneousnessof appearance 
observed by the gentleman from Ireland, on the two sides of the At- 
lantic, was observable in different sections of our own country. 

In conclusion, Dr. Davis requested to be excused from a further con- 
tinuance of the self-imposed labor which he undertook at the meeting at 
Newport, in the preparation each year of this report, feeling that his de- 
clining years and strength would not permit him to devote the neces- 
sary time and energy to it. The secretary remarked that wliatever of 
physical abatement of force and diminished elasticity the reader of the 
report might be personally conscious of, these conditions bad certainly 
not in the slightest degree reached his mental vigor. He had been in 
doubt whether most to admire the great value of the rep>ort or the amoant 
of labor which had been expended in its preparation. It was, however, 
due to Dr. Davis that his request should be granted, and in seconding 
it, he also wislied to move a special vote of thanks to that gentleman 
for his services in connection with the section. The motion was car- 
ried. Dr. Davis feelingly acknowledged the compliment, and pi-oceeded 
to sketch briefly, for the benefit of those who should take up the work 
of the committee, tho lines on which it had been prepared to carry on 
these observations. The different agencies on which he bad relied for 
information were: 

First. The United States signal service observers, at such points as 
it had been deemed advisable to obtain data, for the meteorological ob- 
servations which they are by law required to make. 

Second. Other scientific observers, official or voluntary, for determi- 
nations of ozone and peroxide of hydrogen nt or near the same points. 

Third. Chemists who could be relied upon for examinations of the 
atmosphere for organic impurities, at the same stations; and. 



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No. 16.] Amebican Medical Absociation. 863 

Fourth. Physicians, who were called npou to make letiims of all cases 
of aonte disease occurring in their own practice, in the ueig-hborhood of 
these stations. 

He regretted to be compelled to say that, while the signal service of- 
ficers were perfectly ready to ^ive all the assistance in their power, and 
scientific volnntary obaervers were also to be depended un, and a chem- 
ist could occasionally be found who was willing' to devote attention to 
the subject, the physicians could not be aroused to a sense of the im- 
portance of the subject, or to give the slightest assistance. 

Dr. Hibberd suggested that it would facilitate the work of the section 
in this respect if Dr. Davis would kindly name his own successor in the 
work, and a motion was passed requesting him to do so, at his con- 



Id the absence of the author, Dr. C. A. Lindsley read the paper of Dr. 
Joseph S. Smith, colonel and sui^eon United States army, medical di- 
rector department of Arizona, entitled " Sickness and Mortality in the 
Army of the United States." 

Dr. A. N. Bell, of Brooklyn, then read his paper on " The Beueficeuce 
of Disease." 

A paper on " The Sanitary and Unsanitary Relations of Undei^fround 
Waters" was next read by Div Peter H. Bryce, of Toronto. 

Dr. Lawrence F. Flick, of Philadelphia, followed with a paper on 
"The Duty of the Government in the PreTention of Tuberculosis." 

Opportunity for the discussion of these valuable papers, which were 
listened to with great interest, was prevented by the fact that it was 
necessary to vacate the 1*0001 by a certain hour. 

Election of officers for the ensniug year being now in order: 

Dr. Bell nominated Dr. Benjamin Lee, of Philadelphia, as chairman. 

There being no other nomination, n viva voce vote was taken, and Dr. 
Lee was announced as elected. 

Dr. Hibberd nominated Dr. Lawi'ence F. Flick, of Philadelphia, as sec- 
retary. 

There being no other nomination, n vtva voce vote was taken, and Dr. 
Flick was announced as elected. 

On motion of Dr. Bell, it was resolved, that the chairman and secre- 
tary elect be a committee to nominate the members of the committee 
on state medicine, and be instructed to send the list of the names to 
the secretary of the association. 

The section then, on motion, adjourned to meet .it the same place at 
8 p. m.. May 7, 1891. 

Third Day. 
The section met, pursuant to adjournment, at 3 p. ui., May 7, 1891. 
Dr. J. Berrien Lindsley wiw called to the chair. The secretary an- 
nonoced that he had received a telegram from Dr. J. D. Flunkett, the 



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364 State Board of Health. [Off. Doc. 

chairmauof the section, statiofi: that he had been detained by the soddea 
illness of his wife, and regretted that be would be tinable to be present. 

Dr. A. X. Bell moved that the secretary be instructed to express to 
Dr. Plunkett the regretd of the section at his absence, and to reqaest him 
to forward at once a copy of his addresH for publication. It was carried. 

Dr. H. O. Marcy beingf compelled to read a paper in another section, 
his paper was substituted for the first paper on the profrramme, the 
author of which was absent. Dr. Marcy read his paper on " The Cor- 
oner System in the United States." 

The paper of Dr. George M. Sternberg, lieutenant colonel and sur- 
geon Uniteil States army, on the " Disinfection of Excreta," was read, 
in the absence of the author, by Dr. Peter H, Bryce, of Ontario. 

Dr. C. W. Chancellor, secretary of the State Board of Health of Mary- 
land, then read a paper on " Simple Methods of Sewagre DispoeaJ," ac- 
companied by the presentation of a model apparatus for the purpose of 
ose in sabnrban residences. 

The secretary read a letter from Dr. Bobert C. Davis, member of the 
board of health of the city of New York, stating that owing to illness, 
he regretted to be unable to he present to open the discussion on these 
papers, as announced. 

Discussion being invited, Dr. Lyster, of the Michigan State Board of 
Health, remarked on the fact of the necessity of some definite action on 
the part of the section for the protection of water supplies, both in wells 
and rivers, from the sources of pollution referred to in Dr. Chancellor's 
paper. He thought we should put ourselves on record as utterly con- 
demning the use of the ordinary unprotected privy vault. 

Dr. Bryce, while greatly interested in the manner in which Dr. Chan- 
cellor has sketched the different methods of sewage disposal, and in the 
method proposed for dealing with it in small quantities, which liecould 
see might work very fully for separate bouses, confessed that he had 
been disappointed in the want of success attributed by the reader of the 
paper to systems of sewage irrigation. Water carriage has such a vast 
advantage over all other systems in convenience, and in cleanliness, and 
in inoffensiveness about the residence or building, and with good mod- 
em plumbing may be made so perfectly safe to the occupants of the 
house, that we are practically compelled to accept it for all towns of any 

It had been demonstrated that the separate system could be intro- 
dnced for a town of 5,000 inhabitants, at a cost of from $7,000 to $9,000 
per mile, with all necessary appliances for flushing automatically. The 
question of expense, therefore, is met. The only question is, in cases 
where there is not a large river with a strong current, what to do with 
the effluent. It did seem to him that Dr. Chancellor bad overstated the 
difficulties attendant upon treating this by irrigation. As an instance 
of bow readily this might be done, he referred to the system in use by 



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No. 16.] Amebioan Medical Assocution. 365 

the Ijondon hospital in Ontario. The entire plant, £1*001 beginning to 
end, cost only $25,000, and it Bnfficed for the necessities of a population 
of 1,200 people. The eeporate system was adopted. The in-ig:ation 
farm was only four acres in extent. One-third of this sarface was used 
every day, so that each portion had two days of rest. The efilneut flowed 
on to it, BO thoroughly mixed by its rapid poaaage through the pipes, 
that it was absolutely fluid and left only a thin film on the surface, which 
when dry was raked in by a laborer. Thei-e had never been the slight- 
est offensive odor from it, and chemical tests indicated complete nitrifi- 
cation of all the organic filth. 

Dr. Chancellor, in closing the disoossion, said that Dr. Bryce had evi- 
dently misunderstood him, as regarded the intent of his paper, which 
was not intended to take up the discussion of large systems of sewerage, 
bat only of devices, where lai^ systems are not available His figures 
on the expensiveness of irrigation were with reference to places in 
which it was absolately necessary to prepare theground by an elaborate 
system of double underdrains. Very few places were so fortunately 
sitoatad as London with its natural filter bed of sand close at hand. 
And even then he feared that in a few years it would be necessary for 
them to take in new ground for the purpose. This had been the ex- 
perience in Berlin and other continental cities. In regard to the puri- 
fication of infected wells, he had often been able to accompUsh it by 
having a quantity of chloride of lime placed in the well, allowed to re- 
main a few hours, and the well then pumped out completely. By re- 
peating this process two or three times, the water could often be com- 
pletely ptuified. Of course, when it was practicable, he preferred to 
have BDch a well abandoned. 

The next and last paper of the programme was read by Dr. G. W. 
Jenkins, of Kilboume City, Wisconsin, under the title "Hygiene in the 
Bural Districts." 

The suggestion contained in the paper that physicians could do much 
to improve the hygienic conditions in rural districts, by forming social 
clubs, which should meet from house to house, and before which demon- 
strations of truths familiar to hygienists, which wonld interest and im- 
preaa the minds of the people, was considered a practical and valuable 
one by Drs. Lee, Lyster and other members. 

The section was then declared adjourned, to meet at the time and 
place determined upon by the association, in the year 1892. 

Benj. Lee, • 
Secretary. 



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State Boabd op Health. [Off. Doc. 



By X. H. Davim, M. D., C.Wicmon, o/ CMe-iffo. 

The work origiDally aseif^ned to your committee was commenced by 
ite cbairman in 1671, amil it was prosecuted witb more or less activity 
aud Buccesa until 1885 since which time it has received less attentiou. 

Beports containing important facts and the r^ults of original inveB- 
tigr&tions were made and published in the volumes of transactious of the 
association for 1876, 1877, 1879, 1881 and 1882, and in The Journal ot 
the BBeociatioD, vol. II, pp. 85-169. 

The leading object of the committee has been to obtain more exact 
and reliable knowledge concerning the causes and circumstances that 
originate or increase the prevalence of the various forms of acute dis- 
ease, by procuring and preserving continous daily records of all appre- 
ciable conditions of the atmosphere, water and soil, and coincident rec- 
ord of the date of the commencement of acute diseases, in localities 
representing different parts of the country and various climatic condi- 
tions. For details of the plan adopted and its practical working, I 
must refer you to the report made to the associotioQ in 1883, and pub- 
lished in TIte Journal, vol. II, pp. 86-169, 1884. That report included 
the results of one year of observation and record of the ozone and hy- 
drogen peroxide in ten or twelve stations, as indicated by unifoi-m test 
papers, and in Chicago a complete record of the relative amount of free 
and albuminoid ammonia for the same period of time, as determined 
by Professor J. H. Long, of the laboratory of the Northwestern Univer- 
sity. These records, iu connection with those previously made, enable 
us to deduce the following propositions: 

1. That the indications of the presence of ozone and hydrogen per- 
oxide iu the atmosphere vary very much at short distances, being gen- 
erally increased by high winds, cold dry air, and proximity to large 
bodies of water, and diminished by still, warm and moist air, and still 
more in the interior ot cities, houses and densely populated districts. 

2. That an appreciable amount of both free and albuminoid ammonia is 
almost always present in the atmosphere, especially in cities and densely 
populated districts of country. The albuminoid is much more abun- 
dant than the free ammonia, and being chiefly derived from putrefactii-e 
changes in animal matter, its i-elativo prevalence is greatest during the 
antnmu and early winter months, and least during the spring and early 
summer, when it is most actively consumed by growing vegetation. 

3. The observations of Prof. Long and others show that putrefactive 
processes iu the presence of moisture favor the production of free am- 
monia, while with greater dryness, more albuminoid ammonia is liber- 



ty GoOglc 



Na 16.] Ahebioan Medical Asbooutioh. 367 

ated, and that boUi are capable of being carried by atmospheric currents 
several miles from their sonrce. His experiments, as detailed in the re- 
port of 1B84, also show that the free and albuminoid ammooia are di- 
rectly acted npOD by the ozone, and their identity destroyed by entering 
into uew combinations or being resolved into ultimate elements. 

If these propositions are correct, they point directly to the important 
fact that whenever we have, coincidently, an abundance of decomposa- 
ble animal matter on the earth's surface, a favorable temperature, slow 
atmospheric currents, a minimum of moisture, and little active vegeta- 
table growth, albuminoid ammonia will appear most abundant in the 
atmosphere; sufficiently so, it would seem, to either become the pabu- 
lum tor the rapid growth of pathogeni'j germs, or for the evolution of 
tozalbamens or ptomaines, and thus aid in explaining the rapidity of 
development and spread of some important epidemics. 

On the other hand, when we have coincidently, either dry cold air or 
rapid vegetable growth with rapid atmospheric currents, and fi-eqneut 
fresh falling water, we have increased indications of the presence of the 
active oxidizers, ozone and hydrogen peroxide, with the minimum of al* 
buminoid ammonia in the atmosphere. The influence of these combi- 
nations of atmospheric elements on the prevalence of both endemic and 
epidemic diseases, is pretty clearly shown by the recorded observations 
made in Chicago during the last ten years, particularly in reference to 
typhoid fever, pneumonia and epidemic influenza or la grippe. 

In speaking of atmospheric and climatic conditions at Chicago, it 
should be borne in mind that the city is built ou nearly level ground, 
skirted for many miles to the east and northwest by Lake Michigan, and 
to the west and southwest by a still broader expanse of nearly level, rich 
prairie country, while the most prevalent winds are from the southwest 
and northeast, l^e winter of 18S0-81 was characterized by at least the 
average degree of coldness and other ordinary atmospheric conditions, 
but was followed late in March, 1661, by an extraordinary fall of snow 
over a wide district of country. Melting rapidly, it caused unusual floods 
and thorough saturation of soil during the month of April. But for three 
months following May 1 there was not enough rainf ail to wet the dust in the 
fitreets. and only an ordinary average during the months of August 
and September, while the prevailing winds were from the southwest, 
and minsaally light or slow. This early complete saturation of the soil, 
followed by protracted dryness, wjth average summer heat and compar- 
atively slight atmospheric currents, strongly favored the formation of 
an unnsually large amount of albuminoid ammonia, with only occasional 
tmces of ozone. The records of disease aud mortality show that early in 
June attacks of typhoid fever began to be more frequent, and the num- 
ber increased i-apidly through July and August, culminating in Septem- 
ber, nnd then declining to the ordinary average through October and 
November. During the eight months from May 1 to December 31, 1881, 



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State Board of Heai.th. 



[Off. Doc. 



the wliole number of deaths from typhoid fever, as reported to the city 
health office, waa 627; while the total number reported for the corre- 
sponding mouths of 1880 was 143, and for the same in 1882 was only 
236. As the extraordinary prevalence of typhoid fever in 1881 dimin- 
ished to nearly the averagfe of other years in November and Deoember, 
attacks of pneumonia be^an to increase, and culminated in a decided ex- 
cess above the average in January, 1882, when 122 deaths were recorded 
from that disease, whereas only 48 had been recorded during the corre- 
sponding month of the preceding year. But the moat important Snotna- 
tions in the prevalence of certain diseases, and coincident extraordinary 
atmospheric conditions, have been observed during the years 1890 
and 1691. 

At the annual meeting of the American Medical Association, May, 
1890, 1 had the pleasure of reading a brief paper on the meteorologit^ 
and other local conditions coincident with the prevalence of epidemic 
influenza in Chicago during tiie preceding winter. But as the figtues 
regarding the prevalence of diseases given in that, were limited to the 
older twenty-four wards, and included only the two months prior to the 
appearance of the epidemic and two months after its subsidence, I have 
taken the liberty of extending my observations regarding the further 
prevalence of that disease in the same city, and its relations to the prev- 
alence of other diseases of importance. The statistics given in this 
paper relate to the entire city, with a population, as by the census of 
1890, of 1,100,000. The diseases considered will be designated as pneu. 
monia, other acute affections of the respiratory organs, influenza or la 
grippe, typhoid fever, acute diarrhoeal diseases and sunstroke. The 
acute diarrhoeal diseases will include cholera infantum, cholera morbus, 
diarrhoea and dysentery. The following tables have been carefully com- 
piled from the books of the registrar of vital statistics in the health 
office of Chicago, and extend over the entire years 1869, 1690, and the 
first quarter of 1891. Of coarse they refer only to deaths, and afford a 
basis for only a proximate estimate of the number of attacks of each dis- 





Mortality 


FOR 


Year 1869. 














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1 


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1 


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ill 




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1 


1 


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la 111 


90 


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iU 






Tot.l 







1 i 






. — 

in 














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No. 16.] 



AuERicAN Medical Assocution. 

MOKTALITX FOB YeAB 1890. 





i 


t 


i 


1 


i 


i 


i 


1 


1 

1 
1 


7 


1 


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OUmt aeote iwplntorr 


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m 


39 


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188 


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MURTALITT TOR 


KllUT QUIKTIK IM1 






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FAViU ur NKATH. 


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The mortality from thediseases named iu the {oregoiiigtables, a» showi; 
for 1889, is very noarly the average ratio of mortality from the same dis- 
eases for a aeries of years. If there is any deviatioD, it is in a slight ex- 
cess of mortality from diarrhoeal diseases during the early waves of h igh 
temperature in July, accompanied by a few suuBtrokes. Taking that 
year as the standard of average mortality, not only for the year but also 
for the several seasons of the year, we are enabled to see the marked 
deviatiouB from that in the table for 1890 and the first quarter of 1891, 
both as i'e$;ards the oocurrence of the epidemic influenza and its appar- 
eot infloence on the mortality from other diseases. Thus, while the 
total mortality in 1890 from pneamonis and other acute diseases of the 
respiratory organs was 2,106, only one-third of which occurred during 
the first quarter, t. e., January, February and March, and only one death 
from the epidemic influenza, which occnrred the last week of the year, ' 
the total mortality from pneumonia and other acute diseases of the re- 
spiratory organs in 1889 was 3,186, more than half of which took place 
during the first quarter, and for those months was double the mort^ity 
from the same diseases the preceding year. Coincidently, the influenza 
epidemic that had just shown itself the last week of December, 1889, 
rapidly culmirtated in Jviuary, 1890, and almost as rapidly declined 
tiirongh February and March, leaving a recognized direct mortality of 
only 111. The reappearaaoe of this epidemic influenza during the first 
34-16-91. 



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370 State Board op Health. [Off. Dog 

quarter of 1891, at first mildly, occasioning only four cleatbs in January 
and six in February, but suddenly culminating with 155 in March, Tvas 
accompanied by the same extraordinary mortality from acut« diseases 
of the respiratory organs as in 1890. 

Thus the table for 1891 shows the mortality from pneumonia in Jui- 
nary, 260; February, 233, and in March, 722, while that from other auute 
diseases of the respiratory organs was, for January, 176; February, 172, 
and March, 344, making the total mortality from these diaeeses during 
the first quarter of 1891, 1 ,927 — or 149 more than the aunsnal mortality 
of the same month of 1890, and 1,200 more than in 1889, representing 
the ordinary average. The same influenza epidemic infiueuce was 
plainly seen, though less exaggerated, on the mortality from typhoid 
fever and diarrhceal diseases. Thus, during the first quarter of 1889 
the mortality fropi typhoid fever was only 66, while for 1890, it was 292, 
and for the same months in 1891 it was 199. And from acute diarrhceal 
diseases during the first quarter of 1889 the mortality was 29, tot the 
same period of 1890, 161, and for 1891, 114. After mailing a fair allow- 
ance for increase of population during the past two years and Uiree 
months, the foregoing figures show that the same etiological conditions 
that gave rise to the epidemic influenza in the city of Chicago, canaed 
at the same time the mortality from pneumonia and other acute dis- 
eases of the respiratory organs to be more than doubled, bom typhoid 
fever to be trebled, and from diarrhceal diseases to be increased five-fold. 

EHolcxfieai Condiii<me. — In considering the etiological conditions pre- 
ceding, accompanying and following the epidemic of the first quarter 
of 1690, in the paper I read to this section at the last annual meeting, 
it was shown that during the time of the epidemic the water supplied 
to the inhabitants contained an unsafe amount of free and albuminoid 
ammonia and of micro-organisma. It was also shown that during the 
month preceding the outbreak of the epidemic, the mean atmospheric 
temperature was 9° F. above that of the same month of the preceding 
healthy year, and that of the mouth during which it reached its climax, 
the mean temperature was 2.4° F. above that of the same month of the 
preceding year. It was further shown that during the epidemic and 
for three months preceding, the atmospheric currents had been light 
and from the southwest. 

An examination of the meteorological conditions as shown by the 
records of the signal service station in Chicago, develops the fact that 
for three months prior to the reappearance of the epidemic in 1891, the 
prevailing winds were from the southwest, the mean temperature above 
the average of healthy seasons, with on unusually light precipitation, 
either in rain or snow,- until after the climax of the epidemic influenza 
had been reached, and evidences of impurities in the water supply re- 
mained the same as the preceding year. When the epidemic had 
reached its climax the prevailing wind changed to the northeast, and 



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No. 16.] Hyqiene in Rdbal Distbictb. 371 

an increaaed precipitation, chiefly in the form of light snow followed. 
But on the eTening of the thirtieth of March a copious rainfall oc- 
cnrred, accompanied by thmider and lightning, which was followed by 
a rapid decline of the epidemic and its associated diseases through the 
month of April. 

It will be seen by our tables that the epidemic influence that culmi- 
nated in January, 1890, did not reach its climax until in March, 1891, 
and still the preceding and accompanying conditions of the atmos- 
phere and water, the two elements common to our whole population, 
were nearly the same in both seasons. What influence, if any, the ex- 
traordinary waves of heat in Jime and July, 1890, may have had in 
lessening; the vital resistance of the people and thereby increasing the 
mortality from the inSaenza, pneumonia and acute respiratory affec- 
tions that followed several months later, cui only be a subject of con- 
jecture. That the varying degrees of atmospheric heat as characteriz- 
ing different seasons of the year, and different years, exert a very 
important influence on the physiological aud pathological processes 
taking place in the living hnman body, there can be no reasonable 
doabt. That the influence of this agent is much modified by the coin- 
cident degrees of aqneous vapor, or atmospheric moisture, is equally 
certain. And, as already stated in this and a preceding paper, the 
varying quantities of organic products in the forms of free aud albu- 
minoid ammonia pervading the atmosphere and their antagonistic ele- 
ments, ozone and hydrogen peroxide, constitute the additional elements 
to which we must turn our attention in searching for the active etiolog- 
ical factors in such widespread and rapidly developed epidemics as 
influenza and dengue. The severe and protracted depressing effect of 
the essential cause or causes of the recent influenza epidemics on the 
fonctions of the cardiac, vaso-motor and ganglionic systems of nerves, 
coincident with excessive irritant action on the respiratory and diges- 
tive organs, ia very analogous to the action of some of the ptomaines or 
tozalbnmens. And it is difficult to flnd any other atmospheric elements 
than the albuminoid, that could be capable of either conversion directly 
into toxalbumens or of becoming pabulum for the rapid propagation of 
pathogenic microbes. 



Hygiene In tbe Rural DlstrlotB. 

By <iKO. W. JbNkinh, M. D., of Kilbourn City, WU. 

To be able to successfully combat all the diseases which flesh is heir 
to, "is a consummation devoutly to be wished;" but greater is it to be 
able to point out the hidden and lurking causes of disease, and thereby 



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372 State Board of Health. [Off. Doc. 

prevent the raTageH it entails upon the human family — of tea widespread 
in its effects, and equally disastrous in its results. 

Ever since the Lord made "man and breathed into his nostrils the 
breath of life, and man became a living soul," diiiease and death have 
surrounded him at every turn, and it is a lamentable fact that man, left 
to himself without the direction of superior intelligence, would fall into 
habits of neglect of necessary cleanliness, thereby bringing disease npon 
himself and the community in which he resides. So we read in the 
Holy Writ that when the liord took the children of Israel unto Himself 
as His chosen people, He gave them directions which would conduce to 
their continnance as a nation, and their health as mdividnalfi, and was 
careful to show them how to observe the great laws of health. One in 
particolar in Deuteronomy 23: 12, 13, in regard to the disposition of all 
faecal matter — that it should be carried without the camp and properly 
iiisposed of in the earili. Moses was one of the first hygienists on 
record; and mach better wonld it have been for the human family to-day 
if his commands had been followed to the letter. 

Having had a large experience in the practice of my profession in the 
rural districta, I have been impressed with the fact that the people that 
I have visited have been in a most lamentable state of ignorance of the 
fnndamental principles of right living and hygienic conditions of their 
surronndings. 

One great evil that constantly confronts you in the rural districts is 
the unwholesome water snpply. Too often the water in wells is con- 
taminated by surface water and drainage from the house and barnyards. 
The well is dug near the kitehen door to be of easy access to the family 
and in close proximity to the woodpile, and year after year the well re- 
ceives the w^ water and slops from the kitchen, after first filtering- 
through the chips and <Mn-is that lie about in the back yard. At first 
the earth serves as a filter for all impurities which the water contains, be- 
fore it reaches the well. But after a time the earth becomes so charged 
with filth by constant filtration that it ceases te dispose of its impori- 
ties and the waste from the kitchen reaches the water in the well in 
nearly the same condition it left the kitchen-maid's hands from the 
wBshtnb or the slop basin. 

A few cases to the point will illustrate more fully the truth of the 
above assertions. They are from a report of cases that I presented to 
the State Board of Health of Wisconsin. 

A family of father, mother and five children, were all more or less sick 
with a fever induced, as I fully believed, by drmking water which was 
very much contaminated by drainage from the barnyard. The well was 
situated between the house and bam, with a gentle slope toward tiie 
well. The yard was very foul from the accumulation of the rubbish of 
yeai-<^ and the water in the well became impregnated with the filth from 
this souFt« until it looked, tasted and smelt badly. I ascertained fnmi 



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No. 160 Hygiene m Bdbal Distriots. 373 

the family that when they moved upon the place the frost was in the 
^roand, and the water, to all appearances, was pare and good. When 
the frost came oat the water befiran to look and taste badly. Of this 
water all the family used until I was called to see the mother and 
dsQghter who were soffering with a maUgnant form of diphtheria, at- 
tended with great depression of all the vital powers and bloody passages 
from the bowels. I explained to them the probable cause of their sick- 
ness and fcvbade the further use of the water. They soon began to im- 
prove and made a good recovery, after using good water from another 
source. They continued to use the good water for a time, and then 
they returned to the use of the water in the contaminated welL The 
mother very soon oame down with exactly the eaine symptoms as be- 
fore. The family soon left this farm, and a German, who owned it, hav- 
ing a family of eight children, moved upon it. He declared that the 
water was good and pure, and that the doctor did not know anything 
abonb it. After using the water fco* a short time, one of the children 
came down with diphtheria, cronpal form, and died in less than a week. 
After this every member of the family was sick of the same disease, 
and five of them died in less than ten days from the date of the first at. 
tack — nor were there any other oases of diphtheria in that section of the 
country where it proved as fatal as to this family. Is it reasonable to 
suppose that the cause of that sickness lay in any other direction than 
that filthy well t I think not. 

Again, during the summer of 1881, 1 noticed that all the isases of 
typhoid fever which occurred in a certain village, were in families who 
obtained their water supply from one particular well. Its water was 
cold and looked pure. This well stood in the center of a little square, 
and in the summer mouths, cattle and other animals were allowed to 
stand around its curbing fighting insects and stamping the ground until 
a hole was made sufficiently large to catch all the water that was wasted 
during the drawing of it by the several famifies. In a short time this 
collected water in the hole was reeking with filth from the animals, and 
soaked through tiie earth into the well. I insisted that the typhoid 
fever originated from the water in that well, but could not make its pa. 
trons believe it contained any impurities, »uitil I proved it to them by 
actual demonstration. I then ordered the ground dug np around the 
well down to the rock. The well from the rock to the surface of 
the earth contained tubing about six inches in diameter. This 
tubiuK was firmly fixed by filling in around it cement and stone to the 
surface of the earth, thus effectually cutting off all surface drainage. 
After having the well thoroughly cleaned no more typhoid fever origi- 
nated from that well, nor have any cases occurred in that section 
up to the present date. Many farmers allow their cattle in the same 
way about their wells, with no thought of the possibihty of such results. 

During the past year I was called early in December to attead a case 



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374 State Board op Health. [Off. Doo. 

of diphtheria in a section of country where there bad been no expoBure, 
and found on looking for the cause that the family had been in the habit 
of protecting their potatoes in the cellar from the frost by coTerinjr 
them four or five inches deep with forest leaves. On farther inqniry I 
ascertained that these same leaves had been left in the cellar tor several 
years, and as there was no window or outside door, the cellar could not 
be ventilated. The floor above the cellar was old and poor, and the 
emanations from the decaying leaves could be distinctly smelled. I 
ordered the leaves to be removed immediately, door and windows made 
that the cellar might be ventilated, and chloride of lime freely used. 
That made an end of diphtheria in that family. 

How often is it the case when the doctor enters the cellar to ascertain 
the cause of sickness in any given case, that he finds it poorly venti- 
lated, containing decaying v^etables and decomposing matter of 
various kinds — and in this same cellar the milk is kept from which their 
butter is made. As milk forms so large a part of the farmers' diet it 
should be pure, but most farmers never think that milk can become 
contaminated by being kept in an atmosphere that is full of the germs 
of decaying substances. 

The truth of the matter is this, that notwithstanding lecture upon 
lecture, line upon line, and precept upon precept, is given to those whom 
it is calculated te benefit, little good will result therefrom, unless it is 
given in s way commensurate to their degree of understanding and 
abihty to receive it. 

If the people living in the rural districts of our country could be 
made to understand the great importance of being enlightened upon 
this important subject, many lives might be saved and much sickness 
prevented, but so far as I know, no one has ever suggested any plan by 
which this great branch of their education might become popular and 
highly instructive to them. I propose to offer a few suggestions by 
which that object may be obtained. 

My idea to gain that desired end, is, that the physicians of two or 
more adjoining townships shonld form themselves into a hygiene society, 
to meet at stated times at some farmer's house, and then and there show 
to all that attend those meetings, the dangers that lie hidden and un- 
suspected about them. 

Let any one member of the hygiene society be required to report upon 
some subject connected therewith at any one meeting, which may be 
fixed by previous announcement, and report fully upon that subject, by 
the use of tests and other demonstrations as the subject demands, to 
make it intelligible and instructive to the people. 

Of course this will require labor and time of the members composing 
tho board, but if they can prevent disease, and save life by so doing, 
they will be richly repaid for all their efforts — life and health are of 
m()re value than money. 



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No. 16.] Bbneficehce of Dibease. 375 

It U the every-day duties that we are called opou to attend to — the 
little details, and to point out ^ain fuid ^ain a lurking danger to 
health and life ; it is this faithf ulneBs in little things that accomplishes 
BO much that is lasting and beneficial. Say that these datiee are irk- 
some — granted. What dntiea of the physioian are not bo, from the time 
that he begins his professional career until it ends T What is his reward 1 

We receive it every day in the consciousness of having been the means 
of preventing disease as well as Baving the Uvea of many { and he whose 
eyes never slumber will surely reward us according to the motives that 
have prompted us to perform them. 



TtM Benefloenoe of Disease. 
By A. N. BblIh A. M., M. D.. 0/ Brooklyn, N. Y. 

The 6rst thought which this title suggeste to the unrefleotive mind 
is that it is in conflict with the almost universally popular belief that 
disease is an independent, active principle or entity, the result of sin — 
a penalty for the transgreBsioQ of some physiological or sanitary law — 
which is identified with the pnniahment of our first parents for partak- 
ing of the forbidden fruit ; a belief which, logically considered, 'without 
any conception of organic stmotore, would imply that man, as originally 
constituted, was intended to occupy this world forever. 

That disease was unknown in the world before the fall of Adam, is 
only equally true with the statement that so was all knowledge of the 
ooucems of mankind unknown. 

It is not my purpose to analyze the sacred record with regard to such 
special manifestations and miracles as appear to have been adapted by 
the Creator to the compreheuBion of man in his primitive state, or to call 
in qnestion their design ; but to consider disease as an essential condi- 
tion of life, instituted for a beneficent purpose. 

I have so long entertained this belief and have had such frequent op- 
ix>rtnnities of testing its practical utility, that, to my mind, it now 
amonnts to a thorough conviction. 

For illustration : About thirty-five years ago I was called to a very 
sick child, about eight years old, the daughter of a learned, but exceed- 
ingly sensitive, clergyman. I found him in the room with the child. 
walking the floor and wringing his hands, and otherwise giving vent to 
his feelings by prayer ; with frequent appeals to Orod to know why his 
dear child should be so stricken. "Oh, my God," he cried, "for what is 
this affliction sent — what has my darling child done that she Bhonld be 
called upon to suffer 1" and by various similar expressions greatly dis- 
turbing to the patient and agonizing to himself. 



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376 State Boasd op Health. [Off. Doc. 

I, of cotirse, led him from the loom and remonstrated with him, and 
had to repeat the proce^ several times dvuing the few days next follow- 
ing ; bnt finally sncceeded in excluding him altogether, until the child 
had well nigh recovered and be had become composed. 

Some two or three months afterward, the reverend father, who, I bad 
learned, was the editor of a church magazine, called upon me and re- 
quested me to be kind enough to write out in substance what he had 
learned from me of the nature of disease, and allow him to pablish it. 
I made a conditional promise, and after a few weeks, I wrote out enoogh 
to make half a dozen printed pages, and without caption or signature, 
I sent it with a note ; " Here is your baby, name it to suit yourself." 

It appeared in his next issue under the title of " The Goodness of God 
Manifest in Disease." 

This was in 1867. Three years subsequently I re-wrote the article and 
made it the concluding chapter of a little book called " Knowledge of 
Living Things," published by Bailliere Brothers, New York, 1860. 

What follows, comprises the substance of those articles, in conjonctioD 
with more knowledge of the structure of the human organism and con- 
tinued reflection upon the subject. 

Every organized being and every orgao and tissue of every such be- 
ing, even the hairs and nails, and the most minute nerves after they are 
lost to view under the most powerful microscope, are now known to be 
composed and maintained by living cells. Each one of the cells thus 
incorporated is possessed of an individual life of its own, has a period 
of development and maturity, possesses the property of reproduction, 
and dies. Life presents itself in th^'Oi^anism as the sum of these vital 
unities. It is maintained by the circulation of the blood, which is also 
for the most part composed of living ceUs ; and the processes of organ- 
ization and function are sustained, or otherwise, according to the condi- 
tions of the blood supply and of the oi^an or organism to which it is 
distributed. So that all irregular actions, disturbances and pains which 
follow, are just as much in accordance with the laws which govern the 
existence of a single cell, as if the cell relied on its own independent 
action. And all the changes that take place, whether favorable or un- 
favorable to the continuance of life, are based upon the same fundsr 
mental laws. 

The cells exist before the being which they organize, and survive it 
after the play of its functions has been arrested, insomuch that the life 
of the organism throughout is the resultant of the life of the cells which 
constitute it ; their individual existence being co-ordinated to subserve 
a perfectly definite object. When this co-ordination is interfered with, 
the result is disease. The favorable orunfavorableinfiuences determine 
whether the already existing parts or cells persist, increase or diminish ; 
whether the conditicns necessary to the varied play of the organic func- 
tions remain, or whether the machinery of life is arrested by the change 
or cessation of these conditions. 



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No. I6.3 Beneficence of Disease. 377 

The orEraQiBm, like the cells of which it is constitated and by which 
it is maintaiQed, has a period of development and growth ; a period of 
middle life, in which the fanctious Btrive to maintain an unaltered mass ; 
and an epoch of decrease or decline, which is concladed by natui'al 
death. It is only in accordance with these conditions that life is em- 
bodied. 

The world was not made for man alone. His life is linked with the 
plants and animals which co-exist with him, and these are the issue of 
long anticipations and preparations. 

Not only the comfort, health and the degree of civilization, but the 
very existence of mankind in any given locality, depends, upon the state 
of the earth, the atmosphere of the earth, the climate of tiie earth, and 
the productions of the earth. He is placed in a system where aU the 
changes produced in other objects occur according to a relation exist- 
ing among the substances changed, and his own organization x>artici- 
pates in all these things that surround him. He has been endowed 
with a degree of intelligence equal to the necessity of determining the 
relation of these things to his health and life, and what he ought to do 
tor himself is as abundantly indicated by the knowledge of his organi- 
zation and powers, as the uses of any machine is understood by an ac- 
qoaintance with its constraction. 

The nature of the hmnan organism is sacb that a most intricate con- 
nection is established between the organic functions, and this connec- 
tion has a constant relation to the necessity of harmonizing the func- 
tions and keeping them in sympathy with each other. 

The constant physical and chemical changes which accompany life 
depend npon the various reciprocities which axe produced by the work 
of the different parts of the body. The assimilation of what is received, 
the diminatioQ of that which is useless^ and the restoration and mainte- 
nance of the oi^ans by which these operations are effected. 

We need no reasoning to convince ns that an oiganism so curious 
and so wonderfully perfect in all its parts as the human body, was de- 
signed to continue as long as the material composing it and the condi- 
tions to which it is exposed will admit of, and that upon us devolves 
the dnty of giving it that continuance. 

The preservation of health is an incumbent duty. We must preserve 
it in ita perfect state, that in which the powers of the constitution can 
be most effectually exerted. All the health and strength of which we 
aro capable were intended for nse ; and any tmfitness for the functions 
of life is a partial death, by a weakening of the compensating powersof 
the system. The life and activity of every part is merged into such a ■ 
perfect otfranism, that all the organs composing it are united together 
in a bond of mutual dependence, and the complete performance of the 
entire series of actions is necessary for the healthy maintenance of any 
one action. AU the functions are so completely bound up in each 



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878 Spate Boabd of Heai/th. [Off. Doc. 

other, that none of them can be Baspended without Berioosly disturbing 
or causing the cessation of all the test Hence, if any one organ is dis- 
eased, all the other organs are embarrassed. 

We are all so placed that there are very few of the objects surrounding 
us which may not be serrioeable or hurtful ; uor is that service to be 
obtained or injury avoided otherwise than by au acquaintance with 
things external, and their relations to our existence. The more exact 
our knowledge of this kind is, the more we lessen the calamities and 
odd to the comforts of life 

Our knowledge of external things wholly depends upon our sense 
perceptions. To onr senses we trust directly, and by their cultivation 
we become acquainted with the relation of external things to health, 
and gain the power of increasing and varying the facts upon which we 
rely for gnidfuice. 

When tiie body is in full health and strength, the mind is so far as- 
sisted thereby that it can bear a closer and longer application. Appre- 
hension is readier, imagination livelier, the compass of thought is more 
capable of enlargement, perceptions can be more quickly examined and 
more exactly compared, and a tmer judgment can be formed. We can 
iu all things have a clearer understanding of our relation to external 
things, of that which is best for nsaod of what is most for onr interest, 
and thence determine our actions more readily, and persist therein with 
greater resolution and steadiness. 

It is in this way that the soundness of the body is serviceable to the 
mind — each needs, each helps the other. 

But the lifetime of man is perfectly consistent with the temporary 
existence of the cells of which his body is constituted and his relation 
to the conditions which surround him. Under the most favorable con- 
ditions, parts of his frame that ^re concerned in development onceas- 
ingly accumulate the neoessai'y particles by a process as beautifnl and 
systematic as it is mysterions and sublime; until, ultimately, the 
growth peculiar to the species and the individual is attained. 

At this point the preponderance which before existed in the actdon of 
the exhalents over the absorbents ceases, and all is equality. Ere long 
his exhalants fall off in their wonted activity ; the fluids decrease in 
quantity; the solids become more rigid; and all those changes supet^ 
veno which characterize the decline of life. 

But death may occur at any period of life, a few only ceasing to live 
by the effects of age fdone. The duration of life varies according to 
numerous conditions and circumstances. The original constitution of 
the individual, the habits and occupations of life, locality and various 
other ctiases, some of which, accidental or otherwise, are inappreciable 
before their fatal effects are encountei'ed. 

Latitude, elevation, nature of the soil, degree of cultivation, relative 
position in regard to mountains, forests, rivers, etc., and general aspect 



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No. 16.] . BBNEnoENCE OP Disease. 379 

of the neigbborhood, all modify the coDditiou of man and prove his 
adaptability by anch effects as serve to make him understand his rela- 
tions to what is aronnd him. 

Man's relatioQ to these thin^ is known by their effects. And with 
the faculty of reason for his ^^nide in the prosecution of his purpose, he 
continoally risks the consequences of his free a^ncy by fortifying him- 
self against recognized conditions inimical to his heKilth and life, or by 
boldly setting them at defiance in the irregularities of his conduct. 

Disease in all its aspects is no less constant than the physical phe- 
nomena of the universe. The more attentively it is studied from the 
earliest records of it, to the present time, the more evident it appears 
that not a single one of the many diseases deeeribed in ancient or mod- 
em times has wholly disappeared, or that a sint^le new one has been 
discovered. The same and all exist to-day, as ever have existed, and 
with equ^ liability to assert themselves under the same conditions as 
their wont at any period in their history. 

The Divine institution of disease in relation to man's free agency and 
• the qualities of natural phenomena suited to the whole organic world, 
requires that there should be more or less uncertainty and irregularity 
in its action. Diveisity and dissimilarity are everywhere manifest, and 
not less so in disease and its results than in the classes, orders, genera 
and species of the animals and plants ; individuals of the same species 
are not onfreqnently very dissimilar. 

Disease forms no exception to the Divine arrangement of natural 
phenomena. The beginning and end of human life are only steps in an 
eternal existence. Death is the completion of life, but if disease had no 
other purpose nor end than death, it woold be an anomaly in the works 
of the Creator, as involving an arrangement of vitality withoat salutary 
tendencies. Like our own handiwork, which has in itself no provision 
for repair, we should wear out ; labor and sorrow would be the end of all 
our days; life would be a burden, health beyond hope, and eternity a 
new creation. 

The gratification which the reasoning faculties constantly seek, even 
if it involve a sacrifice of individual health, discloses truths of universal 
application. And as man tastes of the delights of intellectual action 
and gives way to the impulses of his nature to pursue them, he will see 
in disease a providential mercy to encourage his willing sabniission to 
it, and to mitigate its severity. As its pains are but temporary, he can 
find strength to bear them patiently, if not to welcome them in the 
thought of the enduring good which they are intended to work within 
him. 

The uncertainty of the issue in any disease, however slight in the be- 
ginning, is evidence of its merciful object. Were it otherwise, were our 
bodies so constituted as never to be sick but unto death, how appalling 
and hopeless would be the condition of man— hardened in sin, by the 



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380 State Boabd or Health. . [Off. Doc. 

deliberate poetponemeDt of immortal coucerns on aocoitnt of the cer- 
tainty of time ! But the imcertain dm^ation of, and occasional recovery 
from, eveo the most fatal diseases, ^ruards and aeoures their fitness tor 
the common purpose, and prevents them from beinf? any exception to 
the Divine arran^meot. 

Bat let us go further and suppose disease to be of one kind only and 
always fatal at a particular period. Then the case would be much ag- 
gravated. A death-bed repentance would be the universal reliance, for 
while health coutinned there would be do concern for a future state. 
Feeling sure of time for the necessary preparation, convenience and ne- 
ce^ty would take the place of duty, and the deceptions of weakness 
and bewilderment, instead of strength and clear perception in the fall 
enjoyment of health and faculties, would determine the chances of 
eternity. 

On the otlier hand, people sometimes die without the intervention of 
disease — are suddenly cut off in the full possession of health. But such 
deaths are rare and exceptions to the greneral rule. And how would it 
be if they were the rule instead of the exception! How indescribably 
dreadful would be the fear of certain, sudden death ! The whole of life 
would consist in the dread of impending danger ; pleasure would be 
unexperienced and unknown, and civilization among the things that 
are not. 

Indeed, it ia only by the present arrangement of disease that its 
Divine origin can be appreciated and its beneficence disoemed. In any 
other way it would have no analogy to the diversity everywhere mani- 
fest in natural phenomena, nor woald it serve the merciful purpose for 
which it was ordained. 

Disease was not instituted simply as the road to death, or it would 
have been uniform and certain in its course. True happiness consists 
in the influence of religion, to which the whole of life should be de- 
voted. 

That fulness of communion which actuates the most kindly emotions, 
induces peace, inspires love and waits for heaven, is more or less the 
fruit of disease. It brings out and nourishes all the finest feelings of 
human nature. When strength is laid low and man is made to see and 
feel his dependence upon his fellowman, who that has watched and 
studied the motions of the faithful physician and seen the sympathy of 
bis full heart overfiow, lest through too much confidence in human aid 
the purpose of God may not be fully accomplished— who has seen this 
and not felt the benefit of the ^ck room T Or, again, when the surgeon 
has to take the responsibility of hazarding the most intense suffering 
with the least bare hope of relief from impending death ; with what 
sympathy, what self-denying devotion, the wife, the mother, the sister, 
the friend, aye, the enemy even, and the most abandoned of mankind, 
all find their feelings softened under such circumstance. But again. 



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No. 16.] Beheficbncb of Disease. 381 

when disease appears Id its most appalling aspect, and the heart of the 
nation is stirred by the advance of a fatal epidemic on a nee^lectfnl com- 
monitr, to keep itself fortified a^nst such an event, bttt instead, is 
beset ronnd-abont with the moat favorable conditions for the reception 
and propagation of snch a disease, and the life of thonsands, it may be 
is made to depend npoQ the fortitnde of the practical sanitarian who is 
called upon to defend such a commnnity, until it can be aroused from 
its sleeping indifference and made to bestir itself by the use of its rea- 
son — who that has witnessed such scenes is not ready to confess that it 
is in mercy and not in wrath that God has sent disease into the world T 

All conflict with this conclusion is removed by onr Lord's blessed 
answer to the qaestioB, "Master, who did sin, this man or his parents, 
that he was bom blindt" 

"Neither hath this man sinned nor his parents, but that the works of 
Qod should be made manifest in Mm." 

The apparent punishment of Azariah with leprosy for profanity, and 
of Gehazzi for covetousness and falsehood was in reality a correction in 
mercy. And in like manner were the punishments of Uie IsraeHtes. 

Disease is nowhere manifest as mere punishment, but as a correction 
in mercy for the salvation of Hie soul. Even when it is brought about by 
oar own misconduct, it is consonant with this view, because we are ad- 
monished by it to be re^dy for death. 

We are corrected against the impmdence committed for future 
improvement in ourselves, not punished that others may profit by our 
example, which is the tme design of pmiishment. Moreover, as a gen- 
eral thing there is no connection between acts periormed and disease. 
Indeed, if this were the case, we should find that the righteoos and the 
wicked could be designated by their relative degree of health, and we 
shonld be constantly led to inquire, "trho did sin, this man or his 
parents 1 " 

It is conclusive tiiat no manner of life can be alleged in justification 
of disease. From infancy to old age the itmocent and the guilty are 
alike subject to its uncertainties. 

The inherent aversion of man to live for the futore needs a constant 
monitor. 

There is no condition in which we are in so much danger of forget- 
ting that an eternity awaits us as when we are in the uniform enjoyment 
of heidth. The porpose of disease may indeed be disregarded, nn- 
beeded; in which case the visitation will be unprofitable, as it was to 
the Philistines, but its purpose is not on this account altered. A thor- 
ough conviction of Ckid's love and merciful providence in all His dis- 
pensations is the only adequate proof of a submissive spirit. 

The benefit of disease is to be obtained by endeavoring to discover 
its nature, how it may have been avoided, and how its recnrrence may 



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382 State Board of Health. [Off. Doc . 

be prevented as long as possible, coasistent with the human organism, 
and finally by a meek submission to the Divine will. 

It is thus thai the Creator, having' designed man for a hij^her sphere, 
has not only given him the capacity oF knowledge and virtae, but has 
instituted disease a^ a sentinel on the threshold of his future existence. 



The Ooronar System In the TTnited States. 
B7 Hknrv O. Marct, M. D., 0/ Boston, Mast. 

I am aware thai the great body of the medical profession have re- 
garded the coroner and his duties as a subject bearing only an indirect 
relation to the practice of medicine. It was not until 1877, when the 
coroner laws were pretty thoroughly investigated in Massachusetts, 
that I believe they demanded revision. 

The investigation of the law as practiced in Massachusetts showed 
clearly that it was not adapted to the best ends of justice ; that the cor- 
oner, no matter how skilled in any branch of special training, could, 
under the law, scarcely be expected to discharge his duties in a satis- 
factory manner. In other words, that the primal fault lay, not so much 
in the functionary as in the class of duties he was expected to fulfil. 
The analysis of these duties showed that the same person was expected 
to be competent as a medical expert, to serve as an administrator of tiiu 
law, as a judge to hear evidence, to decide upon its admissibility, be 
being also a witness in the case. Upon his own authority, or assisted 
by a physician, he was first to determine in a ease under investigation 
if death had occurred by natural means or by violence ; that is, by the 
evil intent of another. It having been decided that further investi^- 
tion was necessary, a jury was summoned, and testimony was taken, 
usually in open session. To this he added his own testimony. 

From this brief review it wilt be clearly observed that the office de- 
manded two entirely distinct cla8s«B of functions to be discharged by 
one and the same person. These duties were both legal and scientific, 
and each in torn might involve questions of the greatest magnitude, 
often requiring the highest skill and experience in two great branches 
of learning. A further investigation showed that in matter of fact the 
office was generally regarded as political, and that the appointees were 
more commonly men versed neither in law or medicine, and, as a conse- 
quence, were necessarily unfitted for the proper discharge of either of 
the main subdivisions of their duties. This was brought so clearly to 
the notice of the proper authorities that the manifest unfitness of the 
law for the complex requirements of modern life was plainly apparent. 



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No. 16.] The Coroner System. 383 

and Massachasetts abolished her entire system of coroner laws, and es- 
tablished in their place provision for medical ezaminationa and inquest 
in cases of death and violence. This reformation was accomplished 
under the leadership of Mr. Theodore H. Tyndale, a member of the Bos- 
ton bar, witii the active co-operation of several distinguished members 
of onr own profession, aided by the state medical society, and the law 
which is hereg^ven in full was adopted by the Legislature of Massochu- 
aetts in May, 1877 : 

An Act to abolish the office of coroner, and to provide for medical exsmltiationa 
and inquest in casea of death by violence. 

Be it enacted by (lie Senate arid House of Representatives in General 
Court assembled, and by Ike authority of the same, as follows : 

Section 1. The offices of coroner and special coroner are hereby abol- 
ished. 

Section 2. The Governor shall nominate, and by and with advice and 
consent of the cotmcil shall appoint, in the county of Suffolk, not ex-, 
ceeding two, and in each county not exceeding' the number to be desig- 
nated by the county commiflsionera as hereinafter provided, able and 
discreet men, learned in the science of medicine, to be medical exam- 
iners; and every such nomination shall be made at least seven days prior 
to such appointment. 

SEcnoN 3. In the county of Suffolk each medical examiner shall re- 
ceive in full for all services performed by him an annual salary of threo 
thousand doliars, to be paid quarterly from the treasury of said county ; 
and in other counties they shall receive for a view without an autopsy, 
four dollars; for a view and autopsy, thirty dollars, and travel at the 
rate of five cents per mile to and from the place of the view. 

SEcnoN 4. Medical examiners shall hold their offices for the term of 
seven years from the time of appointment, but sliall be liable to removal 
from office at any time by the Governor and council for cause shown. 

Sectiok fi. Sach medical examiner, before entering upon the duties of 
his office, shall he sworn and give bond, with sureties, in the sum of five 
hundred dollars, to the treasurer of the county, conditioned for thefaith- 
fnl performance of the duties of his office. If a medical examiner neg- 
lects or ref OSes to give bond as herein required, for the period of thirty 
days after his appointment, the same shall be void, and another shall be 
made instead thereof. 

Section 6. The county commissioners in each county shall, as soon 
as may be after the passage of this act, divide their several counties into 
suitable districts for the appointment of one medical examiner in each 
district under this act ; and when such division is made, shall at once 
certify their action to the Secretary of the Commonwealth, who shall lay 
Buch certificate before the Qovemor and council. But nothing herein 
shall prevent any medical examiner from acting as such in any part of 
bis county. 



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884 State Boabd of Health. [Off. Doc. 

SEcnoN 7. Medical examineiB Bhall make examinatioue as hereinafter 
provided, upon the view of the dead bodies of sued persons only as are 
Bappoeed to have come to their death by violence. 

Section 8. Whenever a medical examiner has notice that there has 
been foond, or is lyin^ ^thiu his comity, the dead body of a person who 
is supposed to have come to his death by violence, he shall fortiivith 
repair to the place where such body lies and take chaise of the same ; 
and if, on view thereof and personal inquiry into the cause and manner 
of the death, he deems a further examination necessary, he shall, upon 
being thereto authorized in writing by the district attorney, mayor, or 
selectmen of the district, city or town where such body lies, in the 
presence of two or more discreet persons, whose attendance he may 
compel by subpcena, if necessary, make an autopsy, and then and there 
carefully reduce or cause to be reduced to writing every fact and circum- 
stance tending to show the condition of the body, and the cause and 
manner of death, together with the names and addresses of said wit. 
nesses, which record he shall subscribe. Before making such autopsy 
he shall call the attention of said witnesses to the position and appear^ 
ance of the body. 

Section 9. If, upon such view, personal inquiry or autopsy, be shall be 
of opinion that the death was caused by violence, he shall at onoe 
notify the district attorney and a justice of the district, police or ma- 
nicipal court for the district or city in which the body lies, or a trial 
justice, and shall file a duly attested copy of t)ie record of his autopsy 
in such conrt, or with such justice, and a like copy with snch district 
attorney; and shall in all cases certify to the clerk or registrar having: 
the custody of the records of births, marriages and deaths in the city or 
town in which the person deceased came to his death, the name and 
residence of the person deceased, if known, or a description of his per- 
son as full as may be for identification, when the name and residence 
cannot be ascertained, together with the cause and manner in and by 
which the person deceased came to his death. 

Section 10, The court or trial justice shall thereupon hold an inquest, 
which may be private, in which case any or all persons other than those 
required to be present by the provisions of tliis chapter may be ex- 
cluded from the place where the same is held ; and said court or trial 
justice may also direct the witnesses to be kept separate, so that they 
cannot converse with each other until they have been examined. The 
district attorney, or some person designated by him, may attend the 
inquest, and may examine all witnesses. An inquest shall be held in 
all cases of death by accident upon any railroad, and the district attor- 
ney or the Attorney General may direct an inquest to be held in the case 
of any other casualty from which the death of any person results, if, in 
his opinion, such inquest is necessary or expedient. 



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Mo. 16.] The Coroner Bibtbu. 386 

SBCnofJ 11. ThejuBtice or district attorney may issne subpoenas for 
wituesBee, returnable before such court or trial justice. The persons 
aeryed with such process shall be allowed the oame fees and their at- 
tendance may be enforced in the same manner and they shall be subject 
to the eame penalties as if served with a subpoena in behalf of the com- 
monwealth in a oriminal prosecution pending in said court or before 
said trial justice. 

Section 12. The presiding justice or trial justice shall, after hearing 
the testimony, draw up and sign a report lu which be shall find and 
certify when, where, and by what means the person deceased came to 
his death, his name, if known, and all material circumstances attending 
his death ; and if it appears that his death resulted wholly or in part 
from the unlawful act of any, other person, he shall further state if 
known to him, the name of such person, and of any person whose un- 
lawful act contributed to such death, which report he shall file with the 
records of the superior court in the county wherein the inquest is held. 

Section 13. If the justice finds that murder, manslaughter or an 
assault has been committed, he may bind over as in criminal prosecu- 
tions, such witn^Bes as he deems necessary, or as' the district attorney 
may designate, to appear and testify at the court in which an indict- 
ment for such offense may be found or presented. 

Seciiok 14- If a person charged by the report with the commission 
of any offense is not in custody, the justice shall forthwith issue process 
for his apprehension, and such process shall be made returnable before 
any court or magistrate having jurisdictioa in the premises, who shall 
proceed therein in the manner required by law. But nothing herein 
shall prevent any justice from issuing such process before the finding 
of such report, if it be otherwise lawful to issue the same. 

Section 15. It the medical examiner reports that the death was not 
caused by violence, and the district attorney or the Attorney General shall 
be of a contrary opinion, either the district attorney or the Attorney Gen- 
eral may direct an inquest to be held in accordance with the provisions 
of this act, notwithstanding the report, at which inquest he, or some 
person designated by him, shall be present and examine all the wit- 
nesses. 

Section 16. The medical examiner may, if he deems it necessary, call 
a ohemist to aid in the examination of the body, or of substances 
supposed to have caused or contributed to the death, and such chemist 
shall be entitled to such compensation for his services as the medical 
examiner certifies to be just and reasonable, the same being audited and 
allowed in the manner herein provided. The clerk or amanuensis, if 
any, employed to reduce to writing the results of the medical examina- 
tion or autopsy, shall be allowed for his services two dollars per day. 

SECnON 17. When a medical examiner views or makes an examination 
of the dead body of a stranger, he shall cause the body to be decently 
25-16-91. 



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386 State Board of HbaltB. [Off. Doo. 

buried, and if he certifies that ha La8 made careful inquiry, and that to 
the best of his knowledge and belief the person found dead is a atrauger, 
having no settlement in any city or town of this commonwealth, hia 
fees, with the actual expenses of burial, shall be paid from the treosuTy 
of the commonwealth. In aH other cases the expense shall be paid by 
the city or town, and all other expenses by the county wherein the 
body is found. 

Sectiok 16. When services are rendered in bringing' to land the dead 
body of a person foond in any of the harbors, rivets or water« of the 
commonwealth, the medical examiner may allow such compensation for 
said services as he deems reasonable, but this provision shall not entitle 
any person to compensation for services rendered in searching for such 
dead body. 

Section 19. In all cases arising under the provisions of this act, the 
medical examiner shall take charge of any money or other personal 
property of the deceased, fonnd upon or near the body, and deliver the 
same to the person or persons entitled to its custody or possession; bat 
if not claimed by such person within sixty days, then to a public admin- 
istrator, to be administered upon according to law. 

Sectiok 20. Any medical examiner who shall fraadnlently neglect or 
refuse to deliver such property to such person within three days after 
due demand upon him therefor, shall be punished by imprisonment in 
the jail or house of correction not exceeding two years, or by fine not 
exceeding five hondred dollars. 

Section 21. The medical examiner shall return an acoount of the ex- 
penses of each view or autopsy, including his fees, to the county com- 
missioners having jurisdiction over the place where the view or exam- 
ination is held, or in the county of Suffolk to the auditor of the city of 
Boston, and shall annex thereto the written authority under which the 
autopsy was made. Such commissioners or auditor shall audit such 
accounts and certify to the treasurer of the commonwealth, or the treas- 
urer of the county, as the case may be, what items therein are deemed 
just and reasonable, which shall be paid by said treasorer to the person 
entitled to receive the same. 

Section 22. Whenever any sheriff is a party to a suit or proceeding, 
or otherwise disqualified to act therein, the sheriff, or a deputy sheriff, 
of any adjoining county may serve and execute all writs and precepts, 
and perform all duties of such sheriff which he is disqualified to per- 
form, and may serve and execute all such writs and precepts wherein 
any county, town, parish, religions society or school district is a party 
or interested, notwithstanding he is nt the time a member of .such cor- 
poration. 

Section 23. Whenever a vaoaocy occurs in the office of sheriff of any 
county, the senior deputy sheriff in service shall perform all the duties 
required by law to be performed by the sheriff, until the office of 



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No. IS.J The Coroner Sybtem. 387 

sheriff is filled ia the msDiier reqaired by law, giviog boud as uow re- 
quired by law of sheriffs. And in case of aach vacaucy, the deputies of 
the sheriff vacating the office shall contiiiiie to have and exercise the 
power of depnty sheriffs until said ofSce is filled as aforesaid. 

Section 24. Sections seventy-five, seventy-six and seventy-seven of 
chapter seventeen, and section one himdred of chapter sixty-three, and 
section eifi^hteen of chapter one hnndred and sixty-three of the general 
statates are hereby amended by substitnting' for the word "coroner," 
wherever the same occurs, the words "medical examiner," and for 
the word "coroners," the words, "medical examiners." The second 
clause of section fifty-two, and sections seventy-four, seventy-eight, sev- 
enty-nine and eighty of chapter seventeen of the general statntes, chap- 
ter one hundred and seventy-five ot the general statutes, chapter one 
hnndred and thirteen of the acts of year eighteen hundred and sixty -one, 
chapter one hundred and seventy-two of the acts of the year eighteen 
hundred and sixty-two, chapter twenty-eight of the acts of the year 
eighteen hundred and sixty-four, chapter two hnndred and forty-one of 
the acte of the year eighteen hundred and seventy-one, and chapter one 
hundred (md fifteen of the acts of the year eighteen hundred and sev- 
enty-six, and all other acts and parts of acts inconsistent herewith are 
hereby repealed. 

SeonoM 26. For the purposes of the appointment and qualification of 
medical examiners and tbe action of the county commissioners herein 
provided for, this act shall take effect upon its passage, and it shall take 
full effect on the first day of July next. 

We shall have occasion to revert to the experience of Massachusetts 
during the last thirteen years to show the advantages in the working of 
the new law. Suffice it to state in passing, that the i-adical changes 
made in this act are: first, the doing away entirely with the office of 
coroner; second, the abandonment of examination by a jury on what is 
necessarily a preliminary trial ; third, the adoption of a new plan by 
which a specially trained medical expert makes a scientific investigation, 
and properly qualified legal officials conduct the legal inquiry, prelimi- 
nary to the final trial after indictment of the accused parties. 

In 1881, Dr. John G, Lee, of Philadelphia, published a book entitled 
"Hand-book for Coroners," containing a digest of all the coroner laws 
in the United States. This valuable work consists of the selection, col- 
lation and arrangement of such material as the author could command, 
and is offered especially "as a guide for the instruction of newly elected 
coroners, or as a convenient hand-book for occasional and rapid refer- 
ence." It does not appear to the author that any especial criticism 
should be made upon the laws as collated, or that there is an imperative 
need of a radical revision of the same. He recognizes, however, that 
there is often a difficulty of proper adjustment of the relation which tho 
coroner holds to the prosecuting attorney and the other departments of 



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888 State Boabd of Health. [Off. Doo. 

juBtice, and coDclades by saying: "If the coroner will admioister Lis 
office fearlessly and according to the lawn of hia state, we feel sure that 
the clamor which periodically demands the abolition of the coroaer and 
his fanctions will be heard no more." 

However, the impartial critic who studies at all carefully the coroner 
laws tt8 they exist in the several states would Beem to require no better 
evidence of the neetl of their revision than therein contained, and as if 
in emphasis of this conclusion, the author adds a considerable number 
of pa^es of anecdotes full of grim humor which would be high comedy 
were it not for the seriousness of the subject. 

In 1887 a committee was appointed by the American Medical Asso- 
ciation, of which I was chairman, to examine into and report upon the 
coroner system of the United States. The first report of this commits 
tee was made at the May meeting, in 1888, supplemented by a report at 
the annual meetings of 1889 and 1890. At the last meeting a resolu- 
tion was adopted in the general session calling the attention of the va- 
rious state and district societies to this subject, requesting the members 
of the association to personally investigate and as far as ^kossible to cor- 
rect the evils inherent in the present system. 

I desire by this paper to enlist the interest of the profession gener- 
ally in this subject, as one eminently suitable for their investigation, 
and I sincerely trust that the infiuence of this learned body may be exer- 
cised in behalf of a much needed reform. It had been my purpose to 
examine in detail the laws in effect in each of the several states and ter- 
ritories, and to this end I entered into correspondence with the secreta- 
ries of the various boards of health, and other prominent officials, and 
I have, as the result therefrom, collected a lai^ amount of valuable ma- 
terial. However, the limit of this paper prevents an analysis in detaiL 
The essential principles of the coroner laws (except in Massachusetts, 
Connecticut and Rhode Island) are very similar in all the states, and it is a 
source of absolute wonder how such an absurd and valueless office for 
the detection of crime should have continued through all these years. 

These laws owe their origin very naturally to the laws of England, 
and were first adopted in the early colonial days. The conservatidm of 
English thought is nowhere bet^'Cr exemplified than in the history of 
her legal enactments. The primary medico-legal inquiry in cases of 
death by violence has been conducted in England by the coroner's in- 
quest for the last thousand years, and has not been essentially changed 
for several centuries. According to Sir Thomas Smith, who wrote in 
1583, the name of the office originated from the word "Crowner," or 
"Coromator," because "the death of every subject by violence is ac- 
counted to touch the Crowne, and to be a detriment to it; in other 
words, the coroner was a representative of the Crown." The system of 
trial by jury has ever been very dear to the English heart, and this, in 
the earlier days of Eoglieh history, when society was less complex than 



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No. 16.] The Coboner Systeh. 389 

at present, was very properly aflsooiated with the duties of the coroaer 
aystem, Then both pathology and chemistry were in their infancy, and 
the combined jad^ment of the average citizen represented the highest 
verdict of pablio opinion. 

In the early part of the present century, Mr. Thomae Wakeley, the 
able editor of the London Lancet, pointed ont the inefficiency of the 
coroner laws as practiced in England, and demanded that the office of 
coroner should be filled by a competent medical man, since which time 
the coroner in England has usoslly been selected from among the bet- 
ter class of medic^ practitioners. 

At the present time, in nearly all the states of the Union, the coro- 
ner's office is considered one of political preferment, and as such, is sub- 
ject to party politics, holding the office not seldom as a subsidy for sup- 
posed services rendered, rather than because of fitness to discharge du- 
ties of BO ^reat importance to the state. 

In the progress of legal learning, as well as in medical science, these 
two great branches of special knowledge have outgrown their former 
status, and to be well versed in both is beyond the training and educa- 
tion of the present generation. 

The object of a medico-legal inquiry is manifestly the detection of 
crime, and the evidence sought is the direct cause of death and the 
identity of the individuals committing the crime. To ascertain the 
cause of death, it often requires the highest qualification of a pathologi- 
cal expert. The post-mortem examination must often be made in a 
thorough and skilful manner, and must frequently be supplemented by 
a careful and exhaustive chemical research. To this portion of the sub- 
ject an especially trained medical expert limits his inquiry. Here, in 
the large majoiity of cases requiring investigation, the examination 
ahoold end, since by it, it is clearly determined that death has been due 
to natural causes, and that the case does not come within the limit of 
criminal investigation. In such cases, at least, it is useless and un- 
necessary expense to summon j urymen, and too often calls the attention 
of the public through the press to a subject keenly painful to all parties 
involved. 

If death has not occurred from natural causes, the question then 
arises, has a crime been committed i In all doubtful c^ses, the evidence 
of this is lai^ly determined by a careful, competent and thorough med- 
ical examination. When this has been fairly established, the further in- 
vestigation of the relation of "the party or parties to the act" becomes 
a purely legsl one, and here, singtdarly, the evidence, as usually ren- 
dered by the verdict of a coroner's jury, is generally considered of little 
value. In an able article * by Mr. Clark Bell, of Kew York, entitled 
"The Coroner's Office; Should it be Abolished^" he writes; "There 
can probably be no more startling evidence of the ntter uselessness of a 
•The MKdxeo-Legal JoiirnaJ, September, lS9a 



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390 State Boabd of Health. [Opf. Doc. 

coroner's jury than the statement of this fact, that whatever may be the 
verdict in a given case, the subseqaent indictment, trial and entire judi- 
cial proceeding is absolutely independent of it, and proceeds as if the 
coroner's jury h d never acted at all. • ■ » 

" We cannot be too jealous of the right of trial by jury, but in all cases 
under eziating law two juries must agree before any person can be con- 
victed of crime, without counting thecoroner's jury, viz; The grand jur>' 
which presents the indictment, and the jury in the trial of the accused 
after indictment; so that the abolition of the jury on the preliminaiy 
inquiry and a change as to vho shall make the inquest in its stead, is 
not in any sense true an infringement upon the right of trial by jury 
which iu all cases would exist if the proposed change was made." 

Under the coroner system, aa in actual use in the various states, much 
time is frequently lost by reversing what seems the proper order of pro- 
cedure. A jury is summoned, witnesses are heard, and at last it is de- 
termined that a post-mortem examination is necessary, and yet it is 
often of the greatest importance that the autopsy be promptly made 
before decomposition is pronounced. 

In a subject the fundamental principles of which are of oniveiBal ap- 
plication, it may be well to broaden the inquiry as to the methods 
adopted by the great nations of Europe which cover the important du- 
ties I'elegated to the coroner's inquest in England and America. For 
au excellent resume of the same, I take pleasure in making I'eferenoe to 
the valuable articles of Mr. Bell from which I have just quoted. 
France. 

Iu France two distinct and separate officers take charge of all madioo- 
legal investigations. The legal officer, attorney of the republic, is an 
authority not unlike the district attorney of our states. He makes a 
record of evidence, has the power of seizing articles or papers if con- 
nected with crime, and can temporarily hold in durance suspected per- 
sons. He may employ detectivcs.andisheldresponsibleforallthelesal 
questions involved. The scientific investigation is under the charge of 
a competent medical expert, especially selected for the office, who has 
full power, and is held responsible for a careful scientific investigation. 
Germany. 

The present law of the German Empire was adopted in 1879. The 
judicial officer {staatsanwalt) is called tlie district attorney. The police 
are his subordinates as officers of the law in the investigation of crime. 
They aie obliged to report to this officer all coses of sudden death or 
death by violence, and no interment of the body is allowed ontil after 
the consent has been obtained from this officer or a competent court. 
Medical examinations are made by experts especially selected for this 
purpose, who ore summoned by the above mentioned authorities, and 
they in all respects conduct the ftxamination. Upon tlie evidence of the 



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No. 16.1 '['he Goboneb Sisteh. 391 

pretimiaary examination, the district attorney enters suit Itefore a com- 
petent coart. 

ScOTTiAND. 

The lav in Scotland is analof^us to that of France. 
Greece. 

The system in force in Greece is almost identical with that of France. 
A medical officer takes exclnslTe chai^ of the medical question of the 
examination, and detectiTes or experts trained to the business are sub- 
ject to the call of the prosecutintir officer. 

The officer designated in charge of the medico-legal examinations is 
known as judge of the institute; is on officer of the crown, appointed 
in and for each district by the central goyemor or council of the prov- 
ince or state. He is possessed of large powers, and may even place in 
close confinement an accused or suspected person. The medical side 
of the case is in charge of a physician who is a salaried officer under 
the crown. He conducts autopsies, and carefully reduces his examina- 
tion and conclusions to writing, whicli he furnishes to the court, and 
also to the central medical council, or board, held in every province at 
the seat of the government, who have a. power of review of the same in 
case doubt exists. 

In 1883 a new law was enacted iu Connecticut, appointing a properly 
qualified attorney as a coroner for each county, and a medical examiner 
for each town. 1 quote briefly from a letter written me upon the sub- 
ject by Dr. M. 0. White, medical examiner for New Haven: "One fea- 
ture of our new law, giving all the business of the county to one lawyer, 
secures immediate investigation by an experienced officer who under- 
stands law and the beat methods of examining witnesses. * * * He 
must investiKate immediately all suspicious cases. He may call a jury. 
All this works admirably. Three-fourths of all the sudden, violent or 
nntimely deaths are disposed of by the medical examiners, reported 
aad recorded, but require no legal investigation, since there is no sos- 
pioion of crime. ♦ * * After nearly five years' experience under the 
present law, I think the defects or questionable points are so few that 
we may say there is very general satisfaction with the law." 

Bhode Island somewhat recently passed laws similar to those of 
Masaachosetts, and Dr. Charles H. Fisher, secretary of the State Board 
of Health, writes me " that it is a great improvement upon the preced- 
mg law and methods." 

I am indebted to Dr. Samuel W. Abbott, the efficient secretary of the 
Massachosette Board of Health, for most valuable information upon the 
working of the law as enforced in this state since 1877. I take pleasure 



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392 State Boabd op Health. [Off. Doc. 

in referring to a valuable article published by I>r. Abbott in the Forum 
for 1889, entitled "The Defects of the Coroner System." Under the uew 
re^me, about 15,000 cases of death from sudden, suBpicious, violent or 
unknown causes have been investigated in a manner much more Ealis- 
factory than was possible under the old system. "Another importaot 
feature of the new method of procedure is the decided lessening of ex- 
pense. Under the coroner system the cost of executing- the lav tor 
three years (1874, 1875, 1876) was found to be )63, 712.04, and under the 
new law it was $54,509.31 for the three years (1878, 1879, 1880), a de- 
crease of $9,202.73, or more than three thousand dollars per year, not- 
withstanding au increase in the population of about eight per cent. 
The principal reasons for this diminished expense are found in the abo- 
lition of the jury, and in the decrease in the number of inquests. The 
ratio of inquests to cases investigated under the old law was forty per 
cent., while under the present law for the period of eleven years (1877- 
1888) it has been been but twenty per cent., or half as many." 

In review of the celebrated Barron case, in Maine, which created a 
wide interest outside of the state, Dr. Abbott wrote a valuable criticism, 
from which I quote. lu the trial of one Stain, as having committed 
the murder, the chief question of interest was the uncertainty as to the 
exact cause of death. "The cashier of the Dexter bank was foond destl 
in the vault of the bank under suspicious circumstances. Marks of vio- 
lence were found upon his head. Two theories were advanced, and the 
little community of Dexter became divided as to the question of murder 
or suicide. What would have been the most reasonable course to pur- 
sue under such circumstances? An immediate and thorough examina- 
tion of the body, especially of the brain and stomach, would undoubt- 
edly have settled the question of murder or suicide at once. 

"What was actually done? The good-natured coroner (to use the 
words of the account printed at the time of the affair) deferred to tlie 
wishes of the family, and made no autopsy. Then came the farce of a 
coroner's jury. Six men sat in a solemn conclave and pronounced a ver- 
dict, and of what possible value was the verdict!" 

From the advanced sheets of the report of the State Board of Healtii, 
Dr. Abbott furnishes me the following statistical tabic; 

Expenses of Medical Examination for 1889. 
The total expenses of the medical examinations for the year 1889, in- 
cluding the cost of registration, was $19,489.69. The average cost ot 
each of the 1,654 medical esaminations was $11.78. In Bristol, EsBei, 
Hampden, Hampshire and Middlesex the expense was greater, and in 
the remaining counties it was less, than tiiat of the previous year. 



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No. 16,] The Coroner Svbtem. 

Tbo espenses of the five yeani, 1885-1889, were aa follows: 



Ybab. 


Total num- 

traror cases 
examined. 


Autop- 
Blea. 


Total 
expenses. 


expense of 




1,260 
1,878 
1,5&6 
l,S51 
1,654 


1S6 
S02 
188 
210 
216 


$16,322 54 
18,024 22 
18,626 26 
19,611 S8 
19,489 69 


(12 96 












1889 


1178 



lu the follovin^ itemized table are presented the expenses of con- 
ducticgr the medical examinations lu each county and for the whole 
state for the year 1888 : 

Expenaen incurred in cmiducling the inedical examinations required by 
the medical examiner laws of Maasack-usetts — 1889. 



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1,,-^ 



In evidence of the grea,i Talue of the working of the new law in 
Massachnaetts, I quote from an exhaustive article upon the subject, 
"The Abolition of the Coroner in Massachusetts, " by T. H. Tyndale, 
Esq.:* "With the abolition of the composite functionary and of the 
jury, a hiphly-trained class of 'medical examiners,' an office g:ladly ac- 
cepted by the first physicians in the state, we open the door for special 
Interest in, and previously unknown penetration into fields of detailed 
investi^tion of pathology ; we have laid the foandation of a valuable 
body of observed facts, as shown by the publication of our medico- 
legal transactions, contributed entirely by the medical examiners ; we 
have attained accuracy, and we have never, since the x>assag« of the 
medical examiner act, failed in a single prosecution for want or insuf- 
•The MedlccT.egal Journni, March, 189IL 



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89i State Board of Health. [Oft. Doo. 

ficitjnt clearness of the medical testimony. The previous statistics vere, 
some htmdreds of inqu^ts annually — some tens of convictions. Now 
the great majority of prosecutions beg^in Tvitb the skilful investigatioD 
of trained men, acting* promptly and delayed by no cumbersome, mean- 
ingleBB machinery, and end in convictious. * * " "^q have attained 
that greatest deterrent of crime, the chief tei-ror to criminals — swiftnese 
in discovery and certainty in punisbment. 

Incidentally, a ^a dear to the lover of social cleanliness and mor. 
ality has been obtained. I refer to the total disappearance from the 
press, except as news from other states, of the nauseons and ofFeoBive 
details formerly furnished by the coroner's inquest and eagerly sought 
after by the prurient curiosity-mongers. These cbanf^ee have been 
wrought by a simple act, abolishing the office of coroner and appoiut- 
iDg for Boston tvo, foi: each other county in the state some four, medical 
examineiB whose basiness is solely tlie physical examination and sabse- 
quent giving of testimony. * * * The new system has now been in 
operation about twelve years and has proved itself capable of exact and 
valuable work ; no instance of wilful dereliction of duty under it has 
token place. It has now the commendation of judges, prosecating of- 
ficers and the general public, and may fairly be pronounced a step in 
the direction of purifying the public service." 

The limit of time at my disposal prevents a more detailed discoBsion 
of a subject of such vast importance, and m closing I desire to com- 
mend for earnest consideration in each of the several states the follow- 
ing propositions: 

1. To abolish the office of coroner. 

2. To dispense with jnry service. 

3. To separate the medical from the legal duties in all cases involfisf 
the examination into the causes of death where crime is suspected. 

i. To entrust the medical examination only to competent medical of- 
ficers properly trained in their work. 

6. To make the number of - these medical officers as small as conust- 
ent with the proper discharge of their duties. 

6. To consign all questions of law only to properly qualified legal 
ma^trates. 

7. To remove the appointment of these officers entirely from the quefr 
tion of political consideration, and to be .based only upon their posses- 
sion of the requisite and proper qualifications. 

Upon some basis of this character should the coroner's laws De re- 
vised. Much useless expenditure of time and money will be avoided, 
often great sorrow and anxiety will be prevented, and that which is of 
vastly greater importance — the ends of justice — will be far better 
served. 



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No. 16.] Sickness and MoBTALm ik the Army. 



aioknesa and Mortality Id the Army of th« Unitad States. 



L. M-, M.D., (Jolonfl a'Hit HargeoJi, V. N. Anny, Medical Direc- 
tor nejiarlmettt 11/ Arizona. 



All statistics' telling the amount of disease (wd death in any connid- 
erable portion of the community, and showing the variations in s^d 
amouQt from year to year, seem properly to belong to state medicine. 

As there is no section of military medicine and surgery in the Ameri- 
cau Meiical Association, I deem it proper to present to the section on 
state medicine the followiug paper, in which I have collated and com- 
pared figures showing tlie absolute aud relative amount of disease, 
death, and non-effectiveness iu the army of the United States. 

While these statistics have been collected under conditions of consid- 
erable nniformity from year to year, yet it is to be remarked that they 
have been collected by a large number of observers, all of them medical 
officers of education and intelligence, yet each differing fi-om the other 
in powers of observation, and in mental characteristics or peculiarities. 

To some this last-named fact will make the statistics more reliable 
and valuable than if they had been collated and reported by a single in- 
dividual; to others less reliable and valuable. 

In 1862 I presented to the American Medical Association a paper 
which was printed in its transactions, and contained the health statis- 
tics of the Uuited States army for eleven years —from 1871 to 1881, in- 
clusive. 

I now present similar data from the annual reports of the surgeon 
^neral for a period of nine years, from 1882 to 1889 inclusive. 



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State Board op Health. 



[Off. Doc. 



Table I, Showing the sickness and raorlality from disease in the ormj 
o/tfie United Staies during the years 1882-1889, inclveive. 



Cases per M. of 
mean strength 
reported as 
taken on siclc 
report for dls- 



Deatbs from dis- 
ease per M. or 
mean stren^h. 



Deatba trom dh- 
ease per M. of 
caseiofdium 





t 


5 


1 


i 


1 
1 

7.06 

6.26 
6.50 
S.15 
S.IB 
4.67 
8.48 
11.59 
7.46 


6.81 
6.91 

8.56 
7.45 
4.76 
6.36 
6.2B 
6.59 
4.32 


1 
1 


4.60 
3.87 
4.17 
6.28 

a.65 

3.78 
7.76 
9.95 
7.<7 


i 


Juno SO, 1882, 

June SO, 1888, 


1,461 
1,570 


1,537 

l,5b8 
1,458 
1.203 
1.238 
1,004 
1,104 
987 


1,468 
1,67G 

1,580 
1,267 
1,118 
1,036 
1,002 

iloee 


6.79 
6.98 

8.80 
7.2? 
4.02 
6.&3 
6.02 
6.06 


4 
4 
5 

6 

4 

e 

6 
3 


65 
45 
56 
88 
48 
48 
06 
EF7 
71 


4.H 
4.U 


December 31, IS84, . . . 
December 31, 18M6, . . . 

December 31, 1887, . . . 

December 31, 1889, . . . 


i,23n 

1,110 

1.017 
092 
1.013 
1,073 

1,222 


1.91 

6.14 
6.34 
«.41 
4.0S 


Total for whole peri- 
od or niue years,, . 


1,310 


1,231 


6.33 


7.», 


6.42 


6.18 


6.47 


5,!I 


Total In former re- 
port* for eleven 




1,498 


1,546 


_ 


,..„ 


8.71 


5.45 











The number taken sick or dying from disease, nud the number con- 
stantly sick at different times, are both, in their own way, measures of 
the health of an army; each has its own peculiar value. 

The difference between the numbers admitted on sick report for dis- 
ease in the two periods tabulated in 1882 and now, might be due to dif- 
ference of physique of the soldiers, to differences in the nature of their 
ser^'ice and the differences in the sanitary care and attention bestowed 
npon them. 

So far OB can be discovered, the material in both periods was about 
the same; the nature of the service was unchanged. So, reasoning by 
exclusion, better sanitary care and attention must have been mainly oi 
entirely operative in causing the decrease of numbers taken sick during 
the period 1882 to 1889 inclusive. 

Differences in the ratios of those dying from disease (not injury) per 
1,000 of mean strength, might be due to these above-named causes, ami, 
in addition, to a difference in the character or constitution of each ludi- 
vidnal disease, and to better therapeusis. 

As before, the first two causes may be excluded. A difference in tlie 
character of the diseases has not been proved or even asserted; rest, the 
improvements in sanitation and therapeusis, as the effective factors. 

The difference in the ratio of those dying from disease per 1,000 of 
cases of disease, would seem, besides the above-named causes, specially 
due to either a difference in the character of the disease; that is,* 



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Ko. 16,1 Sickness and Mortality in thb Army. 397 

greater or less teodency to death, or to better treatment, these two be- 
in^ either combiiied or complem^tary ; one more efficient as the other 
is less BO. 

The impoitaiioe of the ratios of constant non-effectiveness as a meas- 
ure of comparative health, was first emphasized by the surgeon general 
of the army in his report for 1888. The writer of the pages in that re- 
port, on the health of the army as a whole, says: "The actual impair- 
ment of force which the army suffers on account of sickness, as well as 
the relative importance of the various causes of sickness, cannot be 
measnred with any degree of accuracy by the number of admissions to 
sick report, but they are shown very clearly by the aggregate loss of 
time which these admissions individually and collectively cause, and 
from this aggregate the average non effectiveness can be accurately and 
readily determined." 

So it is desirsble to consider these data, and I have accordingly con- 
etmcted a new table, containing figures relating to non-effectiveoess. I 
have also added the ratios of "deaths from all causes," the foregoing 
tables induding only those from disease. It is apparent that the differ- 
ence between the ratios of deaths from disease and deaths from all 
causes, is the ratio of deaths from injury, violence, etc, 

I have deemed it beet also to add the figures for some years preced- 
ing: 1871 — and I have commenced with 1667, because during that year 
the army was reduced from a war to a peace footing, and because in that 
year appeared first Qie statistics of average of mean strength (termed in 
the reports "average" for the years 1867, 1868, 1869, 1886, 1887, 1888 
and 1889, and " average mean " for other years), the number taken on 
sick report for disease, the number taken on sick report for injury, the 
mort^ity, and the constant sickness rate, all for whitesand blacks sepa- 
i-ately, for the fiscal year ending June 30, to which yeai- the rest of the 
report refers. Himilai' data have appeared in each annual report since, 
until 1885. 

In tbe annual report dated October 1, 1865, and subsequent annual 
reports of the surgeon general, while the rest of the report refers to the 
previous fiscal year, ending June 30, the health statistics relate to the 
calendar year next preceding. 

This and subsequent reports also fail to give the constant sicknesti 
rates for disease and injury separately. Ko reason was given for these 
changes, nor is one apparent which is entirely satisfactory. 

In consequence of them, accurate, rigorons comparison is prevented 
between ^nres of preceding and subsequent reports, aud the report re- 
ferred to embraces statistics for six months common to it and the pre- 
vious report. 

Consequent on these omissions, my table does not contain the non- 
effective rates for disease and injury separately, but the rate for both 
combine! 1. 



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398 State Boasd of Heai.th. [Oft. Doa 

This same report of the sorgreon general, for the first time gives data 
as to the nnmber of days' service lost' in conseqaence of admissioDs to 
sick report. 

Explanatory of some of the figures in these tables, the text of the re- 
ports of the Surgeon Qeneral states that 1,310 deaths from cholera oc 
curred in 1867. 

That cholera and yellow fever combined caused 681 deaths in 186^ 
and that yellow fever to a limited extent occnrred in 1869, 1874, 187fi, 
1876, 1877, 1878, 1883 and 1884. 

The text states that for the year 1870, "the comparatively large mw- 
tality from wounds, accidents and injuries, is explained by the Indian 
hostilities -, " and it shows the same in 1876, to be mainly due to tlie 
Custer massacre. 

For the year ending June 30, 1884, the text reads : " It is interesting 
to note thatnot only ia this the lowest death-rate yet reached among ooloied 
troops since their organization, but it is the first time that the rate bas 
fallen lower than that for white troops, the usual average difference be- 
ing 3.2 per thousand of mean strength in favor of the latter class." 

For the year 1885, the text says ; " It is a matter of congratulation 
that not only the admission rate for the troops, but also the death-rate 
has fallen to a lower point than at any time within the history of the 
medical department." 

I remark here that my tables show that, for the succeeding years 1886, 
1887, 1888 and 1889. the admission rates, though not the deaUi-rates, for 
all cansett, were still lower. 



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No. 16.] 



Sickness axd Mobtautv ik the Ammy. 



it 






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98S«SiS3SS33:;3333l:S3S337; 


's; 


moj, 


SSSSfeSS3SRSB3=J8=SE;:Se83a 






1 )!3S8SE:sSf!:sS^=SSS3SS;sa;£^S 




1 
1^^ 






■win* 5ji2«^££2gg^«^«a=2«2'^='"-'* 


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ill 


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SS£^3S3SS3£3SSS8S::SS£S8 = 


aE—^s--""'-"' -" -"""-— 


ssisee83S»2RS«ssS'SSS!s^ss^ 


i 


.,..,. 


i:s=«RI^BSS(iSl:$SS£SSS!£il)lS^ | 




paJOl.JJ 




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Si 


HlDi 


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400 State Board of Health, [Off. Doo. 

In the report for the year ending December 31, 1884, the text of the 
report of the Surgeon Oeueral meatioDB the " mean strength" obtained 
from the reports of the Adjutant General of the Army, which variesfrom 
the "mean strength" obtained from the rejMrtB of medical ofiScers from 
which all preceding rates had been calcalated. The text says that Hba 
death and discharge rates in these tables, so calculated, are " higher than 
they should be," as the figures given by medical officers do not embrace 
the whole strength of the army. The subject was only considered of 
euoogb importance to be mentioned in a foot note merely, and it is bo 
mentioned in a footnote in the report of the ensuing year. 

In the report for 1886, the matter is moi-e fully treated of, and the differ- 
ence between the two "mean strengths" is fully recognized, that given 
by medical officers being generally the smaller. 

The reason is shown why the "mean strength" reported by the Adju- 
tant Oteneral is the proper strength from which to calculate ratios of 
deaths and discbatges, and these ratios are, in the 188fi and subsequent 
reports, calculated from the figures of the Adjutant General, while rates 
of admission and non-effectiveness are calculated from the figures of mean 
strength given by medical officers^the same is the case for succeeding 
years. 

It may here be remarked that, from many points of view, this report 
of 1886 shows a distinct advance beyond its predecessors. 

It is manifest that for purposes of comparison within themselves, the 
ratios of all reports must be calculated on similar data, and those data 
given. 

As the data given in the reports before 1886 will not enable ns to cal- 
culate ratios for these years on the figures of the Adjutant Geneml, I 
have used for the ratios of every year in Tables II and IH, the figures 
given by medical officers. 

The exact difference between these two "mean strengths" appears 
below, the figures being taken from all the annual reports of the Sur- 
geon General which give such figures. 

Since 1383, 1 have given much attention to the question of the correct 
mean strength of the army. For many military posts, month aftermonth, 
I have compared the figures in the reports of the Adjutant General, the 
figures given by medical officers, and the actual numbers on which these 
figures are based. It would take too much space to give all the grounds 
for my convictions, which I therefore merely recite, as follows- 

As stated in the text of the i-eport of the Surgeon Gren«^ for 1886, 
the figures in the report of the Adjutant Genei-al are the proper data on 
which to compute ratios of deaths and discharges. 

But neither the mean strength given by the Adjutant General, nor 
that obtained from reports of medical officers, are correct for the ualcn- 
lation of ratios of admission and constant sickness. 

The figures of the post surgeon should be the basis with certain ad- 



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No. 16.] 



SlCENKSS AND MOBTALlTr IM THE AbHY. 



ditions wbioh have been habitoally omitted, but which may be easily a 
oertaiiied and which may in the future be supplied. 

HBAIT STBBHaTH OF ARNV. 





Writk. 


CouiBKP. 


TOTAI.. 


















?. 


:- 




i 




u« 


Yhar. 




f 












1'^ 
30 




i*^ 


Hi 


1= 








>,s$ 




^B$ 




hSi! 




































Z 


M2 


M 


lf« 






















28,SS7 


21,601 




2,240 


?s 


SOS 


2S 










24,723 


22,691 


2,eio 


2,417 





















The difference in the ratios computed from these main 
jriven below: 





!l 




II 


6 


^11 


d 


1 
1 


c 




5^ 

If 


1 

1 


11 


o 
< 


Hi 


1 




1 




1 


1 


ii 


! 


i 




1 


i^ 


1 




1 




1 


IBM, 


1,2G7 


1,167 


7.46 


6.86 


10^94 


10.02 


44.48 


40.92 






1,017 


4.76 


4.S3 


7.54 


6.88 


41.06 


S7.34 




i,osa 












89.41 


36.60 






900 




G.es 


e.9B 


6.12 


42.36 


38.31 


IS88, 


1,028 




fM 








41.90 


38.74 


188B. 


1,086 


970 


3.96 


0.92 


0.33 


44.11 


4U.84 



In consequence of using the fignres f^iven by post surg^eons, without 
the corrections above indicated, for comparison with the statistics of 
other armies, all tiie ratios in Tables Ilandlll are too high ; and the amount 
of correction should be probably in accordance with the fibres imme- 
diately preceding, which show the differences as computed by the differ- 
ent mean strengths. 
26-16-91. 



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402 State Boabd of Health. [Off. Doo. 

Ill thti report of the Surgeon Qeueral for tlie year ending June 30, 
1884, the number of cases of typhoid fever U givea iu the different urns 
of the service, and among recroits and older soldiers. No attempt is 
made to ezplaJu the differing conditions of these diffeient arms; and as 
it will hardly be supposed that typhoid fever favors a man simply becaose 
he is a cavalry or artillery man, the remarks under this head are not of 
very great significance. 

Elsewhere remarks are made as to the greater or less prevalence of 
this disease at various poets, where more or leas unaaDitary couditioD is 
also treated of. 

The next annual report, 1885, again mentions the greater prevalence 
of the disease among cavalry men, and gives farther details about the 
pasta where prevalent. 

Data are also given as to a^ and length of service of those affected. 

Iu the same report appear tables to show the influence on mortality 
of rank, age, arm of service, race and nationality, and season of the year; 
also the relation of discharges for disability to arm of servioe, age and 



Data of a similar nature, mora or less complete, appear in all subse- 
quent reports. 

The text of the report for 1889 speaks of the death rate as the lowest 
annual death rate in the history of the army, and makes pertinent com- * 
ment on the effect produced by the number of discharges for disability 
on certain other health statistics of the army. 

On critical examination of the figures in Tables U and III, it will bu evi- 
dent, that taking for a measure the admission ratios on account of ilis- 
' efises exclusive of injury, the figures are most favorable for the black 
troops for the period of four years, 1868-70 inclusive, and the poiod of 
eleven years, 1871-81 inclusive, but most favorable for the white troops 
for the period of nine years, 1882-9 inclusive, and the period of the whole 
twenty -four yeaira. 

Taking for our measure the mortaUty ratios the figures are most favur- 
able for the white troops for each and every period given separately in 
Table in. 

Taking for our measure the non-effective I'ate the figures are sUgbtly 
in favor of the whites for nine years, 1882-9 inclusive, and mnch more in 
favor of the blacks for all the other periods. 

It farther appears that the death rates are more nearly equal for whites 
and blacks iu the latter period of nine years, 1882-9 inclusive, than in 
the preceding two periods. That is to say, the blacks are overtaking 
the whites in the race of which longevity is the goal. 

As regards the admission ratios for disease and the ratios for non-effec- 
tiveness, the white troops in the last period of nine years have overtaken 
and a little passed the blacks. 

For obvious reasons, the general deductions from the figures relatia)? 



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No. 16.J Sickness and Hohtalitx in the Abmy. US 

to Icmger periods of service are more valuable thau those from the fig- 
ares relating to individual years ; yet attention may be called to the fact 
that for the last year, 1889, the admission rate for disease and that fur 
constant sickness are in favor of the black troops; while the mortality 
rates are considerably is favor of the white troops, while in general, the 
year, as regards vital statistics, was one of the best iu the array's history. 

It will be further noticed that the indications from admission rate for 
disease, mortality rate, and constant sickness rate, are unanimously in 
favor of any one color, bat for seven years of the 24, viz: in 1874, 1878, 
1881. 1S85, 1887 and 1888, in favor of the white; in 1884 in favor of the 
black troops. 

For about three-quarters of the years given, the health of the white 
troops has been the best, as measured by rate of admission for disease 
and death rate. 

Measured by rate of non-effectiveness, the white troops have been less 
affected by disease than the blacks for twelve years, and the blacks less 
thsu the whites for twelve years. 

The maximum admission rate for disease among the whites, vizi 27.17 
per thousand of mean strength, occurred in 1867; the minimum, 992, in 
1887. 

The maximum of the same rate among tlie colored troops, 28.66 per 
thousand, occurred in 1868; the minimum, 997, in 1889. 

The mazimom death rate per thousand of mean strength among the 
. white troops, viz : 37.15 occnrred in 1867 ; the minimum 3.98, in 1887. 

The msximnm for the same rate among the colored troops, viz: 114.46 
per thousand, occurred in 1867; the minimum, 3.19, in 1685. 

The maximum of non-effectiveness among the white troops, viz; 63.02 
per thonsand, occurred in 1868; the minimum, 39.01 per thousand, in 
1886. 

The maximum of the same among colored troops, 59.28 per thoasaud, 
occurred in 1868; the minimnm, 37.58, in 1880. 

The maximnm death rate for disease per thousand of cases of disease 
treated among the whites, viz : 13.68 per thousand, occurred in 1867 ; tlie 
minimom, 3.71, in 1889. 

Themaximumof same ratio among colored troops, viz: 39.96 per thou- 
Band, occurred in 1667; the minimum, 2.66, in 1885. 

I am unable in the reports of the Surgeon General or elsewhere to find 
facts reported which adequately explain all the fluctuations in the fig- 
ures of Tables II and IU, and without further remark I offer the foregoing 
figures and comments to the students of army and other ntal statistics, 
only adding that the figures given point unmistakably to the conclusion, 
that in the latter series of years talnilated, tho amount of sickness and 
mortality was less than in the former series. 



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State Board op Health. [Off. Doc. 



The Duty of the Oovenun«nt in the Prevention of Tuberouloels. 
By Lawrkhce F. Fliok, M. D., of Pkilaitelphia, At. 

We read in the Declaration of Independence of the United States, 
" We hold these truths to be self-erident, that all men are created eqnsl ; 
thst they are endowed by their Creator with certain unalienable rights; 
that among these are life, liberty and the pursuit of happiness. Thai, 
to secore these rights, frovemmentsore institutedamong men." * * * 
* * * All governments, indeed, which have been constituted upon tlie 
principles laid down in the great Ma^rna. Obarta, have, as one of tiieir 
foremost duties, the preservation of the lives and health of the people 
The common law of England sums up the rights of individuals nuder 
three principal articles, namely : "The right ofpeiBOiial security, the 
rightof personal liberty, and the right of private property ; " and defines 
the right of personal security to consist, " in a person's legal right and 
uninterrupted enjoyment of his life, his limbs, his health and his repn- 
tation." 

In the earlier days of civilization, many diseases were looked npou as 
pi'ovideatial visitations, and therefore non-preventable. In the common 
law of England, however, the principle that the government is bound to 
take every possible precaution against the spread of disease is well de- 
fined, not only indirectly by declaring for the preservation of life aod 
health, but directly by providing penalties for persons offending against 
public health, or spreading such diseases as were then looked upon as con- 
tagious. The common law of England is operative in principle in most 
of the states of our Union; and its provision for life and health are af- 
firmed in the constitution of probably most of the states. Section one of 
the Constitution of Pennsylvania reads: "All men are bom equally 
fi-ee and independent, and have certain inherent and indefeasable rights, 
among which are those of enjoying and defending life and liberty," etc. 
The words " defending life " must be given a broader interpretation than 
mere defense against the anger of a fellowman. A reasonable interpre- 
tation makes it a defense against every danger to life for which the 
ingenuity of man has constructed a defense. 

Modem science tt^aches us that many of the diseases which were for- 
merly looked upon as divine visitations, are bnt ordinary warfares be- 
tween various forms of organic life for self-existence ; and that when 
death ensues, it is the going under of the weakest and the survival of 
tile fittest. Man, the most perfect and the most intelligent of all of God's 
creatures, falls a victim to the onslaughts of organismB so minute that 
they can only be seen by the aid of most powerful lensus. "What these 
little warriors lack in size they make up in number, and in their great 



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No. 16.] PeEVKNTION op ToBERCOLOfllB.- 405 

power of reproditotioa and moltipUcatioD. The orgaoiam of maD, so 
perfect in its construction, bo complex in it« macbinery, and bo complete 
in its equipment for defensive warfare a^^nst parasitio veg«tation, ou^^bt 
never to prove tlie weakest iu a contest with or^nismB so pnmitive in 
coQstmction as are disease germs. But the tiniest and the simplest 
organism becomes a power when acting in concert with a large enough 
nnmber of organisms of its own kind. There is a law in nature that the 
smaller and more primitive an organism, the more rapid its reproduction, 
and in pursoanoe of this law, disease germs, when they once gain en- 
trance into proper soil, multiply so rapidly that the mechanical obstruo- 
iioD of their presence in itself becomes a menace. It is in this their 
great numbers that they become great and prove themselves the victors 
in the contest for sarvivaL 

Ever since man has inhabited the earth he has bethought himaelf of 
ways and means to escape and overcome disease. The accumulated 
thought and ingenuity of centuries has at last demonstrated to us buw 
some diseases can at least be avoided. We now not only know that dis- 
ease is mostly dne to a living organism, bat of some diseases we have 
learned enough about the oi^^nism that we can lay down pretty definite 
mtes as to how to circumvent its development. We know what kind of 
soil it needs, how it is transplanted from person to person, or from per- 
sons to animals, and from animals to persons, what will readily destroy 
it outside of its host, how it is influenced by temperature and moisture, 
etc. We know, in fact, how we can prevent it from propagating any 
longer among ns, and thus drive it entirely from our midst. 

Of all diseases, the one concerning which we have this knowledge with 
the greatest accuracy, is tuberculosis. Bo dreadful has been the on- 
siaught of this disease upon the human family that in all ages, from the 
days of Hippocrates down to the present, some of the brightest minds 
the world has produced have devoted themselvw to the study of its cure 
aod prevention. The qoestion of its cure has not yet been satisfactorily 
solved, but that of its prevention has been made as clear as any problem 
in mathematics. We know positively that the propagation of the dis- 
ease germ depends upon the contamination of the well by the sick. We 
know also that this contamination can only take place in a certain way, 
namely through the medium of broken-down tubercular tissue. We know 
farther, that the disease germ can very readily foe destroyed in this 
broken-down tissue before it is able to reach a new host, and that if this 
is done the propagation of the disease will be stopped. The question 
of the prevention of tuberculosis, therefore, resolves itself into a ques- 
tion of how the broken-down tubercular tissue given off by hundreds of 
thousands of persons and animolB, laboring under the disease, can be de- 
stroyed before it has an opportunity of reaching and infecting others. 
The praetical solution of this question can only be accomplished by the 
govemmeot. 



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KI6 - State Boabd of Health. [Off. Doc. 

Ill most of the £iirupeaD f^vemments, in liarmoQy with their politi- 
cal inbtitations, there are national boards of health with many depend- 
ent sabordinate boaids, to which is eotrusted the care for the health of 
the people. Under our American form of trovemment this system is not 
practicable, but we could have United States and state boards of health, 
which would act in haimony, and to each of which certain duties would 
iiatunilly fall. There is no more reason why we should not have such 
boards of health, than there is, why we should not have United States 
and state courts. We have state boards of health ia most of the atates, 
bnt we have none in the United States. Not only should we have a de- 
partment of health in the United States, bnt it should be made compul- 
sory on every state to have such a department. The contract betweeu 
the people and the government cannot and will not be carried out until 
the machinery for such departments has been constructed and put into 
operation. 

The duties which would fall to a United States department of health 
in the prevention of tubercoloais, and which caunot be performed by a 
state department, are the prevention of the importation of the disease 
from foreign countries aad the carrying of it from state to state by com- 
merce and travel. No immigrants should be allowed to enter oor ports 
who ore soffering from tuberculosis. Where such have been carried it 
should be seen that the ship which has carried them is properly disin- 
fected, or at least that our own people be warned against traveling in 
that ship unless it is so disinfected. A thorough system of disinfectiou 
sliould be practiced, under the supervisioD of the United States, on the 
coast vessels plying between norUi and south, all of which cany a laige 
number of consumptives. All interstate railway travd should be kept 
under surveillance by the United States government, and railway com- 
panies should be compelled to provide a complete system of disinfection 
of all apartments occupied by persons suffering from tuberculosis. The 
transportation of tuberculous animals or tuberculous meat should be en- 
tirely prohibited. 

In addition to these duties for the prevention of tuberculosis, which 
are iucumbent upon the United States, because they cannot be performed 
by the states, there are others in which the Federal government is co- 
shorer with the state government. The Constitution of the United 
States gives congress power to "lay and collect taxes, duties, impost, 
and excises, to pay debts and provide for the common defense, and gen- 
eral welfare of the United States." * * * Under the power thus given the 
United States maintains on army and navy, and marine hospital service, 
army and navy hospitals, and educational institutions for the training 
of soldiers and sailors. Under the same power it could and ought to 
maintain a department of health, hospitals for the isolation and treat- 
ment of tuberculosis, and scientific institutions in which the disease could 
bo studied and men given a practical training in methods of prevention. 



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No. 16.] PaEVEimoN op Toberoulosk. 407 

Oar people have as muolt righi to be proteoted against a disease which 
is known to be preventable as against a foreign foe. 

To the state falls the lion's share of the daty in the preventioo of tuber- 
onlosis. Every state in the Union should have a department of health, 
with subordinate departments in every coanty of the state. It ought 
to be the dnty of this body to keep a record of every oasd of tubercnlosis 
in the state, and of every movement of such case. Physicians ought, 
therefore, to be required to reportevery case of tuberculosis immediately 
apon discovery. When a cose has been reported a competent officer of 
the state should at once be sent to the family to instruct them how to 
protect themselves against the disease. If they are too poor to snpply 
themselves with the necessary meaue of self-protection, such means 
should be supplied to them, or they should be induced to remove the 
sick member to a special hospital for treatment. In order that sufficient 
opportunity be given for the tuberculous poor to be properly treated for 
the disease, the state ought to maintain well equipped special hospitals 
in various parts of the state of convenient access. Whenever a case of 
tabercnlosis removes from a hoose, or dies, the state should at once, be- 
fore the honse can be occupied by another, thoroughly disinfect every 
part of it, scrape and replaster the room which was occupied by the pa- 
tient, and take precautions that none of the clothing or furniture which 
had been used by the patient be given away or left for the use of others 
vritbont first having been thoroughly disinfected. A bouse thus cleansed 
should be so recorded in the office of the department, so that any one 
vishiug to move into it may be able to first assure himself that be runs 
no risk.* The state should also forbid and restrain the sale of food con- 
taminated vi& the disease germ of tuberculosis. All slaughter houses 
and dairies should be inspected by competent men, and fdl tuberculous 
meat, and tuberculous milk-cows be condemned and redeemed by the 
state. No persons soffering from tnbercnlosis should be allowed to fol- 
low any avocation, in which he can contaminate the food, the imple- 
ments or the wearing apparel of another. To obviate any hardships, 
every person snffeting from tubercnlosis, who is compelled to support a 
fiunily, or who has anyone depending upon him, should for the time be- 
ing become a pensioner of the state to the amount of his wages. Inas- 
much as he gives up his eamingsforthegoodof the public, it is but just 
and proper that he be supported as well as those depending upon him, 
at the expense of the public. I know that this will be cried down as ex- 
pensive, and by some even as useless. That it would be expensive I ad- 
mit ; but I cannot help but feel that our present knowledge of tuberculosis 
will satisfy every one who will take the trouble to study the question, 
and whose mind is not preoccupied by a pet theory of his own, that such 
preventive measures would wipe ont the disease. 

■PortbfBthongbtl timlodebtedtoiny friend, J. V. P. Tarner, registrar of the Phll- 
AdelphfK bosr'I of health. 



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408 Stats Boabd of Health. [Off. Doc. 

As regards the expense, the ^vemmeot, both federal and state, ia 
not only justified, but U boond, by the very contract apon which it is 
based, to protect the people af^ainst preventable disease. All the par- 
poses for which fo^vemment is constituted may be briefly summed up 
□nder Ufe ami iia continuation for the allotted length of time unthout en- 
dangermeiU by vtolence or disea/ie. Every act of rational man is tmcon- 
scionsly tinted by a motive for nnmolested existence. Our very physical 
oonstmction is framed with this in view. Nature lets us soffer pain to 
indicate to us that life or limb is in danger. We have feelings (^ well 
being to show that all is right. All happiness, indeed, is dependent for 
its existence upon a feeling of security against danger to life. We seek 
to be at liberty, because we fear that restraint may prejudice our exis- 
tence or that of those who are dear to ns, or may place ne in a position 
where at some time or at another we might not be able to protect our- 
selves or tliem. We seek to possess property in order that we can always 
supply the wants of nature to ourselves and those dependent upon us, 
and that we and they can refrain from exertions when our bodies need 
rest. In short the pursuit of happiness may be tersely defined as the 
chase of the foes of life. The question of expense can, therefore, hardly 
be allowed to be brought forward as an ai^ament against any preven- 
tive measures against tuberculosis. Whatever the expense might be, 
however, it would certainly be very small as compared to what would be 
saved to the people by an avoidance of the disease, even though the 
question of the preservation of life were left out. The return for the ex- 
penditure in the way of individual and public prosperity would amply 
compensate for the outlay. 

It is estimated that one hundred thousand people die annually from 
tuberculosis in the United StateB.t It is well known that the largest 
number of victims are taken during the first half of ordinary life. Mak- 
ing a due allowance for the number who, being saved from tuberculosis, 
might fall a victim to accident or some non-preventable disease, it would, 
I think, be a fair estimate to assume that the average number of years 
of usefulness lost by each of these one hundred thoiuaud people is ten 
years. We then lose every year by tuberculosis the earning capacity of 
one million people for one year, which, put down in doUare and cents, 
at the low estimate of an average earning capacity for each individual 
of three hundred dollars a year, would amount to three hundred million 
dollars. Tuberculosis is, moreover, usually a chronic disease, and of long 
duration. At a very low estimate, the average length of time for which 
a tuberculous patient is incapacitated for work before death, may be 
placed at six months, during which time the earning capacity of one 
other member of the family is at leaat crippled because of nursing and 
care required by the sick one. In this way the earning capacity of from 
nalU by Wm. M. Collum, M. D., Journal Atnertcan 



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No. 16.J The DisntFEOnoH of Exobeta. 109 

fifty to a hundred thoosand people more, for one year, is sacrificed and 
lost to pablio wealth. To the loss of time must be added the expenses 
incidental to sickness, which, if they averaged bat fifty dollars for each 
sick person, woold amomit to five million dollars a year. It will be very 
apparent to every one that I have placed all my estimates too low; but 
even with tiiese low estimates, the imnual loss to the public wealth of 
the United States because of the existence of tuberculosis will reach close 
on to five hundred million dollars. The expenditure of one-fifth of that 
amooDt by the federal and 'state ^vemments for the extermination of the 
disease, would completely wipe out the disease in a sint^le feneration. 
I am fully aware that there are men in the medical profession, and 
promineot men too, who still hold that tuberculosis is not a preventable 
disease, and who cry down any preventive measures on the part of the 
government as a useless waste of pablio money. If there is any doubt 
ou the part of the government on this question, it is ceiiainly its duty 
to appoint a commissioD to carefully examine into the question and dear 
np the doubt one way or another. Either tuberculosis is a preventable 
disease or it is not. If it is a preventable disease, the f^ovemment is in 
duty bound to prevent it, just as much as it is bound to protect its citi- 
zens against war. The finger of science points to the fact that tuber- 
culosis is a preventable disease. Can our government afford to wait until 
every skeptic in the land has been convinced that it is preventablel Ko ; 
its duty begins in the very beginning, with the scientific research into 
the preventobility of the disease, and does not end until its citizens can 
walk this noble loud for threescore and ten years, unmolested in health, 
life and limb by aught that can be brought under the domain and con- 
trol of man. 



The Dlsinfeotlon of Bzareta. 
Oko. Nf. Stbrnbkro, M.D., LieulenatU Colonel and Surgeon U. S. A. 

The committee on disinfectants appointed by the American Public 
Health Association in 18&4, in its final report submitted in 1887, gives 
the following general directions : 

" Diain/ection of Excreta, etc. — The infectious character of the deject- 
ionsof patients suffering from choleraand from typhoid fever is well eetab- 
lished, and this is true of mild cases and of the earliest stages of these 
diseases as well as of severe and fatal cases. It is probable that epi- 
demic dysentery, tuberculosis, and perhaps diphtheria, yellow fever, 
scarlet fever, and typhus fever, may also be transmitted by means of the 



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ilO Statb Boabd of Heu.th. [Off. Doc. 

alvine diachai^es of the sick. It is, therefore, of the first importance 
that tkese should be disinfected. In cholera, diphtheria, yellow fever, 
and scarlet fever, all vomited material should also be looked apon as in- 
fections. And in tuberculosis, diphtheria, scarlet fever and infections 
pneumonia, the sputa of the sick should be disinfected or destroyed by 
fire. It seems advisable also to treat the urine of patients sick with an 
infectious disease with one of the disinfecting solutions below recom- 
meuded. 

" Chloride of bme, or bleaching powder, is perhaps entitled to the first 
place for disinfecting excreta, on account of the rapidity of its action. 

"The followiu)^ standard solution is recommended : 

"Dissolve chloride ofUmeoftke best quality * inpure waier, in the pro- 
portion of six ounces to the gallon. Use one quart of this solution for the 
disinfection of each dischai^e in cholera, typhoid fever, etcf U>x well 
and leave in the vessel for at least one hour before throwing into privy 
vault or water closet. 

"Thesamedirectionsapply tothe disinfection of vomit«d matters. In- 
fected sputum should be dischan;^ directly into a cup half full of tiie 
solution. A five per cent, solution of carbolic acid may be used instead 
of the chloride of lime solution, the time of exposure to the action of the 
disinfectant being four hours." (Op. cit., pp. 287, 238). 

The object of this paper is to inquire whether these reoommeudations, 
which were based upon the experimental data available at the time they 
were made, are sustained by subsequent investigations ; and whether 
any other agents have been shown to possess superior adviutages for the 
purpose in view. 

But first we desirp to call attention to auother portion of the report 
of the committee ou disinfectants. On page 236 the following defini- 
tion of disinfection and disinfectants is given: 

"The object of disinfection is to prevent the extension of infections 
diseases by destroying the specific infections material which gives rise 
to them. This is accomplished by the use of disinfectants. There can be 
no partial disinfection of such material ; either ita infecting power is de- 
stroyed or it is not. In the latter case there is a failure to disinfect 
Nor can there be any disinfection tn the abse7ice of infectious material.' 

I have italicised the last sentence because I ^Hsh to call especial at- 
tention to it. I am frequently asked "what is the best disinfectant to 
put into a water closett " Now if a closet or privy vault is resorted to 
only by healthy persons and no infoctioua material has been thrown into 
it there is nothing in it to disinfect, and the recomendation of the com- 



* Oood chloride nf lime sliould conuin at lea'<t Z'l per cent, of available chloriD^ 
(page DZ). It niHf be purcltased by the quantity at SI cents per pound. The costol 
the Btandanl solutinn rt'oom mended ia Ihererore but little more tban a ceot a gallon. 
A clear Hohitlon may lie obtained by ttUration or bj ctecaotatioa, but the iuaoluble 
Bsdiment does no harm anil tlih la an unneoesflnry rermement 

t For a very copious discharge use a larger citiantlty. 



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Ko, 16. ] The Disinfectios of Excreta. 411 

mittee on diBinfectantH doe» not apply to it at all. It may smell badly, 
and' in this case the bad odor may be neutralized by the use of deodor- 
ants; or we may prevent putrefactive decomposition of its contents and 
thus prevent the formation of the offensive ^ases given off as a result of 
Btivb de<x>mpoBitiou, by the use of antiseptics. But to accomplish this 
it is not necessary to sterilize the entire contents by the use of active 
germicide o^nts. 

A. solution of sulphate of iron or of chloride of zinc is an oseful anti- 
septic and deodorizing agent, and the committee on disinfectants in 
makini? its recommendation did not intend to discourage the use of such 
agents. But exact experimental data showed that these agents could 
not be depended upon for the destruction of infectious disease germs, 
and the xecommendation made related to disinfection in the strict and 
proper nse of the term as above defined. This definition is now ac- 
<]epted by sanitarians in all parts of the world, but many practicing 
physicians still nse the term disinfectant as synonymous with deodorant. 
For example, I find in a recent sanitary periodical under the heading 
"Medical Excerpt," an item copied from the American Jouriud of Ob- 
stelrice, to which the name of a distinguished gynecolf^st is attached, 
in which the following statement is made with reference to a much-ad- 
vertised so-called "disinfectant:" "As a disinfectant I have used it in 
my bouse for over a year with great satisfaction." Now the agent re- 
ferred to has been proved by exact experiments to have comparatively 
little disinfecting power, although it is a very good deodorant. Ac- 
cording to our definition " the object of disinfection is to prevent the ex- 
tension of infections diseases by destroying the specific infectious ma- 
terial which gives rise to them." Are we to suppose that the distin- 
guished gynecologist above quoted had such infectious material in his 
liouse "for over a year" at the time he was employing "with great 
satisfaction " the agent he recommends? If not, the term was improperly 
employed for "there can be no disinfection in the absence of infec- 
tious material." I wish to emphasize this point because I have reason 
to believe that, in the army at least, the recommendation of the com- 
mittee on disinfectants has led to the substitution of chloride of lime 
for cheaper deodorants and antiseptic agents — and especially for sul- 
phate of iron — in latrines which are frequented only by healthy persons 
and consequently need no disinfection. The amount of chloride of lime 
iBsned from the Medical Purveying Depot at flan Francisco during the 
past six months for nse at military posts on the Pacific coast, is more 
than double the amount of sulphate of iron ) but there has been no epi- 
demic of an infectious disease, and probably comparatively little call 
for the use of a disinfecting agent in the sick room. We qnote again 
from the report of the committee on disinfectants : 

" In the sick room we have disease germs at an advantage, for we know 
where to find them as well as how to kill them. Having this knowledge, 



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112 State Boabd of Health. [Off. Doc. 

not to apply it woald be orimiusl negligence, fot our efforts to restrict 
the extension of infectious diseases must depend largely upon the proper 
use of disinfectants in the sick room." (Op. cit., p. 237.) 

"The injurious consequences which are likely to result from socU nus- 
apprehensions and misuse of the word disinfectant, will be appreciated 
when it is known that recent researches have demonstrated that many 
of the agents which have been found nseful as deodorizers or as antisep- 
tics, are entirely without v&loe for the destruction of disease germs. 

"This is true, for example, as regards the sulphate of iron or copperas, 
a salt which has been eztensivel; osed with the idea that it is a valnable 
disinfectant. As a matter of fact, sulphate of iron in saturated solntion 
does not destroy the vitahty of disease germs or the infecting power of 
material containing them. This salt is, nevertheless, a very valuable 
antiseptic, and its low price makes it one of the most available agents 
for the arrest of putrefactive decomposition." (Op. cit., p. 237.) 

Chloride of lime is also a valoable antiseptic and deodorant, and I 
know of no objection- to substituting it for sulphate of iron other than 
the question of cost. The first cost of chloride of lime by the quantity, 
is about double that of sulphate of iron, but practidally, the difference 
is much greater because it is necessary to preserve the chloride of lime 
in air-tight packages. When exposed to the air it deteriorates in valne 
very rapidly. It is therefore necessary to pack it in air-tight receptacles, 
which will not be injured by the corrosive action of free chloride, and in 
comparatively small quantities, so that the contents of a package may 
be used soon after it is opened. 

We now proceed to consider the experimental data relatiug to the 
germicide value of chloride of lime. 

The committee on disinfectants gave it "the first place for disinfecting 
excreta on account of the rapidity of its action." lliis recommendation 
was upon experimental data obtained in the pathological laboratory of 
the Johns Hopkins University, under the writer's direction, and is sus- 
tained by more recent experiments made in Germany. 

The experiments of Bolton, made for the committee on disinfectants 
in 18B6, gave the following results; The time of exposure being two 
hours the typhoid bacillus and cholera spirillum in bouillon cultures 
wero killed by a solution containing one part to 1000 i>art8 of water (con- 
taining 0.03 per cent of available chlorine). Anthrax spores were killed 
in the same time by a solution, containing 0.3 per cent, of available 
chlorine. Typhoid fteces were sterihzed by a two per cent, solution, and 
in several instances by a one-half per cent, solution, but some resistant 
spores of non-pathogenic bacilli survived in two experiments in which 
a solution of l.IOO was used. In bouillon cultures to which 10 percent, 
of dried egg albumen hod beenadded, the typhoid bacillus i^asdestroyed 
one-half per cent. (1 : 200). 



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No 16. ] The Dibinfeotios op Excreta. 413 

Nissen, whose experiments were made iu Koch's laboratory in 1890, 
found that anthrax spores were destroyed in thirty minutes by a fi per 
cent, solution and in seventy minutes by a 1 per cent solution. In 
his experiments the typhoid baeillns and the cholera spirillnm vere 
destroyed with certainty in five minutes by s solution containing: 
0.12 per cent. <1 : 83S) ; the anthrax bacillus in one minute by 1 : 1000 ; 
staphylococcus pyo^nes aoreos in one minute by 1 : 500. Experi- 
ments made by the same author on the sterilization of fteces showed 
that 1 per cent, could be relied upon to destroy the bacillus of typhoid 
fever and the epirillum of cholera in ffeces in ten minutes. 

Carbolic acid. — The committee on disinfectants says: "A five per 
cent, solution of carbolic acid may be used instead of -the chloride of 
lime solution, the time of exposure to the action of the disinfectant being; 
foar hours." This recommendation is made in view of the fact that in 
those diseases in which it is most important to disinfect the excreta, the 
specific ^rm does not form spores. This is now believed to be true of 
the typhoid bacillus, the spirillum of cholera, the bacillus of diphtheria, 
the bacillus of glanders, and the streptococcus of erysipelas ; and it has 
been shown by exact experiments that all of these pathogenic bacteria 
are destroyed in two hours by a one per cent, solution, or less, ot this 
a^ent. 

Spores require for their destruction a stronger solution and a longer 
time. Koch foand a one per cent, solution to be without effect on an- 
thrax spores after fifteen days exposure ; a two per cent, solution I'etarded 
their development, but did not destroy their vitality in seven days ; a 
three per cent, solution was effective In two days. According to Nocht, 
at a temperature of 87.60 0., anthrax spores are kille^ by a five per cent, 
solution in three hours. 

Oarbolic acid poeseeees the advantage of not being neutralized by the 
subetances found in excreta, or by the presence of albumen. Thus Bol- 
ton found that the addition of ten per cent, of dried albumen to a bou- 
illon culture of the typhoid bacillus did not materially influence the re- 
salt, the bacillus being destroyed in two hours by a one per cent, solution. 

This agent, then, is fimdy established as a valuable disinfectant for 
excreta, bat we still give the preference to the standard solution of chlo- 
ride of lime of the committee on disinfectants for use in the sick room, " on 
account of the rapidity of its action," and also on account of its com- 
parative cheapness. 

At the International Sanitary Conference of Borne (1S86) the writer, 
who was associated with Dr. Koch on the coiumittee on disinfectants, 
presented the claims of chloride of lime, and in the recommendations of 
the committee it was placed beside carbolic acid with the following di- 
rection: 

" Carbolic acid and chloride of lime are to be used in aqueous solution. 

" Weak solutions, carbolic acid, two per oeut. ; chloride of lime, one per 



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411 State Boakd op Health. [Off. Doc. 

" Strong solutiona, carbolic acid, livu per cent ; chloride of lime, four 
per cent," 

The strong solutiona were to be used for the disinfection of excreta. 

Creolin, a coat tar product, which is a syrupy dark brown fluid with 
the odor of tar, has, daring the past three years, received much attentioa 
from the Carman Imcteriologists. It is probably the same product 
which was tested under the writer's directioo for the oommittee on dis- 
infeotants, in 1885, under the name of " Little's soluble phenyle." It 
stood at the bead of the " commercial disiofectants " tested. The ex- 
periments made in Germany, show that it is not so active for spores as 
carbolic acid, but that it very promptly kills known pathc^enio bacteria 
in the absence of spores, iu solutions of two per cent or less. Eisenber^ 
found that a solution of two per cent, killed all test organisms within 
fifteen minutes. Esmarch found it especially fatal to the cholera spir- 
illum, which was killed by solutions of 1 : 1000 in ten minutes. The ty- 
phoid bacillus showed much greater resisting power — a one-half per 
cent. Bohition failed after ten minutes exposure. The pus cocci were 
still more resistant. Behriog has shown that the presence of albumen 
greatly diminishes its germicide power. As a deodorant, it is superior 
to carbolic acid, and on this account is to be preferred in the sick room. 
A recently prepared emulsion may be used to disinfect the liquid excreta 
of cholera or typhoid patieuts in the proportion of four per cent, two 
hours time being allowed for the action of the disinfectant. The experi- 
ment of Jaeger upon pure cultures of the turbercle bacillus attached 
to silk threads were successful in destroying the infecting power of 
these cultures, as tested by inoculation into the anterior chamber of the 
eye of a rabbit, when solutions of two per cent were used. 

The value of this agent as a disinfectant is then fully established; as 
to its cost in comparisoQ vdtb the agents heretofore mentioned I am not 
informed. 

Quick-Lime. — Experiments made in Koch's laboratory in 1887 by Li- 
boriuB led him to place a high value upon recently burned quick-lime 
as a disinfectant. More recent experiments by Jaeger, Kitisato, Ffobl 
and others have shown that this agent has considerable germicide power, 
in the absence of spores, and that the value which has long been placed 
upon it for the treatment of excrementitious material in latrines, etc., 
and as a wash for exposed surfaces, is justified by the results of exact 
experiments made upon known pathogenic bacteria. The germicide 
power of lime is not interfered with by the presence of albuminous ma- 
terial, but is neutralized by phosphates, carbonat-es and other bases, and 
by carbonic acid. 

In the writer's experiments a saturated aqueous solution of calcium 
oxide faile<:l to kill typhoid bacilli; but when suspended in vrater in the 
proportion of 1:10 by weight this bacillus was killed at the end of two 
hours. Anthrax spores were not killed in the ^me time by a lime wash 



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No. 16.J The DiaiNFEonoN of Excreta. HB 

contuninf 20 per cent, by weight of pure calcium oxide. According to 
Kitiaato Uie typhoid baoillna tmi the cholera spiriltam in booilloD cul- 
tniea are destroyed by the addition of 0.1 per cent, of calcium oxide. 
Pfuhl experimented upon sterilized faeoss to which pure cultures of the 
typhoid bacillus, or cholera spirillum were added. The liquid disdiar^a 
CHf patients with typhoid fever or diarrhoea were used for the purpose. 
He found that sterilization was effected at the end of two hours by add- 
ing fragments of caJoium hydrate in the proportion of 6 per cent, and 
that 3 percent, wa? effective in six hours. When a milk of lime was used 
which could be thoroug^hly mixed with the dejecta the result was still 
more favorable. A standard preparation of milk of lime coutainiufir 20 
per cent, of calcium hydrate killed the typhoid bacillus and the cholera 
spirillum in one hour when added to liquid fieces in the proportion of 2 
per cent 

The experiments with this a^nt show that time is an important fac- 
tor and that much lon^r exposures, as well as stronger solutions, are re- 
quired to destroy pathogenic bacteria, than is the case with chloride of 
lime. For this reason we still ^ve the last named agent the preference 
for the disinfection of excreta in the sick room. But in latrines the time 
required to accomplish disinfection is of less importance, and ice are di»- 
posed to give recently burned quick-lime the first place for the disinfection 
qfexcreta in privy vaults, or on the surface oftlte ground. It may be ap- 
plied in the form of milk of lime, prepared by adding gradually eight 
p&rts, by weight, of water to one part of calcium hydrate. This must 
be freshly prepared, or protected from the air to prevent the formation 
of the inactive carbonate of lime. 

According to Behring, lune has about the same germicide value as the 
other caustic alkalies, and destroys the cholora spirillnm and the bacillus 
of typhoid fever, of diphtheria, and of glanders, after several hours ex- 
posure, in the proportion of 50 cc. normal bauge per litre. Wood ashes 
of lye of the same ^kaline strength may therefore be substituted for 
qai<^-Ume. 

Finally, it must not be foi^tten that we have a ready means of disin- 
fecting excreta in the sick-room, or its vicinity, by the application of 
beat. Exact experiments made by the writer and others show that the 
thermal death-point of the following pathogenic bactera, and of the 
kinds of virus mentioned is below SO" C. (140° P.): Spirillum of cho- 
lera, bacillus of anthrax, bacillus of typhoid fever, bacillus of diphtheria, 
bacillus of glanders, diplococcus of pneumonia (M. Pasteuri), streptococ- 
cus of erysipelas, staphylococci of pus, micrococcus of gonorrhoea, vac- 
cine virus, sheep-pox virus, hydrophobia virus. Ten minutes exposure 
to the temperature mentioned may be relied upon for the disinfection of 
material containing any of these pathogenic organisms — except the an- 
thrax baeillns when in the stageof spore formation. The use, therefore, 
of boiling tvater in the proportion of three or four parts to one part of the 



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416 Statk Board of Health. [Off. Doc. 

malericU to be diainfedM may be safely reoommended for such mateml. 
Or, better still, a 10 per cent, solution of enlphate of iron or of ohlotide 
of zinc, at the boiliDg point, may be used in thesame way (three parts to 
one). This will have a higher boiling point than water,aiid will serve at 
the same time as a deodorsni During: an epidemic of ch<dera or typhoid 
fever snoh a solution might be kept boilingiaaproper receptacle in the 
vicinity of the hospital wards containing patient^ and would ssrre to 
conveniently, promptly and cheaply disinfect all excreta. 

LiTEBATURE KeFERRED TO. 

Disinfection and Disinfectants. — Report of committee on disinfectants 
appointed by the American Public Health Association. Submitted in 
1887. Pabliahed by the Association in 1888. 

Sternberg — Practical experiments on the sterilization of feces. Be- 
port of committee on disinfectants, p. 8S Oalcium oxide, Ibid, p. 169. 
Chloride of lime, Ibid p. 163. 

Bolton. — Experiments with chloride of lime. Beport of committee 
on disinfectants, p. 166. 

Koch. — Ueber desinf ection. Mittheilungen aua dem Kaiserl. Gaund- 
heitsamte, 1881. 

Jaeger — TTnterBuchongen ueber die Wirksamkeit Terschiedener cbe- 
miscber desinfectionsmittel bei kurz dauemder Einwirkung aot TDfe^ 
tionsstoffe. Arbeiter am dem Kaiserl. Oesundkeitsamte, 1889. 

Eisenberg. — Ueber die desinficirende Wirkung vjxd die praitische 
Anwendnngsweise des Creolins. Wiener med. Wochenschrifi, 1888, 
Nos. 17, 18 and 19. 

Esmarch. — Das Creolin Ceniralbl von Bacteriol u. Parasitenk., 1887. 
Bd. n. Nos. 10, and 11. 

Pfuhl. — Ueber die disinfection der Typhusund choleraausleerun^ 
mit Kalk. Zeitschrift filr Hygiene. Bd. VI, 1889. 

Kissen. — Ueber die desinficirende Eigenscbrift des Chlorkalkes. Zale- 
chrift fUr Hygiene. Bd. VIII, 1890. 

Liborius. — Einige Untersuch ueber die deainfieirende Wirkunp des 
Ktilkes. Zeitschrift far Hygiene. Bd, 11, 1887. 

Behring.— Ueber desinfection, desinfectionsmittel und desinfectioM 
methoden. Zeitschrift filr Hygiene Bd. IX, 1890. 



The Sanitary and Unsanitary BelationB of Underground Waters. 

By a H. BttrCE, M. !>., .,/ Toronto. 

It is not my intention to deal at any length with this subject, but 
rather to present some of the principles to be observed in the selection 
of drinking-waters. 



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No. 16 . ] Underground Waters. 417 

Mach has been said Tith ref^w^ to the dangers of drinldDS- water from 
wells, but it has cot beeu until receotly that the differentiation has been 
made as r^^ards wells that are dangerous sad those that are healthy. 

As a general principle, it may be said that practically all really under- 
ground waters are sanitarily ^ood; but it must be clearly understood 
what is meant by on oaderground water. For instance : 

1. A water lying in a shallow dug out in prairie or bog land, down 
only to the imperrions clay or rock below, cannot fairly be called under- 
ground water. 

2. Neither can a well down even into a true water-bearing stratum of 
sand or gravel, be called an nndeiground water, if the water of the upper 
organic soil layer is allowed to percolate toward the well laterally, with- 
out really moving downward through the underlying beds of clay loam, 
sand or gravel, which serve to sterilize the wateis in their passage 
downward. 

3. Neither ctta a well be called underground if , as is commonly the 
case, the well is covered with loose boards, or a wooden framework, thereby 
allowing the filth washings from the surface of the boards to be carried 
down through cracks into the water of the well. 

Carl Fraenkel and others have carefully examined into the water of 
pit-wells, and such have by Ffliigge been called " hygienic monsters." 

Clearly, then, underground waters mean those which have primarily 
fallen upon the suiface, have there been contaminated with soil microbes, 
but which have, in their passage downward, through percolation to the 
water-bearing zone situated ou some impervions stratum, been purified 
by the several natural agencies which are at work. 

Of these, doubUees, the one of the greatest importance is the me- 
chanical retention in the upper layers, of the grosser organic matters, 
for instance those ot sewage on a sewage farm. 

I have found that at a sewage farm, the upper yard or two of the bed 
of sand has retained practically all suspended organic matters, and that 
even soluble organic matters are gradually abstracted by capillary ad- 
' heaion from waters as they pass downwud. 

In addition, however, to this cleansing action of capillarity, we have 
at work under favoring conditions, the destructive action of bacteria. 
With various kinds of organic matters, saprophytic bacteria deal largely; 
bnt their work, while purifying to the soil, may result in emanations of 
an extremely injurious character. lu order that this decomposition may 
go on rapidly and without pernicious results, intermittencj/ of deposit of 
organic matter on the surface and the attendant penetration pf air with 
its oxygen into the soil is required, in order that the nitrifying germ, 
proper, may carry on its beneficent work. 

Manifestly, therefore, we have in towns conditions where, with the 
permanent presence of masses of oi^^anio matter in back yards and in 
privies, waters may move latterly or from the surface, carrying to the 
27-16-91. 



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418 State Boabd of Health. [Off. Doa 

largest extent their sol ability admits of, organic materials to uudergronad 
strata, which, appearing in wells, and their coming into contact with 
oxygen, supply conditions for the free multiplication of germs borne in 
from the suiiCace or the air, and hence waters tliat have been sterile as 
tmdergrouBd streams, and loaded with soluble organic matters, become 
culture media for certain pathogenic bacteria in those seasons of the 
year when the water temperature makes their development abondaut. 
Every one is familiar with wells, dangerous only in Uie later summer 
months when deep, ot from springs in early summer, when their water 
reaches a hieber temperature. 

Much interest has for many years attached to the experiments of Pet- 
tenkofer, with regard to the rising and falling of uudergronnd waters, 
in their bearing upon the increase in the mortality from filth diseases, 
notably that of typhoid fever. It has beeu assumed that he was correct 
in saying that after a summer lowering of the ground water, and then a 
rise with autumn rains, typhoid invariably increased. 

Now, with regard to this, as with so many other conditions, individual 
local circumstances will decide whether or not he is correct. For in- 
stance. Buck and Franklin have laid special stress on wetneea of soil in 
general, and the effect of highness or lowness of the subsoil waier, an 
increasing cholera infantum. Hirsch, on the other hand, examined the 
relationship between the number of cases of cholera infantum and tiie 
level of the subsoil water at Berlin from 1877 to 1882, and concluded 
that the height of the subsoil water in Berlin, gives no measure of the 
rate of mortality. Xow if we look closely into the facts there, his con- 
clusions are as we would expect. The city is largely supplied with pub- 
lic water from river sources, and naturally we find that during periods 
of high ground water, the rivers become increased in t^eir volume, and 
instead of the drinking water being more impure at such times, it would 
be less so. 

But the case is different where well water is used. During the periods 
of dry weather, as tbe water in the superficial soil layers has gradoally 
passed downward, it has been followed, according to the permeability ' 
of a soil by atmospheric air, thereby extending the line ot organic de- 
composition downward — this however being limited usually to the upper 
four or five feet. 

What then takes place when heavy rains comet The first result is 
that the upper permeable bed, loaded with bacteria from free decompo- 
sition of organic matters, becomes saturated with moisture, while privies 
also, which have during tbe dry weather lost most of their fluid contents 
by evaporation, likewise become surcharged with moisture. The water 
from botli these supersaturated sources moves along laterally downward 
toward the wells, as the lowest point, and loads them with soluble or- 
ganic impurities, and with putrefactive and nitrifying bacteria, in addi- 
tion to suspended impurities washed in from the surface. This causes 



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*lo. 16.1 XJndbrqbodnd WATEBa 419 

diseaee. beyond question ; but this is not due to the rise of gronnd 
water necessarily, since, as all know, the actual rise, in other than shal- 
low subterranean water-streams and in springs, does not take place till 
weeks, or even months, after the spring or autumnal heavy rainfalls. 

We, therefore, can see that the conditions governing the purity of 
water supplies from ponded streams and small lakes, are very different 
from those governing: well waters, as in pit-wells. When the first are 
most foul, the latter are often least so. 

The question, then, of the use of underground waters, is of a much 
wider nature than that relating merely to pit-wells in town and country. 

Falling upon pervious uppersoil and upland and cultivated fields, the 
rain forms those great reservoirs upon which river and lake supplies, as 
also that of ordinary weUs depend. Springs on the hillside are the in- 
dex of their existence, and to these streams must we look for a pure 
water supply, obtained under conditions widely different from those we 
have just referred to. 

Analyze these spring waters before contaminated by- surface filth, 
drive an iron pipe down to this water-bearing stratum, and we find a 
water in all cases absolutely free from bacterial life, and those conditious 
which make pit-wells under ordinary conditions, such dan^rous sources 
of supply. 

As the rivers, in recent years, have been falling daring the long sum- 
mer, through the loss of the upland forests which formerly held back the 
water, and whose absence likewise create long summer droughts, re- 
lieved at most by destmotive thunder-storms, we have found ourselves 
depending upon ponded waters, becoming more impure by evaporation, 
lessening their amount, or upon rivers becoming more polluted by les- 
sening Tolnme, .together with increasing pollution by our growing 
towns. We are hence forced to turn our attention to these underground 
waters, sometimes, it is true, somewhat excessive in hardness, but always 
sterile, and supplying artesian wells, driven wells, water galleries of 
perforated pipes, and springs carefully collected abd protected against 
surface pollution ; while the utilization of such will do much to solve 
the qoestions both of water supply and sewage disposal which, upon 
this rapidly populating continent, are to-day of more importance than 
probably f^l other health problems combined. 



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120 SfTATE Board of Hbalth. [Off. Doc 

Siinple Methoda of 8ewair« Disposal. 
ByC. W, CHANCEI.1.0II, M. D., Seeretari/ male Board of Health, Bnllimori, Mil. 

Among the many problems engaging tbe atteotioD of sanitary engi- 
neers, that w'hicli embraces the removal or disposal of honsebold sew- 
age, la perhaps the most important. With the advance of natntal 
sciences, the principles which are recognized as goverqing he^th and dis- 
ease, have been gradually developed, until we are now face to face with 
the fact that if we would be free from filth diseases, it is necesaary to 
remove from our midst those elements which are either their direct cause 
or agents of transmission. 

The question resolves itself into disposing of such matters in a man- 
ner best suited to the conditions and locality in which they are prodnced, 
having regard: 

1. To the sanitary efficiency of the method employed. ' 

2. To the economical attainment of the result aimed at ; and 

3. To the method of disposal affording some return for the means ex- 
pended. 

The conclusions which naturally follow the foregoing propositioDs, 
and which, from a sanitary standpoint, dominate the whole question, 
may be summed up as follows: 

a. That wherever there is excretal refuse to be disposed of, it should 
be so treated as to remove or separate the solid from the liquid parte. 

b. That the impurities conveyed by tbe liquid parts of sewage which 
are more readily oxidized, are insigDifioant as compared with those of 
the solid parts. 

c. That the solid parts of excretal sewage should never under any cir- 
cumstances, be allowed to enter a water-way; and if the fluid parts can 
be subjected to some artificial process of purification, and subsequent!; 
passed through the soil by sub-surface irrigation, so mnch tbe better. 

These are fundamental axioms which require no discussion ; but it 
must be admitted that, thus far, serious difficulties have environed the 
practical application of these principles to the question of sewage dis- 
posal. 

Apart from the question of health, the practice of discharging crude 
sewage into water courses has its attendant evils. The solid matteis 
will gravitate to the banks and bed of the stream, which not only (A- 
stnicts natural drainage but is liable to decompose and become offensive 
as the water falls, and exposes it to the action of the sun and air. A^^ 
the more finely diffused solid particles are exceedingly hurtful to fisH, 
(hokiug up their gills and sufi'ocating them. Moreover.fish breatbeb.v 
moans of the free oxygen which is contained in the water in which they 



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No. 16.} Methods of Sewaqe Disposal. 421 

Dfttate, and this element beiogr deprived of its oxy^ii by the adtniitiire 
vith sewage, the fish must necessarily die. 

This fact alone, viewed in the light of political economy, should re- 
strict the amount of sewage poured into any limited area of water ; for 
however admissible fresh sewsge may be as food for fish, it soon becomes 
stale, and in this condition acts as a poison which will eventually destroy 
the fish and oysters of any water area into which it is discharged. 

A^in, when sewage passes into & putrefactive state, the gases that 
are generated either in sewer pipes or watercourses, are capable of pro- 
dncingr certain malignant diseases ; but whether the iUiiess is to be i-e- 
garded as the direct e£fect of inhaling the mixed chemical gases, or as an 
expression of the consequences of inspiring a micro-organism which is 
reprodnoed in the human body, is not known to medical men— who are, 
however, perfectly familiar with the illness. 

One of the greatest difficulties of adequately dealing with this sewage 
qoestion, lies in the enormous bulk to be operated upon — equal to about 
five gallons of water to every three ounces of fiecal matter — and it is there- 
fore reasonable to suppose that, could some simple mechanical appliance 
be devised by which the liquid could be drawn off and separated from the 
solid parts, it would greatly assist in the efficient treatment of excretal 
refuse. The fioid part need not necessarily be passed directly into a 
water-course ; it could be first distributed by sub-surface irrigation over 
a sufficient area of land, for which it would serve as a useful manure, and 
by which it woold be effectively filtered and still further purified. The 
employment of such a method is the more to be i-ecommended because, 
when a process of separation only has been employed, as oontradistinct 
from a process of precipitation with chemicals, the effluent is richer in 
organic substances available for the nutrition of plant life, and the solid 
matters being excluded, the pores of the soil will not become clogged. 

ka to the manorial valne of the solid matters retained, that must be 
judged rather by the practical resnlts of the agriculturist than by the 
presumed theoretical values based on analjrtical data The percentage 
of combined nitrogen, however, in this material is remarkably constant, 
and the phosphoric acid which it contains is also an important ingredi- 
ent in an agricultural point of view. 

Ftecal matter has been termed "the natural food of the soil," as it re- 
turns to the soil those elements which are taken from it by the growth 
of vegetable products neoessary for the proper nutrition of man. By 
treating excremeutitions matters by a process of separation, moreover, 
what is now a nuisance to cities and towns may be mode a source of pro- 
fit to the country generally, especially to the agriculturist, who wonld 
find in the solid matters a valuable goano — superior to most manures in 
the market — produced at his own door. 

"The most fertilizing and effective manure," says Victor Hugo, "is hu- 
man mannrci bnt what is done with this golden dung f It is swept into 



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422 State Boaad of Health. [Off. Doc. 

tlie gulf 1 yfe send, at great ezpeoBe, fleets of ships to collect at the 
southern pole the guano of petrels and penguins, and cast into the sea 
the incalculable elemeut of wealth which we have under our own hands."* 

If this HO-called "golden dung" has the value that is ordiDarily at- 
tached to it, private enterprise would sorely be rewarded for itscoUec- 
tioQ and utilization, and could well afford to pay a handsome bonus for 
itd preservation. A^eulture, so important a factor in the country's in- 
dustry and prosperity, has up to this time suffered such heavy losses 
from this material being "cast into the fipilf," that, apart from the ques- 
tion of health, its interests are fully entitled to the serious oonsideration 
of political economists and legislative bodies. 

It has been asserted that one prime cause of the fall of the Roman Em- 
pire was the building of the great sewers of Borne, and the consequent 
disastrous deflection of what might have been an enormous fertilizing 
material into the Tiber where it went to waste. 

The Chinese are said to preserve carefully everything that can be used 
to enrich the earth for food production, and there seems to be a growing 
disposition, both in Europe and America, to follow their example, by de- 
vising measures and maUng experiments to utilize excretal refuse for en- 
riching the Boili but we must admit that there is still a squandering of 
this valuable material that may well alarm the political scientiBt. 

It is undeniably, of the last importance that household sewage, which 
is now allowed to go to waste with a reckless disregard of both public 
health and agricultural prosperity, should be utilized in some cheap, 
cleanly and simple fashion ; and surely, the ingenuity of man can be ap- 
plied in no more useful way than to a proper solution of this important 
question, which embraces not only the welfare of society, but even the 
integrity of nations. 

Passing by the difficulties which are unmistakably attendtuit upon the 
disposal of sewage in large quantities^ the question comes up, how is it 
te be treated, as treated it must be, if the health of the inhabitants of 
our tewns is to be considered! The methods of treatment, other than 
those involved in the systems by which the whole of the sewage is sent 
into water-courses — if, indeed, this may be considered a system of treat- 
ment at alt — and in applying crude sewage for the irrigation of land, are 
pretty numerous; but numerous as they are, they all come under oneor 
the other of the following classes: 

1. Dealing with excretal refuse in a special way, altogether sepaiate 
from large sewage drains, leaving these to conduct the waste waters of 
domestic aud industrial operations and also the rain or storm waters 
alone. 

2. The pi-ecipitntingprocesa.by which thesolid organic and patrescible 
jiortious of the sewage are deposited in a solid form, which may l»e used 

•Lea Miserable!!, i*. 290l 



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No. ic] 



Methods or Sewaqe DisPoaAL. 




ae an ordinary manure, pasB- 

in^ the liqaid portion, in 

a cond i tion more or lass clear 

into some Btream or river. 
3. Keeping the raiu or 

storm water on the surface, 

or sending it intodrains dis- 
tinct from thoBe conveying 

sewage, to be dischai^ed 

into some river or stream ; 

while the crude sewa^, in 

a more concentrated form 

is also passed in to the watci - 

course or on the land forir- 

rigation purposes. 

i. A combination procees 

of straining, precipitating 

and filtering, by which the 

solid part of the excreta is 

separated from the liquid, 

as it were, at the fountain 

bead, and retained iu a her- 
metically closed vessel, or 

tank, under a cohimn of 
water, while the fluid parts, 
with the ordinary water of 
:he closet, are passed 
through the meshes of a fine 
strainer, and then either run 
into the soil by sub-surface 
gatiou or filtered 
;hrough some oxidizing 
agent, as burnt or spongy 
to besnbseqnently dis- 
charged on the surface of 
the ground, or into a water- 
course. 

Under the first of these 
four classes, there are a num- 
ber of arrangements, which, 
1 when taken collectively, may 
i termed the dry system 
of collection. 

The cess-pit and the mid- 
3 the Sist attempts at collecting excreta, not so much, however 




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424 



State Board of Health. 



[Off.Doo. 



for the purpose of profit as with the idea of pi^ventuig nuisance. The 
cess-pit need only be mentioned to be condemned. The ash pit midden, 
or privy, has its advantages and its difficulties; of the difficulties, the 
edacation of the people to nse them properly is chief — a difficulty, how- 
ever, that applies quite as raoch to water closets as to middens. 

The general principle of the ash pit midden or privy system is illus- 
trated in Figure 1. It consists of a common privy, with a small covered 
ash pit, from the top of which a ventilating shaft is taken to the roof 
of the house to which it is attached. The floor of the aah pit is of glased 




FidunB 3.— Rochdale Paii. Clobbt. 
pall. B, ash tub. C, seat cover (raised). D, iron collar below w 



pail. 



E, iiinged uprlgbt of seat. O, door 



earthen-ware, absolutely water tight. The ashes used as an abecvbeut 
are emptied into the pit through the privy seat, whenever the closet ix 
used. These pits are cleaned aa often as may be necessary. This 
system is used at Hull, England. 
The Manchester methotl. Figure 2, consists of a common privy, out- 



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Wo. 16.] 



Methods of Sbwaqe Disforal. 



126 



side the house, conBtmctod with a sunken pit in which st&uds a galvan- 
ized iron receptacle, placed under the seat of the closet. 

The floor of the pit is of earthenware, and the ventilation is through 
the flue as shown in the illustration. The door for temoving the recep- 
tacle is at the Bide or back lo the absence of the receptacle, the ash 
pit can be used. The r*weptacle is emptied weekly. 

The Bochdale 
method is similar to 
the Mancshester, ex- 
cept that the wooden 
pail, ^nerally made 
from a kerosene barrel, 
is substituted for iron, 
and sits immediately 
beneath the closet seat 
and on the same level 
of the floor, instead of 
below the surface of 
the f^rouud, which 
makes removal more 
<lifficult. Figure 3 is 
;iu illustration of the 
Rochdale system. 

The Qoux system 
consists in lining the 
inside of the tub with 
absorbents as charred 
sea weed or dry earth 
rammed in by a cen- 
tral core so as to give 
auniform lininf^to the 
tub, thus preventing 

splashing. This * '" ~ 

method necessitates the frequent removal of the excreta. The ffecal 
matter is received in the central cavity of the lining. 

At Birmii^ham, where the galvanized pails are used to the extent of 
some 40,000, representing a population of 250,000, the contents are col- 
lected weekly. These are emptied into a vat at the place of deposit, 
and some snlphurie acid added to fix the ammonia. 

The object of these several methods is the conversion of the old and 
dangerous system of privy pits into receptacle^] calculated to promote 
health and decency, and keep out from sewers as much of the excre- 
mental matter as possible. There is no doubt whatever of the fact that 
either of these systems is infinitely more healthy and more reasonable 
in every way than the cess pool, and, personally, I am strongly inclined 




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426 State Board of Health. [Off. Doc. 

to tlilak that the system of coUeotioa in Tillag^es and small tovDB, even 
if not in larf^er centeis of population, is to be recommended in prefe*-- 
ence to the usual water^ama^ system. 

Lastly, we have amonff the dry syBtems of collection, Moole's dry earth 
closet, in which the deodorizing" and absorbent power of the earth is ap- 
plied to the treatment of excreta. This closet is illttstrated in Fi^nu^ 4. 

However efficient as a deodorizer and absorbent dry earth may be, 
there are almost insuperable difficulties attendant upon its use, which 
have retarded its general introduction, even in country districte. About 
four and one half pounds of dry earth per head per day are required to 
obtain a consolidated and inoffensive compost. A village of 1,000 per- 
sons would need, therefore, about two tons of dry earth per day. More- 
over, it is a sine qua non that no liquids are to be dischar^^ into the 
closet, so that it is a system which does not provide for liquid excreta; 
or if the air is very damp, which is the normal condition in certain places, 
or if the contents get moist in any way, we have, to all intents and pur- 
poses, a cesspool without its advantages, or without the special precau- 
tions that are commonly taken with regard to cesspools. 

We come now to consider the precipitating processes. A great num- 
ber of these have been tried, but the general result seems not to have 
been satisfactory, since none have thus far been free from a feature which 
practically condemns the whole of them, vizr The employment of expen- 
sive chemicals in large qnantities for the purpose of precipitating from 
the water certain matters which are therein suspended. 

The third plan is that by whii'h the great dilution of sewage with 
water is proposed to be avoided by having two distinct seta of drains, 
one to convey away the household sewage alone to some water-course, or 
to be treated by precipitation or sub-surtace irrigation; the other set o( 
drains to cury off storm and street water. This was first proposed half 
a century ago by Mr. P. O. Ward, of England, and was subsequently 
practically carried out by Mr. Menzes, at Eaton, and, more recently, by 
Ool. Geo. E. Waring, at Memphis. There can be no doubt that if the 
rainfall could be excluded from the sewage proper, a vast step would be 
gained towards the practicability of usefully applying sewage to the 
soil, but even then the area of land required would be so great and the 
cost of preparation so immense that the sug^stion has been considered 
by high authorities to be hardly practicable. Mol%over, it has been 
pretty well established that the putrefactive decomposition of solid ex- 
cretal matter in soils gives rise to the production of malarial and para- 
sitic diseases, and that such eolid organic matters, after a time, will form 
a crust or cake upon and in the interstices of the soil, which gives off 
offensive and dangerous effluvia. Again, the sub-soil water from broad 
irrigation is charged with decomposing matters, and Petenkofer is not 
alone in his opinion that " there is no more fruitful source of disease than 
polluted snb-soil water which is constantly changing its level." 



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No. 16.] Methods of Sewage Disposal, 427 

TIm mere fact that the avniUble buid near larj^e cities, at least, is in- 
sofficieDt for the disposal of sewage by ini^ticD, is sufBciently con- 
(ItmDatory of the process as an exclusive means of utilizing sewage. 
According to M. Lefeldt, an acre of land is required for the excreta of 
every twenty or thirty persons when applied by broad irrigation; while 
Mr. Henry Bobertson, of England, in a paper on sewage disposal {^ani- 
tavy Becord, 1884), contribated to the'sanitury institute meeting at Dub- 
lin (1884), states that " open porous land with a good free sub-soil drained 
six feet deep, will deal, per aore, with the sewage of 600 people," but the 
cost of preparing the land he estimates at from $4,000 to $5,000 per acre, 
BO that, practically, it does not much matter which kind of irrigation be 
used. 

The theory of purification by irrigation is that the fluid part of sew- 
age gradually percolates througli the land, and is finally carried off by the 
artificial underdrains, while its organic constituents are subjected to oxi- 
dation by the agency of micro-organisms producing the phenomenon 
known as "nitrification." The solid parts left in the soil are lUso attached, 
and gradually succumb to the influence of hydration and oxidation; but 
there is a limit to this process, and should the land become overcharged 
or choked with solid matters, which often occurs on sewage farms, oxi- 
dation will not proceed, and an intolerable nuisance ensues. 

To prevent this the separation of the solids from the fluids of sewage 
is essential, and after this the effluent may be disposed of with entire 
immunity by a process of irrigation ; or, in the absence of special objec- 
tions, the effluent may be discharged into a river or other water area 
having sufficient volume or flow to oxidize the organic matters which are 
held in solution. This, however, applies only to sewage, whether mixed 
with rainwater or Hot, that has been so dealt with by screening, subsi- 
dence, precipitation or otherwise, that the solid parts are removed from 
the liquid parte. 

If our boasted scien tific knowledge is worth anything, it should enable 
ud to separate the fluid from the solid parts of excretal sewage, and to 
convert the latter into a good practical manure, while the fluids may be 
discharged into the soil, or into some water-course, iu an innocuous con- 
dition. 

Some three or four years ago Mr. C T. E.ingzett, the distinguished 
Loudon chemist, suggested that a small portable apparatus might be 
supplied to each house, provided with a strainer, whereby the water of 
crude sewage wouldbe separate<l from the solid parts, and the receivers 
could, by a properly organized system, be collected as often as neces- 
sary, and a clean one left in the place of the one removed. Such an ap- 
paratus, it scarce need be said, should be as simple and as economical 
as possible, consistently with preventing nuisance or danger to public 
health; and I claim for a device which I have lately introduced, that it 
is at once the most simple, the most efiective and the most economical 



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428 State Board op Health. [Off. Doc. 

that has yet been (iiupoaeil for the purpose. The metUutt cuoBlste of a 
process and apparatus by which the solid matters of house-hold refuse 
are effectively separated from the water of crude sewage by mechanical 
straining, subsidence and precipitation, whereby a lar^ proportion of 
the suspended mattera are detained in a hermetically closed receptacle, 
which when full can be removed and replaced with an empty one by a 
common laborer, while the liquid parts are continuously delivered in suck 
a oonditioQ of purity, that they may be used to irrigate the-soil with ad- 
vanta^, and without any danger of choking its pores, or the effluent 
from the precipitating tank may bo further puri&ed by filtration through 
iron to such au extent that it can be discharged into any drain, sewer, 
cesspit, river or stream with entire immunity. The apparatus is illus- 
trated in the following diagram: 



Figure 5 represents a vertical section of the apparatus with alt its 
parts intact, except the filter, which is omitted aa it is rarely to be used. 
A, represents the receiving vessel or "receiver;" B, the settling or "pre- 
cipitating tank:" D, the outer cylinder of the "strainers;" E, the inner 



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No. 16.] MjaraoDs of Sewage Disposal. 129 

perforated "strainer;" F F, the soil pipe ooDnected with the straiDer E 
aboTd and below; G, the collar which coDQects the soil pipe with the re- 
ceiver; H, the box or holder for the precipitating rea^nt ; I, pipe con- 
necting the receiver and precipitating tank for the pnrpoBo of drawing 
down the water to prevent slopping when the receiver A is detached at 
the cellar (? to be removed. When detached the opening at G is closed 
with's close-fitting cap. 

The operation of the apparatus is as follows : All such matters as are 
geaerally disohai^red into the soil pipes of houses are conveyed into the 
"receptacle," which is removably connected with the soil or drain pipe. 
The coarser, undissolved matters, such as foreign bodies, ordure, and 
paper not yet dissolved, which the trap of the soil pipe has allowed to 
pass, sink by gravity to the bottom of the receptacle, while the matters 
that are more or less dissolved in water find their way along with the 
supernatant liquid of the sewage through the meshes of the strainer, 
aud from thence by a connecting pipe D into the precipitating tank. 

The precipitating tank receives the overflow from the "receptacle" 
which has passed through the strainer. This tank is provided with an 
automatic device for discharging a certain quantity of chemical precipi- 
tants into its contents. The supernatant liquid in the precipitating tank, 
already quite pure, is discharged through the pipe A, which, when the 
efSuent is to be disposed of by sab-surface irrigation, is converted into 
a siphon simply by extending this pipe downward, on the inside of the 
tank, to a point near the bottom. In this way the flush throngh the sub- 
surface irrigation pipes becomes rapid aud continuous until the tank is 
emptied. 

The receivers, containing the solid parts of excretal matters, are to be 
collected, when full, by a properly organized system, and clean ones left 
in their places. These receivers should be taken directly to the usine 
or compost factory, where there contents may be worked np, with other ' 
substances, it may be, into an innocuous aud valuable manure powder 
ready for immediate application to the soil. The utilization of the solid 
excreta is not, however (and this is a very important matter to public 
bodies which have to do with the disposal of sewage), confined in any 
sense to its employment as a manure, or as asource of ammonia and cer- 
tain salts. It may be pressed, air-dried, and employed as ordinary fuel 
for use in boilers or other furnaces. Further, it may be ground up with 
clsy and lime, and converted into brick or cement after the process de- 
vised by the late General Scott, of England ; or, again, it may be ad- 
mixed with other materials, such as are ordinarily employed, and con- 
verted into a material for use in the construction of sidewalks, fonnda- 
tio IS of buildings, etc. 



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Btate Boaad of Health. [Off Doc. 



Original Tnveatisations on tha Heatio; and Ventilation of Sobool 



'.n, M. D., ■./ .Mn.i«/i./.', Ohio. 



At the meetiugofthe American Medical ABsooiatioD, held at Newport, 
B. I., two years a^, a special committee was appointed by the section 
of Btate medicine on "school hygiene," consisting of Dr. J). F. Lincoln, 
Geneva. N. Y. ; Dr. J. A. Schenck, Topeka, Kan. j Dr. Geo. H. Bohe, 
Baltimore, Md. ; Dr. J. G. Pinkham, Lynn, Mass. ; and the author. 

After some correspondence, it was decided to divide the work of this 
committee, and as a result, I was assigned the "original investigations 
on the heating and ventilation of school buildings." 

After DO small amount of research among the multiplicity of reports 
of the numerous air analyses of the different school rooms in the various 
cities, I found them all practically valueless, so far as making anything 
like a.systematic comparison of results wad concerned, of even an ap- 
proximately scientific character. 

By thia I mean to say that they all lacked the details regarding those 
numerous modifying elements, which of necessity surround each individ- 
ual room; such as the temperature oitieide of the school building; the 
temperature t'nsiV^ of the same at the level of thefioor, mouth and ceiling, 
both in the front and at the rear of the room, the same observations re- 
garding the humidity, as well as that of the carbon dioxide ; the number 
of scholars present; the size of the room; the method of heating the 
same, as well as the system of ventilation employed; the amount of fresh 
air supplied, and the quantity of foul air discharged from a room, iu a 
given time, together with the barometric pressure — each one of which 
is an important arc of a complete circle ; and of necessity must all be con- 
sidered together, and due credit given each one, in order to obtain any- 
thing like definite or reliable information regarding any special method 
or system of heating and ventilating a given room or a certein bnilding. 

With a view of obtaining the most reliable results possible, I devised 
a blank chart, which I thought would, as near as possible, contain all 
these more important factors. 

I then determined to pursue tlie same line of investigation, of differ- 
ent schoolrooms in the same building; and different buildings in the 
same city; and different cities in the same state: among which I designed 
to embrace as large a variety of the various methods of heating and ven- 
tilation, as we practically could, and to repeat our examinations suffi- 
ciently often on the same systems, when at all practical, to enable us to 



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No. 16.] Ventilation of School Buildisos. 431 

arrive at some defiaite oouclusious, regarding any special method of heat- 
ing and ventilation, if such were at all possible. 

Aa u resalt, I prepared a chart which embraces the following details: 

1st. — Date and time of day inspection was made. 

2d. — Xome of school building. 

3d. — Name of school room. 

4th. — Nnmber of papils present. 

5th. — Number of cubic feet of air contained in the room. 

6th, — Temperature outside of the building. 

7th.— Humidity outside of the building. 

8tb. — Barometric pressure in inchee. 

9th. — State or condition of the weather. 

10th. — Ejnd of heating apparatus in use. 

11th. — System of ventilation employed. 

12th.— Number of cubic feet of fresh air supplied per hour. 

13th. — Number of cubic feet of foul air discharged per hour. 

14th. — Temperature at the front of the room, a, at the floor: '', at the 
mouth ; c, at the ceiling. 

16th. — Temperature at the rear of the room, a, at the floor; A, at the 
mouth; c, at the ceiling. 

16th. — Humidity at the front of the i-oom. u, at the floor; b, at the 
mouth; c, at the ceiling. 

17th.— Humidity at the i-ear of the room, n, at the floor; h, at the 
mouth; c, at the ceiling. 

18th. — The amount of carbon dioxide found in the air of tlw city ]ier 
10,000 ports. 

19th. — The amount of carbon dioxide per 10,000 parts found in the air 
in the front of the room, a, at tho floor ; b, at the mouth ; c, at the ceihng. 

20th. — The amount of carbon dioxide per 10,000 parts found in the air 
at the i-ear of the room, a, at the floor ; h, at the mouth ; <;, at the ceiling. 

Bactebiologicai, Isvestiqatiox. 



2lBt. — Germs found iii the air of school rooms when occupied, a, near 
the floor at the point of entrance of the fi'esh air; b, near the floor at 
point of exit of foul air. 

22d. — MiscellaneooB observations. 

Having completed the general plan of investigations, I then deter- 
mined to investigate, as far as practicable, the following methods of heat- 
int; and -ventilating school rooms. 

Ist.- School rooms warmed by common stoves, with and without any 
provisions of ventilation, other than windows, doors and transoms. 

2d. — School rooms warmed by small furnaces placed in each room, 
which heated fresh air received from the outside, and delivei-ed it to the 



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132 State Boabo of Health. [Off. Doc. 

room, with and withoat provisionB fur the escape of the foul atr, other 
than that furnished by the do(»B, windows and transoms. 

3d.— School rooms warmed by furnaces or heaters, and ventilated at 
the top. 

4th. — School rooms warmed by furnaces m heaters, and Tentilat«d at 
the floor. 

5th. — School rooms warmed by furnaces or heaters, and ventilated at 
the floor and ceiling: both. 

6th. — School rooms warmed by direct steam and ventilated b;- doors, 
transoms and windows. 

7th. — School rooms warmed by indirect steam and only ventilated by 
foul air ducts, windows and transoms. 

gth. — School rooms warmed by both direct and indirect steam and 
ventilated by foul air shafts, windows and transoms. 

9tli. — A school room warmed by direct steam, and ventilated by an 
open flre place and a top ventilator. 

10th.— School rooms warmed by a furnace which delivers the hot air 
to the room at the floor, and which room is also supplied with cold fresh 
air at tlie floor, and is provided with means for removal of foul air at 
the top of the room. 

11th. — School rooms warmed by an air warmer, which supplies the 
warm air at the floor, and removes the foul air at the floor without the 
aid of open doors, windows or transoms. 

Aiter having completed the outline of these proposed investi^tdons, 
I uext found it quite a difficult task to secure the services of a compe- 
tent chemist, who was willing and able to undeistake the work I had 
laid out. But, after correspondinfir with the chemists of several cities, I 
obtained the services of Prof. Lewis Schmidt, B. Sc. (Massachusetts In- 
stitute of Technolc^y), of Cincinnati, Ohio, to undertake the chemical 
inve8tigations,togetherwith the humidity, temperatnre, etc., etc.; which 
he conducted throughout the entire investigation for me, in a perfectly 
satisfactory manner. 

The original report contemplated the examinations for carbon mon- 
oxide (C O) but as this product is seldom found in the air, except when 
it has been passed for a considerable period, of at least two hours, 
over red-hot iron plates, we decided to omit this part of the report, and 
also the examination for organic matter, owing to the impractical 
character of the former, and the unreliable methods of determining with 
any degree of scientific accuracy the latter. 

Arrangements were supposed to have been made with couple of bac- 
teriologists to complete the bacteriological part of the work in a sys- 
tematic manner. But when their work was received, it was found to 
have been conducted in such a heifer-skelter manner, as to render it ut- 
terly valueless for this report, and in consequence I am compelled to 
omit it entirely. In fact I don't think it has detracted anything from 



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No. 16. J VEBmjmoK or Smooi. Boildwos. 



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D,Bi,z,db,Goo<^le 



432 State Board of Health. 

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No. 16. ] Ventilation op School BniLDiNas. 483 

the practical value of the report at best ; my experience in this direotion, 
has led me to conclade that there is little to be derived from this partic- 
ular field, of a practical character, that will effect either the heating or 
ventilation of school rooms, either pro or con. Tet if properly con- 
ducted in a Bystemaiic manner, it might be made to serve the purpose 
of proving whether the germs are inoreased or diminiahed in quantity, 
from the time the airenters the room Until it leaves it, and approximately 
to what extendi, and under what circumstances. Outside of this I can- 
not conceive of any particular value to be derived from it; and certainly 
not when made without any apparent reference to a definite object, as 
was done in this case. 

I next selected Cleveland, Mansfield, Columbus and Cincinnati, Ohio, 
for the cities in which I would conduct the proposed investigationB; and 
to which I gave my personal attention, in Mansfield and Cleveland, and 
in part my personal attention in Columbus and Cincinnati, but least so 
in the latter, having only visited a few of the school rooms in that city, 
owing to unavoidable circumstances, which prevented my presence dur- 
ing the investigations there. 

My instructions were to make investigations of each room, as near as 
possible under the conditions it was usually kept in, and to be very 
careful to leave nothing undone that would enable us to obtain the high- 
est degree of accuracy possible, regardless of the system of heating and 
ventilation we were iuTestigating, as we were seeking actual facts, for 
scientific purposes, let them reveal what they would. 

Id carrying out these investigations, we have made altogether 221 de- 
terminations of the carbon dioxide, not including the examinations of 
the outdde air ; 233 determinations of the humidity, not including 
those made outside of the buildings ; and 232 examinations of the tem- 
perature exclusive of those made outside of the buildings ; saying noth- 
ing of the numerous other auxiliary observations of surrounding condi- 
tions 

These examinations were made in 39 different school rooms, of 23 dif- 
ferent school buildings, in i different cities, and include 10 different sys- 
tems of heating and ventilation. 

By referring to the itemized charts, you will observe that we have ex- 
amined the air in 1 rooms in Mansfield, 7 rooms in Cleveland, 4 rooms 
in Columbus and 18 rooms in Cincinnati: which embraced 11 rooms 
heated by the so-called Grossius system ; 11 rooms warmed by the 
Smead system ; 5 by the Johnson system ; 3 by indirect steam ; 3 by 
common stoves ; 2 by direct steam ; 1 each by the Patrio and Miller 
famaces; direct steam with an open grate, and direct and indirect steam. 
7ou will also observe that we have made six examinations each, of the 
temperatnre, humidity and carbonic dioxide in each room, viz. : Two each 
si the floor, one each in the front and rear of the room ; two at the 
jnouth, one each in the front and rear of the room ; and two at the ceil- 
28-16-91 



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434 State Boaed of Health. [Off. Doc. 

ing, one each at the front and retu of the room ; beeides all the aapple- 
mentary iDvestigstiona we have asBooiated with these thxee primary de- 
terminations. 

In making these inveatigatioDB we need tested Fahrenheit thermcwae- 
tereforobtaiiiiiigthetempetatarejwhilstaoarefnllycoiiBtractedhy^rome- 
ter waa used for determining the amoont of moiatnre contained in the 
air, the scale of which was so coostmcted as to represent complete sat- 
uration at 100 and complete dryness at 0. For determining Uie Telocity 
of the currents of air. we used a delicately oonatruoted anemcunet«r, 
which would register the Telocity of an; cnrrent of air, that was mOTing 
OTer 80 feet a minnte. By means of glass rods, rubber hose and a small 
bellows, we could obtain air from any desired part of the room, a ^ren 
quantity of which was pumped into clean dry bottles, of a known capac- 
ity, which were carefully corked and Ubled, and taken to the laboratory 
for the determinatioti of the GO, which was obtained by Deutn^iog 
the carbon dioxide with a barium solution of a known quantity and 
strength, and calculating the amount of G0( per 10,000 parts of air from 
that, in the usual manner, which is familar to all practical chemisla. 

By referring to these itemized charts, one of which has been. prepared 
for each city in which examinatioiis of the air was made, you will ob- 
serve that, with the exception of the Smead system, either doors, win- 
dows and transoms, or all, were relied on for ventilating and r^mlatini^ 
the temperature of the room. 

From these itemited charts yre have compiled a number of tables which 
embrace : 

1. The highest and lowest temperatore, and the highest and lowest 
humidity, outside of the building examined, and also the average tem- 
perature and humidity of the sir of the city, which we have shown : a, 
aa found in each, city ; b, as found associated with each system of heat- 
ing and ventilation ; c, the general average of each. 



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No. 16.] 



Ventilation of School Buildinos. 



l.OOATIOl*. 




11, 

1 
s 


lii 

ill 


1 

H 

|3 


MaDBfleld, Ohio, ! 

Cleveland, Ohio, j 


Highest, . . 
Lowest, . . 
Averaga, . 

Highest, . . 
Lowest, , . 
Average, , 

Highest, . . 
Lowest, . . 
Average, . 

Highest. . . 
Lowest, . , 
Average, . 


38.0 

27.5 
32.0 

55.2 
33.0 
46.3 

63.0 
44.6 
49.5 

89.0 
33.6 

52.0 


89.8 
46.8 
71.1 

89.6 
36.4 
49.0 

69.4 
42.3 

60.8 

100.0 
48.0 
75.3 


> , 








s 






OraDdaverBgeforUierourcUisssbove ^ 


Highest, . . 
Lowest, 
Average, . 


62.0 
82.0 
44.9 


76.3 
40.0 

61.6 





2. The highest and loweet temperature, and the highest and lowest 
hnmidity inside of the school rooms examined, t<^ether with the aver- 
af?e of the same : a, as found in each city ; b, as found associated with 
each system of beating and ventilation ; c, the general average of each. 



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State Board of Health. 



[Off. Doc. 



Table II, 

Showing the hIgheatAnd lowest lemperature and th« hlghsHt sad lowest hiunldit; 
outside of tbe bnildlngs, together with the avarKge of Uie same bj ayetama. 



JohasoQ HjBteoi (witb open wln- 
Indlrect Bte>in (with open windows, 



Direct steam (with open windows, 
etc), 

Pstric furnace (with open wlodowB, 
etc). 

Milier furnace (with open windows, 



c), 



Highest, . 

Average, 

Higheit, . 
Lowest, . 
Average, 

HIgheM, . 
Lowest, . 

Highest, . 

Average, 

Hlgheat, . 

Average, 

Highest, . 
Lowest, . 

Highest, . 

Avera^, 

Highest, . 
Lowest, . 

Highest, . 
Lowest, . 
Average, 

Highest, . 

Average, 



1^ 



111 



II 



3. The highest and lowest amount of carbon dioxide found per 10,000 
ports of air, inside of the school rooms, and the avera^ of the same: a, 
as found in each city ; b, as found associated with each system of heating 
and ventilation ; c, the general average of each. 

4. The average amount of carbon dioxide found per 10,000 parts iii 
each city. 



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No. 16-1 ■ Ventilation op School BoiLDraoa. 437 

Before commenciiig the study of these tables it might be well to re- 
mark that 70° Fahr. is a iair average standard to adopt for the tempeia- 
tore of a sahool room, and from 40 to 60 for the ideal laoge of humidity, 
and whilst the CU, varies in different cities, and on different days Id the 
same city, and at different times in the same day, yet we have found 
that the general average in the four cities tmder consideration, was 4.863 
parts in 10,000 parts of air, which we will be obliged to use in this case 
for the standard of onr comparisons. 

We will readily observe that Tables Nos. 1 and 2 are only designed to 
prepare us for those which are to follow, by giving us tbe otUside rela- 
tions of the same conditions we are about to consider ineideoi the school 
rooms. 

By studying Table No. S, you will observe that we have given the ex- 
trernea of temperatures and humidities, as well as the average tempera- 
tures and humidities found in the four cities, without regard to the sys- 
tem of heating and ventilation which produced them ; whilst Table No. 
4 considers the same conditions with reference to the systems of heating 
and ventilation that produced these results ; whilst Tables Nos. 6 and 6 
show the determinations of carbon dioxide, in the same manner as de- 
scribed for the temperature in Tables Nos. 3 and 4. 

The limited time and space allotted to this paper will not permit me 
to enter into a detailed discussion of these numerous tables, which rep- 
resent a multiplicity of conditions, which modify and change the gen- 
eral results, all of which must be duly considered, in order to arrive at 
legitimate conclusions. 

For the present, at least, I will have to content myself with giving 
you an accumulation of data, which I will be obhged to leave for you to 
study at your leisure; whilst I proceed to consider some of the more 
prominent features of this report. 

The Heatino. 

By examining this report you will observe that we have examined 
quite a variety of methods of heating, which has shown a still greater 
-range of temperature, which is especially noticeable between the floor 
and top of the room ; but when you come to compare tbe general aver- 
age of the temperatures taken of the different systems, they vary but 
little at the same point of the different levels, which, at the floor, in the 
front of the rooms, show a range of from 69.5° to 68.8°, and at the mouth 
in front from 67.0° to 78.8°, and at the ceiling in front from 68.5° to 
85.0°, whilst there is quite a difference in the range of the average of 
temperatures, there is a much greater difference observed between the 
floor and ceiling, which ranges from 69.5° to 85.0°, or a difference 
of 25.6". 

Again, in the average at the rear of the room, the range of tempera- 
tures at the floor varies from 60.0° to 74.6", and at the mouth from 64.0° 



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438 State Boabd of Health. [Off. Doc. 

to 70.2° ; and at the oeiling from 70.7° to 90.0°; whilst at the rear of the 
TOODOS there woB f onud to be a differenoe betTeen the lowest arera^ at 
the floor and the highest avera^ at the oeilin); of 80.0°. 

It most be remembered in the study of these resnlts, that, with the 
BiDgle exception of the Smead system, the temperature in every instuioe 
was modified by open doors, windows or traii8oms,and not unfrequenUy 
all of them. In the majority of instances the windows were open sev- 
eral inches between the sash and very frequently at the top, and often 
at the bottom; and which not unfrequently had a strooK' ally in the form 
of an open transom or door. Theee methods of modifying the temper- 
ature, to a certain extent aooomplished the desired results, so far aa the 
average temperature was concerned, but at a great expense of fuel and 
waste of beat; and unavoidable exposure of the pupils to cold and 
changeable drafts of air. 

Ou the other hand, the Smead system of heating accomplished even better 
average results, and veiy much bettar individual results, at the different 
levels of the room than any other system examined, and that, too, with- 
out exposing the pupils to changeable drafts of air from open doors, 
windows and transoms; saying nothingof the economy of fnel by the 
prevention of the unnecessary waste of heat through the»e objectionable 
openings in the doors, windows and transoms. 

The HumDnr. 

The amount of moisture contained in the air of our school rooms should 
not be lost sight of. Warm air that is too dry, is irritating to the respi- 
ratory tract, and is more liable to be charged with dust, than air contain- 
ing a greater amount of moisture; whilst air that is over chai-ged with 
moisture at the same temperature creates a sultry^ oppressive atmos- 
phere, which will predispose the pupils to "catching cold" on leaving 
the school room. 

By examining these charts and tables you will observe that, as a rule, 
the humidity decreases in the production of artificial heat as the tempera- 
ture increases. Yet this condition is very greatly modified by the hu- 
midity of the outside atmosphere. For example, take a wet, sultry day, 
when the humidity of the external air is almost at the point of complete 
saturation, and at the same time the outside temperature so high that 
bat little artificial heat is required, or can be tolerated, the humidity will 
be found to be exceedingly high m the school rooms, as a natural result 
of a combination of circumstances. Again, with the same d^ree of hu- 
midity outside, associated with a cold raw air requiring a considerable 
quantity of artificial heat to make the school room comfortable, the hu- 
midity of the school room, whilst somewhat high, will be found much 
lower than under the former conditions; and at the same time the aver- 
age temperature will be almost or practically the same. 

Tou will observe by Table No. 4, that the average humidity at the 



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No. 16.] Venthation of School Boildings. 439 

floor ID front of the school rooms, in the various systeiiiB varies from 
27.6 to 61.2; whilst at the mouth it ranges from 29,4 to 50.7; and at the 
ceiUug from 19.8 to 49.2. At the rear of the room, it varies.at the floor 
from 25.6 to 60.8; whilst at the mouth it ranges from 33.3 to 61.fi ; and 
at the ceiling from 16.5 to 16.0. 

By these you will observe that even many of the general averages are 
entirely too low, although few of them are fonnd to be too high. Yet, 
notwithstanding all this, when we examine the itemized charts and study 
the individual reanlte in isolated cases, you will find still greater varia- 
tioDB of the humidity indifferent parts of the same room; and especially 
so when no regular system of circalating and ohan^^g the air has been 
adopted. 

Oil the other hand when a regular system ot circulating the air has 
been adopted, it is remarkable how the results are modified regarding 
the amount of moisture contained in the air at different points in the 
same room, and even different rooms in the same building. 

Notwithstanding we have advocates at the present time who qnestion 

Carbon Dioxide. 

the injurious effects of even large qiuntities of carbon dioside in the air 
of 'School rooms, yet I am not prepared to accept their theories, without 
more than circumstantial evidence to verify their correctness. 

We must bear in miud that the presence of large quantities of CO, 
does notnecessarily make any physical changes in the air that are i-eadily 
observed by the senses. 

It is true that immense quantities of CO, will produce fatal asphyxia, 
yet it never has been, and no doubt never will be found in such immense 
quantities as to produce death in school rooms ; but it is found in soffi- 
cient quantities, in a large majority of school rooms, as to act as a slow 
poison from day to day, during a largo portion of the scholars' school 
life, in proportion to the quantity of COj present, and the correspond- 
ing restrictions on the natural supply of fresh air. 

The question of where the carbon dioxide prevails in the largest quan- 
titles, in school rooms, has long since been a mooted question. The old 
anthors, as well as public opinion, placed it at the lop of the room; and 
as a result of their belief, advised making provisions for its escape at or 
near the ceiling. On the other hand, the more recent writers affirmed 
that it prevailed in the greatest quantities at or near the floor, ot a given 
room; and cited you to the fact that it was heavier than air, and of ne- 
cessity must accumulate at the bottom; and produced as evidence to 
prove their theory, the old cave story — ^in which a man can walk with im- 
punity, while his d(^ would be asphyxiated with carbon dioxide, which 
they backed with the experiment of the model house, in which a large, 
medium and short lighted candle was placed, and theair excluded —when 
the short candle would go out first, the medium next and the Ions candle 



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140 State Board of Health [Off. Doc. 

last. But you must remember that in ueither oi these coses, is there any 
circulation of air, aud, consequently, barring the law of diffusion of j^asee, 
there is noitinf? to intermix the CO, with the sundry stratums of air, 
and modify the natural laws of gravitation. On the other hand, we have 
quite a dififerent condition of affairs in the school room, which modify 
the primary laws of gravity, and which give us entirely different leanlts 
than the imaginary attributes from which we have heretofore woven oar 
theoretic web of supposed coaditioos regarding the CO,, which, however, 
in fact did not exist, as you will observe by a careful study of the charts 
and tables which accompany this report. 

By turning to Table No. 6, you will observe that the highest average 
of GO, found associated with any particular system of heating and ven- * 
tilation, iu 'he /ron^ of the room at the level of the floor, was 19.127 parts 
per 10,000, and the lowest average was 8.754; whilst at the motUh thb 
highest average was found to be 17 499, and the lowest at the same level 
was 9.557 ; and at the ceiling the highest avenge was found to be 16.493, 
and the lowest 9.914; which only ahowsa difference of 1.160 parts in 10,- 
000, between the lowest average at the floor and the lowest average aithe 
ceiling, in favor of the ceiling ; and only 2.634 parts between the highest 
average at the floor, and the highest avenge at the ceiling, in favor of the 
floor. 

Again, in the rear of the room, the highest average of OO, at the floor 
was 16.671, and the lowest 10.240; whilst at the mouth it was 16.971 
against 10.286, and at the coiling 18.223, as compared with 9.761; with 
only a fraction of .469 difference between the lowest average at the 
mouth and the lowest average at the ceiling, in favor of the latter; 
whilst the difference between the highest average at the ceiling, and 
the highest average at the floor, was only 1.552 in favor of the ceiling. 
But go with me, if yoii please to Table No. 5, and there turn to tiie 
grand average of the four cities, taken from two hundred and twenty-four 
determinations, and you will And that there is only a fraction of a differ- 
ence between the amount of CO, at any level of the room, either at 
the rear or front; which grand average shows in the front of the rooms 
13.137 at the floor, and 13.785 at the mouth, and 13.064 at the ceiling. 
Whilst in the rear of the rooms, it shows 14.350 at the floor, 13.661 at 
the mouth, and 13.912 at the ceiling; or, in other words, only the frac- 
tion of .075 difference between the floor and the ceiHng in the front of 
the rooms, in favor of the floor; and but .438 difference between the floor 
and the ceiling at the rear of the rooms, in favor of the former. 

It seems to me that this investigation ought to settle, without a ques- 
tion, the problem regarding the location of the COj in the school toowb 
oE toniay, and especially those which are heated artificially, and to prove 
beyond a shadow of a doubt, that CO, is an omnipresent factor, iu prac- 
tically the same relative proportions at all levels of a schoolroom, 
whether ventilated at the top, sides or the bottom, or all. 



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Na 16.] VENTILATrON OF 8OHOOL Bdildikos. 



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No. 16.] TaSTILATlON OF ScHOOL BuiLDINQS. 445 

Genebaii Bemarkb. 

Tbe next important question that confronts us, after having obtained 
all this "array of facte and figures." is — how shall we proceed to heat 
and ventilate our school rooms in the most sanitary, economical practi- 
cally and Bcientifio manserT In answer to these questions 1 will say: 

Ist, That to heat and ventilate our school rooms in the most edenti/ic 
manner will require a system of heating and ventilation which will avoid 
the necessity of having either open doors, windows or transoms, and 
which will at the same time supply each scholar with not less than 1,000 
cnbio feet of fresh air every hour, and which will remove a corresponding 
qoautity of foul air at the same time, without subjecting any scholar in 
ttie room to au uncomfortable draught of either cold or over-heai«d air. 
Bufficient fresh worm air should be supplied to each scholar, at an aver- ' 
age temperature of about 70°. and an average humidity ranging from 
40 to 60; whilst the foul air should be removed su£Bciently rapid as to 
prevent an accumulation of CO, to exceed 10 parts in 10,000 parts of 
air at any time, or in any part of the room.or a variation of the temi>erar 
tnie between the fioor and the ceiling to exceed 10° Fahr., or at any 
level of the same between the front and the rear, or either, to exceed 
5° Fahr. 

2d. To accomplish these results in t^ie most ecmwntical manner will 
require an air warmer, with sufficient capacity to heat the required 
amount of air to the desired temperature without superheating it (for 
under no circumstances should it be allowed to pass over red-hot iron 
plates) ; and which fresh warm air ahoold be dischai^^ in agen tie current 
at the floor, and exhausted at the same level at the sides of the room, 
without the assistance of a top ventilator or the aid of an open door, 
window or transom. But if the top ventilators are used at all, they 
should only be used to cool the room, in the event it became over heated 
from aay cause; outside of this they are of do value whatever, except 
to wantonly waste our heat and fuel, without giving us any advantages 
in retam for their lose. 

Sd. I am fully aware of the tact, that it is usually a very difficult task 
to realize, in a practical manner, the theories that fill us with enthusiasm 
when demonstrated on paper; and, further, that there is perhaps no sys- 
tem of heating and ventilation in use at the present time, that is cap- 
able of carrying out in every particular, under all possible circumstances, 
the ideal heating and ventilating of the average school room, yet after 
years of investigation, and examining scores of different kinds of heat- 
ing and ventilating apparatus, without "either fear or favor" to any one, 
I am thoroughly convinced that there is no system of heating and ven- 
tilating at the present time that will come so near fulfilling the require- 
ments of the ideal methods of accompliahing these results, in the most 
sanitary, economic, practical, scientific manner, as the so-called Smoad 
system. In makiog the above assertion, I do so in all candor, and with- 



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446 State Board of Health. [Off. Doc. 

oat perBon&l favor, or iDteotional disparaf^ment to any one, but Bimply 
as the legitimate conolusioii I have derived from actual facts, obtained 
from repeated personal and scientific inveetigations. 

CONCLDBION. 

^ trust yon will pardon the prosy character of this report, which is 
largely composed of "facts and figures," which to obtain, has been a 
tedious, irksome and an expensive task. Yet if only it serves the pur- 
pose of Becuring a better heated and more liberal supply of Ciod's pore 
lur to ihe rising generations, who spend (from a hygienic standpoint at 
least) the very best and most important part of their lives in onr public 
and private schools. I will feel that all my laboi-s have been fully repaid. 



The Oonstruotlon of School Buildtivs- 

/ the Commitle* of School 



In dealing with this question, we are obliged to make allowance for 
difference in oircamstajices. We demand space, fresh air, light i fmd 
these needful things undeniably cost money. The poorer sod less en- 
lightened communities will grudge payment even for such neoeBsaries 
of life ; but the number must be very small of thosj who have not a dis- 
position to improve and a willingness to makesome sacrifice. The bar 
den does not always fall heaviest upon the poor districts; land costs 
next to nothing in the country, and the struggle for elbow-room between 
tall overshadowing buildings is unknown, while in rich cities it may 
happen that the millions appropriated for public schools are as inade- 
quate as the hundreds granted by a country district. 

The city school is greatly restricted in thd space available for build- 
ing; and in no city is this difficalty more pressing than in New Yoti. 
Without assuming the right to condemn any one's omissions, we may 
still be permitted to offer suggestions which may meet with appreciation 
in certain quarters. 

The suggestion, then, which is first offered, is to this effect that it 
would be well if the space sorrouDding each school house could be at the 
outset ample for the purpose of supplying light, and that regnlatioiis 
might be made to prevent encroachments upon the sky area. It coald 
be ordered, for instance, that the width of such space be made equal to 
the height of buildings now standing, or likely to be erected, in con- 
tiguity ; and that the height of such future adjoining edifices should be 



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No. 16.3 CoNaTBUcnoN of School Bdildimos. 147 

restricted. It may be diffioalt to anticipate the future. But surely we 
need not commit the blunder of allowing only a six or ten foot passage 
at the side of the school house — of which it would be easy to point out 
examples. 

To the recommendation of a liberal ground space may be added an- 
other of kindred character; that of moderate size and height in the 
edifice. The leaeons for this are varions. On the one hand, there are 
objeotionB to the Tnassing of great numbers of ohildren ; there is the 
diffioolty of management to be considered, and other matters, the dis- 
cussion of wMoh may be omitted here. Apart from this, there are ob- 
jections to the great compact hoose, the central parts of which are re~ 
mote from the freshness of the outer air and the beneficial efiect of sun* 
light. Then there is the objection to many-storied buildings, on the 
ground of loss of time in passing scholars to and from the yards at recess, 
and on the further ground of occasional injury to the system in the case 
of girls in their teens, at the period of sexual development. 

The safety of the inmates in case of fire should be insured by suitable 
arrangements of stairs, and by strict drill. I cannot approve of tiie 
ladders or twisting stairs of iron openwork clamped to the outside of the 
bnildinff, as a refuge for a crowd of panic-stricken children. Safety re- 
qaires that the ordinary staircases be planned so as to be incombuHtible, 
and that they should present no impediment or trap for the foot, such 
as spiral curves, uarrow-comered steps, steepness or dark passages. 
Stairways ought to be ao placed that every room has access to more ihon 
one, in different directions. 

LighUng.— The best opinions at present, in this country, seem to agree 
in preferring light which enters from the left side of the pupils, and in 
absolutely objecting to that which enters in front. Whether lightshould 
be admitted from the right hand or the rear cannot be categorically 
stated; in some circamstances (as in the case of small countiT school 
booses) it seems a desirable addition to the left-hand light. 

There ore two mistakes, against which serious warning should be 
given. One is the placing of windows at a low point, for architectural 
or other esthetic reasons. The best place for the light to enter the 
room is the highest point attainable. Windows should nearly touch the 
oeiling, and their upper part should be as free as possible from incum- 
brances which obstruct light. The other mistake referred to is the at- 
tempt to light very wide rooms of moderate height by side windows. 
The poverty of light in such cases is not to be estimated by the ordinary 
Btandards, or by one's impressions, but by observing the way in which 
tbe horizontal rays of light fall on a book placed flat on the desk as for 
study. 

Verandas are fatal to good working light. The "Italian" awning is 
nearly as bad. In general, no form of curtain or other screen covering 
the upper part of a window is allowable except on the ground of strict 



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448 State Boa&d of Health. [Off. Doo. 

necessity. If shades are required to exclude the sau, they mast be re- 
moTable when not needed. 

The eye should be favored by avoiding: the grlaringf effect of pure white 
walls; a sHgbt neutral tint, or bluish or greenish, is preferable. The 
ceiling, however, may be as white as possible. 

School rooms. — Their dimensions are partly dependent on the require- 
ments of ventilation. It may be added, that their length is limited by 
the distance at which the ordinary eye can read ordinary work on the 
blackboard, or not greatly over thirty feet. The width should not ex- 
ceed the moderate dimenaions which are compatible with gt>od lightio)^ 
from twenty-two to twenty-five feet if light comes from one side. 

The floors should everywhere be made of material which can be washed 
convemently — a wood which will not splinter or wear ragged. 

Seaia and desks. — The American patterns in common use are at least 
comfortable— from one point of view. The chairs are very easy to sit 
back in when one is tired. lu this they differ widely from the accepted 
patterns of the European schools, whose children are taught to sit up 
straight, and are furnished with short-backed seats which support the 
hips sufficiently, but not the shoulders. These models are strange, to 
our eyes, and there is little chance of our rocking-chaii-loTing race adopt- 
ing them at present. They possess obvious merit, however. 

From the Germans we have learned that the front edge of the desk 
must reach or overhang the edge of the seat. This principle is com- 
monly imitated among us. What we have not yet seen fit to adopt is 
the no less rational principle that the desk should not crowd the arms 
and elbows upward. T-he arms ought to hang so freely that the elbows, 
when writing is going on, are at the level of the desk. In no other way 
can we insure a correct — t. e. a straight and squared — position in writing. 

In conclusion, let me say that a number of points have been left un- 
touched in' this paper, which might properly 'have been treated ot as re- 
lated to the general subject of construction. This is due to the fact that 
a special assignment of the subject of drainf^ and sewage has been 
made by which it is placed in the hands of another member of the com- 
mittee; his work is expected at the next annual meeting. 



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No. 16 1 Fifth State Sasitart Convention. 



Held at Altoona, Mai/ /.5 and 16, 1891. 

oncers. 
Programme. 

Annual Addreoo, by Samael O. Dixon, M. D. 

Should Tuberculosis be made Returnable to the Board of Realth, by U F. Flick, 
H. D. 

The Oatrich and the Camel ; or bow Home People Treat Kpldemic«, by Charles 
Hclntire, M. D. 

The DlfflcultieaBucounteredbyaStateOfHcer in Bnforclng'QiiaranUueln Kural 
Districts, by Spencer M. Free, M. D. 

Wnt«r Supply in Mountain Towns, by C. B. Dudley, M. D. 

Information from the Records of the Altoona Board of Health, by C. H. ('losson, 
M. D. 

Some Neglected PoinU in R«ilroad Sanitation, by [I. R. Smith, M. D. 



Officers of the Cokvention. 

Freeident, Hon. John Dean, judge court of common pleas, Blair 
Connt? ; first vice president, Theo. K. Ely, general superintendent mo- 
tive power, PenDsyWania Kailroad Company ; second vice president. 
Dr. M. L. Davis, prefudent Lancaster County Medical Society. 
Honorary Vice Presidents. 

Local — Mr. F. L. Sbeppard, general superintendeiit Pennsylvania 
Railroad Company ; Mr. J. M. Wallis, superintendent motive power, 
Pennsylvania Bailroad Company ; Mr. W. L. Baonard, superintendent 
Altoona division, Pennsylvania Bailroad Company ; Mr. John Lloyd, 
Altoona ; Mr. H. C. Dem, Altoona ; Mr. D. S. Eeith, superintendent of 
schools, Altoona; John Fay, M. D., Altoona; Mr. O. W. Strattan, 
master mechanic, Pennsylvania Railroad machine shops, Altoona ; Mr. 
L. B. Beifsneider. president school board, Altoona ; Mr. H. A. McPike, 
Altoona; Mr. Thomas Moore, president select council, Altoona; Hon. 
David Kinch, ex-mayor of Altoona; Mr. John P. Levan, general fore- 
man Pennsylvania car shops, Altoona; Mr. W. H. Schwartz, Altooua; 
Mr. W. R. Dunham. Altoona; Mr. 8. M. Hoyer, Altoona; Mr. Theo. J. 
Burchfield, mayor of Altoona; Mr. J. K. Patterson, president common 
council, Altoona; Mr. Geor^ F. Fresh, Altoona; Mr. Paul Kreuzpoint- 
ner, Altoona ; Mr. Theo. J. Nigeten, Altoona. 

Legislative— ^Qu. Boies Penrose, President pro tern. Senate i Hon. 
Charles Moore, Pottstown. 
29-16-91. 



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460 State Board of Health. [Off. Uoa 

Meutbrs <>^ C'uminiltee on Public Health and Sanitation — Hon. J. B. 
Showalter. Senate ; Hod. A. D. Markley. Senate ; Hon. N. B. Critchfield, 
Senate; Hon. Wm. H, McCnllongb, Honee of Bepreeentativea ; Hon. 
Andrew 8. Stayer, House of Bepresentatives i Hon. P. S. Weber, Hoose 
of Bepresentativest Hon. S. S. Towler, Hoaaeof Bepres^itativesi Hod. 
H. N. HesB, Honse of Bepresentativee ; Hon. J. H. LafTerty, House of 
Beprese&tatives ; Hon. J, Wilson Morrow, Hoaae of BepresentatiTes : 
Hon. Henry F. Walton. House of Bepresentatives ; Hon. Joseph G. West, 
House of Bepresentatives -, Hon. Peter J. Oriate, Honse of Bepresen- 
tatives. 

Secretary — Dr. William B. Atkinson, honorary professor of hygieue, 
Medico-Chinirfrical College, Philitdelphia 

Assistant Secretaiy—Di: C. H. Clossoo, secretary board of health of 
Altoona. 

Committee of State Board of Health— Dr. Samuel T. Davis, Dr. J. H 
McClelland, Dr. Benjamin Lee 

Committee of the AlloonaBoard of Health— Dt. J. U. Blose, Dr. J. W. 
Bowe, Mr. Joseph Nixou. 

Beceptiwi Committee— ^ariy DuDham, cliairmaa j Hon, J, W. Cuny, 
Capt. Bobert Johnson. 

Music by Neff's Orchestra. 

PROOKAUHE. 

First Session — Friday, May IS, at JO a. Mi. 

SANITARY LEGISLATION. 

1. Convention called to order by the piesident. 

2. Prayer by the Eev. A. S. Woodle. 

3. Music. 

4. Address of welcome by His Honor Theodore J. Burchfield, mayor 
of Altooua. 

5. Besponse to the address of welcome, by Prof. George G. Groff, M. 
D., LL. D., president of the State Board of Health of Pennsylvania. 

6. Opening remarks, by Dr. Pemberton Dudley, professor of hygiene, 
Hahnemaun Medical College, Philadelphia, member of State Board of 
Health. 

7. Music. 

8. " Tlie Powers and Limitations ot Borough and Municipal Authori- 
ties in Promoting the Public Health," by the Hon. John Dean of HolU- 
daysbnrg. 



10. " Sanitary Science Demands an Educate<l Medical Profession," by 
Dr. George W. Wagoner of Johnstown. 

11. Discussion. 

12. Music. 



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No 16.] Fifth State SANiTAitY Contention. 451 

Second Seseioyt — Friday, May 16, at S:SO y, lit. 

(lENEKAL nAKITATlON. 

1. Music. 

2. " The OBtrich and the Camel," by Dr. Charleu Mulutire, Jr., medical 
inspector to the State Board of Health for the Lehigh district. 

3. " The NeceBsity for Sanitary Inspection of the Bural DistrictH of 
the State," by Dr. Daniel B. D. Beaver of Reading. 

4. " The Earth Closet in Coantry and Towns," by Prof. Geo. G. Groflf 
of Lewiflburgr, president of the State Board of Health. 

5. Discussion on the above papers, opened by Pant Ereutzpointuer. 
C. Music. 

7. " Shonld Tuberculosis (Consomption) be placed upon the List of 
Diseases to be Reported to Boards of ■ Health t " by Dr. Jjawrence F, 
Flick of FhiUdelphia. 

8. Discussion, opened by Dr. W. M. Findley. 

9. " Some N^lected Points in Bailroad Sanitation," by Dr. Horace 
Smith, medical examiner Pennsylvania Bailxoad Belief Fond. 

10. Discussion, opened by Dr. W. L Bishop, snrgeon Pennsylvania 
Bailroad Company, HarrisburE. 

11. Music. 

Third Session — Friday, May 16, at H p.m. 

1. Music. 

2. The annual address before the State Board of Health, by Dr. Samuel 
G.Dixon of Phitiuielphia, professor of hygiene in the University ofPenu* 
sylvania ; subject, " Tuberculosis." 

3. Music 

4. "Garbage Cremation," by Dr. M. L. Davlh, president of the Lan- 
ftaster County Medical Society. 

These papers will be illustrated with the stereopticou. 

5. Discussion 

6. Music. 

Fourth Session— Saturday, May 16, at TO a. m. 

LOCAL SANITATION — WATER SUPPLY, SEWERAGE AND QUARANTINE. 

1. Music. 

2. " The Sewer System of Altoona, with a Proposed Method of Sewage 
Disposal," by Harvey Linton, city engineer of Altoona 

3. Discussion. 

4. " TbeDiflBoulties Encountered by a State Officer in Enforcing Qoar- 
antine in the Bural Districts," by Dr. Spencer M. Free, medical inspec- 
tor Western Slope district. Beechtree 

6 Moflic. 



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452 State Boahd of Hbalth. [Off. Doc. 

6. " luforoiatioD from the Becords of the AltooDK Board of Health," 
by Br. C H. CIossod, secretary of the Board. 

7. " Water Supply in Mountain Towns, with Especial Reference to the 
Altoooa Water Supply," by Dr. Charles B. Dudley, medical inspector to 
the State Board of Health for the Central district. 

8. " A Demonstration of the Purification of Water by Metallic Iron," 
by Prof. Henry Leffmann, food analyst to the State Board of Health of 
FeuDsylTania. 

9. Discussion. 

10. Voluntary paper 

11. Music. 

12. Adjournment. 

Through the courtesy of the Pennsylvania Railroad Company, a specinl 
train will be in readiness at 3 o'clock p. m., to afford the members an 
opportunity of Tiewing the magnificent scenery of the Bell's Gap rail- 
road. 

The headquarters of the buard will be at the Log^u House. 



Annual Addrsas befbre tbe Btate Board of Health of PanasylTania. 

By Sahukl (J. Dixon, M. ])., Pro/eaaor of Hygiatie in the UnivertiCg o/ Ftnnsgl- 



Oentlbhen: Before entering upon the important topics which I pro- 
pose to discuss before you this evening, I will take the first opportunity 
that presents itself of expressing the great pleasure and honor which I 
experience in having been requested to deliver the address before a 
body of gentlemen whose high function it is to act as the guardians of 
the health of the people of this great state, and to keep a vigilant eye 
upon all measures, which, whether local or genei-al in their application, 
are-calculated, in your judgment, either favorably or adversely, to affect 
the public health. 

It is difficult, gentlemen, to overrate the importance of yoor miasioD, 
and it is a matter for congratulation that the age in which we live is far 
and away in advance in its recognition of the importance of hygiene a» 
a public question than were the days in the earlier periods of our his- 
tory. 

Facts which were then ignored or scoffed at are now generally ad- 
mitted, even if not fully realized and acted on ; and the era of ignorance 
and unbelief, which was followed by that of speculation — times, no 
doubt, exceedingly tryiuR to your predecessors intrusted with the ei- 



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No. 16.] Fifth State SANrrABJ Convention. 453 

eoation of Banitary imprOTemeDt and mamtenaQce of proper precau- 
tions — has passed avay. 

And yet much remainB in the way of public enlightenment before you 
can be expected to accomplish the full measure of your calling, or re- 
ceive that ^neral and cordial co-opeiation, without which your hands 
are tied and your work hampered. 

Public sanitation can only be accomplished by a public body repre- 
senting the state; individual effort, however much directed by zeal, may 
be altogether without knowledge; and thus a single ignoramus may 
cultivate enough propagating germs of disease to infect a whole town 
or district, and bo frustrate the good work of a representative board. 

Therefore, it is upon a board of health, such as I see beforeme this 
evening, in a great measure depends the health of the people; but, at 
the same time, the best efforts you may make are doomed to failure, 
unless you receive those plenary powers which will enable you to carry 
out your plans. 

And it is important to remember that while curative medicine is still 
but ao art, which has prof^ressed but little during the last fifty years, 
preventive medicine or sanitary knowledge has advanced to the dignity 
of a science, which may be destined within a few years to monopolize 
the attention of the medical profession, to the partial exclusion of the 
old-&shioned methods in which we have been reared. 

The accession or increase to our knowledge as to the origin and growth 
of disease during the last ten years has been Tery great, and particularly 
is this thecase respecting the recent researches into tabercnlosis, thereby 
throwing upon ns a greater degree of responsibility in using all means 
at our commimd to prevent and minimize the spread of this fell disease. 

If we should sit still and permit the enemy to plant his guns right 
within our midst, it follows as a matter of course that we are beaten be- 
fore the battle begins ; and so if our citizens refuse to faJl into the rauks, 
shoulder their muskets, and volunteer their aid under the orders of their 
superior officers, is it reasonable to hold the latter responsible for the 
killed and woondedT Certainly not. We may preach, and counsel, and 
exhort, and more than that, prove what we teach until we are tired ; but 
unless we can obtain the zealous and intelligent co-operatiou of om- fel- 
low-dtizens, we might as well talk to the moon. 

A few weeks ago a wave of excitement swept over the land at the pos- 
siblity of a rupture in our peaceful relations with Italy ; and it looked 
at one time as if a recourse to arms of precision would be resorted to in 
default of on amicable arrangement ; but, thanks to the skilful handling 
of the matter by our secretary of state and the return to common sense 
on the part of the statesmen of Italy, this calamity was averted. 

Well, gentlemen, such an outcome to the dispute would have been a 
matter gravely to be deplored, hut I doubt whether it would in the long 
run have proved more disastrous to us than is the constant and ever- 



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454 State Board op Health. [Off. Doc. 

iDcreasiDg flood into this country of the lowest, most degraded sod often 
plague-strickeD populations of the Latin, Hungarian and SclaTonio laces. 
These people bring with them her© and perpetuate the unsavory and 
insanitary habits of life under which they existed in their own lands with 
an utter disregard of those elementary principles of health which do 
obtain among the poorest classes of our own citizeus; and thus when an 
outbreak of dlaeaae or epidemia ocoors, these foreign settlements of 
Iti^ians, HuQS and Sclavs, etc., form nuclei or hotbeds of infection from 
which points of vantage disease and death hold high camival. 

I do feel most strongly that it is the imperative duty of our repreeen- 
tatives in congress to give these matters ni^rent attention, and take 
measures to protect the health of our people by excluding from these 
shores tiiis deluge of undesirable people from other lands, who really 
add nothing to the prosperity of our country, but in the majority of in- 
stances return aft«r many years to their homes, carrying back with them 
the money which they have made here, in consequence of the higher 
wages and prevailing happier economic conditions. 

The elements of disorder which accompany this wholesale immigra* 
tion are patent to everyone, and some startling illustrations have been 
afforded us in our own state within the last few months ; but this phase 
of the question is not within our province, although we are fully within 
our domain in approaching the subject from the standpoint of public 
health. 

There are many moments when we, who devote the best part of onr 
lives to the endeavor to trace back to its source man's greatest foe — dis- 
ease — to find ont its hidden ways and to devise means for overoomiDg 
its hidden and stealthy marches upon its ansnspecting victims, must of 
necessity feel much discouragement at the scanty sympathy accorded 
to our work. 

It would almost seem as if the energies of our statesmen were concen- 
trated upon the health of the American hog and bullock. They are the 
subjects of much affectionate solicitude, and the resources of our great 
legations are exhausted in the endeavor to induce foreign governments 
to cast favorable eyes upon these much-maligned animals and permit 
them entrance into their countries. 

It cholera breaks out among hogs immediate attention is given them 
by the local authorities, or if pleuro-pneumonia shows itself in cattle 
nothing is left undone to stamp it out; and in the same way, if our com 
or potatoes are attacked by a parasite the whole science of the conntry 
is brought to bear upon the question. 

In doing this our legislators and local authorities simply obey the 
mandates of the people whose servants they are, or ought to be. It is 
not that they imdenalue human life, or set animal life above it, hut 
simply that in the one case the results appeal directly to their pockets, 
while the other lies more in the region of feeling and sentiment. 



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No. 16.] Fifth State Sakitabt Cosventiok, 465 

Daring the cattle plagtie that devastated England some years ago 
thoasands of valnable beasts either died from plenro-pneumonia or were 
slaughtered to prevent the spread of the disease ; and the loss in money 
amounted to millions of dollars ; butii thesame number of human beings 
had died from an epidemic, the loss in money would have notamounted 
to anything; and yet how immeaeminbly greater the one calamity than 
the other. The subject is a thorny one andalmost impossible of correct 
presentment. 

What, however, we of the medical profession feel, and feel strongly, 
is that there ought not to be anything in the shape of a " favored-uatioa 
clause " in regard to public effort and expenditure for the prevention of 
disease among animals as distinguished from that among the human 
race. 

The neglect and supineness which exist among our authorities some- 
times strike me as almost criminal. Take, for example, the question of 
the sewers in Philadelphia. I have no Jiesitation in saying that they are 
probably the worst in the world, at least in a city of her rank and im- 
portance. The day will assuredly come when, the conditions for it be- 
ing favorable, some terrible outbreak will drive the lesson home in a way 
that now seems impossible. 

But certain it is that not until our people in Pennsylvania realize that 
without health nothing is worth having, will the State Board of Health 
iake that place to which it is entitled, and be regarded as the most im- 
portant body in our state govemment. A minister of agriculture is a 
very oaefnl and important personage, and the health of our Bocks and 
heida is of vital moment to us, yet it cannot be compared with the su- 
preme question of human health and, therefore, happiness. 

When we who are willing to march daily into the camps of the tuber- 
cle bacillus — the more deadly anthrax bacillos, those of diphtheria and 
typhoid fever— oome tc be regarded as soldiers who risk their lives for 
those who are hviag in their comfortable offices and counting rooms, 
then, and not until then, cau we expect that support which is justly due 
to those who will face leaden bullets and give their lives to benefit their 
fellow-creatures. 

The discoveries which have been made within recent years encourage 
us to go forward in the endeavor to stamp out disease before it reaches 
a point beybnd onr grasp. " Venienti occurrite morbo" — Hasten to meet 
the coming disease — is the true watchword of our profession. 

We know now that disease is either originated or, to say the least, 
much aggravated in most cases by a mico-organiem which enters the 
body from without, thereby bringing more lives to a premature end than 
lias ever been caused by the fiercest of wars and bloodiest of campaigns. 
With this knowledge before us we ore encouraged and stimulated to take 
oqr lives in our hands in order to study and learn thelife history of these 
our greatest foes- and, therefore, it seems appropriate that we should 



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456 State Boabd op Health. [Off. Doc. 

take tbe subject of tubercnloeia this evening: as one of the diseases which 
has proved so deadly and caused so much suffering, and speak of what 
we know concerning its origin, growth, etc., etc. 

Yet, gentlemen, there is no subject that has been so thoiougbly diag- 
nosed during the last year as tuberculosis in regard to its causes and 
effects, its treatment and prevention, and I doubt whether it be possible 
to summon a set of professional men who are more converaant witii this 
malady than those comprising the- health board of Pennsylvania, whom 
I am now addressing; therefore, all i can hope to accomplish is to lay 
open this subject in all its varied aspects for your more thorough dis- 
cussion from a sanitary point ot view, for there is now abundant evid- 
ence of the preventability of this disease to a greater or less degree. 

In speaking of this disease, I must confine myself to phthisis and 
those maladies accompanied by the tubercle bacillns. Whether the 
tubercle bacillns only becomes a specific irritant, or is per ee the csose 
of tuberculosis, after making caseous d^eneration of infianunatory pro- 
ducts its habitat, we do not know; we mast cot, therefore, scoff atKieiu, 
Gibbes ei al., who are endeavoring to show that tbe tubercle baoilloB is 
not always to be found in the very early stages of this disease. Work 
in this direction brings about a healthy condition of original research. 
At present we possess but little knowledge regarding tbe life history of 
this microbe. 

In OUT searches for this single-cellea oigauism, as it is found in dis- 
eased animal tissue outside the animal body, we have only found it in 
such places and under such circatnstances as justify us in believing that 
it has been secondarily deposited there either by the excretions of tnb- 
erculous animals or dead tuberculous tissue. 

What its cycle of life is outside the animal economy we do not know, 
but we do know that on certain ai'tifioial culture mediums we can grov 
it to such an age that instead of its morphology being a straight rod, as 
usually described, it will be seen throwing out branches. 

From the fact that we find these branches of such varying lengths, I 
am inclined to believe that it is not tbe resalt of a union established 
through coalescence, but to the displacement of the cell& Hiis condi~ 
tion, however is not at all permanent, as a fresh culture medium will, 
from masses of these branched forms, grow the simple rod-shaped bacilli, 
yet after continoing the transplantation of the micro-oi^fanism in Has 
more complex stage onto a fresh medium twenty-five times or mrae, its 
power to produce tuberculosis in the animal economy is much reduced; 
in fact, I have young dogs, guinea-pigs and rabbits resisting large ino- 
culations of these growths, while the control animals inoculated with 
the second removal of bovine tubercle bacilli have developed general 
tubercnlosLS, or a form of disease which means death to the animal af- 
fected, and, at tbe same time, have present all those features which are 



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No. 16.] Fifth State Sasiiaby Oonventio.s. 467 

thorou|(hly characterietic of human tuberculosis in its bistolQt^y, etc., 
etc. 

This result, however, will make us halt at the threshold of the germ 
theory of disease, and prompt us to ask whether or not it is a toxio 
sgrent that is earned in with the bacillus, or whether the bacillus has been 
cultivated after living on caseous tissue to break down healthy cells into 
the caseous condition which may be essential for its own existence. 

The very fact that we all breathe the so-called tubercle bacillus, and 
many resist iia attack, shows, beyond doubt, that it holds, at least, an 
intermediate place between the lion and the maggot. The former over- 
comes and destroys the deer in full and perfect physical health, while 
the latter con only prey on lifeless matter. The tubercle bacillus may 
be saprophytic 

These speculations must stimulate us to carry the line of investigaticai 
still further, so that the results thus far obttdned may be brought to 
bear in disproof or confirmation of one of these theories. If further in- 
vestigation shows that the pabulum is the factor concerned in reducing 
its virole&ce. we must conclude that the tubercle bacillus at most only 
becomes pathc^enic or disease-producing when cultivated on a particu- 
lar pabulum. 

Another interesting observation, that it has been my pleasure to 
\t-&tch, is that a mass of bacilli, far removed by artificial culture from the 
original tuberculous tissue whence it was taken, will not, when intro- 
duced subcutaneously into the animal economy, produoe the immediate 
general toxio effect observed from the introduction of a mass only twice 
or thrice removed. 

Again, my observations enable me to oonolude that the power of the 
tubercle bacillus depends larnrely upon the health of the animal into 
wbos.-) system it is introduced. 

If an animal is poorly ted the power of the bacillus is much more 
mwked, as it is also iu ommals kept in small cages or exposed to bad 
ventilatioD, and, again, in those kept in filthy pens. 

My animals, kept for experimental purposes in the country, under 
proper sanitary conditions, being well fed, in clean cages, plaoed in pure 
air, and permitted to enjoy the sou's rays for many hours of the day, 
when not too hot, have a much greater resisting power than those kept 
in my city laboratory. 

These experiments are quite consistent with the known facts that, 
where there is the greatest exemption from the malady, viz., on the high 
mountains, in the deserts, iu the Arctic and Antamtic regions, it is yet 
to be found nuder insanitary conditions. 

These foots I will apply further on in my address. 

While acknowled^ug, however, our ignorance r^ardiog the life-his- 
tory of tho bacillus, as well as just how much power it has to produce 
tuberculosis when taken into the lungs or stomach of a perfectly healthy 
man, unless accompanied by much of the toxic substance so generally 



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468 State Board of Health. TOff. Doc. 

found with it, ve do certainly know, beyond all doubt, that by feeding 
carnivorous, herbivorous and omnivorous animals with caseous masses of 
bovine tubercle bacilli, we can produce deadly tuberouloas oondittons, 
let them be quite similar or not. 

I liave accomplished this by feeding' raw bovine tuberculous Imig to a 
puppy-dofT six months old. 

This being established with the do^, in which animal exists a great 
similarity between the mucouB membrane and that of man, plus the fact 
that the digestive juices of the dog's stomach are the more acid of the 
two, we are forced to the conclusion that man can contract tubercnloeis 
by eating raw bovine tuberciilouu meat. 

, To brin^ this still nearer to n condition likely to be met with in every 
day civilized life, I roasted in an oveu a piece of bovine tuberculons 
luDf?, weighing, I should suppose, about two pounds, uutil it was cer- 
tainly better done than most of the roast beef eaten by our epicures. 
From the center of this piece of lung I opened a tubercle and grew from 
it bacilli. This should have been carried still further in a practical line 
by injecting a mass of it into the body of some one of the lower animals, 
so as to eliminate, as far as possible, the element of conjecture ; yet, gen- 
tlemen, the experiments were quite sufficient to confirm me iu the behef 
that, in all probability, a man can coutract tuberculosis from eating the 
muscles of the cow, sheep, horse or fowl containing tuberculous lymph 
atics, let alone the more dangerous viscera, such as the liver, spleen, 
lung, kidneys, etc. 

If the tubercle bacillus is a spore-forming fungus, as I am inclined to 
believe it is, we do not know just how much heat is necessary to render 
the spores sterile ; this can only be determtued when we learn to recog- 
nize them when present. 

As lon^ OS my conclusions in this regard remain nnimpeaobed, i must 
look upon taberculoQs meat as a very dangerous article of food, at any 
rate for those who ure at all disposed to a caseous breakdown of the tis- 
sues ; and as that condition isoften not manifested until the system has 
taken on tuberculosis, it behooves you, as our goardians of health, to for- 
bid the rearing, selling or eatiug of such meat. 

From our preseut knowledge on this point we mast deem it prudent, 
nay, we most prohibit the consumption of any food containing micro- 
organisms recognized as tubercle bacilli. 

Cows suffering from tubercular mammitis will produce milk and cream 
containing those bacilh, and I expect yet to be able to find them in the 
milk of cows affected with pulmonary phthisis only ; however, in well- 
marked tubercular mammitis I have never failed to prove the presence 
of b&cilli in the milk. 

If a test-tube of this milk is set aside for a few hours the micro-uigan- 
isms are found in greatest abundance in the sediment, while a few can 
genentlly be discovered in the cream. Some of the bacilli I observed so 



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No. 16.] FiriH State Sanitahy Conventios. 45& 

closely resembled those foond in humaa spntum tbatlwould have diag-- 
nosed them as njomug in that medinm. Some were quite as large, 
while others presented that beaded appearance that has bo often been 
spoken of by bacteriolo^sto as characteristic of those grown in the 
human economy. 

This, however, was not at all snrprising to me, as I have never been 
able to believe that the very slight morphological distinctions made by 
Klein, Gibbes and others were of any significance so far as the power 
of the germ or its toxic agent was concerned in producing a very simi- 
lar distnrbance in the animal economy. 

Kot that the bovine bacillus, ns foand in the giant cell of bovine tuber- 
culosis, does not average smaller and of a more even texture, bnt from 
the fact that maoy are quite the same size, and that on removal on a 
oidas rich with glycerine immediately grow bacilli equally as long and 
as beaded in appearance as those found in the B[)utnm of man ; and 
again, when passed once through the tissues of a guinea-pig they have 
produced the same morphological characteristics, therefore I cannot, 
from my own practical experience, differentiate as far as infection is 
concerned between the human and the bovine tubercle bacillus. 

Certain it is that we can, by inoculating the dog with limnan tubercle 
bacillus and its debris, prodnce a wasting disease, accompanied by 
tubercles quite similar to those generally found in man. 

Soientifically it will be of particular interest to have the bovine and 
human tubercle bacillus differentiated, >et at present, for all sanitary 
porposes, we will have to consider the tubercle bacillus of the cow, ac- 
companied with its nidus, as being destructive to human life, for it is 
well established that the bacillus of man will produce in the lower ani- 
mal economy, such as the cow, dog, guinea-pig, rabbit, opossum, etc, a 
deadly malady, and that the bacillus from the cow will also bring about 
a like disturbance in the same line of animals, and, further, bacilli from 
the rabbit, etc., will, in turn, reproduce tuberculosis in the cow. 

From this intercommunicability we must believe the tuberculosis 
lymphatics interspersed in the muscles and the liver and the kidney, 
and other of the viscera that are subject to the growth of bacilli, such as 
found in the cow or fowl, are capable, when ingested into men, of pro- 
dnciog a disease quite similar. 

We must also look upon milk, cream, and consequently butter, as 
another channel through which like diseases, fatal to man, may be com- 
municated. 

It would seem well settled that matter containing either bovine, 
human or chicken tubercle bacilli when subcutaneously injected into a 
variety of animals, will produce a deadly disease that many of us are 
yet unable to differentiate from a tubercular malady. 

Again, we have undeniable evidence that like matter will manifest the 
same power of harm when fed to such animals as i-espond to the inocu- 



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460 State Board of Health. [Off. Doc. 

latioD, yet, at the same time we moet admit that theire is no direct 
proof of the tnuiHtnissioQ of such a malady to man by his feeding npou 
what is now designated as tubercnlosis meat or milk. And I fear it will 
be a long time before we can establish it by direct evidence, as mui is 
exposed to this dire disease iu a. handred anA one ways daring the laag 
time elapsiog between the period of infection and the manifestation of 
any symptoms. 

Among the arguments against the probability of tubercular disease 
being communicated to man by the ingestion of tubercnloua matter is 
the one that tiibercolosis in man rarely manifests itself as a primar; 
lesion in the intestine. This, however, is not all conclasive, for it is 
quite probable that the lymphatics, situate so near the frontier, where 
they are cootinaally ekirmishing with the enemy, become, to a limited 
degree, immune, coDsequeutly the invader will only gain tlie victory by 
making his way into a more remote portion of the territory where there 
is less resistance and there become established. 

It may be taken into the laoteals, on into the chyle, and thenoe iolo 
the circulation, by whioh it can be carried to the most remote parte. 

In children we often find tubercular lesions of the abdominal glands 
only, all other viscera being entitely free from any form of tuberculosis. 
I feet snre that time will soon reveal the fact that this is more often the 
case with adults than is generally believed. 

However, from the fact that a tuberculous condition is transmissible 
through the digestive tract from man to many of the lower an i mp]", and 
from one lower animal to another, backward and forward, we must, for 
the present, conclude that a tuberculous malady can be transmitted from 
tuberculous meat, milk and butter to man ; also by dentists' instnunents 
conveying spntum from one to another, by cooking and cooking uten- 
sils handled by those having tuberculous matter on their bands— for 
instance, bread or other dough-containing foods, pulled candies and the 
like. 

In my individual search for tubercle bacilli I have found them in 
human sputum, in tissues of man, horses, cows, dogs, cats, rabbits, 
opossums, guinea-pigs, hogs, ostriches, fowl, street railway cars, dwell- 
ing houses and bacteriological laboratories, and in tooth brushes. 

If the tubercle bacillus is to be found in street cars and dwellings we 
must believe it to be in the air of most inhabited places, and the more 
thickly populated and the more filthy the air the greater will be tbe 
proportion. 

This being the case, it is for us to decide on general prinoiples and 
tacts whether or not we are to conclude, for our present purpose, the 
probability of tuberoulons material infecting the animal economy vheu 
commingled with the inspired air with which ourdieeased muooasmem- 
brane and outside skin are being constantly bathed. 



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No. 16.] Fifth State Sanitary Convention. 461 

It seems to me we must suspect the abraded mucous membrane of the 
respiratory and oral tracts or injured skin when covered with eczema or 
other skin diseases, of being likely points of entrance. 

By lacerating the gums and the l inin g of the oral cavity of the mouth 
of n guinea-pig — not more than the dentist often lacerates man's — and 
powdering the wounds with a mass of tuberculous material, I have 
caused to be produced a sub-maxillary disturbance microscopically re- 
sembling tuberculosis, while the mioroscopical examination revealed 
tubercle bacillL 

While most of the inoculations on guinea-pif^ for experimentation 
are made by subcutaneous injections, I have also succeeded in producing 
infection by rubbing a mass of the bacilli on a superficially lacerated 
skin and sealing it over with rubber-cloth and sticking-plaster. 

Other experimenters have irritated the respiratory tract with ground 
^lass and then compelled the animal so treated to inhale particle of 
the tuberculous material, and ^ereby produced what they have described 
OS tuberonlosis. 

We must, therefore, believe, for practical purposes, that the lower ani- 
mals can be infected with a deadly disease closely related to tubercu- 
losis either by the inspiration of tuberculous matter ou the injnred 
mucous membrane of the respiratory tract or through the injured skin 
when besmeared with tuberculous material. 

These facts, coupled with those already alluded to, showing that 
human tuberculous material is capable of infecting the guinea-pig, 
rabbit, opossum, calf and other animals in almost, if not in precisely 
the same manner as the tuberculous material of a cow will affect the 
same kind of animals; and further, that tuberculous material from a 
guinea pig will infect the other animals in exactly the same manner as 
when taken from man or cow, compel us to conclude that man suffering 
from inflammatory processes, or traumatic conditions of the mucous 
membrane or skin, may contract a deadly disease from germ particles 
in the air. 

Just how long tubercle bacilli or their spores, if such exist, can retain 
vitality after Isolation from a favorable nidus such as tissue or pus, we 
do not know, yet we have a good right, reasouing from the life of higher 
fungi on up through green v^etable life to that of fish and mamihals, 
to conclude that the act of separation from the nidus does not per se 
cause immediate death of the cell, but that some time elapses before the 
germ dies in its non-life-su staining surroundings. 

If this be so, and the separation is constantly going on in man's im- 
mediate presence, why should the toxic agent not again implant itself 
ou his abraded skin or mucous membrane while it still has vital powert 

Even should we have to admit that the very act of separation of the 
disturbing germ from its original pabulum is presently fatal to its life, 
we must not forget what experiment has already demonstrated — that a 



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162 State Board of Health. [Off. Doo. 

very slight ourrent uf lur can carry with it not only the germ bat also 
its nidus. 

From the fact that instndyinf^microeoopic preparations of langtiasne 
we often find particles of coal that have worked themseWeti down into 
the very alveoli, we must, at least, suspect the poflsibility — in fact stnMig 
probability — of the tuberculous matter also woi^inf? its way into tbe 
finer ramifications of the air passafifes. 

The function of tbe respiratory apparatus ia to convey air from with- 
out into the body. Its construction is such that, in full health, it screens 
out most of the lig^ht, short particles of deleterious matter, yet, when at 
all diseased it must, we believe, lose this power to a greater or less 
degree. 

Dr. Arthur Bansome has shown that in bronchitis and catarrh, and 
other diseases in which there was much expectoration, the proportion- 
ate amount of oi^;anic matter exhaled from the lungs was only one half 
of that from tbe healthy person— not that there was less Oi^anic matter 
excreted, but because it was held by the mucous before it reached the 
mouth — and Professor Tyndall, as you must all remember, has demon- 
strated, by means of the illuminated tube, the filtering action of the 
respiratory organs. 

Under such conditions as chronic bronchitis the ciliffl must, of neces- 
sity, lose their power to expel foreign material. The muscular walls 
becomo weakened, and dilatation and plugging, in all probability, take 
place, and the bacilli find a quiet habilat and a medium wherein to 
fructify. 

Catarrhal pneumonia fumtsbes a goodly example of this condition 
predisposing to tuberculosis. 

We cannot, however, make any estimate of the possibility of the harm 
arisini? from the entrance of such material into even the most remote 
and inactive portions of thb healthy lung tissue. 

This, however, is not necessary for you to consider as sanitary offi- 
cers, iuasmuch as there are few men with perfectly healthy respiratory 
organs who ought to look to you for protection against the invasion of 
this most fell disease. This, coupled with the fact that the healthy, if 
any, are constantly commingling with the unhealthy, makes it incum- 
bent on you to render all places sufficiently harmless to both, particn- 
larly if you believe that tuberculosis in the air isliurtful to maninsncb 
health as the average human being enjoys. 

It would appear from what has been said that it is probable that man. 
when in n certain condition, is susceptible to tuberculous infection when 
exposed to the materies morbi, and that it may make itn entrance into 
the animal eoinomy either through the stomach, the mucous membnmc 
of the digestive or respiratory tracts, or through the abraded skin ; and 
further, that man is constantly exposed to tbe toxic agent, and yet all 
men are not affected with tnl^erculoais. 



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No. 16.1 Fifth State Sanitaby Convention. 463 

I have little or do doubt but that all of you can remember instances 
when men have been severely exposed to tuberculous material and lived 
to a good old a^ untainted with the* disease, while others who have 
been, in all probability, but slightly exposed have taken on the infection. 

This special susceptibility demonstrates that some must furnish a salt- 
able soil, and that, in such oases, the affinity of the constituents of the 
tiesae most be weak, and thus enable the toxic agent to break it up and 
pass throufh the process of tuberculosis. 

This conditioD, we most admit, is often hereditary. We have seen veiy 
many instances of members of the same family, living in different tmd 
fardistant localities, who have, at or near a certain age, succumbed to 
tnberculoeis. 

We cannot explain all the possible inherited factors, yet we can readily 
conceive mere abnormal and inconsistent proportions of the viscera as 
being a predisposing cause ; a mere mechanical course pursued by the 
air pasaagee, weak ciliee in the air passages, digestive glands that secrete 
a weak gastric juice, papOli of the intestiDal canal incompetent to make 
a proper selection of food, or a weak phafrocytic power may each afford 
a cause for susceptibility. 

There is certainly inherited noi only a tendeDcy to contract but a 
marked readiness to yield to an attack. 

Hereditary predisposition is often intensified by intermarriage. If we 
find in the bovine